"It's Not That We Care Less": Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos.

Despite robust knowledge regarding the socio-economic and cultural factors affecting Latino* access to healthcare, limited research has explored service utilization in the context of comorbid conditions like diabetes and depression. This qualitative study, embedded in a larger mixed-methods project, aimed to investigate perceptions held by Latinos and their social support systems (i.e., family members) regarding comorbid diabetes and depression and to identify barriers and facilitators to their help-seeking behaviors and treatment engagement. Bilingual and bicultural researchers conducted eight focus groups with 94 participants in a large U.S. metropolitan area and were primarily conducted in Spanish. The participants either had a diagnosis of diabetes and depression or were closely associated with someone who did. This study identified key individual and structural barriers and facilitators affecting healthcare access and treatment for Latinos living with comorbid diagnoses. A thematic analysis revealed structural barriers to healthcare access, including financial burdens and navigating healthcare institutions. Personal barriers included fears, personal responsibility, and negative family dynamics. Facilitators included accessible information, family support, and spirituality. These findings underscore the need to address these multi-level factors and for healthcare institutions and providers to actively involve Hispanic community members in developing services and interventions.

Mental health help-seeking in Mexico.

Most people in need of mental health services in Mexico do not seek formal support or professional services to address their mental health needs. Understanding help-seeking behaviors is crucial to addressing underutilized mental health services and to leverage health promotion efforts. Data were collected as part of a larger research project on stigma and help-seeking for mental-health-related concerns in Mexico. A convenience sample of 469 adults residing in Mexico City participated in the study using an experimental vignette methodology assessing stigma toward individuals with mental health conditions, along with characteristics and demographic correlates of help-seeking. All survey measures were administered in Spanish. A structural regression was conducted for the outcome 'openness to professional help seeking for mental health problems' as a latent variable. Compared with males, females were more open to professional help seeking (b = 0.09, p = 0.038), as were people who endorsed higher spirituality (b = 0.01, p = 0.006); while people who experienced self-stigma were less open to professional help-seeking for mental health concerns (b = -0.15, p = 0.005). Self-stigma was a major driver of low service utilization. Contrary to previous studies, spirituality was a significant positive predictor of professional help-seeking. A more nuanced understanding of mental health help-seeking in Mexico can be useful for outreach efforts to increase service utilization both in Mexico and among Latinos in the United States (US). Given historical, geographic, and cultural ties with the US, it is important to understand mental health help-seeking in Mexico, which may relate directly to help-seeking behaviors in many US Latinos who have immigrated to the US. Directions for future research and practice implications are discussed, including a roadmap for health promotion activities.

Why Culture and Context Matters: Examining Differences in Mental Health Stigma and Social Distance Between Latino Individuals in the United States and Mexico.

This study examines the influence of cultural context on social distance and perceptions of stigma towards mental health conditions among Latino populations in Houston, TX, USA and Mexico City, Mexico. We employed a community-based experimental vignette survey to assess perceptions towards individuals experiencing symptoms of alcohol misuse, depression, and psychosis. Participants (n = 513) from Houston and Mexico City were asked about their willingness to accept community members experiencing mental health symptoms in various social roles, their perceptions of stigma related to these symptoms, anticipated danger, possible positive outcomes, and the community member's ability to change. Findings demonstrate significant differences in stigma perceptions between Latino respondents in the US and in Mexico. Houston participants reported lower public stigma and perceived dangerousness of someone with mental health concerns compared to respondents in Mexico City. Furthermore, the cultural context may influence the association between various dimensions of stigma, with some inverse relationships occurring based on location of data collection. Findings illuminate the complex interplay between cultural context, mental health symptoms, and stigma, and underscores the need for culturally nuanced interventions to reduce mental health stigma and promote service utilization in Latino communities.

Exception Reporting: A Novel Approach to Tracking of Multiple Behavioral Health Outcomes.

Federally funded medical and behavioral healthcare programs often have substantial evaluation outcome tracking and reporting requirements, which can become burdensome to program staff resulting in decreased buy-in, increased chance of staff burnout and turnover, and less rigorous and consistent data collection efforts. To address this issue, a novel data collection approach, "exception reporting," was implemented to supplement and support the required data collection for a federally funded Assertive Outpatient Treatment (AOT) program. This work details the process and outcomes related to exception reporting for this comprehensive behavioral health treatment program that serves justice involved clients with serious mental illness (SMI). Results indicate that exception reporting was easily integrated into clinician's normal workflows and resulted in a number of benefits. Specifically, results indicated that exception reporting decreased the data collection burden for program staff while allowing them to efficiently track program outcomes required by the funder. Additional research into which practice settings exception reporting can most easily be integrated into, and which client outcomes may be best tracked using this methodology, is indicated.

