Can I Leave the Past Behind? Associations between Childhood Abuse and Adult Psychopathology.

BACKGROUND: Research consistently shows that abuse during childhood is related to adult psychopathology. Information regarding childhood abuse is frequently collected from either previous documentation or from participants' self-reports. OBJECTIVE: In the current study, we combined information on reports of childhood abuse from several informants (patients, treating clinicians, and independent interviewer), as well as diagnostic assessments of adult patients based on independent interviewer assessments based on structured diagnostic interviews (SCID) and clinician judgments, to better examine the association between exposure to abuse during childhood and adult psychopathology. PARTICIPANTS AND SETTING: A convenience sample of patients in community mental health and hospital-based clinics (N = 170) and their clinicians (N = 80) participated in the study. METHODS: Patients and clinicians completed the Clinical Data Form. Patients also completed the Childhood Trauma Questionnaire. Independent interviewer-assessed patients and completed the Familial Experiences Interview. Clinicians completed a diagnostic assessment of their patients based on clinical judgment. Independent interviewers completed the Structured Clinical Interview (SCID). RESULTS: Reports of exposure to physical, emotional, and sexual abuse during childhood from all informants correlated with the treating clinician's diagnosis of borderline personality disorder (BPD; r range 0.23-0.37, p < 0.05), but not with SCID diagnosis of BPD. Clinician and SCID diagnosis of post-traumatic stress disorder (PTSD) correlated with patient and interviewer reports of childhood sexual abuse (r range 0.23-0.30, p < 0.05), but there were no correlations with treating clinician's reports of sexual abuse. CONCLUSIONS: The association between BPD and childhood abuse is consistent across different ratings and measurements. The study raises questions of the ability of a structured interview to accurately capture BPD and highlights the connection between sexual abuse and PTSD, and the importance of treating clinicians' examination of childhood sexual abuse among their patients.

Gender Differences in the Relationship between Lifetime Exposure to Trauma and the Development of Pathological Personality Traits.

Gender differences in the prevalence, types and outcomes of traumas have consistently been reported in the literature. Other research has documented that exposure to trauma is associated with the development and maintenance of pathological personality traits. In the current study, we examined the moderating role of gender in the association between lifetime exposure to trauma and pathological personality traits. The sample included 148 clients who sought treatment at a community mental health clinic. All participants completed online questionnaires including demographic information, the Trauma History Questionnaire (THQ), and the Personality Inventory for DSM-5-Brief Form (PID-5-BF) at the entry to treatment. Our findings documented a significant association between exposure to trauma and pathological personality traits in men, but not in women. Furthermore, this pattern of results was specifically evident within two personality domains: antagonism and detachment. These findings contribute to the theoretical understanding of the interplay between trauma, gender, and the development of pathological personality traits. They expand upon the growing knowledge about the mental health crisis among boys and men by shedding light on the unique vulnerabilities that men face in response to traumatic experiences and how these experiences can have a lasting impact on their adaptive functioning. Consequently, at the clinical level, the current study emphasizes the importance of paying particular attention to men's trauma histories and explicitly exploring these during the intake session.

Determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel.

BACKGROUND: Mental health challenges are widespread among adolescents undergoing significant physical, emotional, social, and academic changes. However, rates of formal help-seeking remain low, particularly among those from ethnic minorities. AIMS: This study investigated the determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel, focusing on mental health literacy (MHL) and trust in formal sources of information. METHODS: A total of 178 adolescents (Mage = 16.24 ± 1.24 years, 61.8% female) completed measures assessing intention for formal help-seeking, psychological distress, MHL, trust in formal sources of information, sociodemographic, and clinical characteristics. RESULTS: Findings revealed low levels of intention to seek formal help and psychological distress, alongside average or above-average levels on all MHL dimensions and trust in formal sources for information. Our analysis identified socioeconomic status (ß = .17, p < .05), psychological distress (ß = .18, p < .05), trust in formal sources of information (ß = .28, p < .001), and two MHL dimensions: knowledge of where to seek information (ß = .25, p < .01) and attitudes that promote recognition or appropriate help-seeking behavior (ß = .16, p < .05) - as the main determinants of intention for formal help-seeking. CONCLUSIONS: This study underscores the critical role of trust in formal sources of information and MHL in seeking formal help among adolescents from ethnic minorities. Interventions aiming to improve access to mental health-related information, address and enhance attitudes, and foster trust in formal professionals and institutions may contribute to an increased tendency for formal mental health help-seeking among this population and others.

