The Epidemic of Internalizing Problems Among Latinx Adolescents Before and During the Coronavirus 2019 Pandemic.

OBJECTIVE: Latinx youth exhibit disproportionately higher internalizing symptoms than their peers from other racial/ethnic groups. This study compares depression and anxiety symptoms between referred students of Latinx and non-Latinx backgrounds before and during the COVID-19 pandemic and examines key determinants within the Latinx sample. METHOD: Data are analyzed from four academic years - two before and two during the pandemic - from 1220 5th through 8th grade students (Mage = 12.1; 59.6% female; 59.9% Latinx or mixed-Latinx) referred for services across 59 Chicago Public School District (CPS) elementary schools. Using the Children's Depression Inventory (CDI) and the Revised Child Anxiety and Depression Scale (RCADS), mean scores and risk levels for depression, social anxiety, and generalized anxiety are examined. RESULTS: Higher internalizing risk and comorbidity rates were found in the second year of the pandemic, compared to pre-pandemic levels. Latinx students reported higher depression, social anxiety, and generalized anxiety symptoms than non-Latinx students. During the pandemic, more Latinx students were classified as having comorbid depression and anxiety, and scored in the clinical range for depression, generalized anxiety, and social anxiety than non-Latinx students. Within the Latinx sample, girls and gender non-conforming students reported the highest maladjustment. CONCLUSIONS: Results highlight the pressing need to examine the long-term impact of COVID-19 on the mental health of Latinx children and adolescents, and to address their internalizing problems.

The Reciprocal Effects of Language Proficiency and Depression among Low-Income Latinx Youth.

Extant research associates language with essential social and emotional processes. Although the risk for depression among Latinx youth in the United States is well documented, the link between their language proficiency and depressive symptoms remains poorly understood. Further, research employing standardized language assessments with Latinx early adolescents is scarce and reciprocal associations between language proficiency and depressive symptoms have not been examined. This longitudinal study addressed these gaps by investigating the relation between language proficiency and depression in a sample of 218 dual language Latinx students of predominantly low-income backgrounds (Mage = 12.1, SD = 1.1; 49.1% female) recruited from seven public schools in a large city in the Midwest of the United States. Language proficiency in English and Spanish was assessed using the Woodcock-Muñoz Language Survey-Revised and depressive symptoms were assessed using the Children's Depression Inventory. Paired samples t-tests showed lower than expected growth in English vocabulary and higher than expected growth in the ability to reason using lexical knowledge in Spanish over a one-year period. Cross-lagged panel analyses (χ2 (99) = 211.19, p < .001, CFI = .93, TLI = .92, RMSEA = .07 (90% CI [.06, .09])) indicated that growth in English language proficiency is predictive of decreased depressive symptoms. Likewise, increases in depressive symptoms are predictive of decreased English language proficiency. Results have important implications for the design of appropriate psychological interventions and sensible educational policies for students of linguistic minority backgrounds.

Heterogeneous Trajectories of Depression Symptoms in Latino Youth.

Latino youth are at greater risk for depression relative to youth of other ethnic groups. The course of depression among Latino children and adolescents, however, remains largely unexamined, along with family and cultural factors that can help explain dissimilar symptom paths. The present study used growth mixture modeling to map trajectories of depression symptoms and to examine youth and parent familism as predictors of these trajectories. Participants were 133 Latino 5th- to 7th-grade students (Mage = 12.4 years, SD = 0.91; 55.6% boys) and a subsample of their parents (n = 89). Youth reported on their depression symptoms at four time points, including two surveys (Time 1 and Time 3) and two in-person interviews (Time 2 and Time 4) over the course of 2 years. Familism reports were obtained from youth at Time 1 and from parents at Time 2. The trajectories identified include stable-low, recovery, and escalating, and only youth familism predicted membership in these trajectories. Relative to those in the recovery trajectory, youth reporting higher familism were more likely to belong to the stable-low trajectory. This study helps to highlight the heterogeneous course of depression among Latino youth and illustrates the importance of incorporating youth perspectives on family cultural values when considering their well-being.

