Sex and Psychosocial Differences in Acute Stress Symptoms Prior to Open-Heart Surgery.

BACKGROUND: Acute stress symptoms can occur while cardiac patients await open-heart surgery (OHS). The distress leads to poor outcomes. This study aimed to investigate the association of sex and psychosocial factors (quality-of-life and character strengths). METHOD: Our study cohort included 481 pre-OHS patients (female 42%; mean age 62 years). Medical indices/factors were obtained from the Society of Thoracic Surgeon's national database. Multiple regression analyses were performed following pre-planned steps and adjusting medical factors. RESULTS: Our findings revealed that sex differences in trauma-related symptoms were associated with poor mental well-being, alongside comorbidities. Both mental well-being and comorbidity factors were directly related to acute stress symptoms, while dispositional optimism had an inverse association with this outcome. CONCLUSION: To improve OHS outcomes, our findings suggest healthcare providers be attentive to pre-OHS acute stress symptoms, pay greater attention to the emotional well-being of their female patients, and develop supportive interventions to enhance personality strengths.

Perceived spiritual support counteracts the traumatic impact of extreme disasters: Exploration of moderators.

INTRODUCTION: Extreme disasters have increased exponentially in recent years and result in threats and traumatic reactions in communities globally. Humans turn to their existential relations for survival following disasters; yet, religion and spirituality (R/S) remains underinvestigated in disaster contexts, with most studies measuring general R/S concepts in Christian samples. To address the resulting gap, this study sought to (a) establish short form, disaster-specific scales of perceived spiritual support (PSS); (b) test the factor's relationships with mental health outcomes; and (c) explore moderators of those relationships. METHOD: With strong community engagement, a culturally diverse sample (N = 566) completed an online survey after Hurricanes Maria and Michael (H-MM). Multivariate analyses established psychometric properties for 2 PSS short-form scales (PSSS-S1 and -S2) and revealed associations between and moderators of (disaster-related experiences and character strengths) the scales and 2 traumatic outcomes: posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). RESULTS: PSSS-S1 and -S2 demonstrated adequate reliability and validity. PSS was associated inversely with PTSD symptoms at a marginal level but positively and strongly with PTG. Character strengths moderated the link of PSS to PTSD but not PTG. Most disaster-related factors were associated with both outcomes. CONCLUSIONS: The findings highlight the function of PSS in survival. PSSS-S1 and -S2 are adequate measures for rapid and cross-cultural data collection in extreme disasters. The differential associations of PSS and moderators with the 2 outcomes can be interpreted in light of 2 forms of well-being, which may have implications for theory, research, and practice in trauma psychology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family Factors Related to Three Major Mental Health Issues Among Asian-Americans Nationwide.

Asian-Americans (AAs) constitute the fastest growing minority group in the USA. AAs share a common emphasis on collective cultural strengths, especially family values. Using the National Latino and Asian American Study (NLAAS) data, this study investigated the roles of family cohesiveness, along with other cultural strength factors and negative family interactions in three psychiatric disorders. Supporting the study's hypotheses, multivariate analyses showed that family cohesiveness was associated with a lower incidence of general anxiety disorder (GAD), while regular religious attendance was linked with a lower likelihood of having substance use disorder (SUD). Conversely, negative family interactions increased the likelihood of experiencing major depression disorder (MDD) and SUD. Whereas perceived discrimination was related to higher odds of all diagnoses, family cohesiveness moderated the relationship between discrimination and GAD. These findings suggest that family relationships play a critical role in AAs' mental health and should be further explored through a prospective design.

ADL and IADL Following Open-Heart Surgery: The Role of a Character Strength Factor and Preoperative Medical Comorbidities.