Predictors of Stigma toward Alcohol Misuse in Mexico.

Objective: This study explored factors associated with public stigma toward individuals misusing alcohol in Mexico. Methods: A randomized experimental vignette methodology was used to assess multiple domains of substance use-related stigma and their relationship to the gender of the vignette subject and the sociodemographic characteristics of respondents. Results: Although levels of stigma toward women who were misusing alcohol did not differ significantly from stigma toward men misusing alcohol, stigma levels and type of stigma reported varied with the sociodemographic characteristics of respondents. Education level, gender, self-stigma and openness to seeking mental health services were differentially associated with the three stigma domains. Conclusions: Accordingly, targeted community based stigma reduction efforts are needed to decrease stigma toward those misusing alcohol, and to support treatment initiation, ongoing treatment engagement and long term recovery efforts. Suggestions for future research on the relationship between substance use and stigma are offered.

Needs and Attitudes Related to the Adoption of Evidence-Based Practices Among Latinx Mental Health Professionals.

Empirically supported interventions are warranted to achieve desired clinical outcomes and improve service delivery. Thus, efforts to identify, adopt, and implement Evidence-Based Practices (EBPs) are underway across various Latinx communities, including Puerto Ricans, where there is a growing recognition and prevalence of mental health and substance use disorders. This study investigated the needs and attitudes toward EBPs among an interdisciplinary sample of mental health professionals in Puerto Rico. An anonymous survey was distributed to social workers, psychologists, and professional counselors (N = 237). Using structural equation modeling, four dimensions of attitudes towards EBPs (openness, divergence, appeal, and requirement) were regressed on various individual and organizational factors. Some socio-demographic characteristics, educational opportunities, and organizational factors significantly contributed to specific attitudes related to the adoption of EBPs. Female participants and those working in rural settings scored higher in the openness to innovation dimension. Greater organizational support and graduating from a private institution were associated with more divergence from research, while married individuals and those trained on EBPs scored lower on this dimension. The lack of exposure to EBPs in college and younger age predicted greater interest in the appeal of adopting an EBP intervention (i.e., would adopt an EBP if it made sense). No differences in attitudes toward EBPs were found by professional discipline or work setting (i.e., clinical, community, and schools). Recommendations to increase openness and interest in the appeal of EBPs among Spanish-speaking professional communities in Latin America are highlighted.

Public Stigma Toward Schizophrenia Within Latino Communities in the United States.

Public stigma toward those experiencing symptoms of schizophrenia in the general population is high; yet research into such stigma within the diverse Latino communities remains under-investigated. This study employed a randomized experimental vignette methodology to assess various domains of public stigma toward individuals experiencing psychosis and/or diabetes within Latino communities. A communitybased sample of 243 Latino adults participated. Contrary to our expectations, respondents who were more sympathetic toward those with mental health problems tended to score higher on public stigma. The belief that a person was responsible for their own mental health problems was associated with higher levels of stigma. Results indicate that perceptions of dangerousness toward someone experiencing psychosis were common, and the perception that a person was responsible for their mental health problems was associated with higher levels of stigma Results emphasize the complex nature of stigma within the diverse Latino communities and the need for ongoing research.

Suicide in China: Community Attitudes and Stigma.

China accounts for an estimated third of the world's suicides, yet individuals experiencing suicidality typically do not seek out or receive treatment. This study examines community perceptions and public stigma toward suicide. In Shanghai, China 186 adults were recruited to participate in a survey with an experimental vignette describing a suicidal individual, manipulated on gender and age, followed by questions eliciting attitudes toward suicide. Most participants agreed that the suicidal subject had a serious problem, with seriousness of the problem decreasing with participant's age. Participants reported moderate levels of public stigma. More stigma was found toward adolescent subjects rather than adult. Male subjects were perceived as being more likely to change than females. The public's accurate view of suicide without biases could help prevent suicide from getting worse. Public perceptions regarding a suicidal individual's likelihood to change could lead to stigma reduction, which can subsequently help with effective crisis intervention.

Predictors of Help-Seeking for Mental Health Treatment Among Latinos.