Evidence-Based Psychosocial Interventions for Ethnic Minority Youth: The 10-Year Update.

This is the official update on the status of evidence-based psychosocial interventions for ethnic minority youth. Compared to a decade ago, there has been expansion of well-designed intervention studies, growth in the number (not type) of interventions meeting evidence-based criteria, and greater focus on testing ethnicity/race moderator effects. In terms of standard of evidence, 4 psychosocial interventions are now well-established and 10 are probably efficacious or possibly efficacious, with most protocols drawing on cognitive and behavioral change procedures and/or family systems models. Yet the research literature remains mostly focused on testing interventions with European Americans (White Caucasians), and little to no progress has been made in testing the effects of interventions with Asian American or Native American youth. Knowledge of the effects of cultural tailoring on program engagement, outcomes, and mechanisms of change remains scant.

Neighborhood Context, Family Cultural Values, and Latinx Youth Externalizing Problems.

Latinx youth living in the United States reside in a myriad of cultural and neighborhood contexts, yet little is known regarding how cultural values influence behavior problems across neighborhood contexts. Using a person-environment fit framework, the present study explored the degree to which youth cultural values were associated with their externalizing problems, and the degree to which this association was shaped by their neighborhood's socioeconomic status (SES), and Latinx and immigrant concentration. The sample comprised of 998 Latinx youth (Female = 54.2%), ages 10 to 14 years old (Mage = 11.8), from three large United States metropolitan areas. Multilevel modeling methods indicated that increased fit between youth cultural values and neighborhood Latinx and immigrant concentration was associated with fewer externalizing problems, but only in higher SES neighborhoods. The results support the importance of studying social determinants of Latinx youth behavioral health, and provide implications for both neighborhood-level and individual-level prevention and intervention programming.

Symptom variation on the trauma symptom checklist for children: a within-scale meta-analytic review.

Trauma exposure in youth is widespread, yet symptom expression varies. The present study employs a within-scale meta-analytic framework to explore determinants of differential responses to trauma exposure. The meta-analysis included 74 studies employing samples of youth exposed to traumatic events and who completed the Trauma Symptom Checklist for Children (TSCC). Mean weighted T scores across all TSCC subscales for U.S. samples ranged between 49 and 52. Youth outside the U.S. reported higher posttraumatic stress, anxiety, and depressive symptoms, whereas those exposed to sexual abuse reported the highest posttraumatic stress, anxiety, depressive, and dissociative symptoms. Higher female representation in samples was associated with higher symptoms on all TSCC subscales except anger. In contrast, ethnic minority representation was associated with lower depressive symptoms. Moderator analyses revealed that sexual abuse, increased percentage of females, and older age were all associated with higher posttraumatic symptoms. The present meta-analytic results help elucidate some of the divergent findings on symptom expression in youth exposed to traumatic events.

The Parental Schoolwork Support Measure-Youth: development and psychometric evaluation.

Parental involvement in school-related tasks is associated with a number of positive outcomes across ethnic groups. However, a growing literature suggests that unique forms of involvement and barriers exist among linguistic minority Latino families. The Parental Schoolwork Support Measure-Youth (PSSM-Y) is introduced in this study along with the psychometric properties found with a sample of 133 Latino youth in Grades 5 through 7 from a public school in a low-income urban neighborhood. Exploratory factor analyses indicated the presence of three factors called direct support, language and support, and indirect support, which together accounted for 66.3% of the common variance in the 16-item version. Strong internal consistency and test-retest coefficients were found for the PSSM-Y in this sample. In addition, schoolwork support was correlated with youth depression, economic pressure, loneliness, and familism in the expected directions. The findings are discussed in terms of the potential utility of this measure for future school-based studies of Latino students and youth of immigrant backgrounds in the United States.

Culture, context, and the internalizing distress of Mexican American youth.

Latino youth appear to be at higher risk for depression relative to youth from other ethnic groups. This study assessed the relationship between nativity and several forms of internalizing distress among Mexican American middle school students as well as sociocultural factors that may help explain this relationship. Immigrant Mexican American youth (n = 78) reported significantly higher social anxiety and loneliness than U.S.-born Mexican American youth (n = 83). Acculturation stress and English proficiency were identified as significant mediators of these nativity differences. Although internalizing problems and depression symptoms did not vary across nativity groups, both were related to lower affiliative obedience. The findings point to cultural socialization values and contextual influences as important variables in the mental health of youth in immigrant families.