Open-heart surgery (OHS) is common in late life and is expected to improve functioning despite aging of OHS patients. Few studies have explored the influence of both psychosocial strength factors, metal health, and pre- and peri-OHS medical factors, including cardiac indices, on post-OHS functioning. This study explores the role of character strengths (e.g., hope and spirituality) in post-OHS activities of daily living (ADL) and instrumental ADL (IADL), along with cardiac indices used by all cardio-thoracic surgeons, after controlling for self-reported pre-OHS depression, quality of life indicators, and non-cardiac medical comorbidities. Three waves of interview data and cardiac/surgical indices in the Society of Thoracic Surgeon (STS) national database were collected for a cohort of 481 patients (age = 62 +, female 42%). Multiple linear regression was used to identify pre-OHS predictors of post-OHS functional status. ADL and IADL statuses after OHS were better among those who pursued pre-OHS positive spiritual/religious coping than those who did not. Outcomes were poorer for those reporting poor pre-OHS, higher numbers of medical comorbidities, and use of more post-OHS prayer for coping. Perfusion time, a proxy for surgical complexity, was associated with poor IADL only. Pre-OHS positive spiritual coping, a common coping means used among cardiac patients in medical crises, could have played a positive role in better post-OHS functional status during the post-OHS recovery month. Cardiac health providers should pay more attention to patient-centered character strengths and coping and non-cardiac conditions. More nuanced interdisciplinary research is necessary to identify mechanisms underlying these associations.

Childhood Mistreatment, PTSD, and Substance Use in Latinx: The Role of Discrimination in an Omitted-Variable Bias.

BACKGROUND: Childhood mistreatment (CM) has been associated with adult posttraumatic disorder (PTSD) and substance use disorders (SUDs) in the general population. Few studies have examined the role of PTSD in the CM-SUD association among Latinx. This cross-sectional study evaluated a theory-driven conceptual model with a specific focus on the impact of perceived discrimination, which may interfere with these associations. METHOD: Using a nationally representative sample and structural equation modeling (SEM), the study evaluated the mediation of PTSD in the CM-SUD link, adjusting for or omitting discrimination and other sociodemographic variables that are known predictors of Latinx behavioral health. Multi-subsample analyses were then conducted to review nativity differences (US-born = 924.43% and immigrant = 1630.57%). RESULTS: The fully specified final model (model 1, covariates adjusted) failed to show a significant mediation of PTSD in the tested link, but a direct detrimental effect group of discrimination, for all Latinx. The mediation was only supported, when treating discrimination and other covariates as omitted variables (model 5), which also showed additional direct and indirect effect of CM on SUD. In subsample analyses, models of US-born and immigrant-Latinx subpopulations were identical but showed nativity differences when omitting covariates. CONCLUSION: When discrimination and other covariates were fully adjusted, Latinx exposed to trauma were more likely to develop SUD in adulthood, regardless of when traumatic exposure occurred. This unexpected finding challenges theories explaining the CM-SUD connection, suggesting possible model misspecifications of parametric SES; namely, omitting the unique impact of perceived discrimination in Latinx can lead to biased results. From a clinical standpoint, both trauma and discrimination must be addressed when assessing Latinx behavioral health.

Depression After Open Heart Surgery: Influences of Optimism, Sex, and Event-Related Medical Factors.

ABSTRACT: Postoperative depression is a multifaceted condition that can limit quality of life and potentially decrease the survival benefits of open heart surgery (OHS). We postulated that sex, pre-event character strengths, medical, and certain surgery indicators would predict post-event/myocardial infarction depression. To identify predictors, we collected three-wave survey data from 481 OHS patients at a large academic referral institution (age, 62+; female, 42%) and included key medical and surgical information. The final model (F[7, N = 293] = 28.15, p < 0.001, R2 = 0.408) accounted for over two fifths of the variance in post-OHS depression. Pre-event/OHS optimism mitigated post-OHS depression. Being female, older, living alone, longer surgical perfusion time, absence of left main disease greater than 50%, and pre-OHS depression were associated with the increased likelihood of post-OHS depression. Our findings suggest that teaching optimism to OHS patients might be beneficial in reducing the risk of postoperative depression and that female patients should be monitored more closely for the development of depression through an interdisciplinary approach.

Understanding a mechanism between perceived discrimination and obesity among Latinas in the United States.

