Co-location of specialized mental health services in an intimate partner violence advocacy organization.

Historically, services for intimate partner violence (IPV) survivors predominantly focused on advocacy, resulting in service gaps for IPV survivors who need mental health care. When mental health services are offered, there are several barriers that limit treatment engagement. To address these gaps, a novel, integrated care model, comprised of psychiatrists, clinical psychologists, and social workers were embedded into the five New York City (NYC) Family Justice Centers (FJCs), to provide free co-located mental health care to adult survivors of IPV alongside the existing advocacy, social, and legal services. This article reports on the evaluation of the Health + Hospitals Family Justice Center Mental Health Program (FJCMHP) via: (i) seven focus groups with FJC clients and staff and Health + Hospitals (H+H) clinicians; and (ii) de-identified online surveys completed by 53 FJC clients and 130 FJC staff. Clients reported increased access to care, with 67.2% seeing a mental health clinician within two weeks of a request, and improvement in symptom relief, including sleep, mood, irritability, reduction in thoughts of self-harm, improved relationships with others, especially their children, and improved self-efficacy in parenting skills. Additionally, FJC staff reported satisfaction with the FJCMHP model, and increased understanding of clients' mental health needs. The evaluation results highlight the feasibility and tolerability of integrated mental health services in a non-medical setting. The evaluation also identifies areas for improvement, as well as the strengths of an integrated, multidisciplinary mental health service program for IPV survivors co-located in a non-medical, advocacy setting.

Holding Space for Facilitated Dialogues on Antiracism in Academic Medicine.

The year 2020 brought unprecedented challenges and renewed focus on racial disparities and inequities in the United States. For racial and ethnic minority groups, and in particular African Americans, racial disparities have been a constant presence and threat from the time of slavery through the present day. These racial disparities, sanctioned and maintained by institutional racism, manifest in all aspects of life for African Americans-segregated and unequal education and housing systems, health and mental health care disparities, disproportionally elevated incarceration rates, and, as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. In addition, most recently, there has been a renewed focus on the increased suicide rate for Black youth and its relationship to these racial disparities.1 In a large urban environment, our academic Child Psychiatry Department recognized that progress toward addressing racial disparities would be impeded without raising awareness and taking individual and collective action to identify implicit bias, power, and privilege differentials, and systemic racism inherent within academic medicine and our own lived experiences. This letter describes the development of such examination through facilitated dialogues on race and antiracism in our department.

Associations between childhood maltreatment, poor sleep, and prenatal distress in pregnant adolescents.

Childhood maltreatment (CM) is a known risk factor for adolescent pregnancy. Sleep disturbances and psychological distress, both common negative sequelae of CM, often co-occur during pregnancy, although directionality remains unclear. Furthermore, little is known about how CM affects sleep-distress associations during pregnancy. In pregnant adolescents, we examined: (a) whether there are significant predictive associations from CM to sleep quality and distress and (b) bidirectional influences of distress and sleep quality. Healthy pregnant adolescents (n = 204) were recruited before or during the 2nd trimester. CM was assessed at enrollment; sleep quality and distress were assessed in the 2nd and 3rd trimesters. Hypotheses were tested using path analysis. Findings revealed that CM was associated with worse 2nd trimester sleep quality and distress (ß = .19, p < .05 for sleep; ß = .30, p < .001 for distress). Higher levels of 2nd trimester distress were associated with lower 3rd trimester sleep quality (ß = .19, p < .05). Findings provide novel information about (a) associations from CM to prenatal mood and sleep in pregnant adolescents, and (b) sleep-distress directionality over the course of pregnancy. These results have implications for better understanding the ways in which CM potentially exerts influences later in life, and for targeting interventions to address physical and mental health during pregnancy.

Editorial: Race-Based Traumatic Stress and Vicarious Racism Within the Parent-Child Dyad: Opportunities for Intervention.

With every disaster, there are fault lines that deepen our understanding of what has happened and what needs to come. The events over the past 18 months including the coronavirus disease 2019 (COVID-19) pandemic as well as the murder of George Floyd and the associated protests throughout the United States brought those fault lines into stark relief by highlighting the history of systemic racism that has fostered marginalization and discrimination against Black Americans. These clouds of systemic racism and discrimination-encompassing 250 years of slavery, 100 years of Jim Crow, police brutality, redlining, and the resulting high rates of poverty and poorer health outcomes-have created systems in which Black Americans face unequal and unequitable stressful situations. The medical community is now beginning to take notice of this race-based traumatic stress, a term coined by Carter in 2007,1 to describe how social determinants of health impacted by racial discrimination can "get under the skin" through the accumulative effects of ongoing exposure to toxic stress.2.

