The Affiliate Stigma Scale: Psychometric refinement and validation of a short form in Turkish spinal cord injury/disorder caregivers.

BACKGROUND: Despite the widespread international use of the Affiliate Stigma Scale in the context of disability, much research on its psychometric properties has taken dubious statistical approaches. OBJECTIVE: The aim of this study was to examine the psychometric properties of the Affiliate Stigma Scale in a sample of Turkish spinal cord injury/disorder (SCI/D) caregivers. METHODS: Participants completed the Affiliate Stigma Scale, Zarit Burden Interview, and Generalized Anxiety Disorder-7. This study conducted a series of confirmatory factor analyses (CFAs) of the Turkish Affiliate Stigma Scale using its originally theorized 3-factor structure and a 1-factor structure, as well as an exploratory factor analysis (EFA) to refine the scale items to create a short form, with a final CFA of the items in the short form. RESULTS: The 3-factor and 1-factor CFAs of the 22 items from the Affiliate Stigma Scale suggested poor fit to the data across every fit index. An EFA yielded four factors, although the patterns of item loading onto the factors did not map in any discernible way to the original subscales theorized by the scale creators. A 1-factor CFA with the six items loading onto factor 1 of the EFA showed much better fit indices, with most achieving good or adequate fit. CONCLUSION: The current study supports a 1-factor solution with a short form comprised of six items, at least in Turkish and with SCI/D caregivers.

Psychometric investigation of the affiliate stigma scale in Mexican Parkinson's disease caregivers: Development of a short form.

BACKGROUND: Parkinson's disease (PD) caregivers, particularly in Latin America, may experience high levels of affiliate stigma due to their association with a person having a disability. The most common measure used of this construct in the literature, the Affiliate Stigma Scale, was validated using non-standard and questionable methods. OBJECTIVE: The purpose of this study was to investigate the factor structure and psychometric properties of the Spanish version of the Affiliate Stigma Scale with PD caregivers in Mexico using more widely accepted psychometric approaches including confirmatory and exploratory factor analyses (CFAs, EFAs). METHODS: A sample of 148 PD caregivers from Mexico completed this measure, as well as indices of caregiver burden and anxiety. RESULTS: Initial CFAs revealed that the data did not fit either the originally proposed one-factor or three-factor structures. An EFA was then conducted which was unable to discern any factor structure. Upon instituting a stepwise removal alpha-if-item-deleted process, a 5-item Affiliate Stigma Scale Spanish Short Form was retained with an adequate Cronbach's alpha, good convergent validity, and a Short Form CFA generally indicating adequate fit. CONCLUSIONS: The new Spanish Affiliate Stigma Scale Short Form holds promise for more appropriately measuring affiliate stigma likely in general but particularly in Spanish and among PD caregivers. The Short Form can assist not only in assessing levels of caregiver affiliate stigma, but in creating novel interventions to help support caregivers and decrease stigma.

Racial/Ethnic Differences in Arrest Probability Trajectories after Traumatic Brain Injury: A Model Systems Study.

Background: Previous literature has documented racial/ethnic differences in traumatic brain injury (TBI) risk, cause, treatment, and rehabilitation. The purpose of the current study was to investigate potential racial/ethnic differences in arrest probability trajectories over the first 10 years after TBI and whether injury and sociodemographic characteristics accounted for these differences. Methods: The current study included 13,195 participants with moderate-to-severe TBI in the TBI Model Systems National Database who had arrest data from at least one follow-up time point (Years 1, 2, 5, and/or 10). A series of hierarchical linear models assessed racial/ethnic differences in trajectories of arrest probability over these 10 years post-injury and then included socio-demographic and injury-related covariates. Results: White individuals with TBI had lower arrest probability trajectories than Black and Native American individuals, and Asian individuals with TBI had lower arrest probability trajectories than White, Black, Latinx, and Native American persons. In many cases, racial/ethnic disparities persisted even when injury and sociodemographic characteristics were covaried. Conclusion: These results suggest that rehabilitation clinicians should assess for post-injury arrest risk factors such as age, sex, education, pre-injury unemployment, arrest history, and substance abuse, particularly in Black, Latinx, and Native American groups, and integrate programming to lessen post-injury arrest probability and improve overall rehabilitation outcomes.

Exploring racial performance disparities with the Modified Mini-Mental State Exam (3MS) in an acute brain injury rehabilitation setting.

