O le tagata ma lona aiga, o le tagata ma lona fa'asinomaga (Every person belongs to a family and every family belongs to a person): Development of a parenting framework for adolescent mental wellbeing in American Samoa.

American Samoan adolescents experience a high prevalence of mental health problems, including depression, anxiety, substance use, and suicidal thoughts and behaviors. To complement existing health system efforts, family-based interventions may be a feasible, cost-effective, and relevant opportunity to promote mental health. This community-partnered, qualitative study aimed to: (1) identify potential family-related psychosocial protective factors for adolescent mental health and (2) develop a framework for a parenting program to promote adolescent mental health in American Samoa. Applying the fa'afaletui framework developed for research in Samoan communities, which emphasizes the importance of weaving a range of community member perspectives to reach consensus, semi-structured in-depth interviews with adult key informants (n=28) were conducted between October 2020 and February 2021. Results were validated through five focus groups with Samoan adolescents (n=35) between May and June 2022. Adult participants were sampled for diversity in profession, age, gender, education, and region of residence; adolescent participants were sampled for diversity in gender. Participants were recruited using personal networks and snowball sampling; adolescent participants also responded to Facebook advertising. The semi-structured interviews focused on broad topics including common mental health problems, contributors to mental illness, and potential interventions, among others. Transcripts were coded in duplicate and analyzed using deductive thematic analysis. Themes were collaboratively mapped onto an adapted fonofale model, an existing framework for Pacific Island health research. Six themes described key practices: (1) provide emotional safety and security; (2) provide physical safety and security; (3) encourage sense of self; (4) strengthen intergenerational communication skills; (5) prioritize quality time; and (6) cultivate healthy coping strategies. Participants also expressed the importance of a supportive environment grounded in culture, family and community, and caregiver mental health. These results provide an initial step to identify family-focused factors that promote adolescent mental health in American Samoa and categorize them into a framework to inform intervention development. Drawing on a collaborative and community-partnered process, these findings provide the first evidence-based framework to develop a parenting program to promote adolescent mental wellbeing and resilience in Samoan communities.

Neural Circuit Markers of Familial Risk for Depression Among Healthy Youths in the Adolescent Brain Cognitive Development Study.

BACKGROUND: Family history of depression is a robust predictor of early-onset depression, which may confer risk through alterations in neural circuits that have been implicated in reward and emotional processing. These alterations may be evident in youths who are at familial risk for depression but who do not currently have depression. However, the identification of robust and replicable findings has been hindered by few studies and small sample sizes. In the current study, we sought to identify functional connectivity (FC) patterns associated with familial risk for depression. METHODS: Participants included healthy (i.e., no lifetime psychiatric diagnoses) youths at high familial risk for depression (HR) (n = 754; at least one parent with a history of depression) and healthy youths at low familial risk for psychiatric problems (LR) (n = 1745; no parental history of psychopathology) who were 9 to 10 years of age and from the Adolescent Brain Cognitive Development (ABCD) Study sample. We conducted whole-brain seed-to-voxel analyses to examine group differences in resting-state FC with the amygdala, caudate, nucleus accumbens, and putamen. We hypothesized that HR youths would exhibit global amygdala hyperconnectivity and striatal hypoconnectivity patterns primarily driven by maternal risk. RESULTS: HR youths exhibited weaker caudate-angular gyrus FC than LR youths (α = 0.04, Cohen's d = 0.17). HR youths with a history of maternal depression specifically exhibited weaker caudate-angular gyrus FC (α = 0.03, Cohen's d = 0.19) as well as weaker caudate-dorsolateral prefrontal cortex FC (α = 0.04, Cohen's d = 0.21) than LR youths. CONCLUSIONS: Weaker striatal connectivity may be related to heightened familial risk for depression, primarily driven by maternal history. Identifying brain-based markers of depression risk in youths can inform approaches to improving early detection, diagnosis, and treatment.

"There are still broken or fragmented systems": Qualitative assessment of needs to strengthen adolescent mental health services in American Samoa.

Mental health challenges appear common among adolescents in American Samoa. There is a community-identified need to better understand the health burden and identify opportunities to strengthen the mental health system to better meet adolescent mental health needs. The goal of this qualitative study was to gather community stakeholders' perceptions of common mental health problems among adolescents in American Samoa, identify existing services for adolescent mental health, and highlight strength-based opportunities to enhance care. Using the Fa'afaletui research framework, semi-structured in-depth interviews (n = 28) were conducted between October 2020 and February 2021 using Zoom. Key informants were adults living in American Samoa, sampled for diversity in profession, age, gender, education, and region of residence. Transcripts were coded in duplicate and analysed using deductive thematic analysis. Participants reported that suicide, depression, anxiety, and post-traumatic stress disorder are the conditions of highest burden. Participants identified an impressive amount of infrastructure and community mobilization, but also limitations in these services in addressing adolescents' health needs. Four themes arose related to the need to: (1) strengthen existing infrastructure; (2) reduce barriers to treatment access; (3) improve sustainability; and (4) encourage collaboration among leaders. Policymakers should prioritize the allocation of resources to strengthen infrastructure, public education, and stakeholder collaboration to improve adolescent mental health in American Samoa.

Gender Discrimination and Mental Health Among Health Care Workers: Findings from a Mixed Methods Study.

Background: Gender discrimination among healthcare workers (HCWs) negatively impacts their mental health and career development; however, few studies have explored how experiences of gender discrimination change during times of health system strain. Methods: This survey-based study assesses the associations between gender discrimination and four stress-related mental health outcomes (posttraumatic stress, depression, anxiety, and burnout), as well as the qualitative experiences of gender discrimination in healthcare during the COVID-19 pandemic. Results: Among women, increased gender discrimination was associated with heightened symptoms of posttraumatic stress, depression, anxiety, and burnout after adjusting for demographics and pandemic-related stressors; however, among men, increased gender discrimination was only associated with heightened symptoms of depression. Using thematic analysis, we identified five themes that describe experiences of gender discrimination faced by women in healthcare, including differential valuing of work and contributions, gendered roles and assumptions about roles, maternal discrimination, objectification, and "old boys club." We also identified two themes describing how men perceived gender discrimination, including instances of symbolic discrimination and woman provider preference. Conclusion: These findings suggest that experiences of gender discrimination persist during times of health system strain and negatively impact women HCWs' mental health.