Mental health literacy as a barrier and facilitator for service use: Qualitative inquiry among Palestinian Bedouins in Israel.

BACKGROUND: Mental health literacy (MHL) has been related to health behaviors and outcomes. However, studies examining MHL as a barrier and facilitator to service use are limited, especially among minority groups. AIMS: This study examined MHL as a barrier and facilitator to mental health service use among the Palestinian Bedouin minority in Israel. METHODS: Twenty-five Bedouins (15 women) from southern Israel participated in semi-structured, in-depth interviews. The participants were recruited by publishing an ad on social media about the study, then through a snowball technique. The data were analyzed thematically using ATLAS.ti.9, and the intercoder reliability was 92%. RESULTS: We identified four major themes in the interviews: (1) MHL as a barrier to service use, due to lack of knowledge about professionals in the field, mental health services, or reasons and risk factors for mental health problems; (2) traditional attitudes that acted as barriers to service use, including a preference for informal treatment, a lack of faith in mental health treatment, aversion to discussing private feelings, and the perception that mental health is a luxury; (3) MHL as a facilitator to service use by enabling accurate identification of mental distress and suggesting practical avenues for seeking help; and (4) ways to improve MHL that should be culturally sensitive and under the government agencies' responsibility. CONCLUSIONS: Interventions aimed at increasing the use of mental health services among Bedouins and reducing racial/ethnic disparities should increase knowledge in culturally adapted ways, especially regarding professionals and services, and change negative attitudes such as mental health treatment as ineffective or bonus.

A scoping review of studies examining mental health literacy among Arabs worldwide.

BACKGROUND: There is growing interest in Mental health literacy (MHL) worldwide, given its important role in overcoming barriers to service use and reducing mental health disparities. However, little is known about MHL among Arabs. AIM: We conducted a scoping review to examine MHL levels and correlates among Arabs in both Arab and non-Arab countries, based on Jorm's MHL framework. METHODS: We conducted a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using six electronic databases: PubMed, PsycINFO, CINAHL, Soc Index, Web of Science, and Scopus. Data were summarized and synthesized. RESULTS: Nine studies examining MHL among Arabs met our inclusion criteria. Seven of them used a quantitative cross-sectional design. Four studies were conducted in Arab, and five were in non-Arab countries. Five studies were conducted among university students. The studies included indicate moderate to high levels of MHL. Higher MHL was associated with female gender, personal experience of mental health illness, and with help-seeking behaviours. CONCLUSIONS: Our review shows a significant lack of empirical studies on Arabs' MHL. These findings should be considered as a call for action for public health researchers, mental health workers, and policymakers to prioritize research in this field.

The association between patient-provider racial/ethnic concordance, working alliance, and length of treatment in behavioral health settings.

Racial/ethnic concordance between patients and providers concerning the quality of care has received interest over past decades yielding mixed results. Patients seem to prefer clinicians of their own race/ethnicity, but empirical studies have found small or inconsistent effects on the quality of care. Research on the impact of racial/ethnic concordance and treatment duration appears to suggest that racial/ethnic concordance is associated with retention and completion; however, exactly why racial/ethnic concordance improves treatment length remains unexplored. On the other side, the quality of working alliance is a well-established common factor underlying effective treatments. In this study, we examined the interaction between patient-provider racial/ethnic concordance, length of treatment in the therapeutic dyad, and working alliance as evaluated by both patients themselves and objective raters. The study included 312 patients and 74 providers from 13 community and hospital-based outpatient mental health clinics in Massachusetts. Results indicated that among racial/ethnic concordant therapeutic dyads, longer length of treatment was associated with better quality of working alliance as evaluated by objective raters. Implications for clinical practice and future research on racial/ethnic concordance studies linked to the length of treatment are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychiatric Hospital Ethics Committee Discussions Over a Span of Nearly Three Decades.

