Family dementia caregivers with suicidal ideation improve with mentalizing imagery therapy: Results from a pilot study.

Background: Family caregivers of persons living with dementia often experience increased depression and suicidal ideation (SI). However, the feasibility and impact of therapies on caregiver SI has remained largely unexplored. Mentalizing imagery therapy (MIT) helps reduce psychological symptoms through mindfulness and guided imagery. This pilot study examined the feasibility of participation by caregivers with SI in a randomized controlled trial (RCT) of MIT versus a psychosocial support group (SG), and the respective impact of group on SI, depression, and secondary outcomes. Methods: A secondary analysis of data from an RCT of 4-week MIT or SG for caregivers (n = 46) was performed, identifying SI (n = 23) and non-SI (n = 23) cohorts. Group attendance and home practice were compared between cohorts. In the SI cohort (total n = 23, MIT n = 11, SG n = 12), group differences in SI, depression, and secondary outcomes were evaluated post-group and at 4-month follow-up. Results: Attendance in both groups and home practice in MIT were similar between SI and non-SI cohorts. In the SI cohort, MIT evinced greater improvements relative to SG in SI (p=.02) and depression (p=.02) post-group, and other secondary outcomes at follow-up. Limitations: Limitations include small sample size and single-item assessments of SI from validated depression rating scales. Conclusions: Participation in an RCT was feasible for caregivers with SI. MIT resulted in important benefits for SI and depression, while SG showed no acute SI benefit. The role of MIT in improving SI should be confirmed with adequately powered trials, as effective therapies to address caregiver SI are critical.

Management of Depression in Black People: Effects of Cultural Issues.

Black people are disproportionately affected by mental illness, including depression. While the prevalence of depression is paradoxically lower among the Black population, the impact of depression on Black people results in greater severity of illness and higher chronicity. The main factors through which Black people experience worse mental health outcomes includes delayed treatment seeking, and poor access to mental health services. Mental illness stigma contributes to the delay in treatment seeking behavior. Stigma refers to negative attitudes, beliefs or behaviors about a particular characteristic of an individual such as their health status. Both patients and mental health professionals experience stigma that impacts health engagement, limits access to effective depression treatments, and compromises positive patient-clinician communication. A commitment to lifelong learning about the role of culture, history, and the psychosocial context of our patients is critical to closing public health gaps in the field of mental health.

Understanding the Association Between Mental Health Knowledge and Mental Health Service Utilization Among Black Adults.

Mental health knowledge limitations may contribute to the treatment gap among Black adults. We conducted an online cross-sectional study of Black adults in the United States (n = 262, aged 18-65 years) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). Gamma regression using generalized linear models was used to estimate the associations between mental health knowledge and willingness to seek help from mental health professionals. After adjusting for age, education and ethnicity, participants with higher specific knowledge about mental health (such as recognition of schizophrenia as a mental illness) were 26% more likely to report willingness to seek help from a mental health professional for personal and emotional problems (RR = 1.26, CI 1.12-1.41, p < 0.001). Knowledge building interventions (such as psychoeducation) that seek to increase specific knowledge (rather than general knowledge) may correlate more strongly with utilization of mental health services among Black adults.

Perspectives of university health care students on mental health stigma in Nigeria: Qualitative analysis.

Mental illness is a significant public health burden in low- and middle-income countries. A wide treatment gap in mental health care exists within the Nigerian health care system and this gap is worsened by the presence of stigma associated with mental illness, which leads to delay in treatment or acts as a barrier to any care. In this study, our aim was to understand the factors that underlie mental illness stigma in order to inform the design of effective stigma-reducing interventions among health care students in Nigeria. We conducted four focus groups among university health care students in March 2019 in Nigeria. The students included nursing, pharmacy, and medical trainees from a university teaching hospital. We used an inductive-driven thematic analysis to identify codes and themes related to mental health stigma and conceptualization of mental health within the study group. Among the 40 participants, we identified how specific interpretations of religious and spiritual beliefs may be associated with stigmatizing behaviors such as social distancing and discrimination. Conceptualization of mental illness as a communicable disease and the attribution of mental illness to a moral failing contributed to stigma mechanisms. Overall, eight themes associated with mental health stigma and mental health-related concepts were found: spirituality, discrimination and devaluation, conceptualization of mental health, attribution theories, methods to reduce stigma, shortage of resources, violence and dangerousness, and maltreatment. We found that the co-existence of spiritual beliefs and biomedical and psychological models of mental health is a key factor to consider in the design of effective stigma-reducing interventions among university health students in Nigeria.

Religiosity and Stigmatization Related to Mental Illness Among African Americans and Black Immigrants: Cross-Sectional Observational Study and Moderation Analysis.

