Intersectional discrimination and its impact on Asian American women's mental health: A mixed-methods scoping review.

Introduction: Gendered racism against Asian American women has become an increasing public health threat in recent years. Although intersectional discrimination (i.e., co-occurring race- and gender-based discrimination) against Asian American women is not new, research on this topic is lacking. The present scoping review sought to explore how Asian American women report experiences of intersectional discrimination through a systematic examination of the current literature. We included studies that explicitly or implicitly discuss intersectional discrimination. We also aimed to identify indicators of psychological wellbeing and coping associated with these experiences. Methods: Following PRISMA Guidelines for Systematic Scoping Reviews, database searches were conducted for peer-reviewed articles. A total of 1,476 studies were title- and abstract-screened by two independent reviewers. Then, 148 articles were full-text screened for eligibility. Results: A final sample of 23 studies was identified (15 qualitative and 8 quantitative). Only nine of the included studies explicitly used an intersectional framework. Results from qualitative studies revealed that Asian American women experience intersectional discrimination through fetishization, the ascription of passivity, invalidation through lack of representation and pervasive white beauty ideals, and workplace tokenization and scrutiny. Study findings suggested that Asian American women experience these forms of intersectional discrimination across multiple levels of influence (i.e., internalized, interpersonal, institutional, structural). Findings from both qualitative and quantitative studies also indicated how discrimination, whether explicitly or implicitly intersectional, contributes to adverse mental health outcomes such as body shame, disordered eating, depression, and suicidality. Studies also touched on common coping mechanisms employed by Asian American women when facing or anticipating discrimination, such as avoidance, shifting, proactive coping, and leaning on networks of support. There was a lack of studies using quantitative assessments of intersectional discrimination. Also, most studies did not include disaggregated data by ethnicity, age, sexual identity, religion, socioeconomic status, immigration status, or skin color, all of which are likely to shape their experiences. Discussion: Our scoping review highlights how the marginalization of Asian American women is an urgent threat to their mental wellbeing. These findings are discussed to inform future research, interventions, and policy changes that prevent racialized and gendered violence against Asian American women.

The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis.

BACKGROUND: Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. OBJECTIVE: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. METHODS: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. RESULTS: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. CONCLUSIONS: Overall, this study's findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings.

Attachment buffers against the association between childhood sexual abuse, depression, and substance use problems among transgender women: a moderated-mediation model.

Previous research shows a greater prevalence of substance use among childhood sexual abuse (CSA) survivors. Transgender women experience CSA at a significantly higher rate compared to the general population. Previous studies show a high prevalence of substance use and find that CSA predicts increased drug use among transgender women. It is proposed that the process through which CSA influences substance use behaviour, is mediated by depression. Further, research has shown that secure attachment may buffer against these associations.Participants were 213 transgender women participating in a behavioural intervention to reduce sexual risk and substance use. A moderated mediation model, including a three-way interaction, examined the indirect effect of CSA, through depression, on both substance use problems and alcohol use disorder, as well as the protective effect of secure attachment on these pathways. Findings from the moderated mediation analysis provide evidence to support our hypothesis that depression mediates the pathways from CSA to both substance use problems and alcohol use disorder for transgender women. We also observed a significant three-way interaction (e.g. attachment anxiety x attachment avoidance x CSA) indicating that secure attachment buffered against the association between CSA and symptoms of depression, as well as CSA and substance use problems.

Intersecting Structural Oppression and Black Sexual Minority Men's Health.

INTRODUCTION: Although evidence indicates that Black gay, bisexual, and other sexual minority men experience vast psychological and behavioral health inequities, most research has focused on individual rather than structural drivers of these inequities. This study examines the associations between structural racism and anti-lesbian, gay, bisexual, transgender, and queer policies and the psychological and behavioral health of Black and White sexual minority men. METHODS: Participants were an Internet-based U.S. national sample of 1,379 Black and 5,537 White sexual minority men during 2017-2018. Analysis occurred in 2019-2020. Structural equation modeling tested the associations from indicators of structural racism, anti‒lesbian, gay, bisexual, transgender, and queer policies, and their interaction to anxiety symptoms, depressive symptoms, perceived burdensomeness, heavy drinking, and HIV testing frequency. Separate models for Black and White sexual minority men adjusted for contextual and individual covariates. RESULTS: For Black participants, structural racism was positively associated with anxiety symptoms (ß=0.20, SE=0.10, p=0.04), perceived burdensomeness (ß=0.42, SE=0.09, p<0.001), and heavy drinking (ß=0.23, SE=0.10, p=0.01). Anti‒lesbian, gay, bisexual, transgender, and queer policies were positively associated with anxiety symptoms (ß=0.08, SE=0.04, p=0.03), perceived burdensomeness (ß=0.20, SE=0.04, p<0.001), and heavy drinking (ß=0.10, SE=0.04, p=0.01) and were negatively associated with HIV testing frequency (ß= -0.14, SE=0.07, p=0.04). Results showed significant interaction effects, such that the positive associations between structural racism and both perceived burdensomeness (ß=0.38, SE=0.08, p≤0.001) and heavy drinking (ß=0.22, SE=0.07, p=0.003) were stronger for individuals living in states with high levels of anti‒lesbian, gay, bisexual, transgender, and queer policies. Neither of the oppression variables nor their interaction was significantly associated with outcomes for White sexual minority men. CONCLUSIONS: Results highlight the intersectional nature of structural oppression and suggest that racist and anti-lesbian, gay, bisexual, transgender, and queer policies must be repealed to rectify health inequities facing Black sexual minority men.

Intersectional discrimination, positive feelings, and health indicators among Black sexual minority men.

OBJECTIVE: This study examined psychological and sexual health indicators associated with positive feelings and discrimination at the intersection of race and gender among Black gay, bisexual, and other sexual minority men (SMM). METHOD: Participants were a national sample of 1,064 Black SMM (Mdn age = 28) who responded to self-report measures of positive feelings and discrimination associated with being a Black man, psychological distress, self-efficacy, emotional awareness, and sexual HIV risk and protective behavior. Using structural equation modeling, we examined associations between the positive feelings and discrimination scales and the psychological and sexual health indicators. We also tested age as a moderator of these associations. RESULTS: Our results indicated that positive feelings about being a Black man were significantly positively associated with self-efficacy (b = 0.33), emotional awareness (b = 0.16), and sexual protective behavior (b = 0.93) and negatively associated with psychological distress (b = -0.26) and sexual risk behavior (b = -0.93). Except for emotional awareness and sexual protective behavior, discrimination as a Black man was also associated with these variables, though to a lesser magnitude for positive health indicators. Moderation results showed that, except for the association between positive feelings and emotional awareness, younger men generally had stronger associations between health indicators and the positive feelings and discrimination scales. CONCLUSIONS: These results suggest that positive feelings, in addition to discrimination, at the intersection of race and gender play an important role in the psychological and sexual health of Black SMM, especially earlier in their lives. (PsycINFO Database Record (c) 2020 APA, all rights reserved).