Various types of health settings use clinical ethics committees (CEC) to deal with the ethical issues that confront both healthcare providers and their patients. Although these committees are now more common than ever, changes in the content of ethical dilemmas through the years is still a relatively unexplored area of research. The current study examines the major topics brought to the CEC of a psychiatric hospital in Israel and explores whether there were changes in their frequency across nearly three decades. The present paper reports on a thematic analysis of the written verbatim transcripts from 466 ethical topics brought to the CEC between the years 1991 and 2016. The following major topics related to ethical dilemmas were identified: confidentiality (30%), patient autonomy (23%), health records (14%), dual relationship (12%), allocation of resources (11%), inappropriate professional and personal conduct (9%), and multicultural sensitivity (1%). Topics related to confidentiality increased significantly over the years, as did inappropriate professional and personal conduct. In addition, the analysis showed that the content of the ethical cases and the resolutions suggested by the CEC also varied over the years. In conclusion, although most ethical topics have remained relatively stable over time, the discourse around them has evolved, requiring a dynamic assessment and reflection by the mental health practitioners serving as members of a CEC.

Barriers to Mental Health Service Use among Palestinian-Arab Women in Israel: Psychological Distress as Moderator.

BACKGROUND: Many studies indicate that ethnic minority women, including women from the disadvantaged Palestinian-Arab minority in Israel, experience higher rates of psychological distress but are less likely to use mental health services. This study examined psychological distress and its role as a moderator in the relationship between mental health service use and stigma-related, attitudinal, and instrumental barriers. METHOD: Cross-sectional study of 146 Palestinian-Arab women who completed measures of psychological distress, mental health service use, the Barriers to Care Evaluation scale, and sociodemographic characteristics. RESULTS: Participants who did not utilize mental health services reported higher levels of all barrier types compared to participants who reported previous use, but lower levels of psychological distress. Psychological distress was a significant moderator only in the relationship between attitudinal barriers and mental health service use. CONCLUSIONS: This study highlights the role of psychological distress in the relationship between barriers to and utilization of mental health services, helping professionals and policymakers increase mental health service use among Palestinian-Arab women in Israel and other vulnerable women elsewhere.

Oncology Healthcare Professionals' Mental Health during the COVID-19 Pandemic.

The paper begins by reviewing the literature on oncology healthcare professionals' (HCP) mental health. We summarize and present the current data on HCP mental health in order to understand the baseline state of oncology HCPs' mental health status prior to the COVID-19 pandemic. At each juncture, we will discuss the implications of these mental health variables on the personal lives of HCPs, the healthcare system, and patient care. We follow by reviewing the literature on these parameters during the COVID-19 pandemic in order to better understand the impact of COVID-19 on the overall mental health of HCPs working in oncology. By reviewing and summarizing the data before and after the start of the pandemic, we will get a fuller picture of the pre-existing stressors facing oncology HCPs and the added burden caused by pandemic-related stresses. The second part of this review paper will discuss the implications for the oncology workforce and offer recommendations based on the research literature in order to improve the lives of HCPs, and in the process, improve patient care.

Social Support and Psychological Distress among the Bedouin Arab Elderly in Israel: The Moderating Role of Gender.