Perinatal depression prevention through the mother-infant dyad: The role of maternal childhood maltreatment.

BACKGROUND: Prevention studies for perinatal depression rarely focus on the mother-infant dyad or consider the impact of maternal childhood maltreatment (CM). METHODS: A secondary analysis of two combined randomized controlled trials of Practical Resources for Effective Postpartum Parenting (PREPP) examined the moderating role of CM on the efficacy of preventing perinatal depression and effects on infant behavior at six weeks. RESULTS: 32% of 109 pregnant women endorsed CM (CM+). At six weeks postpartum, women who received PREPP compared to enhanced treatment as usual (ETAU) had significant reductions in depression and anxiety based on the observer-rated Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA) (mean difference of M=-3.84 (SD= 0.14, p<0.01) and M=- 4.31 (SD= 0.32, p <0.001) respectively). When CM was added to the models, there no longer was a significant PREPP versus ETAU treatment effect on HRSD and HRSA outcomes in CM+ women though effects remained for CM- women. However, CM+ women who received PREPP vs ETAU reported a mean increase in infant daytime sleep of 189.8 min (SE= 50.48, p = 0.001). LIMITATIONS: Self-report measures of infant behavior were used. CONCLUSIONS: CM+ women versus CM- had limited response to an intervention to prevent perinatal depression yet still reported an increase in infant daytime sleep. This study adds to the growing literature that prevention studies may need to incorporate approaches tailored to fit women with childhood trauma histories while also considering infant functioning as both may be treatment targets relevant to maternal mood.

Social Determinants of Health: the Impact of Racism on Early Childhood Mental Health.

PURPOSE OF REVIEW: Despite increased literature on the impact of racism in the past decades, relatively few studies have focused on the effects of racism on younger children. This article reviews research from the past 5 years focusing on the impact of racism on infant and early childhood mental health and socioemotional development. RECENT FINDINGS: Longitudinal studies provide evidence that very young children are highly influenced by exposure to multiple and interconnecting levels of racism and discrimination. These forms of exposure (structural and personally mediated, which can be further divided into direct and indirect exposure) are particularly nefarious to young children's socioemotional development and have implications for adolescent and adult mental health with lasting sequelae. Furthermore, the effects of racism on parenting practices and maternal/caregiver mental health appear to indicate mechanisms through which racism affects young children. Although more studies are needed in this area, recent literature indicates that racism is a social determinant of health that adversely impacts infant and early childhood socioemotional, and behavioral development. Future studies should focus on understanding the mechanisms through which racism impacts early childhood development and health, and interventions to prevent and mitigate the effects of racism.

Preventing maternal mental health disorders in the context of poverty: pilot efficacy of a dyadic intervention.

BACKGROUND: The United States Preventive Services Task Force recommends that clinicians provide or refer pregnant and postpartum women who are at an increased risk of perinatal depression to counseling interventions. However, this prevention goal requires effective interventions that reach women at risk of, but before, the development of a depressive disorder. OBJECTIVE: We describe a pilot efficacy trial of a novel dyadic intervention to prevent common maternal mental health disorders, that is, Practical Resources for Effective Postpartum Parenting, in a sample of women at risk of maternal mental health disorders based on poverty status. We hypothesized that Practical Resources for Effective Postpartum Parenting compared with enhanced treatment as usual would reduce symptoms of maternal mental health disorders after birth. STUDY DESIGN: A total of 60 pregnant women who were recruited from obstetrical practices at Columbia University Irving Medical Center were randomized to the Practical Resources for Effective Postpartum Parenting (n=30) or enhanced treatment as usual (n=30) intervention. The Edinburgh Postnatal Depression Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Patient Health Questionnaire were used to compare maternal mood at 6 weeks, 10 weeks, and 16 weeks after delivery. RESULTS: At 6 weeks after delivery, women randomized to Practical Resources for Effective Postpartum Parenting had lower mean Edinburgh Postnatal Depression scores (P=.018), lower mean Hamilton Depression scores (P<.001), and lower mean Hamilton Anxiety scores (P=.041); however, the incidence of postpartum mental disorders did not differ by treatment group. CONCLUSION: The Practical Resources for Effective Postpartum Parenting, which is an intervention integrated within obstetrical care, improves subclinical symptomology for at-risk dyads at a crucial time in the early postpartum period; however, our study did not detect reductions in the incidence of postpartum mental disorders.

Evaluating an Advisor Program for Psychiatry Residents.

