Key stakeholder perspectives on the use of research about supported employment for racially and ethnically diverse patients with mental illness in the United States.

OBJECTIVE: To explore how stakeholders responded to research evidence regarding supported employment (e.g., vocational rehabilitation), and ways evidence could be incorporated into policy and action. DATA SOURCES: Qualitative data were collected from three stakeholder groups-people with lived experience of mental health challenges, community health advocates, and state health policy makers. STUDY DESIGN: This study consisted of two sequential steps. First, three focus groups were conducted after presenting stakeholder groups (inclusive of 22 participants) with simulation data showing that improvement in employment status had a stronger impact on mental health than improvement in education or income for racially/ethnically diverse groups. Second, with guidance from focus group findings, researchers conducted additional in-depth interviews (n = 19) to gain a deeper understanding of the opportunities and challenges related to incorporating these findings into policy and practice. DATA COLLECTION/EXTRACTION METHODS: Focus groups and in-depth interviews were conducted, audio recorded, transcribed, and analyzed using a thematic analysis approach. PRINCIPAL FINDINGS: People with lived experience described the positive effect of employment in their own life while highlighting the need to increase workplace accommodations and social supports for those with mental health challenges. Across stakeholder groups, participants emphasized the need for linguistic and cultural competence to promote equity in delivery of supported employment programs. Stakeholders also underscored that centralizing existing resources and using evidence-based approaches are crucial for successful implementation. CONCLUSION: Implementing effective supported employment programs should focus on meeting the specific needs of target individuals, as many of those needs are not considered in current employment-related programming. Collecting information from diverse users of research demonstrates what other aspects of supported employment are required for the likelihood of successful uptake. Implementation and dissemination efforts need to fortify collaborations and knowledge transfer between stakeholders to optimize supported employment and mental health resources.

Reducing racial/ethnic disparities in mental health service use among emerging adults: community-level supply factors.

Objectives: Emerging adulthood-spanning 18-29 years of age-is associated with the highest risk for onset of certain behavioral health disorders (e.g. major depression, bipolar disorder, psychosis, substance use disorders) and high prevalence of many behavioral health disorders. Yet, rates of mental health service use remain low in this age range. Racial/ethnic minorities are particularly impacted by individual, cultural/linguistic, and community-level barriers to mental health care. This study examined community-level factors associated with mental health service use and investigated whether these associations varied by race/ethnicity.Design: This study analyzed individual- and county-level data for emerging adults in the United States (N=3,294) from the nationally representative Collaborative Psychiatric Epidemiological Surveys (CPES). Using the Andersen Model of Health Care Utilization, analyses examined predisposing, enabling, and need factors utilized in prior studies with adult samples as well as novel community characteristics hypothesized to impact service use among emerging adults of diverse racial/ethnic backgrounds. Past-year use of both specialty and any mental health services were assessed, controlling for individual- and community-level variables, and adjusting for presence of past-year mental health disorder, overall health status, and functional impairment. Differences between racial/ethnic minority groups and Non-Latino Whites were tested through a multilevel model incorporating random intercepts logistic regression, with analysis focusing on the interaction between race/ethnicity and community-level supply variables.Results: For past-year use of specialty mental health services, density of hospitals with child wellness programs was linked to service use among Black emerging adults, whereas density of hospitals with linguistic/translation services was linked to service use among Latino emerging adults.Conclusions: This study expands on previous research in behavioral health disparities to examine ways to improve behavioral health services for an emerging adult population with unmet service needs and identifies specific community-level factors that can improve mental health for racial/ethnic minority emerging adults.

Development of a Youth Civic Engagement Program: Process and Pilot Testing with a Youth-Partnered Research Team.

Although research suggests neighborhood-level factors influence youth well-being, few studies include youth when creating interventions to address these factors. We describe our three-step process of collaborating with youth in low-income communities to develop an intervention focused on civic engagement as a means to address neighborhood-level problems impacting their well-being. In the first step, we analyzed qualitative interviews from a project in which youth shared perceptions about their neighborhoods (e.g., interpersonal relations with neighbors and institutions). Three major themes were identified: pride in youth's communities, desire for change, and perceptions of power and responsibility. Based on these themes, we completed the second step: developing a civic engagement and leadership program, called LEAP, aimed at helping youth take an active role in addressing neighborhood problems. In the third step, we collaborated with youth who completed a pilot version of the civic program and provided feedback to finalize it for large-scale testing. While discussing our process, we highlight the importance of including youth voices when developing programs that affect them. Furthermore, we note the need for more research exploring whether civic engagement serves as a mechanism for encouraging youth involvement in addressing neighborhood-level health disparities and identifying potential psychological costs of such involvement.