PURPOSE/OBJECTIVE: The Modified Mini-Mental State Exam (3MS) is a brief, widely used cognitive screening tool. This study examined differences in 3MS performance between Black and White individuals undergoing acute brain injury rehabilitation. RESEARCH METHOD/DESIGN: Participants were Black (44.1%; n = 78) and White (55.9%; n = 99) individuals admitted over a 2-year period to inpatient rehabilitation for an acute neurological injury or illness at a major, urban mid-Atlantic medical center. An attending psychologist administered the 3MS during assessment at admission, and demographic and injury-related information was extracted from electronic medical records. RESULTS: While there were no significant racial differences in the subsamples' gender, employment status, marital status, years of education, or days on the rehabilitation unit, Black participants were older and had a higher proportion of focal injuries or stroke. There were no significant racial differences in 3MS total scores. At the item level, Black participants scored lower on abstract reasoning, repetition, visuospatial construction, and comprehension. When adjusting for age and type of injury, significant differences remained in repetition and comprehension. The 3MS's internal consistency was adequate and comparable across races, as were item-total correlations, with the exception of White participants having a larger item-total correlation for the basic attention item. CONCLUSIONS/IMPLICATIONS: These findings underscore a point of caution about interpreting the results of a cognitive screening measure like the 3MS without the context of an individual's neurological history and race. Black individuals might be at risk for being inappropriately screened to be cognitively impaired, and some level of racial sensitivity should be taken at the item level for repetition and comprehension constructs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pain, mental health, life satisfaction, and understanding from others in veterans with spinal cord injury.

PURPOSE/OBJECTIVE: This study evaluated the relationships among pain, mental health symptom severity, life satisfaction, and understanding from others in veterans with spinal cord injury (SCI). RESEARCH METHOD/DESIGN: A sample of 221 individuals with SCI were interviewed by a psychologist during their annual evaluation in a Veterans Affairs medical center in an urban Mid-Atlantic region. Participants completed single-item, Likert-scale measures of life satisfaction (McGuire Health Impact on Participation [M-HIP]), pain severity (M-HIP), and understanding of others (from a modified Appraisals of DisAbility Primary and Secondary Scale-Short Form [ADAPSS-sf]), along with the Patient Health Questionnaire-4 (PHQ-4), a measure of mental health symptom severity. RESULTS: In linear regression models, pain (ß = .29, p < .001) and understanding from others (ß = -.28, p < .001) were significantly associated with mental health symptom severity with a marginally significant interaction effect (ß = -.32, p = .099). Pain (ß = -.33, p < .001) and understanding from others (ß = .32, p < .001) were also significantly associated with life satisfaction; however, there was no significant interaction (ß = .22, p = .234). CONCLUSION/IMPLICATIONS: This study showed that understanding from others and pain are important factors related to mental health and life satisfaction for veterans with SCI and highlights interventions targeting these relations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Treatment Outcomes Among Black Adults Receiving Medication for Opioid Use Disorder.

Largely due to structural racism, Black people with substance use disorder have worse outcomes than their White counterparts. The opioid epidemic has amplified these racial disparities. Little is known about strengths that buffer against the systemic issues that disproportionately impact Black adults with opioid use disorder (OUD), particularly those receiving buprenorphine for OUD. The objectives of this study are to (1) assess psychosocial and clinical predictors of OUD outcomes and (2) explore differences in OUD outcomes by gender among a sample of Black adults receiving buprenorphine. This is a secondary data analysis of a cross-sectional survey and medical record review with a convenience sample recruited from an addiction medicine clinic. Analyses included Black participants who provided at least one urine drug test during the study period (n = 98). Prospective 6-month OUD outcomes (treatment retention, substance use recurrence, and buprenorphine continuation) were abstracted from the medical record. Univariate analyses explored differences by gender. Multivariate regressions assessed predictors of OUD outcomes. Participants were 53% women and middle-aged (47 ± 12 years). The majority (59%) had been in treatment for at least 1 year at study enrollment. Substance use recurrence was common, but many individuals remained in treatment. OUD outcomes did not differ by gender. Older age and absence of injection opioid use history were significant predictors of treatment retention and buprenorphine continuation. When provided access to high-quality treatment, Black adults with OUD demonstrate positive outcomes. Addressing structural racism and developing culturally informed treatment interventions are necessary to improve access to high-quality care for this community.

Suicidal ideation after acute traumatic brain injury: A longitudinal actor-partner interdependence model of patients and caregivers in Latin America.