PURPOSE: A formal residency advisory program was instituted in 2010 to assist psychiatry residents in achieving academic and personal goals and to help identify additional mentors. In this project the authors sought to evaluate and improve resident and faculty satisfaction with the residency advisory program. METHODS: At the end of the 2013-2014 academic period, residents completed an anonymous survey to determine baseline satisfaction with the residency advisory program. A series of interventions were then implemented including the addition of a resident liaison to the program, formal recognition of faculty advisors, and email reminders regarding regular residency advisory meetings. Eight months later a follow-up survey was distributed to assess the impact of the interventions on resident and faculty satisfaction with the residency advisory program and mentoring within the residency program. RESULTS: There were notable improvements in overall satisfaction with a 58% increase (p<0.05) in residents meeting with their advisors. After the intervention, residents were more likely to seek their resident advisor for help in facilitating relationships with potential career mentors (28% vs 72%, OR=6.64, 95% CI =1.83-24.08). Although 87% of all residents reported having mentors outside of the formal residency advisory program, approximately half of those who are in their first year post medical school (PGY1s) reported having no mentors outside of the residency advisory program (notably all women). CONCLUSIONS: Resident advisory programs benefit from continuous evaluation and quality improvement with enhanced structure, including a senior resident position, leading to improved satisfaction. Residency advisory programs may be particularly useful in helping to facilitate relationships with other mentors, which may be particularly important for women early in their training.

A 30-Year Study of 3 Generations at High Risk and Low Risk for Depression.

IMPORTANCE: The increased risk of major depression in the offspring of depressed parents is well known. Whether the risk is transmitted beyond 2 generations is less well known. To our knowledge, no published study with direct interviews of family members and the generations in the age of risk for depression has evaluated beyond 2 generations. This information is important for detecting individuals at highest risk who may benefit from early intervention. OBJECTIVE: To examine the familial aggregation of psychiatric disorder and functioning in grandchildren by their biological parents' and grandparents' depression status. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal retrospective cohort family study of 251 grandchildren (generation 3 [mean age, 18 years]) interviewed a mean of 2.0 times and their biological parents (generation 2) interviewed a mean of 4.6 times and grandparents (generation 1) interviewed up to 30 years. The study dates were January 1982 (wave 1) to June 2015 (wave 6). MAIN OUTCOMES AND MEASURES: Cumulative rates of psychiatric disorders and functioning collected for all generations by clinically trained interviewers and best-estimate diagnosis made blind to diagnoses in members of previous generations. RESULTS: There were 91 families (G1) in the original sample, of whom 77 were eligible for inclusion (had a grandchild older than 5 years), and 80.5% (62 of 77) participated in the study. When first examining only 2 generations, the biological children (generation 3) of depressed compared with nondepressed parents (generation 2) had 2-fold increased risk for major depressive disorder (MDD) (hazard ratio [HR], 2.02; 95% CI, 1.08-3.79; P = .03), any disruptive disorder (HR, 1.70; 95% CI, 1.05-2.75; P = .03), substance dependence (HR, 2.96; 95% CI, 1.24-7.08; P = .01), any suicidal ideation or gesture (HR, 2.44; 95% CI, 1.28-4.66; P = .007), and poor functioning (F = 38.25, P < .001). When 3 generations were examined stratified by parental and grandparental depression status, association of a parent's MDD on the grandchild's MDD but not other disorders varied with the grandparent's depression status: grandchildren with both a depressed parent and grandparent (n = 38) were at highest risk for MDD. Among grandchildren without a depressed grandparent, those with (n = 14) vs without (n = 74) a depressed parent had overall poorer functioning (F = 6.31, P = .01) but not higher rates of any of the disorders. Potential confounding variables did not have a meaningful effect on the association between grandchild outcomes and parental or grandparental depression. CONCLUSIONS AND RELEVANCE: In this study, biological offspring with 2 previous generations affected with major depression were at highest risk for major depression, suggesting the potential value of determining family history of depression in children and adolescents beyond 2 generations. Early intervention in offspring of 2 generations affected with moderate to severely impairing MDD seems warranted. The specificity of the transmission of depression across 3 generations may make this group a homogeneous sample for biological marker studies.

Key Role of Social Supports in a Cardiac Transplant Treatment Team.

Only a limited literature focuses on solid organ transplant outcomes using an integrated care approach connecting the transplant team with psychiatry, other medical specialties, and importantly, the patient's social supports. We present the case of a man with heart failure whom we treated for symptoms of anxiety and depression both precardiac and postcardiac transplant. The patient was managed by a multidisciplinary team for his complex medical, psychiatric, family, and social issues. Most notably, the role and involvement of his primary caregiver at home changed during the crucial period between his pretransplant evaluation and clinical care during the year following his cardiac transplant. Unfortunately our patient succumbed to a poor outcome both socially and medically, dying 1 year posttransplant. Our experience with this patient led us to explore the cardiac transplant presurgical and postsurgical assessment and management process, focusing on the key role of social support in the patient care team.