Keeping kids in school through prearrest diversion: School disciplinary outcomes of the Philadelphia Police School Diversion Program.

OBJECTIVES: Developed to keep youth in school and out of court, the Philadelphia Police School Diversion Program allows youth to avoid arrest for specified school-based summary and misdemeanor offenses. This study examined whether diverted youth were also less likely to experience exclusionary discipline, both in response to the referring incident and in the following calendar year. HYPOTHESES: We predicted that diverted youth-compared to youth arrested in schools the year before program implementation-would have been less likely to receive a suspension for their school-based incident, receive a suspension in the year following the incident, and be referred for permanent school removal in the year following the incident. METHOD: Using a quasi-experimental design, we examined data from 1,281 diverted youth and 531 comparable youth arrested in Philadelphia schools in the year before program implementation. These 1,812 students (67% male, 75% Black) ranged from 10 to 22 years of age. After using propensity score matching techniques, we conducted mixed-effects logistic regression analyses to compare the matched groups on 3 outcomes: incident-related suspension, postincident suspension, and postincident referral for permanent school removal. RESULTS: No statistically significant group differences in likelihood of incident-related suspension emerged; however, age and gender moderated the relationship between diverted/arrested status and incident-related suspension. Diverted youth were less likely than matched arrested youth to experience both postincident suspension and postincident permanent school removal referral. CONCLUSIONS: The Philadelphia Police School Diversion Program shows promise in reducing the likelihood that youth will experience future exclusionary discipline following a school-based incident. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Preventing school-based arrest and recidivism through prearrest diversion: Outcomes of the Philadelphia police school diversion program.

OBJECTIVES: Created to combat the school-to-prison pipeline, the Philadelphia Police School Diversion Program offers voluntary community-based services to eligible youth accused of minor school-based offeses in lieu of arrest. This study evaluated program effectiveness in accomplishing goals related to reductions in school-based arrests, serious behavioral incidents, and recidivism. HYPOTHESES: We expected the annual number of school-based arrests in Philadelphia schools to decrease over the program's first 5 years and predicted that the annual number of serious behavioral incidents would not increase. Further, we expected that diverted youth-compared to youth arrested in schools the year before Diversion Program implementation-would have significantly lower rates of recidivism arrests in the 2 years following their school-based incidents. METHOD: Using a quasi-experimental design, we examined data from 2,302 public school students (67.0% male; 76.1% Black; age range: 10-22 years) who were either diverted from arrest through the Diversion Program or arrested in Philadelphia schools in the year prior to Diversion Program implementation. We compared rate of recidivism arrest, number of arrests, and time to arrest between diverted and arrested youth. We also used district-wide descriptive statistics to examine 5-year trends in school-based arrests and serious behavioral incidents. RESULTS: Since program implementation, the annual number of school-based arrests in Philadelphia has declined by 84% and the number of serious behavioral incidents has declined by 34%. Diverted youth demonstrated less recidivism than arrested youth in the 2 years following their initial incident; however, after propensity score matching, we no longer observed significant differences. CONCLUSIONS: Findings indicate that a prearrest diversion program can safely reduce school-based arrests and suggest a need for future research regarding the role of demographic and incident-related characteristics in recidivism outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Addressing Youth-Focused Research Questions in a Community Context: Collecting and Integrating Mixed Methods Data at Multiple Ecological Levels with the PhotoStories Project.

Research seeking to understand and improve social conditions for marginalized youth would benefit from merging complex mixed methods research designs emphasizing multilevel data and participatory-social justice principles. We contribute to mixed methods research by introducing a multilevel, participatory-social justice mixed methods design that accomplishes this task and by illustrating its real-world application via PhotoStories, a multistage study aimed at understanding youths' community-based experiences and emotional well-being. During the project's three phases (preparation, training, and dissemination) we obtained and integrated quantitative and qualitative data at multiple ecological levels. Additionally, we examined youth perceptions about their participation, an important outcome given our participatory-social justice focus. We also provide lessons learned and recommendations for investigators seeking to use similar approaches for youth-focused research.

A Methodological Study of Order Effects in Reporting Relational Aggression Experiences.