PURPOSE/OBJECTIVE: Traumatic brain injury (TBI) is associated with depression, anxiety, and even suicidality in individuals with TBI and in caregivers. Moreover, emotional functioning in individuals with TBI is linked with caregiver functioning. However, no known studies to date have examined linkages in suicidal ideation in individuals with TBI and family caregivers. This is especially important in Latin America, where TBI rates are high, and where cultural norms influence family caregiving. This study examined associations among self-reported suicidal ideation in individuals with TBI and their primary caregivers over time in Mexico and Colombia. Research Method/Design: A total of 109 individuals and their primary caregivers completed measures during hospitalization for TBI and at 2- and 4-months posthospitalization. The primary outcome was Item 9 from the Spanish version of the Patient Health Questionnaire-9, assessing for thoughts of death or suicide in the previous 2 weeks. RESULTS: Patients and caregivers reported high levels of suicidal ideation (18.3%-22.4% and 12.4%-15.7%, respectively) at each time point, and suicidal ideation at one time point strongly predicted ideation at the next. When patients endorsed suicidal ideation in the hospital, their caregivers tended to endorse suicidal ideation 2 months later. Although unaccounted for variables could be driving these relationships, they may also provide possible evidence of causal preponderance between patient and caregiver suicidal ideation post-TBI. CONCLUSIONS/IMPLICATIONS: Clinicians and rehabilitation specialists can use these findings to inform suicide risk assessment by expanding these practices to caregivers of patients who endorsed suicidal ideation. Interventions after TBI should incorporate caregivers given this study showed significant interdependence of suicidality between patients and caregivers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Factor structure of the Modified Mini Mental State (3MS) exam among participants in inpatient neurorehabilitation.

OBJECTIVE: To evaluate the factor structure of the Modified Mini Mental State (3MS) Exam and its suitability as a cognitive screening tool among individuals admitted to an inpatient rehabilitation unit for new-onset neurological injury/illness. METHOD: A retrospective chart review was conducted. Of the 187 individuals meeting the inclusion criteria, 116 had a diffuse pattern of neurological injury/illness; 71 had a focal injury/illness. Confirmatory and exploratory factor analyses (CFA; EFA) were conducted for the whole sample and separately by group. RESULTS: The CFA suggested poor fit indices. The EFA of the total sample suggested a three-factor solution (Orientation/Awareness; Learning/Recall and Executive Functioning; Psychomotor Ability). The EFA of the diffuse subsample suggested a three-factor solution (Attention and Learning/Recall; Psychomotor Ability; Expressive Language). The Orientation/Awareness, Learning/Recall, Executive Functioning, Psychomotor Ability, and Expressive Language four-factor solution observed among the focal subsample was considered invalid. CONCLUSION: The 3MS provides information about the pattern of cognitive performance among individuals in neurorehabilitation; clinicians are advised to interpret total scores with caution. Among individuals with focal injuries/illnesses, clinicians might use the 3MS to compare the pattern of cognitive ability to expectations for performance and to support strengths-based approaches to participation in rehabilitation therapies.

Parkinson's Symptoms and Caregiver Affiliate Stigma: A Multinational Study.

BACKGROUND AND OBJECTIVE: Research has documented the stigma that individuals with degenerative neurological diseases experience, but caregivers also experience stigma by association (i.e., affiliate stigma). In order to shed light on the stigma of caregivers of people with degenerative neurological diseases, the current study aimed to explore cross-cultural differences in the prevalence of Parkinson's disease (PD) caregiver affiliate stigma, as well as the relationship between PD symptoms and caregiver affiliate stigma. Applications for Alzheimer's disease are discussed. METHODS: Survey data were collected in PD clinics at public, academic medical centers. Informal caregivers of an individual with PD from the US (n = 105) and from Mexico (n = 148) participated in the study. Caregivers completed a questionnaire that included the MDS Unified PD Rating Scale to describe the symptoms of the individual with PD, as well as the Affiliate Stigma Scale and demographic information. RESULTS: A series of multiple regressions was run to examine whether PD symptoms were associated with affiliate stigma and if these differed by country. These regressions suggested that different patterns of PD symptoms predicted affiliate stigma in each country. Stigma was higher in the US compared to Mexico, and the relationship between bowel/bladder symptoms and affiliate stigma was significantly stronger in the US. CONCLUSION: Symptoms of individuals with neurodegenerative diseases are related to affiliate stigma experienced by caregivers, and these relationships may differ cross-culturally. Negative public attitudes concerning bowl and bladder issues and the physical symptoms that accompany PD remain a source of stigma for caregivers and families, particularly in the US. Interventions for caregivers of individuals with neurodegenerative diseases should include strategies for coping with stigma concerning bladder and bowel problems, as well as other physical and mental health issues.