In Israel, as in other developed countries, mental health problems are common among older adults who are members of disadvantaged ethnic minorities that are experiencing cultural and social changes. The main goals of the current study were: (a) to examine gender differences in the levels of psychological distress and social support among Bedouin elders, and (b) to examine the moderating role of gender in the associations between social support indices and psychological distress. We used a cross-sectional design, and independent t-tests and hierarchical linear regression analysis were performed. The study was conducted in homes and in social clubs and community centers for elderly people and involved face-to-face interviews and self-administered questionnaires. A convenience sample of 170 Bedouin Arab elderly people living in Israel participated in the study. Participants completed self-report questionnaires that assessed psychological distress, perceived social support, instrumental social support, and socio-demographic characteristics. Male elders reported lower levels of psychological distress and higher levels of instrumental support. Female elders, who reported low levels of both perceived and instrumental support, also reported higher levels of psychological distress. Among the women, there were significant associations between psychological distress and perceived social support, and instrumental support only when the levels of support were low. This study underscores the moderating role of gender in the associations between different types of social support and psychological distress among elderly people belonging to ethnic and cultural underprivileged minority groups.

Strength of social ties and perceived tangible support: distinct characteristics and gender differences of older adults' social circles.

Social connections have been found to promote wellbeing among older adults. Studies note gender differences in older adults' social network characteristics and aspects of social support. The present study examined gender differences in the association of social network characteristics (number of strong social ties) and perceived tangible support among a sample of elders (n = 278). Older men reported higher levels of perceived tangible support, while older women had more strong social ties. The number of strong social ties was associated with older women's, but not men's, increased sense of tangible support. Implications for cultivating elders' wellbeing respective of gender particularities are discussed.

Similarities in client-clinician perceptions of subjective social status and its association to similarities in the quality of working alliance and client anxiety symptoms.

Subjective social status (SSS) has largely been ignored within psychotherapy literature. We investigated the association between similarities in client-clinician perceptions of SSS, similarities in their report of the quality of working alliance, and resultant anxiety symptoms.Participants represented a primarily low-income, culturally diverse sample of 312 clients receiving care from 68 clinicians at 13 outpatient mental health clinics in the Northeastern United States between September 2013 and August 2016. As part of a larger randomized controlled trial, clients and clinicians completed the MacArthur Scale of subjective social status and the Working Alliance Inventory (WAI), and clients completed the Generalized Anxiety Disorder 7-item Scale (GAD-7).At the within-clinician level, client-clinician dyads with less similar perceptions of the client's SSS were characterized by less similar perceptions of their alliance, which in turn resulted in worsening anxiety symptoms.Clinicians' correct perception of their clients' social status might be important for sharing a similar view of the client-clinician level of alliance, which can, in turn, contribute to lowering the client's anxiety symptoms.

Association Between Attachment Patterns and Personality Disorders: A Multimethod Multi-Informant Study Using a Clinical Sample.

ABSTRACT: We investigated the association between personality disorders (PDs) and attachment patterns, and examined the construct validity of attachment patterns against adaptive functioning. We used a multimeasure multi-informant approach, which allowed us to disentangle the effects of the methods and to examine the utility of the various methods for measuring these constructs. The participants included 80 clinicians and 170 clinical outpatients, recruited via convenience sampling. Results showed that secure attachment was positively associated with adaptive functioning, whereas insecure patterns were negatively associated with adaptive functioning. Both categorical and dimensional PD diagnoses were associated with insecure attachment patterns. However, after controlling for comorbidity among the PD diagnoses, only some findings remained significant, most notably the association between borderline PD and the clinicians' assessment of preoccupied and incoherent/disorganized attachment, and the patients' self-reported attachment anxiety. Our findings underscore the importance of controlling for comorbidity in examining the associations between attachment patterns and PDs.

The moderation of attachment in the association between depressive symptoms and self-harm among a clinical sample.