Unlike the overt nature of physical aggression, which lends itself to simpler and more direct methods of investigation, the often-masked nature of relational aggression has led to difficulties and debate regarding the most effective tools of study. Given concerns with the accuracy of third-party relational aggression reports, especially as individuals age, self-report measures may be particularly useful when assessing experiences with relational aggression. However, it is important to recognize validity concerns-in particular, the potential effects of item order presentation-associated with self-report of relational aggression perpetration and victimization. To investigate this issue, surveys were administered and completed by 179 young adults randomly assigned to one of four survey conditions reflecting manipulation of item order. Survey conditions included presentation of (a) perpetration items only, (b) victimization items only, (c) perpetration items followed by victimization items, and (d) victimization items followed by perpetration items. Results revealed that participants reported perpetrating relational aggression significantly more often when asked only about perpetration or when asked about perpetration before victimization, compared with participants who were asked about victimization before perpetration. Item order manipulation did not result in significant differences in self-reported victimization experiences. Results of this study indicate a need for greater consideration of item order when conducting research using self-report data and the importance of additional investigation into which form of item presentation elicits the most accurate self-report information.

Barriers and strategies for implementing community-based interventions with minority elders: positive minds-strong bodies.

BACKGROUND: By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group. This population has an increased risk of mental and physical disability with significant barriers to access care. Community-based organizations (CBOs) often provide programming to serve minority and immigrant elders. Limited resources and other barriers such as lack of trained staff make it difficult to implement evidence-based interventions (EBIs) in CBOs for long-term adoption. Yet little is known about what factors can facilitate adoption of EBIs in CBOs serving minority elders. METHODS: Positive-Minds-Strong Bodies (PM-SB), an evidence-based intervention offered in four languages, aims to reduce mental and physical disability for minority and immigrant elders through the efforts of community health workers and exercise trainers. The intervention consists of cognitive behavior therapy and exercise training sessions delivered over 6 months. During a recent clinical trial of this intervention, we elicited feedback from CBO staff to determine how best to facilitate the implementation and long-term sustainability of PM-SB within their agencies. We surveyed 30 CBO staff members, held four focus groups, and conducted 20 in-depth interviews to examine staff perspectives and to reveal factors or changes needed to facilitate long-term adoption in prospective CBOs. RESULTS: Participants reported that staff motivation and implementation could be improved through the following changes: increasing patient compensation for treatment sessions, decreasing levels of organizational accountability, and reducing staff demands embedded in the intervention. Although most staff perceived that PM-SB improved their agency's ability to address the health and well-being of elders, capacity-building strategies such as a "train-the-trainer" initiative were identified as priorities to address staff turnover for sustainability. Adapting the intervention to get financial reimbursement also emerged as vital. CONCLUSIONS: Augmenting financial incentives, streamlining procedures, and simplifying staff accountability were suggested strategies for facilitating the transition from a disability prevention clinical trial in minority and immigrant elders to a scalable implementation in routine services at CBOs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02317432.

Racial/ethnic differences in general physical symptoms and medically unexplained physical symptoms: Investigating the role of education.

OBJECTIVES: Distressing physical symptoms (e.g., back pain, nausea), many of which lack medical explanation, are a common cause for medical help seeking. However, racial/ethnic and educational differences may complicate identification and explanation of such symptoms, potentially contributing to clinician misdiagnosis and patient dissatisfaction. To better understand this issue, we examined racial/ethnic differences in general physical symptoms (GPS) and, more specifically, medically unexplained physical symptoms (MUPS) and whether differences varied by race/ethnicity and educational attainment. METHOD: A sample of 4,864 Latino, Asian, and non-Latino White community respondents (54% female; average age of 41 years) self-reported their GPS. Two experts then rated whether endorsed symptoms were likely to have a medical basis. We assessed the associations of GPS and MUPS with race/ethnicity, age, gender, educational attainment, chronic physical conditions, and past-year psychiatric diagnoses. RESULTS: Asian respondents reported significantly fewer GPS than non-Latino Whites, and both Asian and Latino respondents endorsed significantly fewer MUPS than non-Latino Whites. When nativity and language were each included as covariates, racial/ethnic differences in GPS count were no longer observed; however, observed differences in MUPS count remained. Educational attainment did not demonstrate a significant relationship with either GPS or MUPS. Although comorbid mental health diagnoses were significantly related to both GPS and MUPS, age, gender, and comorbid physical conditions were the only significant predictors of GPS. CONCLUSIONS: Results from this study question existing stereotypical views of racial/ethnic differences in somatization and suggest that educational attainment does not significantly contribute to reported physical symptoms-with or without medical explanation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Gathering Diverse Perspectives to Tackle "Wicked Problems": Racial/Ethnic Disproportionality in Educational Placement.