Prevalence and Correlates of Childhood-Onset Anxiety Disorders among Latinos and Non-Latino Whites in the United States.

Anxiety disorders are the most prevalent class of psychiatric disorders (Kessler, et al., 2005) and their early onset places individuals at risk for a wide range of subsequent problems (Weissman, et al., 1999). Data from the National Latino and Asian American Study (NLAAS) and the National Comorbidity Survey-Replication (NCS-R) were used to investigate the prevalence and correlates of childhood-onset anxiety disorders among U.S.-born whites, U.S.-born Latinos, and foreign-born Latinos. Significant differences in rates of childhood-onset anxiety disorders were found, with foreign-born Latinos reporting the lowest rates. Across all three ethnicity/nativity groups, individuals with childhood-onset anxiety disorders had equal or higher levels of past-year impairment, relative to individuals with adult-onset anxiety disorders. The chronic course associated with childhood-onset anxiety disorders was also revealed to be present regardless of ethnicity and nativity, as indicated by the similarities across groups in the mean number of lifetime disorders and comorbidity rates. Treatment and assessment recommendations are discussed with respect to the findings.

Diversity in randomized clinical trials of depression: A 36-year review.

Historically, authors reporting the results of randomized clinical trials (RCTs) to address mental health problems have insufficiently described sample characteristics pertaining to the ethnic/racial, linguistic, socioeconomic, and immigrant backgrounds of participants. RCTs have also had inadequate representation of participants from diverse backgrounds. This study reports on the trends in the reporting and representation of various sample demographic characteristics in RCTs of psychotherapy and other psychosocial interventions for depression over a 36-year period, and on the extent to which ethnicity, in particular, is considered in the analyses of treatment effects. A total of 342 trials (85.1% comprised of adult samples), representing 61,283 participants, are summarized in the review. Reporting for ethnicity and socioeconomic indicators improved over time, and RCTs for depression have also increasingly included significant numbers of ethnic minority and low-income groups. However, trials are far more likely to exclude, rather than include, linguistic minorities, and have not enrolled a meaningful number of Asian American, Native Hawaiian/Pacific Islander, Native American/Native Alaskan and multi-ethnic participants. Finally, treatment effects are almost never presented separately across racial/ethnic groups and ethnicity moderation analyses are only sporadically conducted. These findings have implications for generalizability, policy, journal reporting guidelines, and dissemination and implementation.

Evidence-based psychosocial treatments for ethnic minority youth.

This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no well-established treatments were identified, probably efficacious or possibly efficacious treatments were found for ethnic minority youth with anxiety-related problems, attention-deficit/hyperactivity disorder, depression, conduct problems, substance use problems, trauma-related syndromes, and other clinical problems. In addition, all studies met either Nathan and Gorman's (2002) Type 1 or Type 2 methodological criteria. A brief meta-analysis showed overall treatment effects of medium magnitude (d = .44). Effects were larger when EBTs were compared to no treatment (d = .58) or psychological placebos (d = .51) versus treatment as usual (d = .22). Youth ethnicity (African American, Latino, mixed/other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statistical power and poor representation of less acculturated youth. Few tests of cultural adaptation effects have been conducted in the literature and culturally validated outcome measures are mostly lacking. Recommendations for clinical practice and future research directions are provided.

Parent-Child Endorsement Discrepancies among Youth at Chronic-Risk for Depression.