ABSTRACT: Stigma about mental illness is a known barrier to engagement in mental health services. We conducted an online cross-sectional study, aiming to estimate the associations between religiosity and mental illness stigma among Black adults ( n = 269, ages 18-65 years) in the United States. After adjusting for demographic factors (age, education, and ethnicity), respondents with higher attendance at religious services or greater engagement in religious activities ( e.g. , prayer, meditation, or Bible study) reported greater proximity to people living with mental health problems (rate ratio [RR], 1.72; 95% confidence interval [CI], 1.14-2.59 and RR, 1.82; 95% CI, 1.18-2.79, respectively). Despite reporting greater past or current social proximity, respondents with higher religiosity indices also reported greater future intended stigmatizing behavior (or lower future intended social proximity) (RR, 0.92-0.98). Focusing specifically on future intended stigmatizing behavior and the respondent's level of religiosity, age, and ethnicity may be critical for designing effective stigma-reducing interventions for Black adults.

Differences in psychosocial factors of mental health in an ethnically diverse Black adult population.

We conducted a cross-sectional analysis in a convenient sample of Black adults in the United States (n = 269, ages 18-65) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). We examined mean differences in self-reported medical mistrust, use of mental health services, depression symptom severity, mental health knowledge and stigma behavior (or a desire for separation away from people living with a mental illness) according to ethnicity, citizenship status, age group, and gender. African Americans with moderate to severe depression symptoms had greater stigma behavior (mean = 12.2, SD = 3.2) than African Americans who screened in the minimal to mild depression range (mean = 13.1, SD = 3.5). Across the spectrum of depression, immigrants showed greater stigma than African Americans (p = 0.037). This is a pilot study that explores heterogeneity in the Black population in depression symptom severity and psychosocial factors related to mental health. Understanding these differences may contribute to how we approach needs and health system practices and policies at the individual, systemic, and structural level of mental health care.

Recognizing and Addressing Health Care Disparities Among Black Populations.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Perspectives on Mental Illness Stigma Among African Immigrant Pregnant and Post-Partum Women in an Urban Setting: A Brief Report.

Purpose: This study assessed the perspectives of pregnant and postpartum African immigrant women on mental illness. Methods: We conducted a focus group session (n=14) among pregnant and postpartum African immigrant women in June 2020. We used an inductive driven thematic analysis to identify themes related to mental health stigma. Results: Five core themes emerged: conceptualization of mental health, community stigmatizing attitudes, biopsychosocial stressors, management of mental health, and methods to reduce stigma. Conclusion: Understanding the perspectives of pregnant African immigrant women at the intersection of their race, ethnicity, gender, and migration are necessary to improve engagement with mental health services.

Perspectives of Black Immigrant Women on Mental Health: The Role of Stigma.

Background: Black immigrants are a major growing segment of the United States population. The intersection of race, gender, and migration places black immigrant women at the confluence of multiple social determinants of health, and thus, black immigrant women experience ongoing mental health disparities. Understanding their perspectives, mental health needs, and associated stigma is critical to promoting positive mental health outcomes. Methods: We conducted five focus groups (N = 22) among women from two black immigrant community organizations from February 2019 to June 2019. We used an inductive driven thematic analysis to identify codes and themes related to mental health and the role of stigma. Results: Overall five core themes associated with mental health and associated stigma concepts were found: The critical role of trusted sources and confidentiality, Conceptualization of mental illness and anticipated discrimination, Acculturative influence and migration as a source of emotional distress, Spirituality as a source of support and source of stigma, and Management of mental illness and addressing stigma. Conclusion: The conceptualization of mental illness and the associated stigma may be rooted in cultural and religious belief systems among black immigrants. Cultural beliefs and biopsychosocial models can coexist positively without interrupting the pathway toward optimized engagement in mental health care. Our mental health systems need to take these factors into consideration to implement programs that effectively serve black immigrant women's mental health needs.

A Narrative Review of Mental Illness Stigma Reduction Interventions Among African Americans in The United States.

Among African Americans, the chronicity and severity of mental illness correlates with worse health outcomes and widens health disparities. Stigma related to mental illness compounds mental health disparities by creating barriers to help-seeking behavior. We examine the current tools designed to reduce mental illness stigma and promote improved mental health outcomes among African Americans. The authors reviewed the current evidence in the literature for such stigma reduction interventions. The review team developed a focused search across four databases: PubMed, Embase, Scopus, and APA PsycINFO. Initial searches identified 120 articles, from which six studies were included as reporting on mental illness stigma reduction interventions among African Americans. We describe these four quantitative and two qualitative studies. There have been various interventions used among African Americans to reduce mental illness stigma, and the level of efficacy and effectiveness is not well studied. Our review demonstrated a need for more robust studies to yield strong evidence on effectiveness among stigma reduction interventions in this target population. The evidence does support tailoring intervention studies to this population. Effectively engaging and partnering with key stakeholders, including schools, community organizations, and faith-based institutions enhances the acceptance and delivery of stigma reduction interventions.