Predicting caregiver burden over the first 4 months after acute traumatic brain injury in Latin America: a multi-country study.

Background: Traumatic brain injury (TBI) rates and outcomes are worse in Latin American countries relative to high-income countries. This study examined whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation in individuals with an acute TBI in Latin America predict longitudinal trajectories of caregiver burden during the first 4 months post-discharge.Method: A sample of 109 caregivers of individuals with a new TBI from Colombia and Mexico completed the observer European Brain Injury Questionnaire before hospital discharge and the Zarit Burden Inventory at the same time and again at 2 and 4 months after discharge. A hierarchical linear model (HLM) was used to assess whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation at hospital discharge predicted longitudinal trajectories of caregiver burden.Results: Results suggested that burden trajectories decreased over time and men reported higher burden than women. Additionally, results showed that poor patient social and emotional self-regulation predicted higher burden trajectories.Conclusions: Men and caregivers providing care for those experiencing poor social and emotional self-regulation may be at risk for burden. Culturally sensitive interventions focusing on social functioning of individuals with TBI and gender-informed caregiver interventions aimed at burden should be implemented in Latin America.

Spinal Cord Injury/Disorder Function, Affiliate Stigma, and Caregiver Burden in Turkey.

BACKGROUND: The association among spinal cord injury and disorder (SCI/D) function, caregiver affiliate stigma, and caregiver depression and burden has not been adequately studied. In Turkey, a region with a developing healthcare infrastructure, SCI/D caregivers may have a higher responsibility of care given limited resources and may experience greater psychological distress associated with caregiving than in more developed healthcare systems. OBJECTIVE: To examine whether SCI/D function, caregiver affiliate stigma, and caregiver burden and depression in Turkey are associated with each other. DESIGN: Cross-sectional survey design. SETTING: Participants were recruited from the Turkish Spinal Cord Injury Foundation and from the SCI/D service at Istanbul Physical Rehabilitation Hospital. PARTICIPANTS: A total of 82 SCI/D caregivers in Turkey. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Barthel Index, Affiliate Stigma Scale, Zarit Burden Interview, and Patient Health Questionnaire-9. RESULTS: In an initial path model using bootstrapping, SCI/D function did not predict affiliate stigma, and once this path was trimmed, a final path model suggested that SCI/D function and affiliate stigma predicted caregiver burden, which in turn predicted caregiver depression. Burden partially mediated the effects of both SCI/D function and affiliate stigma on caregiver depression. All paths in the final model were statistically significant, and the fit indices suggested good fit. CONCLUSIONS: Because affiliate SCI/D function and stigma exerted a cascade of statistical effects across caregiver burden and depression, interventions should be developed and tested to help caregivers cope with low SCI/D function and combat affiliate stigma, preventing it from exerting harmful effects. Previously developed caregiver interventions should be translated and culturally adapted for a Turkish context, given that the burden and depression outcomes these interventions target are highly relevant for Turkish SCI/D caregivers.

Trajectories of memory, language, and visuoperceptual problems in people with stroke during the first year and controls in Colombia.

AIM: Neuropsychological normative data for Latin America have been recently published, and for Colombia, in particular, but longitudinal neuropsychological outcomes after stroke have not yet been examined in this global region. The purpose of the current study was to compare functioning of individuals with stroke in Colombia, South America during the first year post-stroke to healthy controls across neuropsychological assessments of memory, language, and visuoperceptual impairments. METHOD: A sample of 50 individuals with stroke (mean age = 51.58) and 50 matched healthy controls (mean age = 51.54) from Colombia were included in this study. Because of a lack of access to health services, individuals with stroke did not receive any inpatient or outpatient cognitive or behavioral rehabilitation. Participants were assessed on 10 visuoperceptual, language, and memory tasks at 3, 6, and 12 months. RESULTS: Trajectories of neuropsychological performance were significantly worse among individuals with stroke than healthy controls across every index. Further, hierarchical linear models suggested that although both individuals with stroke and controls generally improved over time on these assessments, the improvements among individuals with stroke were often of no greater magnitude than the improvements seen in controls, suggesting extremely low levels of rehabilitation gains in Colombia. Only three of the 10 neuropsychological assessments did a significant time*group interaction occur, suggesting greater gains for the stroke group than controls. CONCLUSION: These findings suggest profound disparities in post-stroke cognitive functioning in Colombia compared to other more developed global region and underscore the importance of comprehensive cognitive rehabilitation services for individuals with stroke in Colombia and other similar global regions. Implications for rehabilitation Because this study found only negligible cognitive improvements beyond practice effects over the first year after stroke in Colombia among individuals without access to acute rehabilitation, it is imperative that comprehensive cognitive rehabilitation services be implemented immediately during the acute rehabilitation period. Memory, language, and visuoperceptual training strategies can be implemented for people with stroke in underserved global regions as part of the standard of care for stroke rehabilitation. Cognitive rehabilitation strategies should be adapted into Spanish and pilot tested in Latin America to ensure cultural equivalence. Culturally competent cognitive rehabilitation strategies should be tailored based on varied educational and literacy levels.