Depression is one of the most common mental health problems among U.S. adolescents, particularly among Latinos. Parent-child ratings of the presence and severity of child depressive symptoms show only low-to-moderate agreement. However, research has failed to examine discrepancies in populations with the highest levels of unmet need and little is known about patterns and predictors of parent-child agreement in ratings of depressive symptoms among ethnic minority families in community settings. Using a sample of 184 low-income, predominantly Latino, 5th through 7th grade students (63.6% female) at chronic risk for depression, this study utilized exploratory Latent Class Analysis (LCA) to uncover patterns of parent-child endorsement of core diagnostic depressive symptoms. Overall, children reported higher levels of core (i.e., depressed mood, anhedonia, irritability) and secondary (e.g., sleep disturbances) depressive symptoms relative to their parents. The three latent classes identified include a low endorsement and high agreement class (LH), high endorsement and high agreement class (HH), and high child endorsement and low agreement class (HCL). Multinomial regression models revealed that previous mental health service use and higher externalizing problems were associated with HH class membership, relative to HCL class membership. Findings provide evidence that a substantial number of children may have depressive symptoms that go undetected by their parents. Access to services among children at-risk for depression may be increased with psychoeducation to improve parental awareness and stigma reduction.

Effectiveness of the DECIDE Interventions on Shared Decision Making and Perceived Quality of Care in Behavioral Health With Multicultural Patients: A Randomized Clinical Trial.

Importance: Few randomized clinical trials have been conducted with ethnic/racial minorities to improve shared decision making (SDM) and quality of care. Objective: To test the effectiveness of patient and clinician interventions to improve SDM and quality of care among an ethnically/racially diverse sample. Design, Setting, and Participants: This cross-level 2 × 2 randomized clinical trial included clinicians at level 2 and patients (nested within clinicians) at level 1 from 13 Massachusetts behavioral health clinics. Clinicians and patients were randomly selected at each site in a 1:1 ratio for each 2-person block. Clinicians were recruited starting September 1, 2013; patients, starting November 3, 2013. Final data were collected on September 30, 2016. Data were analyzed based on intention to treat. Interventions: The clinician intervention consisted of a workshop and as many as 6 coaching telephone calls to promote communication and therapeutic alliance to improve SDM. The 3-session patient intervention sought to improve SDM and quality of care. Main Outcomes and Measures: The SDM was assessed by a blinded coder based on clinical recordings, patient perception of SDM and quality of care, and clinician perception of SDM. Results: Of 312 randomized patients, 212 (67.9%) were female and 100 (32.1%) were male; mean (SD) age was 44.0 (15.0) years. Of 74 randomized clinicians, 56 (75.7%) were female and 18 (4.3%) were male; mean (SD) age was 39.8 (12.5) years. Patient-clinician pairs were assigned to 1 of the following 4 design arms: patient and clinician in the control condition (n = 72), patient in intervention and clinician in the control condition (n = 68), patient in the control condition and clinician in intervention (n = 83), or patient and clinician in intervention (n = 89). All pairs underwent analysis. The clinician intervention significantly increased SDM as rated by blinded coders using the 12-item Observing Patient Involvement in Shared Decision Making instrument (b = 4.52; SE = 2.17; P = .04; Cohen d = 0.29) but not as assessed by clinician or patient. More clinician coaching sessions (dosage) were significantly associated with increased SDM as rated by blinded coders (b = 12.01; SE = 3.72; P = .001; Cohen d = 0.78). The patient intervention significantly increased patient-perceived quality of care (b = 2.27; SE = 1.16; P = .05; Cohen d = 0.19). There was a significant interaction between patient and clinician dosage (b = 7.40; SE = 3.56; P = .04; Cohen d = 0.62), with the greatest benefit when both obtained the recommended dosage. Conclusions and Relevance: The clinician intervention could improve SDM with minority populations, and the patient intervention could augment patient-reported quality of care. Trial Registration: clinicaltrials.gov Identifier: NCT01947283.

Prevalence of psychiatric disorders across Latino subgroups in the United States.

OBJECTIVES: We examined the prevalence of depressive, anxiety, and substance use disorders among Latinos residing in the United States. METHODS: We used data from the National Latino and Asian American Study, which included a nationally representative sample of Latinos. We calculated weighted prevalence rates of lifetime and past-year psychiatric disorders across different sociodemographic, ethnic, and immigration groups. RESULTS: Lifetime psychiatric disorder prevalence estimates were 28.1% for men and 30.2% for women. Puerto Ricans had the highest overall prevalence rate among the Latino ethnic groups assessed. Increased rates of psychiatric disorders were observed among US-born, English-language-proficient, and third-generation Latinos. CONCLUSIONS: Our results provide important information about potential correlates of psychiatric problems among Latinos that can inform clinical practice and guide program development. Stressors associated with cultural transmutation may exert particular pressure on Latino men. Continued attention to environmental influences, especially among third-generation Latinos, is an important area for substance abuse program development.