BACKGROUND: Self-harm is a severe health problem worldwide and in particular in clinical settings. The association of depression and self-harm has been extensively studied alongside various variables that have been examined as moderating this association. However, no previous study has examined the moderating role of attachment in this association. AIM: We explored the role of attachment orientation in moderating the association between depressive symptoms and self-harm among a sample of patients in a community mental health clinic. METHOD: This study was a de-identified archival study of patients' medical charts, and used a convenience sample of 199 patients, which completed self-report measures following the initial intake appointment as part of clinic procedures. RESULTS: Findings showed that both attachment anxiety and avoidance moderated the association between depressive symptoms and self-harm, such that depressive symptoms were positively associated with self-harm only when attachment anxiety scores were high, and attachment avoidance scores were high or average. CONCLUSIONS: Attachment anxiety and avoidance should be assessed in the initial intake of patients as it has a contribution to understanding self-harm vulnerability among new patients. Future studies should explore this moderation longitudinally so causality could be inferred.

"We are a transit station here": The role of Israeli oncology social workers in responding to mental health distress and suicidality in patients with cancer.

Social workers have a prominent role in responding to cancer patients' mental health needs. Given the risk of mental health distress in cancer patients, and given that social workers are responsible for responding to these needs, the purpose of this study was to explore how social workers describe their role in responding to mental health distress and suicidality in people with cancer. The Grounded Theory method of data collection and analysis was used. Eighteen social workers were recruited and interviewed. Social workers saw themselves and acted as an interprofessional hub for their patients. This approach was based on the values of holistic care, multiple treatment modalities, interpersonal consultation, and continuity of care. From this standpoint, social workers offered their patients (and at times, their families) comprehensive services providing emotional, behavioral and practical support within the hospital setting, but also outside of it in the patient's communities. Consideration should be paid to promote systemic changes to acknowledge and compensate oncology socials workers' invisible labor that includes both emotional carryover and continuous engagement in their role as liaison and intermediaries for their patients.

Centering the Voice of the Client: On Becoming a Collaborative Practitioner with Low-Income Individuals and Families.

Despite current interest in collaborative practices, few investigations document the ways practitioners can facilitate collaboration during in-session interactions. This investigation explores verbatim psychotherapy transcripts to describe and illustrate therapist's communications that facilitate or hinder centering client's voice in work with socioeconomically disadvantaged populations. Four exemplar cases were selected from a large intervention trial aimed at improving shared decision making (SDM) skills of psychotherapists working with low-income clients. The exemplar cases were selected because they showed therapist's different degrees of success in facilitating SDM. Therapist's verbalizations were grouped into five distinct communicative practices that centered or de-centered the voice of clients. Communication practices were examined through the lens of collaborative approaches in family therapy. The analysis suggests that cross-fertilization between SDM and family-oriented collaborative and critical approaches shows promise to illuminate and enhance the challenging road from clinician-led to client-led interactions. This paper also stresses the importance of incorporating relational intersectionality with individuals and families who may not feel entitled to express their expectations or raise questions when interacting with authority figures.

A pesar del interés actual en las prácticas colaborativas, pocas investigaciones documentan las maneras en las que los profesionales pueden facilitar la colaboración durante las interacciones dentro de las sesiones. Esta investigación analiza transcripciones textuales de la psicoterapia para describir e ilustrar las comunicaciones de los terapeutas que facilitan u obstaculizan la centralización de la voz del paciente en el trabajo con poblaciones desfavorecidas socioeconómicamente. Se eligieron cuatro casos ejemplares de un ensayo grande de intervención orientado a mejorar las habilidades para la toma de decisiones compartidas de psicoterapeutas que trabajan con pacientes de bajos recursos. Los casos ejemplares se eligieron porque demostraban los diferentes grados de éxito de los terapeutas a la hora de facilitar la toma de decisiones compartidas. Las verbalizaciones del terapeuta se agruparon en cinco prácticas comunicativas diferentes que centralizaban o descentralizaban la voz de los pacientes. Se examinaron las prácticas de comunicación desde la perspectiva de los enfoques colaborativos en la terapia familiar. El análisis sugiere que la fertilización entre el esquema de decisiones compartidas y los enfoques teóricos críticos y colaborativos orientados a la familia promete iluminar y mejorar el difícil camino desde las interacciones dirigidas por el clínico a las dirigidas por los clientes. Este artículo también acentúa la importancia de incorporar la interseccionalidad relacional con personas y familias que posiblemente no se sientan con derecho a expresar sus expectativas o a hacer preguntas cuando interactúan con figuras de autoridad.