Racism, Mental Health, Healthcare Provider Trust, and Medication Adherence Among Black Patients in Safety-Net Primary Care.

There has been a growing research focus on social determinants to health disparities in general and medication adherence more specifically in low-income Black populations. The purpose of this study was to examine whether prior experiences of racism among Black patients in safety-net primary care indirectly predicts poor medication adherence through increased mental health symptoms and low healthcare provider trust. Two competing models were run whereby mental health leads to provider trust or provider trust leads to mental health in this multiple mediational chain. A group of 134 Black patients (76 men, average age 45.39 years) in a safety-net primary care clinic completed measures of these constructs. Results revealed that in the first model, mental health mediated the relationship between racism and provider trust, and provider trust mediated the relationship between mental health and medication adherence. All paths within this model were statistically significant, except the path between provider trust and medication adherence which approached significance. In the second model, provider trust and mental health significantly mediated the relationship between racism and medication adherence, and all direct and indirect paths were statistically significant, though the path between provider trust and medication adherence was omitted. These results may serve as catalysts to assess and attempt to mitigate specific minority-based stressors and associated outcomes within safety-net primary care settings.

Spontaneous Recovery of Executive Function, Attention, and Processing Speed in Stroke Patients in Colombia.

BACKGROUND: Previous literature has shown disparities between developing and developed regions in executive functioning, attention, and processing speed performance following stroke. Research on post-stroke longitudinal outcomes in Latin America specifically is almost nonexistent. OBJECTIVES: To assess spontaneous recovery among individuals with stroke in the absence of cognitive rehabilitation services in Colombia, South America during the first year post-stroke by comparing their functioning to that of healthy controls across executive functioning, attention, and processing speed at 3, 6, and 12 months. DESIGN: Cohort. SETTING: Stroke rehabilitation center at the regional hospital. PARTICIPANTS: A sample of 50 individuals with stroke and 50 matched healthy controls from Colombia were included in this study. Consistent with the healthcare resources in this region, participants did not receive any inpatient or outpatient cognitive rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Executive functioning, attention, and processing speed. RESULTS: Hierarchical linear models suggested improvements over time for both individuals with stroke and controls, but trajectories of neuropsychological performance were significantly lower for individuals with stroke. Only on one of nine outcomes was there a significant time*group interaction, suggesting greater gains for the stroke group than controls. CONCLUSIONS: These data suggest extremely minor spontaneous recovery among individuals with stroke in Colombia relative to practice effects in controls, and that apparent improvements in executive functioning after stroke were likely just due to practice effects. These findings underscore the bleak outcomes in cognitive functioning after stroke that occur in regions without cognitive rehabilitation.

Health Conditions, Access to Care, Mental Health, and Wellness Behaviors in Lesbian, Gay, Bisexual, and Transgender Adults.

This study examined relationships among wellness behaviors, physical health conditions, mental health, health insurance, and access to care among a sample of 317 lesbian, gay, bisexual, and transgender (LGBT) adults. Participants completed a web-administered survey from May 2013 to April 2014. Of the sample, 41.6% of the participants reported having one or more health conditions. Most participants (92.1%) reported access to a health care facility and current health insurance coverage (84.9%), though 24.9% of those with health insurance reported being incapable of paying the copayments. Physical health conditions, age, and self-esteem explained 24% of the variance in engagement in wellness behaviors; older age, a greater number of health conditions, higher self-esteem, possession of health insurance, and ability to access to care were associated with increased wellness behaviors. Providing affordable insurance coverage, improving access to care, and properly treating mental health in LGBT individuals could improve wellness behaviors.

Resilience After Spinal Cord Injury: A Scoping Review.