OBJECTIVES: Despite mental health disorders being a leading cause of disability among Latinos, treatment-seeking behaviors are very low. Latinos are confronted with significant disparities in mental health treatment. This research study sought to examine (1) what are the attitudes toward professional help-seeking for mental health concerns among Latino individuals and (2) what participant characteristics and demographic factors are associated with Latino individuals' help-seeking attitudes. METHODS: Employing a cross-sectional sampling strategy, 469 participants were recruited for a community-based survey study in the greater Houston area measuring mental health stigma and help-seeking attitudes. Structural equation modeling was used to estimate the associations between Latinos' help-seeking attitudes and sociodemographic characteristics of participants. RESULTS: Findings indicate that openness towards seeking professional help for mental health concerns is influenced by participants' age, marital status, gender, region of origin, education, public stigma, and self-stigma towards mental health problem. Findings support future research to examine broader systemic factors associated with help seeking and how they interact with sociodemographic characteristics and stigma. CONCLUSIONS: Latinos, even in parts of the country where they reside in high concentrations, continue to have low levels of mental health service utilization. Understanding the specific pathways that predict help-seeking for mental health issues is essential to systematically promoting early detection and entry into evidence-based treatments for Latinos.

"I didn't do it!": Lived experiences of suicide attempts made without perceived intent or volition.

Suicide is considered to be a conscious and intentional act that is carried out within a social and cultural context. This study examines the unique phenomenon of a cluster of suicide attempts conducted without perceived intent, ideation, plan, volition, or agency in a remote province in Central Asia. This study investigated the lived experiences of individuals who made such unintended suicide attempts and examined the differences between these experiences and those of individuals who made their suicide attempt with intent and agency. The authors conducted a secondary analysis of qualitative data originally collected for a prior grounded theory study. The present study examined a specific and unique set of participant experiences related to suicide attempts made without agency. Results found that instances of suicide attempts made without perceived intent by participants included themes of impulsivity, not knowing what happened, feeling out of control, attributing these experiences to the supernatural, and being fearful of such events occurring again. Clinical practice may need to be adapted to address experiences of such unique suicide attempt experiences. In addition, further research is warranted to understand and examine the phenomenon of suicide attempts carried out without perceived intent, ideation, plan, volition, or agency.

Mental Health Public Stigma in US Jewish Communities.

ABSTRACT: Stigma is a multifaceted barrier for individuals living with mental illness, contributing to negative stereotypes, prejudice, and discrimination, and is underinvestigated in minority ethnic groups. This study examines the stigma within the US Jewish communities, specifically the following: a) differences in public stigma dimensions based on mental illness ( e.g. , major depressive disorder, anxiety disorder, schizophrenia, or alcohol use disorder) and sex; and b) whether participant characteristics influence the public stigma. A community-based sample of 317 self-identified Jewish individuals participated in an experimental randomized vignette survey on stigma and help-seeking beliefs toward various mental illness. Findings indicate differences in stigma based on stigmatized individuals' sex and diagnosis as well as participants' demographics. Schizophrenia and alcohol use disorder were stigmatized similarly, with lower stigma for depression and the least stigma toward anxiety. Of interest, younger males have the most treatability and professional efficacy stigma, and tailored stigma-reducing interventions are recommended.

Predictors of stigma toward alcohol misuse in Latino communities: a path model.

This study explores stigma-related beliefs within the Latino community concerning alcohol misuse. A community-based convenience sample of 251 self-identified Latino adults were recruited to participate in a research study using an experimental vignette methodology. Participants were randomly assigned one of four vignettes about alcohol misuse and asked to share their attitudes and stigma-related beliefs about the problem and the person in the vignette. Sociodemographic characteristics of participants differentially predicted alcohol-related stigma. These data may be used to inform health literacy and stigma reduction interventions within the Latino community.

Conceptualizations of suicide and suicide-related stigma in Latino communities in the United States.

Suicide continues to be a significant public health concern impacting all cultural and ethnic groups in the United States. Although prior studies indicate that Latino individuals die by suicide at lower rates than their non-Hispanic White or Asian peers, recent data in this area indicate that suicide rates for Latino individuals are rising. Currently, little is known about how Latino individuals perceive those who are experiencing suicidal ideation and the factors that are associated with stigma toward people contemplating self-harm. To address this gap, a convenience sample of 248 adults in the United States identifying as Latino participated in an experimental vignette study investigating their perceptions of persons experiencing suicidal ideation. Results show that generation of immigration significantly predicted various domains of stigma toward individuals with suicidal ideation. Older participants and participants with more children were associated with higher levels of stigma. The gender or age of the person experiencing suicidal ideation did not impact the levels of stigma across domains. Results indicate a need to increase the overall health literacy in relation to suicide within Latino communities, particularly in relation to early identification of suicidal ideation. Implications for future research and practice with Latino communities are offered. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Tech Connect: An Intervention to Promote Treatment Engagement for Adolescents with Depression.