Among students receiving behavioral health and special education services, racial/ethnic minority students are consistently overrepresented in settings separate from general classrooms. Once separated, many young people struggle to improve academically and face significant difficulty upon trying to return to a general education setting. Given the complex, ongoing, and multifaceted nature of this challenge, racial/ethnic disproportionality can be identified as a "wicked problem," for which solutions are not easily identified. Here, we describe our community-engaged research efforts, eliciting perspectives from relevant partners in an ongoing dialogue, to better integrate diverse stakeholders' perspectives when attempting to address such disparities. We conducted focus groups and qualitative interviews with members of three stakeholder groups: community-serving organizations, individuals with lived experience of behavioral health conditions, and state-level policymakers, with a shared interest in addressing racial and ethnic disparities. Participant responses illustrated the "wickedness" of this problem and highlighted the need for additional supports for students, families, and school personnel, increased collaboration across relevant systems and agencies, and reduced barriers related to funding. Overall, this methodology bridged differing perspectives to develop, in concert with our partners, a shared language of the problem and a core set of issues to consider when seeking to effect change.

Parental incarceration during childhood and later delinquent outcomes among Puerto Rican adolescents and young adults in two contexts.

OBJECTIVE: Childhood parental incarceration has been linked to increased rates of delinquency and arrest during adolescence and young adulthood; however, previous research has focused on White and/or Black samples rather than Latinx youth. We examined relationships between childhood parental incarceration and later delinquency and arrest among Puerto Rican youth living in Puerto Rico (majority context) and the mainland United States (minority context). HYPOTHESES: We expected that childhood parental incarceration would be significantly linked to delinquent behavior and arrest. In line with acculturation theory, we hypothesized that residence (proxy for minority status) would be significantly related to delinquent outcomes and that an interaction effect would emerge between parental incarceration and residence. METHOD: Longitudinal data from the Boricua Youth Study were examined for 1,294 Puerto Rican youth from the South Bronx, NY (minority context) and greater San Juan, PR (majority context). We conducted a series of negative binomial and logistic regressions to determine the effects of parental incarceration and residence in childhood on self-reported delinquent behavior and arrest in adolescence and young adulthood, while also examining factors previously linked to delinquency in Puerto Rican youth. RESULTS: Childhood parental incarceration and South Bronx residence were both linked to delinquent behavior but not arrest, even when simultaneously examining several individual, diagnostic, environment/social, and family factors reported in childhood. However, we did not observe an interaction effect between parental incarceration and residence for either outcome. CONCLUSIONS: Findings suggest that Puerto Rican youth with histories of parental incarceration could benefit from targeted programs aimed at preventing future delinquency. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Applying the National Council of Juvenile and Family Court Judges' Resolution to Juvenile Probation Reform.

In 2017, the National Council of Juvenile and Family Court Judges (NCJFCJ) passed a resolution advocating for empirically supported juvenile probation reform nationwide. Here, we review the adolescent development and behavioral decision-making research underlying the principles enumerated in the NCJFCJ resolution and describe several of its critical elements. Then, to provide guidance to jurisdictions seeking to revise local policy and practice, we suggest a series of steps that would help juvenile justice professionals translate NCJFCJ resolution principles into innovative probation reform. Finally, we describe how two jurisdictions-Pierce County, Washington and Philadelphia County, Pennsylvania-have engaged in ongoing juvenile probation reform efforts to provide real-world models of how this translational work can be carried out successfully.

Racial and ethnic differences in individual-level and area-based socioeconomic status and 12-month DSM-IV mental disorders.

The purpose of this study was to: (1) examine the associations of individual-level objective socioeconomic status (OSS), subjective socioeconomic status (SSS), and area-based indicators of socioeconomic status, with 12-month DSM-IV mood, anxiety, alcohol use, and drug use disorders; and, (2) determine the extent of racial/ethnic differences in these associations across non-Latino White, non-Latino Black, Latino, and Asian participants. Data are from the Collaborative Psychiatric Epidemiology Studies dataset, a collection of three population-based surveys of mental disorders among U.S. residents aged 18 and older (n = 13,775). Among all indicators of socioeconomic status, SSS was most consistently associated with 12-month mental disorders. Income was negatively associated with mood and anxiety disorders; education was negatively associated with alcohol use and drug use disorders. Significant interactions with race/ethnicity were found for the associations of socioeconomic indicators with anxiety, alcohol use, and drug use disorders but not with mood disorders. SSS was not associated with any of the 12-month mental disorders among Blacks. Education had stronger associations with 12-month anxiety and alcohol use disorders among Whites than among other racial/ethnic groups. Among Asians, low income compared to high income was associated with a lower risk of anxiety disorders and less than high school completion compared to college or more was associated with a lower risk of alcohol use disorders. Finally, tract-level income inequality was associated with a greater risk of drug use disorders only among Blacks. The patterns and magnitudes of the associations of individual-level and area-based socioeconomic indicators differed by type of disorder and race/ethnicity.