Understanding differences in past year psychiatric disorders for Latinos living in the US.

This study seeks to identify risk factors for psychiatric disorders that may explain differences in nativity effects among adult Latinos in the USA. We evaluate whether factors related to the processes of acculturation and enculturation, immigration factors, family stressors and supports, contextual factors, and social status in the US account for differences in 12-month prevalence of psychiatric disorders for eight subgroups of Latinos. We report results that differentiate Latino respondents by country of origin and age at immigration (whether they were US-born or arrived before age 6: In-US-as-Child [IUSC]; or whether they arrived after age 6: later-arrival immigrants [LAI]). After age and gender adjustments, LAI Mexicans and IUSC Cubans reported a significantly lower prevalence of depressive disorders than IUSC Mexicans. Once we adjust for differences in family stressors, contextual factors and social status factors, these differences are no longer significant. The risk for anxiety disorders appears no different for LAI compared to IUSC Latinos, after age and gender adjustments. For substance use disorders, family factors do not offset the elevated risk of early exposure to neighborhood disadvantage, but coming to the US after age 25 does offset it. Family conflict and burden were consistently related to the risk of mood disorders. Our findings suggest that successful adaptation into the US is a multidimensional process that includes maintenance of family harmony, integration in advantageous US neighborhoods, and positive perceptions of social standing. Our results uncover that nativity may be a less important independent risk factor for current psychiatric morbidity than originally thought.

A Test of the Perfectionism Social Disconnection Model among Ethnic Minority Youth.

Perfectionistic self-presentation (PSP) has been identified as a vulnerability factor in the development of depressive disorders during early adolescence. The Perfectionism Social Disconnection Model (PSDM) offers a theoretical framework suggesting PSP leads to depressive symptoms via interpersonal problems and social disconnection. Previous studies have supported the role of social disconnection as a mediator in the relation between PSP and suicidal ideation, but have not evaluated interpersonal problems in the model. Furthermore, the generalizability of the model has not been established for community and ethnic minority samples. Using cross-sectional data, the present study addresses these gaps by evaluating the PSDM and including social anxiety and loneliness as indicators of interpersonal problems and social disconnection, respectively, as predictors of youth depressive symptoms. The sample includes 289 (51.2% females) predominately low income and Latino and African American youth in fifth through seventh grade in three public schools. As predicted, social anxiety mediates the relationship between both PSP and loneliness and PSP and depressive symptoms. Moreover, mediational analyses indicate that social anxiety accounts for the relation between PSP and depression. Consistent with the PSDM model, the relationship between PSP and youth depressive symptoms is mediated sequentially through both social anxiety and loneliness, but primarily among the Latino sample.

Generalizability of studies on mental health treatment and outcomes, 1981 to 1996.

OBJECTIVE: This study operationalized and measured the external validity, or generalizability, of studies on mental health treatment and outcomes published in four journals between 1981 and 1996. METHOD: MEDLINE was searched for articles on mental health treatment and outcomes that were published in four leading psychiatry and psychology journals between 1981 and 1996. A 156-item instrument was used to assess generalizability of study findings. RESULTS: Of more than 9,000 citations, 414 eligible studies were identified. Inclusion of community sites and patients from racial or ethnic minority groups were documented in only 12 and 25 percent of studies, respectively. Random or systematic sampling methods were rare (3 percent), and 75 percent of studies did not explicitly address sample representativeness. Studies with funding from the National Institute of Mental Health (NIMH) were more likely than those without NIMH funding to document the inclusion of patients from minority groups (30 percent compared with 20 percent). Randomized studies were more likely than nonrandomized studies to document the inclusion of patients from minority groups (28 percent compared with 17 percent), include patients with comorbid psychiatric conditions (31 percent compared with 19 percent), and attend to sample representativeness (28 percent compared with 15 percent). Modest improvements were seen over time in inclusion of patients from minority groups, inclusion of patients with psychiatric comorbidities, and attention to sample representativeness. CONCLUSIONS: Generalizability of studies on treatments and outcomes, whether experimental or observational, remained low and poorly documented over the 16-year period.