Poor treatment engagement remains a challenge in effectively treating adolescents with depression. This exploratory 2-arm RCT aimed to test the feasibility and acceptability of Tech Connect for promoting treatment engagement among adolescents. Twenty youth with depression were randomized to Tech Connect (treatment) or standard community-based mental health care (control). Study aims included: (1) assess the feasibility and acceptability of Tech Connect between-session contacts for adolescents, their parents, and treatment providers and (2) conduct a preliminary analysis of engagement and mental health outcomes. Significant differences were found between the number of treatment sessions attended by the Tech Connect and control group (t = 2.00; p < .05). Adolescents receiving Tech Connect attended 91.3% (mean = 7.5 sessions; SD = 1.58) of their initial eight sessions, while 66.3% (mean = 5.3 sessions; SD = 3.09) attended in the control condition. Tech Connect is a novel, technologically-driven intervention that proved effective in improving treatment engagement among adolescents with depression.

Immigration Policy Changes and the Mental Health of Mexican-American Immigrants.

In recent years, significant policy changes focused on immigrants migrating through the southern United States border have been implemented. To determine if there was an association between time since immigration and increases in negative mental health symptomology, 249 Mexican-American immigrants ages 18-65 were field recruited to participate in a survey exploring their physical and mental health. Results indicate that inconsistent with the Hispanic Health Paradox, the psychological health of immigrants arriving since 2015 was significantly worse than that of more established immigrants. New arrivals had a .38 increased risk of experiencing clinically significant depression and a .47 increased risk of experiencing global psychological distress. Time since immigration was not significantly related to past 30-day alcohol use. Implications for future research and clinical practice with immigrants are explored, and suggestions on how better identify and assist Mexican-American immigrants with mental health concerns are offered.

First-episode psychosis: Ongoing mental health service utilization during the stable period for adolescents.

AIM: The timely identification and treatment of psychosis are increasingly the focus of early interventions, with research targeting the initial high-risk period in the months following first-episode hospitalization. Ongoing treatment after stabilization is also essential in the years following a first-episode psychosis (FEP), but has received less research attention. In this study, variables that could impact continued psychiatric service utilization by adolescents following their FEP and temporal patterns in service utilization are examined. METHODS: Families of 52 adolescents (aged 14.4 ± 2.5 years) discharged following a hospitalization for FEP were contacted two or more years following the adolescents' discharge. A chart review (Time 1) of hospital records provided clinical data on each adolescent's psychiatric diagnosis, symptoms, illness course, medications and family history. Follow-up (Time 2) data were collected from parents/caregivers using a questionnaire enquiring about post-discharge treatment history and service utilization. RESULTS: Bivariate analyses were conducted to identify Time 1 variables associated with psychiatric service utilization at Time 2. Significant variables were included in a logistic regression model and three variables were independently associated with continued service utilization: having a primary diagnosis of schizophrenia (odds ratio (OR) = 24.0; P = 0.02), not having a first-degree relative with depression (OR = 0.12; P = 0.05) and fewer months since the last inpatient discharge (OR = 0.92; P = 0.02). CONCLUSIONS: Findings suggest: (1) the importance of early diagnosis, (2) that a relative with depression may negatively influence the adolescent's ongoing service utilization, and (3) that 18 months post-discharge may be a critical time to review treatment strategies and collaborate with youth and families to ensure appropriateness of services.

Factors Associated With the Likelihood of Hospitalization Following Emergency Department Visits for Behavioral Health Conditions.

OBJECTIVES: Behavioral health-related emergency department (ED) visits have been linked with ED overcrowding, an increased demand on limited resources, and a longer length of stay (LOS) due in part to patients being admitted to the hospital but waiting for an inpatient bed. This study examines factors associated with the likelihood of hospital admission for ED patients with behavioral health conditions at 16 hospital-based EDs in a large urban area in the southern United States. METHODS: Using Andersen's Behavioral Model of Health Service Use for guidance, the study examined the relationship between predisposing (characteristics of the individual, i.e., age, sex, race/ethnicity), enabling (system or structural factors affecting healthcare access), and need (clinical) factors and the likelihood of hospitalization following ED visits for behavioral health conditions (n = 28,716 ED visits). In the adjusted analysis, a logistic fixed-effects model with blockwise entry was used to estimate the relative importance of predisposing, enabling, and need variables added separately as blocks while controlling for variation in unobserved hospital-specific practices across hospitals and time in years. RESULTS: Significant predisposing factors associated with an increased likelihood of hospitalization following an ED visit included increasing age, while African American race was associated with a lower likelihood of hospitalization. Among enabling factors, arrival by emergency transport and a longer ED LOS were associated with a greater likelihood of hospitalization while being uninsured and the availability of community-based behavioral health services within 5 miles of the ED were associated with lower odds. Among need factors, having a discharge diagnosis of schizophrenia/psychotic spectrum disorder, an affective disorder, a personality disorder, dementia, or an impulse control disorder as well as secondary diagnoses of suicidal ideation and/or suicidal behavior increased the likelihood of hospitalization following an ED visit. CONCLUSION: The block of enabling factors was the strongest predictor of hospitalization following an ED visit compared to predisposing and need factors. Our findings also provide evidence of disparities in hospitalization of the uninsured and racial and ethnic minority patients with ED visits for behavioral health conditions. Thus, improved access to community-based behavioral health services and an increased capacity for inpatient psychiatric hospitals for treating indigent patients may be needed to improve the efficiency of ED services in our region for patients with behavioral health conditions. Among need factors, a discharge diagnosis of schizophrenia/psychotic spectrum disorder, an affective disorder, a personality disorder, an impulse control disorder, or dementia as well as secondary diagnoses of suicidal ideation and/or suicidal behavior increased the likelihood of hospitalization following an ED visit, also suggesting an opportunity for improving the efficiency of ED care through the provision of psychiatric services to stabilize and treat patients with serious mental illness.