Prevalence and risk factors for suicidality in cancer patients and oncology healthcare professionals strategies in identifying suicide risk in cancer patients.

PURPOSE OF REVIEW: The aim of this study was to summarize the literature on prevalence and risk factors for suicidality in cancer patients and to document the research on oncology healthcare professionals' strategies in identifying this risk. RECENT FINDINGS: Cancer patients exhibit increased risk of suicidality compared with the general population. Various risk factors have been identified including sociodemographic factors such as poverty, being male and elderly as well as disease-related attributes such as cancer type and stage. The literature on how healthcare professionals identify suicide risk is sparse. Ten articles were found that focused on two main themes. These included information on systematic strategies in identifying suicide risk and factors that affect healthcare professionals' ability to identify risk in their patients. SUMMARY: Although there is an immense amount of literature documenting the problem of suicidality among patients, the research on how healthcare professionals identify and respond to these indications in patients is nearly nonexistent. Cancer centres should implement standardized and systematic screening of cancer patients for suicidality and research on this patient population should collect and report these data. Ongoing training and education for healthcare professionals who work in the oncology setting on how to identify and respond to suicide risk among cancer patients is urgently needed.

Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences.

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.

Emotional distress among the Bedouin Arab and Jewish elderly in Israel: The roles of gender, discrimination, and self-esteem.

Mental-health problems are common among older adults, especially those who are members of disadvantaged ethnic minorities. We explored ethnic and gender differences in emotional distress, perceived discrimination, and self-esteem among elderly Bedouin Arab and Jewish individuals in Israel, as well as the moderating role of discrimination in the association between self-esteem and emotional distress among Bedouin Arabs. The sample included 256 older adults (60 years old and above): 147 native-born Israeli Jews and 109 Bedouin Arabs. Participants completed self-report questionnaires that assessed emotional distress, perceived discrimination, self-esteem, and sociodemographic factors. Israeli Jews reported lower levels of emotional distress than Bedouin Arabs. Bedouin Arab women reported more emotional distress than Bedouin Arab men. Among the Bedouin Arabs, gender differences were found in the associations of perceived discrimination and self-esteem with emotional distress. Among the Bedouin men, discrimination and self-esteem were found to be significant predictors of emotional distress. Among the Bedouin women, we found a similar association between self-esteem and emotional distress. However, the protective role of self-esteem disappeared in the context of higher levels of daily discrimination. This study underscores how gender can affect the moderating role of discrimination in the association between self-esteem and emotional distress among the elderly.

Does Assessment Method Matter in Detecting Mental Health Distress among Ashkenazi and Mizrahi Israeli Women with Breast Cancer?

Authors examined differences in assessment method (structured diagnostic interview versus self-report questionnaire) between ethnic groups in the prevalence of mood and anxiety disorders among women with breast cancer. A convenience sample of 88 Mizrahi (Jews of Middle Eastern/North African descent, n = 42) and Ashkenazi (Jews of European/American descent, n = 46) women with breast cancer from oncology units in three health centers across Israel participated in the study. Participants were within eight months of diagnosis. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a structured diagnostic interview, the Mini-International Neuropsychiatric Interview (MINI). Approximately one-third (31.8 percent, n = 28) of participants were diagnosed with at least one mood or anxiety disorder based on the MINI. Significantly more Mizrahi participants (42.9 percent) were diagnosed with at least one mood or anxiety disorder, compared with their Ashkenazi counterparts (21.7 percent). Mean score on HADS was below the optimal cutoff score (≥13) among all participants, with no significant difference in mean score for emotional distress based on HADS between the two ethnic groups. The findings highlight the role of measurement variance in assessing mental health distress among women with breast cancer in general and among ethnic and racial minorities in particular.