Trauma Exposure and Mental Health Symptoms in Rural Latinx Adolescents: The Role of Family Processes.

Previous research suggests that rural Latinx youth are more likely to experience traumatic events and are at higher risk for developing subsequent psychopathology compared to non-Latinx white youth. The aim of this study is to understand how family processes and values affect risk for internalizing and externalizing symptoms among rural Latinx youth (N = 648, mage = 15.7 (SD = 1.2)) who are exposed to trauma. Multiple mediation analyses were performed to understand if family variables such as familism and family conflict explain the relationship between trauma exposure and psychopathology. Results suggest that familism partially mediates the relationship between trauma exposure and internalizing and externalizing symptoms, whereas family conflict partially mediates the relationship between trauma exposure and externalizing symptoms. These findings show that family variables are differentially impacted by trauma and have a separate and unique impact on mental health outcomes among rural Latinx youth. Specifically, our findings suggest that familial support or closeness may constitute a nonspecific protective factor for psychopathology among Latinx youth, whereas family conflict creates a stressful home environment that may deter adolescent trauma recovery and lead specifically to externalizing symptoms.

Urban Latinx parents' attitudes towards mental health: Mental health literacy and service use.

Latinx youth report elevated internalizing symptomatology as compared to their non-Latinx White counterparts and are less likely to access mental health care for these problems. This qualitative study examined the knowledge, beliefs and perceptions that Latinx parents (86% foreign-born; 66.7% monolingual Spanish speakers) living in urban communities have about mental health and service use for anxiety and depression in children. We used thematic analysis to analyze interview data from 15 Latinx parents who expressed concerns about their child's (age 6-13) worry or sadness. Analyses revealed that Latinx parents often have difficulty identifying mental health problems, report stigma about mental health problems and help-seeking and want more information about how they can help their children. Although Latinx parents report significant mental health and treatment-seeking stigma, the majority were open to seeking mental health services for their children or were already receiving services. Findings suggest that stigma although prevalent, may not deter service utilization for some Latinx families. Implications for community health and future research are discussed.

Gender differences in exposure to potentially traumatic events and diagnosis of posttraumatic stress disorder (PTSD) by racial and ethnic group.

OBJECTIVE: There is a robust literature base documenting gender differences and racial/ethnic differences in exposure to potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) diagnosis. Yet, to the best of our knowledge, this is the first study to evaluate the risk of PTEs and PTSD between genders, stratified by race/ethnicity. We aimed to better understand whether factors associated with poor psychological adjustment following PTEs (e.g., PTE type, sociodemographic factors, social support) varied by gender and race/ethnicity. METHOD: Data were collected from three U.S.-based national studies comprising the Collaborative Psychiatric Epidemiologic Surveys (CPES; N = 13,649). Trained lay interviewers administered questionnaires and collected data on PTE exposure, PTSD, and psychosocial covariates. Regression analyses were conducted to investigate relations between PTEs, PTSD, and gender, stratified by race/ethnicity. RESULTS: Adjusting for sociodemographic variables, mental health comorbidity, social support, and PTE frequency, White, African-American, and Afro-Caribbean women had higher odds of PTSD than men in their respective racial/ethnic groups, whereas gender differences were not observed for Latinos or Asians. CONCLUSION: Findings suggest that risk of exposure to PTEs and PTSD may differ by gender and race/ethnicity. Future studies should consider the contributions of social, cultural, and contextual factors in estimating PTSD risk.

Community-Based Implementation of a Paraprofessional-Delivered Cognitive Behavioral Therapy Program for Youth Involved with the Criminal Justice System.

Psychosocial interventions for common emotional and behavioral difficulties have been developed for use in correctional facilities, yet these programs are largely unavailable upon community re-entry due to a shortage of trained mental health specialists. In this study, we developed and piloted a youth worker-delivered cognitive behavioral therapy (CBT) program for young men at high risk for incarceration receiving services at a youth development organization. We formed a community-academic partnership to support the conduct of research across all phases of this project (2014-2016). We analyzed data gathered through focus groups and individual interviews with program staff, administrators, and young men. This study reports on implementation process and outcomes across phases. Main findings indicate the preliminary feasibility and acceptability of the youth worker-delivered CBT curriculum. We discuss strengths and limitations of our approach and provide suggestions for future studies that aim to implement paraprofessional-delivered CBT programs within community-based organizations.

Provider fidelity and modifications to cognitive processing therapy in a diverse community health clinic: Associations with clinical change.

OBJECTIVE: The purpose of this study is to examine associations between therapist adherence, competence, and modifications of an evidence-based protocol (EBP) delivered in routine clinical care and client outcomes. METHOD: Data were derived from a NIMH-funded implementation-effectiveness hybrid study of Cognitive Processing Therapy (CPT) for PTSD in a diverse community health center. Providers (n = 19) treated clients (n = 58) as part of their routine clinical care. Clients completed the PCL-S and PHQ-9 at baseline, after each CPT session, and posttreatment. CPT sessions were rated for treatment fidelity and therapist modifications. RESULTS: Overall, therapist adherence was high, although it decreased across sessions suggesting potential drift. Therapist competence ratings varied widely. Therapists made on average 1.6 fidelity-consistent and 0.4 fidelity-inconsistent modifications per session. Results show that higher numbers of fidelity-consistent modifications were associated with larger reductions in posttraumatic stress and depressive symptoms. High adherence ratings were associated with greater reductions in depressive symptoms, whereas higher competence ratings were associated with greater reduction in posttraumatic stress symptoms. CONCLUSIONS: The results highlight the importance of differentially assessing therapist adherence, competence, and modifications to EBP in usual care settings. The findings also suggest that effective EBP delivery in routine care may require minor adaptations to meet client needs, consistent with previous studies. Greater attention to fidelity and adaptation can enhance training so providers can tailor while retaining core components of the intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).