Objective: Obesity is a prominent public health concern significantly impacting various minority groups, especially Latina Americans. However, little study has explored acculturation-related factors associated with obesity among Latinas in the United States. This study examines the link between acculturation-related factors and obesity among Latinas.Design: Using the National Latino and Asian American Study (NLAAS), we detected the incremental associations of acculturation-related factors, especially perceived discrimination with obesity, after controlling for socio-demographics, among all 1427 Latinas. Two-step logistic regression analyses were conducted to investigate the association.Results: Results indicated perceived discrimination and older age were positively associated with Latinas' obesity. Conversely, income and acculturation stress were negatively associated with obesity. Further, results revealed a significant moderating effect of education on the association between perceived discrimination and obesity.Conclusion: The findings suggest the need for clinical attention towards socio-cultural influences and ethnic backgrounds in obesity assessment and intervention.

Depression in Patients with Heart Diseases: Gender Differences and Association of Comorbidities, Optimism, and Spiritual Struggle.

BACKGROUND: Depression is a well-established comorbidity of heart disease (HD) and is more prevalent in women than in men. Few studies have examined the gender effect on depression in patients with advanced heart disease prior to open heart surgery (OHS), controlling for cardiac indices. Previous studies indicated the health benefit of optimism but often lacked adjustment for medical confounders. This interdisciplinary study investigated gender differences in pre-OHS depression and the role of medical comorbidities and strength factors. METHOD: Two waves of survey data were collected from 481 patients (mean age = 62, female 42%) along with medical indices in the Society of Thoracic Surgeon's (STS) national database used by all US cardiac surgeons. RESULTS: A t test showed significantly higher levels of pre-OHS depressive symptoms in women than in men. In multivariate analyses, the gender effect on depression vanished after entry of other socio-demographics, medical comorbidities, objectively assessed cardiac indices in the STS database, and psychosocial strength factors. Depressive symptoms linked inversely with dispositional optimism and positively with medical comorbidities and religious/spiritual struggle, but not with any cardiac indices. A mediation analysis supported the role of comorbidities in the gender difference. CONCLUSION: Women with heart disease were more depressed, but the gender difference may be partly explained by multiple comorbid conditions that could complicate disease burden. Reinforcing the literature, optimism, but not other strength factors, appeared to counteract depression after adjusting for health and cardiac conditions. The finding suggests that health providers should be more attentive to overall health of women with heart disease and to the positive expectations of OHS patients.

Preoperative Optimism Related to Low Anxiety in Patients 1 Month After Open Heart Surgery.

Anxiety can contribute to poor prognosis in cardiac patients. Few studies have examined the role of optimism in anxiety after open heart surgery (OHS). This study investigated the influence of preoperative optimism on post-OHS anxiety, adjusting cardiac indices used by cardiac surgeons. Data were collected before and 1 month after OHS in 481 patients (58% men; age, 62.4 ± 11.94 years). Optimism was measured using the Life Orientation Test. Anxiety was measured using the Trait Anxiety Inventory. Medical and cardiac indices were retrieved from the Society of Thoracic Surgeon's national database. Multiple regression analyses showed that greater pre-OHS optimism was associated with lower levels of post-OHS anxiety (F[6, N = 306] = 50.18, p < 0.001, R = 0.502). No other factors showed similar protection. Pre-OHS anxiety, younger age, and minority status were associated with anxiety in the critical recovery month. The findings demonstrate the potential benefit of optimism against post-OHS anxiety, which may have clinical implications for improving disease management.

Optimism/hope associated with low anxiety in patients with advanced heart disease controlling for standardized cardiac confounders.

Anxiety is an under-investigated comorbidity in heart disease patients. Optimism/hope is a character strength that indicates confidence or favorable expectation about the future. Previous research has consistently reported optimal health outcomes among optimists. However, many studies have lacked adjustment for medical confounders and/or used small clinical samples. To bridge this gap, we tested the hypothesis that optimism/hope was inversely related to anxiety in 400+ patients with advanced heart disease during the stressful waiting period prior to open-heart surgery. The findings supported the hypothesis after controlling for general health, illness impact, behavioral risks, and cardiac medical indices used by surgeons.

Childhood Abuse, Religious Involvement, and Lifetime Substance Use Disorders among Latinas Nationwide.