Mental Health Stigma Among Black Immigrant Women in An Urban Setting.

BACKGROUND: Mental health stigma results in unmet mental health needs. Research describing predictors of stigma remains limited among Black immigrants. We aim to examine stigma associated with mental illness among a group of Black immigrant women. METHODS: We examined data from 22 women from two Black immigrant community centers. We collected surveys on demographics, cultural beliefs, migration status, religiosity and mental health stigma. Simple linear regression was used to model the unadjusted association between each component variable and overall stigma scores. All analyses were conducted using R and assumed a two-sided, 5% level of significance. RESULTS: A linear relationship was found between author-generated scale, the Stigma and Culture Survey (SCS) and the Depression Self Stigma Scale (DSSS). Among respondents, use of religious resources was associated with less stigma (p-value: 0.04). Whereas spirituality and morality was associated with greater stigma (p-value: 0.003). United States citizenship was associated with less stigma (p-value: 0.0001). DISCUSSION/CONCLUSION: Religion and spirituality are critical to understanding mental health stigma among Black immigrants. Studies aimed at assessing and reducing stigma need to critically engage with cultural and religious factors.

Mental Health in Women Living With HIV: The Unique and Unmet Needs.

Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic stress symptoms at higher rates than their male counterparts and more often than HIV-unaffected women. These mental health issues affect not only the well-being and quality of life of WLWH, but have implications for HIV management and transmission prevention. Despite these ramifications, WLWH are under-treated for mental health concerns and they are underrepresented in the mental health treatment literature. In this review, we illustrate the unique mental health issues faced by WLWH such as a high prevalence of physical and sexual abuse histories, caregiving stress, and elevated internalized stigma as well as myriad barriers to care. We examine the feasibility and outcomes of mental health interventions that have been tested in WLWH including cognitive behavioral therapy, mindfulness-based interventions, and supportive counseling. Future research is required to address individual and systemic barriers to mental health care for WLWH.

Mental health stigma among university health care students in Nigeria: a cross-sectional observational study.

INTRODUCTION: stigma is a key barrier to access and utilization of mental health services, particularly in low- and middle- income countries. The authors explore the specific content of mental health stigma among Nigerian university health care students at a national teaching hospital. These students are key stakeholders and represent a vital demographic to engage in stigma reduction initiatives. We evaluated the extent to which demographic characteristics, mood symptoms and utilization of resources are associated with stigma. METHODS: the authors examined data obtained from surveys completed by university health care students (N = 82) at Lagos University teaching hospital. Surveys assessed demographic background, mood symptoms and use of mental health services. Simple linear regression was used to model the unadjusted association between each component variable and overall stigma score. All analyses were conducted using R (version 3.5.3, 2019, The R Foundation) and assumed a two-sided, 5% level of significance. RESULTS: being a member of the minority ethnic group within our study population was associated with increased stigma. Individuals having greater need for mental health services (due to mood symptoms) were associated with increased stigma. Willingness to use medical services and community support from family and friends was associated with lower stigma. Religious themes were prominent among the majority of respondents. CONCLUSION: consideration of the content details of stigma among university health care students in Nigeria is essential to inform interventions and strategies to reduce stigma within this subgroup. Those students who have symptoms of depression or anxiety may have lower utilization of mental health services.

Demographic and Personal Characteristics of Male and Female Chairs in Academic Psychiatry.

OBJECTIVE: Despite the strong representation of female psychiatrists in residency and early-career positions, the number of female faculty sharply decreases in tenured or executive leadership positions. Why there exists a marked change in representation at the level of senior leadership within academic psychiatry is unclear. The authors investigated the causative factors contributing to this observation and gathered information about the personal characteristics of women in executive leadership roles. METHODS: The authors surveyed psychiatry chairs at academic institutions. They identified all female chairs and randomly selected a group of male chairs to serve as a control group. The survey assessed perceived barriers, strengths, and weaknesses and differences in demographics and leadership styles between female and male chairs. RESULTS: Ten percent of psychiatry chairs were female. Male chairs were more likely than female chairs to head large departments (p = 0.02, confidence interval (CI) -17.1-69.1) and had a higher H-index (p = 0.001, CI 6.6-37.2). Female chairs were more likely than male chairs to perceive barriers in their career development (p = 0.01, CI 0.7-2.2), citing little or no mentorship (p = 0.04), gender discrimination (p = 0.0001), and family obligations (p = 0.001) more often. CONCLUSION: Academic institutions must incorporate programs to decrease barriers and work to achieve equitable representation of women in upper-level leadership positions. Moreover, academic medicine must evolve to cultivate a family-friendly environment that successfully supports both genders.