Psychosis Literacy Among Latinos With First-Episode Psychosis and Their Caregivers.

OBJECTIVE: The study examined psychosis literacy among Latinos with first-episode psychosis (FEP) and their caregivers. The authors tested a model that knowledge of psychosis and attribution of illness to psychosis predicted professional help seeking in a cross-sectional design. METHODS: The sample (N=148) consisted of 79 Latino consumers who met criteria for a clinical diagnosis of a psychotic disorder and 69 family caregivers. Participants watched a four-minute narrative about a woman with psychosis and were asked to identify the symptoms of serious mental illness (knowledge of psychosis), describe the character's problem and whether she had a serious mental illness (illness attribution), and offer suggestions about what the parents should do (help seeking). Responses to the open-ended questions were reliably coded by two trained raters. RESULTS: Consumers reported low psychosis literacy across all indices (e.g., only 8% included delusions in their knowledge of serious mental illness). Compared with consumers, caregivers reported significantly greater psychosis literacy across most indices, although relatively few reported knowledge of delusions (28%) and disorganized speech (36%). Logistic regression analyses found that caregivers were more than twice as likely as consumers to suggest that the parents seek professional help. Among both consumers and caregivers, greater knowledge of psychosis and attribution of symptoms to serious mental illness were associated with increased likelihood of recommending professional help seeking. CONCLUSIONS: Community campaigns and psychoeducation interventions within clinical settings are needed to improve psychosis literacy among Latinos with FEP. Increasing knowledge of psychosis and facilitating attributions of psychotic symptoms to serious mental illness have the potential to promote professional help seeking.

Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as.

This study examined the utility of a lifetime cumulative adversities and trauma model in predicting the severity of mental health symptoms of depression, anxiety, and posttraumatic stress disorder. We also tested whether ethnicity and gender moderate the effects of this stress exposure construct on mental health using multigroup structural equation modeling. A sample of 500 low-socioeconomic status African American and Latino men and women with histories of adversities and trauma were recruited and assessed with a standard battery of self-report measures of stress and mental health. Multiple-group structural equation models indicated good overall model fit. As hypothesized, experiences of discrimination, childhood family adversities, childhood sexual abuse, other childhood trauma, and chronic stresses all loaded on the latent cumulative burden of adversities and trauma construct (CBAT). The CBAT stress exposure index in turn predicted the mental health status latent variable. Although there were several significant univariate ethnic and gender differences, and ethnic and gender differences were observed on several paths, there were no significant ethnic differences in the final model fit of the data. These findings highlight the deleterious consequences of cumulative stress and trauma for mental health and underscore a need to assess these constructs in selecting appropriate clinical interventions for reducing mental health disparities and improving human health.

Who Improved in a Trauma Intervention for HIV-Positive Women with Child Sexual Abuse Histories?

The Healing Our Women Program, an 11-week integrated trauma/HIV intervention designed for HIV-positive women with child sexual abuse histories, has been found to reduce psychological distress in treatment groups compared to wait-list controls (Chin et al., 2004; Wyatt et al., 2011). This study examines the characteristics of participants who improved vs. those who did not improve among participants who received the active intervention (N=78) at post, three-, and six-month follow-up. Logistic regression analyses conducted post-intervention and at three- and six-month followups examined demographic characteristics, treatment attendance, AIDS diagnosis, and total trauma burden as possible predictors of improvement. Results indicated that at post-test, total trauma burden was significantly associated with improvement. At three-month follow-up, none of the variables discriminated the groups. At six-month follow-up, total trauma burden was again significantly related to improvement. The results suggest that the intervention is most appropriate for women with high trauma burdens. Future HIV interventions should go beyond the "one size fits all" approach" and consider the "fit" between intervention and participants.

Familism and psychological health: the intervening role of closeness and social support.