Ethnicity, expressed emotion, attributions, and course of schizophrenia: family warmth matters.

The authors examined the role of family factors and the course of schizophrenia by carrying out additional assessments and analyses in 2 previously published studies of Mexican American and Anglo American patients and families. The authors found partial support for an attributional model of relapse for families who are low in emotional overinvolvement. Attributions of control, criticism, and warmth together marginally predicted relapse. The data also indicated that for Mexican Americans, family warmth is a significant protective factor, whereas for Anglo Americans, family criticism is a significant risk factor. These findings suggest that the sociocultural context shapes the pathways by which family processes are related to the course of illness. Moreover, the warmth findings suggest that families may contribute to preventing relapse.

Establishing treatment fidelity in evidence-based parent training programs for externalizing disorders in children and adolescents.

The current review evaluates the use of treatment fidelity strategies in evidence-based parent training programs for treating externalizing disorders. We used a broad framework for evaluating treatment fidelity developed by the National Institutes of Health Treatment Fidelity Workgroup that includes the aspects of treatment design, treatment delivery, training providers, and assessment of participant receipt of treatment and enactment of treatment skills. Sixty-five articles reporting outcome trials of evidence-based parent training programs met inclusion criteria and were coded for treatment fidelity strategies. The mean adherence to fidelity strategies was .73, which was higher than two previous review studies employing this framework in the health literature. Strategies related to treatment design showed the highest mean adherence (.83), whereas training of providers and enactment of treatment skills had the lowest (.58). In light of an increasing emphasis on effectiveness and dissemination trials, the broader treatment fidelity framework as applied in this review focuses needed attention on areas often overlooked in fidelity practices, such as training providers and generalization of treatment skills. We discuss the strengths and limitations of fidelity practices in parent training studies, implications of these findings, and areas for future research.

Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention.

IMPORTANCE: Given minority patients' unequal access to quality care, patient activation and self-management strategies have been suggested as a promising approach to improving mental health care. OBJECTIVE: To determine whether the DECIDE (Decide the problem; Explore the questions; Closed or open-ended questions; Identify the who, why, or how of the problem; Direct questions to your health care professional; Enjoy a shared solution) intervention, an educational strategy that teaches patients to ask questions and make collaborative decisions with their health care professional, improves patient activation and self-management, as well as engagement and retention in behavioral health care. DESIGN, SETTING, AND PATIENTS: In this multisite randomized clinical trial performed from February 1, 2009, through October 9, 2011 (date of last follow-up interview), we recruited 647 English- or Spanish-speaking patients 18 to 70 years old from 13 outpatient community mental health clinics across 5 states and 1 US territory. A total of 722 patients were included in analyses of secondary outcomes. INTERVENTIONS: Three DECIDE training sessions delivered by a care manager vs giving patients a brochure on management of behavioral health. MAIN OUTCOMES AND MEASURES: Primary outcomes were patient assessment of activation (Patient Activation Scale) and self-management (Perceived Efficacy in Patient-Physician Interactions). Secondary outcomes included patient engagement (proportion of visits attended of those scheduled) and retention (attending at least 4 visits in the 6 months after the baseline research assessment), collected through medical record review or electronic records. RESULTS: Patients assigned to DECIDE reported significant increases in activation (mean ß = 1.74, SD = 0.58; P = .003) and self-management (mean ß = 2.42, SD = 0.90; P = .008) relative to control patients, but there was no evidence of an effect on engagement or retention in care. CONCLUSIONS AND RELEVANCE: The DECIDE intervention appears to help patients learn to effectively ask questions and participate in decisions about their behavioral health care, but a health care professional component might be needed to augment engagement in care. DECIDE appears to have promise as a strategy for changing the role of minority patients in behavioral health care. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01226329