BACKGROUND: Childhood abuse is a major behavioral health concern and imposes lasting sequelae on mental and physical health, including lifetime substance use disorders (LT-SUD). Yet, gender-specific research examining this early trauma and substance use in Latina-Americans (Latinas) is scarce. No study has explored the relationship between collectivist cultural factors and LT-SUD in this largest minority-female subgroup of the United States' population. OBJECTIVES: Based on coping theory, this study investigated the association between childhood abuse, cultural factors, and LT-SUD among Latinas nationwide. METHODS: Using the National Latino and Asian American Study we performed three-step logistic regressions to investigate LT-SUD for 1,427 Latinas, following three preplanned steps: (1) childhood physical and sexual abuse (CPA and CSA) with LT-SUD; (2) known correlates as controls; and (3) cultural strength factors. RESULTS: The prevalence rates of CPA and CSA were 28.0% and 18.4%, and that of LT-SUD was 4.8%. Religious attendance at a weekly level was negatively related to LT-SUD. Alongside English proficiency, discrimination, and social support, however, CPA and religious coping were positively associated with LT-SUD. Conclusion/Importance: Childhood physical abuse is an early risk factor for long-term substance use, viewed as a negative coping strategy. Religious attendance may have potential protection for Latinas. The victimization history may lead to coexisting positive (e.g., pursing social support, religious coping) and negative (e.g., SUD) coping behaviors within Latino communities.

Acculturation Factors Related to Obesity of Latino American Men Nationwide.

Obesity is a public health epidemic, particularly among underrepresented populations. With a large proportion of immigrants, Latino Americans comprise the largest minority population in the United States. This study examined the association of acculturation factors with obesity among Latino American men ( n = 1,127) using the National Latino and Asian American Study. The result identified two acculturation-related factors (being U.S.-born and living in the United States for the longest period/5-10 years) as positive correlates. In contrast, a different study on obesity in Latino American women demonstrated discrimination, but not the above factors, as significant correlates. The men's pattern suggests that the Hispanic/Latino paradox might have greater implications for men with respect to weight issues. Furthermore, Mexican American and Other Latino American men presented a greater likelihood of being obese than Cuban and Puerto Rican men. The findings, if replicated in prospective research, suggest the need for gender- and ethnic-specific intervention for obesity in Latino American men, particularly for the largest subgroup, Mexican Americans.

Differential Associations of Religious Involvement with the Mental Health of Asian-American Subgroups: A Cultural Perspective.

In the USA, Asian-Americans (AA) constitute the fastest growing ethnic minority group, in which heterogeneous religious patterns and acculturation experiences can impose significant impacts on their mental health. Using national data, the present study examined the contributions of religious involvement and social support to self-rated mental health (SRMH) of Chinese, Vietnamese, and Filipinos. Findings demonstrated cross-group variations, with Filipinos reporting the highest levels of SRMH, acculturation, and discrimination. However, religious involvement was associated with better SRMH in the least religious Chinese subgroup but not in the most religious Filipino subgroup. Social support predicted SRMH for both Chinese and Vietnamese subgroups. The differential religious patterns in the more acculturated generations between the two AA subgroups suggest religious assimilation as part of their acculturation in the context of divergent immigration experiences.

Childhood Abuse, Religious Involvement, and Substance Abuse Among Latino-American Men in the United States.

PURPOSE: Childhood abuse/victimization and subsequent substance abuse are significant behavioral health problems among developed countries. In the United States (U.S.), however, few studies have examined whether this early trauma exacerbates adulthood substance abuse, viewed as a negative coping strategy, among Latino-American men. Furthermore, little is known about how collectivist cultural factors (i.e., ethnic identity, social support, and religious involvement), indicating potentially positive coping resources, were related to substance abuse in this largest minority-male population. METHOD: We investigated Latino-American men (N = 1127) in a nationally representative U.S. sample, using logistic regression analysis adjusting known demographic and acculturation correlates. RESULTS: The results identified considerably elevated rates of childhood physical abuse/victimization (35.7 %) and lifetime substance abuse (17.3 %). Childhood physical (not sexual) abuse/victimization was positively associated with lifetime substance abuse, alongside age, being U.S.-born, and perceived discrimination. Latino-American men with lifetime substance abuse reported more religious coping. CONCLUSION: Findings may contribute to the design of culturally competent behavioral care.

Mental Health Professionals and Behavioral Interventions for Obesity: A Systematic Literature Review.