Familism, a cultural value that emphasizes warm, close, supportive family relationships and that family be prioritized over self, has been associated with psychological health. The goal of this work was to fill a gap in the literature on how familism contributes to psychological health. Drawing from conceptual links between familism and close relationship processes, we hypothesized that familism contributes to better psychological health by facilitating closeness and social support. A university sample of U.S. women and men of Latino (n = 173), European (n = 257), and Asian (n = 642) cultural backgrounds completed measures of familism, closeness to family members, general perceived social support, and psychological health as indexed by perceived stress, general mental health, and depressive symptoms. Structural equation multiple-group modeling analyses found direct effects of familism on closeness to family members and perceived social support and an indirect effect of familism on better psychological health via greater closeness to family members and greater perceived social support. These effects did not differ by cultural background. Consistent with previous research, however, Latinos reported the highest levels of familism of the three cultural groups, and women reported higher familism and support as well as poorer psychological health than men. Discussion is focused on the implications of these findings for understanding the association of familism with psychological health and the relevance of the familism construct for diverse U.S. groups.

Assessing Acculturation Over Time: A Four-year Prospective Study of Asian American Young Adults.

Acculturation is commonly defined as a dynamic and multidimensional process in which individuals and groups change over time when coming into contact with another culture. Despite the emphasis on acculturation as a process of change over time, few researchers have directly assessed this hypothesis. The current study first identifies and then examines "stable" and "dynamic" dimensions of acculturation within a 4-year prospective study of 433 first- and second-generation Chinese- and Korean-American college students. Separate growth model analyses revealed significant linear change for first-generation students toward greater U.S. acculturation. In comparison, tests of linear and quadratic change for second-generation students were not significant. When stratifying by gender, acculturation increased for women but there was no significant change in acculturation for men. While all students reported increases in alcohol consumption over the study period, changes in acculturation predicted changes in alcohol consumption only for women. Chinese men showed greater increases in alcohol consumption than Korean men but there was no effect for ethnicity among women. There was significant individual variability in the models, which underscores the importance of examining change prospectively through within and between person analyses. The findings highlight the importance of examining acculturation changes over time for different migrant groups with implications for further development of acculturation measures, research methodologies, and health interventions. More prospective research designs of acculturation are needed to examine changes in health behavior and overall adaptation across migrant groups at varying stages of development.

Modeling the Relationship between Trauma and Psychological Distress among HIV-Positive and HIV-Negative Women.

This study investigated the association between cumulative exposure to multiple traumatic events and psychological distress, as mediated by problematic substance use and impaired psychosocial resources. A sample of HIV-positive and HIV-negative women were assessed for a history of childhood and adult sexual abuse and non-sexual trauma as predictors of psychological distress (i.e., depression, non-specific anxiety, and posttraumatic stress), as mediated by problematic alcohol and drug use and psychosocial resources (i.e., social support, self-esteem and optimism). Structural equation modeling confirmed that cumulative trauma exposure is positively associated with greater psychological distress, and that this association is partially mediated through impaired psychosocial resources. However, although cumulative trauma was associated with greater problematic substance use, substance use did not mediate the relationship between trauma and psychological distress.

Violence prevention among HIV-positive women with histories of violence: healing women in their communities.

Experiences of past and current gender-based violence are common among HIV-positive women in the United States, who are predominantly from ethnic minority groups. However, culturally congruent, feasible interventions for HIV-positive women who have experienced past and/or current violence are not widely available. The Office on Women's Health Gender Forum has made several recommendations for responding to the National HIV/AIDS Strategy Implementation Plan, including recommendations to incorporate gender-based violence prevention into a comprehensive, gender-responsive national strategy. This paper draws on an example of a community-based project for HIV-positive women, the Healing Our Women Project, to illustrate how violence prevention can be achieved within peer-led and community-based programming. Strong community partnerships, responsiveness to community needs and local cultural norms, a trained workforce, and culturally competent care are programmatic cornerstones of gender-responsive services. HIV-positive women with histories of gender-based violence and risk factors for current and future violence deserve the highest quality gender-responsive services to ensure that they can address their health needs within contexts of safety and respect.

Rehearsing for real life: the impact of the InterACT Sexual Assault Prevention Program on self-reported likelihood of engaging in bystander interventions.