Rehabilitation medicine has recently embraced resilience, and research in this area has surged within the past decade. Several systematic reviews of resilience research have been conducted in traumatic brain injury, chronic diseases, and stroke populations. A decade into research into the role of resilience in the lives of individuals with spinal cord injury, a review of the current state of the research literature is needed to identify trends and knowledge gaps. The aims of this scoping review were (a) to classify study methods and designs used for resilience research in spinal cord injury to date, (b) to describe how researchers have defined "resilience," and (c) to identify knowledge gaps and suggest future directions for research. Literature searches were conducted to identify English-language, peer-reviewed articles on resilience and spinal cord injury. Most of the 40 studies reviewed were correlational using cross-sectional data, although descriptive, longitudinal, qualitative, test development, and intervention studies and review articles were found as well. As is the case outside of rehabilitation medicine, there is considerable definitional and conceptual heterogeneity that limits our ability to apply resilience research to clinical practice. Moving forward, the field needs model-driven, longitudinal research that offers clear, conceptual distinctions between risk and protective factors, processes, and outcomes.

Racial/Ethnic Disparities in Longitudinal Trajectories of Community Integration After Burn Injury.

OBJECTIVES: The aim of this study was to examine potential racial/ethnic disparities in community integration for the 2 yrs after burn injury. DESIGN: A sample of 1773 adults with burn injury from the Burn Model Systems database was used with data on community integration collected at discharge (preinjury recall), 6, 12, and 24 mos after discharge. METHODS: Four sets of hierarchal linear models determined the most appropriate model for understanding racial/ethnic differences in Community Integration Questionnaire trajectories over time. RESULTS: Data indicated a decrease in community integration between discharge and 6 mos, a slight increase between 6 mos and 1 yr, and then a plateau between 1 and 2 yrs. White individuals had higher community integration score trajectories over time than black (b = 0.53, P < 0.001) and Hispanic (b = 0.58, P < 0.001) individuals, and community integration scores were similar between black and Hispanic individuals (b = -0.05, P = 0.788). These racial/ethnic disparities remained after accounting for age, sex, total burned surface area, number of days in rehabilitation, and active range of motion deficits. CONCLUSIONS: Additional rehabilitation resources should be targeted to helping black and Hispanic individuals integrate back into their communities after burn injury.

Social determinants of sleep disturbance in safety-net primary care: unmet needs, classist discrimination, and anxiety.

BACKGROUND: The 3P model proposes that predisposing, precipitating, and perpetuating factors all play a role in sleep disturbance. OBJECTIVE: The purpose of the current study is to investigate social determinants of sleep disturbance by applying the 3P model to a safety-net primary care setting, specifically by evaluating the role of classism and unmet needs as precipitating factors for sleep disturbance, and anxiety as a perpetuating factor for sleep disturbance. METHODS: Participants (N = 210) were a convenience sample of racially/ethnically diverse adults over the age of 18 (age M = 44.7 years) recruited from a safety-net primary care clinic in an urban area. The study employed a cross-sectional design. Participants completed a survey assessing sleep disturbances, anxiety, unmet needs, classism, social support, and a researcher-generated demographic form. RESULTS AND CONCLUSIONS: The unmet need for affordable long-term housing and greater experiences of classism were associated with more sleep disturbance, suggesting that both acted as precipitating factors. In a structural equation model with adequate fit indices, anxiety mediated the relationships with sleep disturbance for both the unmet need for affordable long-term housing and classism, suggesting that it serves as a perpetuating factor. Medical providers are recommended to explore these potential needs in safety-net primary care when patients present with sleep disturbance or anxiety. Assisting with connections to long-term housing and helping patients counteract and cope with classist discrimination may be effective in improving sleep in safety-net primary care.

The minority strengths model: Development and initial path analytic validation in racially/ethnically diverse LGBTQ individuals.

OBJECTIVE: The minority stress model and much research based upon it tend to adopt and reinforce a deficit-based approach. This study created and initially validated the minority strengths model, which by contrast outlines how personal and collective strengths in minority populations create resilience and positive mental and physical health. MATERIALS AND METHOD: A sample of 317 lesbian, gay, bisexual, transgender, and queer individuals from diverse racial/ethnic backgrounds completed a national online survey. RESULTS: A minority strengths path model was generated with statistically significant paths and good fit indices, including all possible significant indirect effects. The model explained 16.8% of the variance in identity pride, 19.7% in self-esteem, 32.9% in resilience, 41.6% in mental health, and 13.0% in positive health behaviors. CONCLUSIONS: The minority strengths model holds promise to stimulate research on the personal and collective strengths of minority populations and the ways in which strengths generate resilience and positive mental and physical health.