Adult obesity in the United States has risen to epidemic proportions, and mental health professionals must be called to action. The objectives of this article were to (a) synthesize outcomes of behavioral health interventions for adult obesity in recent meta-analyses and systematic reviews (MAs/SRs) as well as randomized controlled trials (RCTs) and further, (b) evaluate the role of mental health professionals in these behavioral health interventions. Articles were included if published in English between January 1, 2004, and May 1, 2014, in peer-reviewed journals examining behavioral health interventions for adults with obesity. Data were subsequently extracted and independently checked by two authors. Included MAs/SRs utilized motivational interviewing, financial incentives, multicomponent behavioral weight management programs, as well as dietary and lifestyle interventions. Behavioral health interventions in randomized controlled trials (RCTs) were discussed across 3 major intervention types (educational, modified caloric intake, cognitive-based). Regarding the 1st study objective, multiple positive primary (e.g., weight loss) and secondary outcomes (e.g., quality of life) were found in both MAs/SRs and RCTs. However, the majority of included studies made no mention of interventionist professional background and little inference could be made regarding the effects of professional background on behavioral health intervention outcomes for adults facing obesity; an important limitation and direction for future research. Future studies should assess the effects of interventionist profession in addition to primary and secondary outcomes for adults facing obesity. Implications for mental health professionals' educational curricula, assessment, and treatment strategies are discussed.

Ethnic Identity and Major Depression in Asian American Subgroups Nationwide: Differential Findings in Relation to Subcultural Contexts.

OBJECTIVES: Asian Americans (AA) are the fastest growing minority population in the United States. Leading AA scholars have highlighted the unmet service needs and the necessity to investigate subgroup variations in the mental health of AAs. This study addressed a research gap of whether racial and ethnic identity (REI) in three AA subgroups (Chinese, Filipino, and Vietnamese) consistently protects against major depressive disorder (MDD), counteracting the deleterious role of discrimination. METHOD: Using the National Latino and Asian American Study (NLAAS), we explored the varying and incremental predictive values of REI, above and beyond the effects of known demographic and acculturation predictors, alongside other potentially protective factors. RESULTS: In three sets of two-step logistic regressions, REI had an inverse relationship with MDD in the Filipino subgroup only but a positive association in the Chinese subgroup. The damaging role of negative REI moderated the effect of discrimination. The longest stay in the United States and discrimination predicted a higher likelihood of a MDD diagnosis in the Filipino subgroup. Social support contributed to the lower odds of MDD in Chinese and Vietnamese subgroups, had lower odds of having MDD, and religious attendance may act as a protective factor in the Vietnamese subgroup. CONCLUSION: Our findings do not reinforce uniform protection of REI but lend partial support for two underlying rationales. Based on cultural psychologists' framework, inconsistent findings are interpreted within the sociocultural contexts of the 3 subgroups.

Risk and protective factors for three major mental health problems among Latino American men nationwide.

The present study investigated psychosocial predictors for major depressive disorder (MDD), general anxiety disorder (GAD), and suicidal ideation (SI) of Latino American men identified in the first national mental health epidemiological survey of Latinos. Three separate sets of logistic regression analyses were performed for 1,127 Latinos, following preplanned two steps (Model 1--Known Demographic and Acculturation Predictors as controls, Model 2--Psychosocial Risk and Protective Factors). Results show that Negative Interactions with family members significantly predicted the likelihood of both MDD and SI, while SI was also associated with Discrimination. Acculturation Stress was associated with that of GAD (alongside more Income, Education of 12 years, and Years in the United States for less than 11 years). Other potential protective factors (social support, racial/ethnic identity, religious involvement) were not influential. The differential predictors for mental health issues among Latino men imply that assessment and intervention for them may need certain gender-specific foci in order to improve mental health disparities in this population.

Medication therapy management programs: promises and pitfalls.