The interACT Sexual Assault Prevention Program is an interactive, skill-building performance based on the pedagogy of Augusto Boal's Theatre of the Oppressed. A longitudinal evaluation of this program compared pretest, posttest, and 3-month follow-up data from 509 university student participants. Results suggested that the interACT performance was successful in increasing participants' beliefs about the effectiveness of bystander interventions and the self-rated likelihood that participants would engage in bystander interventions in the future. Differences in both overall ratings and rates of change were noted. Implications of these results for research and practice are discussed.

Cultural variability in the manifestation of expressed emotion.

We examined the distribution of expressed emotion (EE) and its indices in a sample of 224 family caregivers of individuals with schizophrenia pooled from 5 studies, 3 reflecting a contemporary sample of Mexican Americans (MA 2000, N = 126), 1 of an earlier study of Mexican Americans (MA 1980, N = 44), and the other of an earlier study of Anglo Americans (AA, N = 54). Chi-square and path analyses revealed no significant differences between the 2 MA samples in rates of high EE, critical comments, hostility, and emotional over-involvement (EOI). Only caregiver warmth differed for the 2 MA samples; MA 1980 had higher warmth than MA 2000. Significant differences were consistently found between the combined MA samples and the AA sample; AAs had higher rates of high EE, more critical comments, less warmth, less EOI, and a high EE profile comprised more of criticism/hostility. We also examined the relationship of proxy measures of acculturation among the MA 2000 sample. The findings support and extend Jenkins' earlier observations regarding the cultural variability of EE for Mexican Americans. Implications are discussed regarding the cross-cultural measurement of EE and the focus of family interventions.

Trauma and psychosocial predictors of substance abuse in women impacted by HIV/AIDS.

The purpose of this study was to estimate the relative contributions of trauma, chronic stress burden, depression, anxiety, social support, and social undermining in predicting alcohol and drug abuse, and whether ethnicity moderated these relationships. A multi-ethnic sample of 288 HIV-positive and HIV-negative women was recruited. Multiple group path analysis indicated that greater drug dependence was associated with being HIV+, more depression, and higher chronic burden. Trauma was related only to anxiety. Also, greater alcohol dependence was associated with more depression and more social undermining, and these effects were moderated by ethnicity. African American and Latina women evidenced different relationships between depression, social support and social undermining. Depression, social support and social undermining served as intervening variables in influencing the relationships between the other psychosocial variables and drug and alcohol dependence. The implications of these findings for alcohol and drug abuse research and services are discussed.

Patterns and predictors of change in a smoking intervention study: latent growth analysis of a multivariate outcome model.

OBJECTIVE: This study reports the outcome of a smoking intervention study in a general population setting in Germany. DESIGN: A randomized, controlled trial, with a sample of 719 current daily cigarette smokers. MAIN OUTCOME MEASURE: The authors tested a criterion measurement model that is related to the transtheoretical model and that proposes multivariate outcome measures with positive and negative attitudes about smoking and habit strength. The authors analyzed patterns and predictors of change in self-efficacy and in the pros and cons of nonsmoking using latent growth models. RESULTS AND CONCLUSION: Participation in the intervention groups did not predict average mean levels or growth trajectories in the multivariate outcome model. Accounting for attrition in multisample missing-data procedures and accounting for demographic and smoking behavior variables did not alter this result. Thus, the intervention was ineffective. However, endorsement of self-efficacy and the pros of nonsmoking increased linearly over time in all study groups, which may be attributable to historical or societal changes or to repeated, comprehensive smoking assessments. In addition to reporting the outcome of a smoking intervention trial, the current study also illustrates a modeling approach to the measurement of change.

Impact of marriage on HIV/AIDS risk behaviors among impoverished, at-risk couples: a multilevel latent variable approach.

Studies among normative samples generally demonstrate a positive impact of marriage on health behaviors and other related attitudes. In this study, we examine the impact of marriage on HIV/AIDS risk behaviors and attitudes among impoverished, highly stressed, homeless couples, many with severe substance abuse problems. A multilevel analysis of 368 high-risk sexually intimate married and unmarried heterosexual couples assessed individual and couple-level effects on social support, substance use problems, HIV/AIDS knowledge, perceived HIV/AIDS risk, needle-sharing, condom use, multiple sex partners, and HIV/AIDS testing. More variance was explained in the protective and risk variables by couple-level latent variable predictors than by individual latent variable predictors, although some gender effects were found (e.g., more alcohol problems among men). The couple-level variable of marriage predicted lower perceived risk, less deviant social support, and fewer sex partners but predicted more needle-sharing.