Pathway model of parental help seeking for adolescents experiencing first-episode psychosis.

AIM: Parents and caregivers are confronted with many challenges when caring for adolescents experiencing first-episode psychosis (FEP). Understanding and support for parental help-seeking process is essential for adolescents' timely access to treatment. The study aimed to develop a pathway model of parental help seeking for adolescents experiencing FEP and identify crucial time points for intervention. METHODS: Directed content analysis was conducted on semi-structured qualitative interviews of 16 parents whose children had experienced FEP and focused on parents' experiences prior to and during FEP until first hospitalization. RESULTS: The resultant parental help seeking for FEP model included two stages and six phases. The contemplation stage is composed of phases of initial awareness, recognizing severity and considering options. The action stage entailed help-seeking intention, securing help and service appraisal. All parents promptly began help seeking after recognizing severe symptoms and sought advice from professional and community supports, although parents' lack of initial awareness was common. Further analysis on individual parents' help-seeking trajectories showed that among the 50% parents who reported pre-existing childhood conditions, 87.5% did not report initial awareness of psychotic symptoms. CONCLUSIONS: Findings recommend intervention at three specific periods of help seeking. First, psychoeducation is needed when parents first engage with health care for their children's disabling conditions. Professionals treating childhood conditions need training to vigilantly monitor the overall mental health of the children over time. Second, it is important to enhance the roles of formal and informal community resources in facilitating parental help seeking. Finally, family-focused interventions are essential in supporting the family for securing needed treatment.

Prevalence and correlates of depression, posttraumatic stress disorder, and suicidality in Jordanian youth in institutional care.

Youth in institutional care centers have higher mental illness rates compared with community populations. Research examining mental illness among youth in institutional care in the Middle East is lacking. This study examines the prevalence and correlates of depression, posttraumatic stress disorder (PTSD), and suicidality of youth in institutional care in Jordan. Data were collected through youth interviews, staff-caregiver surveys, and administrative files. Prevalence rates and logistic regressions were used to model suicidality across depression, PTSD, and comorbid depression/PTSD, controlling for youth characteristics, case history, and social support factors. Institutionalized youth endorsed high rates of mental illness (45% depression, 24% PTSD, 17% depression/PTSD, 27% suicidality). The odds of suicidality for depressed youth were 3.6 times higher. Abuse was significant, with the odds of suicidality for abused youth 4 times higher. Elevated rates of mental illness and suicidality indicate the importance of addressing these needs within institutions. Developing institutional programs that foster peer relationships is recommended.

Stigma and mental health treatment of adolescents with depression in jordan.

Stigma is a fundamental barrier to seeking and engaging in mental health treatment for individuals managing depression. This study examines stigma perceptions of mental health treatment for Arab adolescents managing depression using a vignette survey completed by adults in public spaces in Amman, Jordan (n = 108). The vignette was systematically changed across four different conditions that varied the described youth's gender and whether or not they were receiving treatment for their depression. Two-way ANOVAs found that gender and receipt of mental health treatment influenced perceptions of stigma. Seeking treatment, however, did not increase perceived stigma, and receiving mental health treatment rather than no treatment was found as more likely to be a helpful approach for both males and females. Findings indicate that personal level stigma may have greater effects on females whereas public stigma may exert more influence on males. Participants endorsed that adolescents with depression are most likely to be helped when a family sought treatment rather than not seeking treatment. Findings also indicate that the community seems to appreciate the need for treatment and the likelihood of benefiting from formal mental health services.