BACKGROUND: Medication therapy management (MTM) is one form of a medication benefit program offered by public and private health providers and insurers. Although the term was first coined in 2003, MTM in its earlier forms has been used since the 1990s as a mechanism to improve health metrics for medically complex patients. Its role expanded with the passage of Medicare Part D, as a mandated component to help patients with multiple chronic conditions, high drug costs, and high utilization to improve the effectiveness and safety of their medication treatments.  OBJECTIVE: To review the evidence on MTM effectiveness in order to (a) provide information on its establishment and goals and (b) summarize research findings under 3 outcomes: economic, clinical, and humanistic.  METHODS: PubMed, a search engine service of the National Center for Biotechnology Information was utilized by trained research assistants to search for articles with the following key words: MTM, randomized controlled trials on MTM, evaluation of MTM, comprehensive medication review, medication action plan, special needs population, special needs plans, Medicaid, disease management, adherence, non-adherence, compliance, chronic conditions, disabling chronic conditions, and disability. Additional searches were conducted for key articles in references listed in the most recent review articles. The initial search identified nearly 300 articles. RESULTS: When evaluated, most studies found economic benefits, but the quality of research design and end point measures varied considerably across evaluations. Clinical outcomes encompassed a wide range of potential metrics, from service utilization, to individual patient and population outcomes, and quality of care. Quality measures such as provider-prescribing habits and medication adherence were frequently found to improve. As noted with the economic outcomes studies, overall rigor of study design was suboptimal, and often underpowered.  Few studies have focused on humanistic outcomes such as improved patient quality of life.  CONCLUSIONS: Evidence suggests that MTM services are a promising way to manage complex patients, but there are gaps in the literature largely because of the limited number of studies with strong designs. Stronger evaluation of MTM programs is warranted.

Family factors contribute to general anxiety disorder and suicidal ideation among Latina Americans.

PURPOSE: Despite a rapidly growing Latina/o American population, little is known about modifiable factors that could protect Latinas against major psychiatric disorders. The present study explored psychosocial risk (Negative Interaction) and protective factors (Family Cohesion, Social Support, Religious Involvement, Racial and Ethnic Identity) for major depressive disorder (MDD), general anxiety disorder (GAD), and suicidal ideation (SI) among Latinas participating in the first national mental health epidemiological survey of Latina Americans. METHOD: We conducted three sets of logistic regressions, predicting outcomes for 1,427 Latinas identified in the National Latino and Asian American Study (NLAAS), the first nationally representative, epidemiological study of Latino and Asian Americans living in the United States. These analyses followed preplanned steps: Model 1 used known predictors as controls and Model 2 added psychosocial risk and predictive factors beyond the known predictors. RESULTS: For each outcome examined, psychosocial risk and protective factors produced a significantly better model fit in Model 2 than sociodemographic and acculturation variables known to predict mental health outcomes in Model 1. Negative Interactions were associated with increased likelihood of GAD and SI, whereas Family Cohesion seemed to be protective against GAD. No psychosocial factors predicted MDD. CONCLUSIONS: Differential protective and risk factors for major psychiatric disorders suggest that assessment and intervention may need certain sex-specific components in order to improve health care and prevention for Latinas.

Starting the Conversation - A Childhood Obesity Knowledge Project Using an App.

PURPOSE: Starting the Conversation was a pilot project to test an intervention for childhood obesity, a major public health epidemic, using a free smartphone application (app). The primary aim was to assess students' knowledge of nutritional indicators, physical exercise and use of screen time before and after the intervention. METHODS: The study was conducted in 2011-2012. The sample, recruited from seven high schools in Snohomish County, Washington, was 65.3% minority participants. Of the 118 participants in the sample (n=118), 79 handwrote their responses (n=78) and 36 responded via the app (n=39). We compared the frequency and types of physical exercise, frequency of screen time, and nutritional variables of high school students. Participants used the cell phone app or a handwritten log to record their daily entries for 20 days. RESULTS: Both males (n=43) and females (n=75) grades 9-12 used the app or handwritten entries. Participants who used the app ate less fast food and exercised more, as compared with those who recorded their entries by hand. Screen time usage decreased over the course of the study, based on a comparison of the post-survey level and the pre-survey level. Knowledge of recommended daily consumption of vegetables increased post-test in the app group and knowledge of water consumption increased significantly in both groups. There was no significant difference in BMI pre and post-test. CONCLUSIONS: Patterns of nutritional intake, physical exercise and knowledge of these issues varied pre and post-test. It is critical to further examine factors associated with lack of physical activity and food intake patterns of youth using social media to further address the childhood obesity epidemic. Future research should focus on specific ethnic subgroups and an intervention at the school level aimed at the students with BMI ≥ 95th percentile.