Structural equation modeling: reviewing the basics and moving forward.

This tutorial begins with an overview of structural equation modeling (SEM) that includes the purpose and goals of the statistical analysis as well as terminology unique to this technique. I will focus on confirmatory factor analysis (CFA), a special type of SEM. After a general introduction, CFA is differentiated from exploratory factor analysis (EFA), and the advantages of CFA techniques are discussed. Following a brief overview, the process of modeling will be discussed and illustrated with an example using data from a HIV risk behavior evaluation of homeless adults (Stein & Nyamathi, 2000). Techniques for analysis of nonnormally distributed data as well as strategies for model modification are shown. The empirical example examines the structure of drug and alcohol use problem scales. Although these scales are not specific personality constructs, the concepts illustrated in this article directly correspond to those found when analyzing personality scales and inventories. Computer program syntax and output for the empirical example from a popular SEM program (EQS 6.1; Bentler, 2001) are included.

Spontaneous cognition and HIV risk behavior.

Theories of cognitive processes and risk behavior have not usually addressed spontaneous forms of cognition that may co-occur with, or possibly influence, behavior. This study evaluated whether measures of spontaneous cognition independently predict HIV risk behavior tendencies. Whereas a trait-centered theory suggests that spontaneous cognitions are a by-product of personality, a cognitive view hypothesizes that spontaneous cognitions should predict behavior independently of personality. The results revealed that spontaneous cognition was an independent predictor of behavior tendencies in cross-sectional analyses. Its predictive effect was stronger than drug use, a frequently emphasized correlate of HIV risk behavior in the literature, and comparable with sensation seeking in magnitude. The results suggested that a relatively spontaneous form of cognition may affect HIV risk behavior.

Classroom social experiences as predictors of academic performance.

A model linking children's peer acceptance in the classroom to academic performance via academic self-concept and internalizing symptoms was tested in a longitudinal study. A sample of 248 children was followed from 4th to 6th grade, with data collected from different informants in each year of the study to reduce respondent bias. A path analysis supported the model; a lack of peer acceptance in the classroom in 4th grade predicted lower academic self-concept and more internalizing symptoms the following year, which in turn, predicted lower academic performance in 6th grade. An alternative path with internalizing symptoms predicting declines in peer acceptance was tested and received some support as well. Implications of the findings for schools are discussed.

Factor structure of the Penn State Worry Questionnaire: examination of a method factor.

The Penn State Worry Questionnaire (PSWQ) was originally designed as a unifactorial measure of pathological trait worry. However, recent studies supported a two-factor solution with positively worded items loading on the first factor and reverse-scored items loading on a second factor. The current study compared this two-factor model to a negative wording method factor solution among college students. A method factor model with all PSWQ items loading on a single worry factor and reverse-scored items loading on a negative wording method factor provided as good a fit as the two-factor model. This method factor alone did not predict a generalized anxiety disorder diagnosis. Finally, the psychometric properties of an abbreviated scale containing only positively worded items were examined. The PSWQ appears to measure a single unitary construct, but response patterns differ between positively worded and reverse-scored items. Theoretical implications for pathological worry and assessment-related issues are discussed.

The impact of maternal depression on adolescent adjustment: the role of expressed emotion.

The present study evaluated the role of expressed emotion (EE) as a predictor of child symptomatology and functional impairment in a sample of nearly 800 adolescent children of mothers with varying histories of depression or who were nondepressed. Structural equation modeling was used to test the hypothesized associations in half of the sample, and all models were cross-validated on the other half of the study sample. Results indicated that EE criticism and degree of maternal depression both had independent predictive associations with youths' externalizing symptoms and functional impairment. In addition, high EE criticism served as an intervening variable between maternal depression and child functioning (externalizing symptoms and functional impairment). Results are discussed in terms of the mutual effects of depressed mothers and dysfunctional youths on each other.