The effect of minority status and social context on the development of depression and anxiety: a longitudinal study of Puerto Rican descent youth.

Few longitudinal studies have explored to date whether minority status in disadvantaged neighborhoods conveys risk for negative mental health outcomes, and the mechanisms possibly leading to such risk. We investigated how minority status influences four developmental mental health outcomes in an ethnically homogeneous sample of Puerto Rican youth. We tested models of risk for major depressive disorder (MDD) and generalized anxiety disorder (GAD), depressive and anxiety symptoms (DAS), and psychological distress, as Puerto Rican youth (aged 5-13 years) transitioned to early adulthood (15-29 years) in two sites, one where they grew up as a majority (the island of Puerto Rico), and another where they were part of a minority group (South Bronx, New York). At baseline, a stratified sample of 2,491 Puerto Rican youth participated from the two sites. After baseline assessment (Wave 1), each youth participant and one caregiver were assessed annually for two years, for a total of three time points (Waves 1-3). From April 2013 to August 2017, participants were contacted for a Wave 4 interview, and a total of 2,004 young people aged 15 to 29 years participated in the assessment (response rate adjusted for eligibility = 82.8%). Using a quasi-experimental design, we assessed impacts of minority status on MDD, GAD, DAS and psychological distress. Via mediation analyses, we explored potential mechanisms underlying the observed relationships. Data from 1,863 Puerto Rican youth (after exclusion of those with MDD or GAD during Waves 1-3) indicated links between minority status and higher rates of lifetime and past-year GAD, DAS and past 30-day psychological distress at Wave 4, and a marginal trend for MDD, even after adjustments. Childhood social support and peer relationships partially explained the differences, as did intercultural conflict, neighborhood discrimination, and unfair treatment in young adulthood. The experience of growing up as a minority, as defined by context, seemingly elevates psychiatric risks, with differences in social relationships and increased social stress as mediators of this relationship. Our findings suggest that interventions at the neighborhood context rather than at the individual level might be important levers to reduce risks for the development of mood disorders in minority youth.

Mentoring future researchers: Advice and considerations.

Despite efforts to increase the diversity of academia, minority scholars continue to face significant barriers (e.g., higher financial burden, lack of institutional support for research interests, social isolation) that undermine their representation in the field and overall professional success. Researchers have suggested increased mentorship as a means of mitigating these challenges. In 2015, with the support of the Robert Wood Johnson Foundation, a panel of senior investigators met via WebEx to discuss strategies to improve the mentorship of underrepresented scholars. The topics covered by this panel included factors that optimize or challenge mentorship based on personal experience, what is special about mentorship in the context of race/ethnicity, relational dynamics, work-life balance, discrimination, and how to address challenges to the mentoring relationship. The current article provides an overview of the convening and synthesizes the lessons learned by panelists' first-hand experiences of mentoring trainees and junior faculty of color. Authors conclude with recommendations and a description of the social and institutional implications of bolstering the professional support of minority scholars. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychological Practice with Unaccompanied Immigrant Minors: Clinical and Legal Considerations.

Among youth who migrate to the United States from Latin America, unaccompanied immigrant minors (UIMs)-traveling without a parent or caregiver-are a unique subpopulation facing substantial challenges before, during, and after migration. UIMs often migrate as a result of traumatic experiences in their home countries, but are also vulnerable to experiencing trauma pre and post-migration. These experiences are compounded by the impact of prolonged separation from caregivers who migrated earlier (pre-migration) and caregivers who were left behind (post-migration). Once in the US, UIMs are typically considered undocumented and often do not have the legal representation necessary to successfully navigate immigration proceedings in a system designed for adults. Further, they often live in areas with increased rates of poverty and community violence and can face stigmatization and exclusion from important protective activities. UIMs are therefore at risk for psychological distress, including depression, anxiety, and posttraumatic stress. This article provides an overview of typical experiences for UIMs, discusses the accompanying legal and clinical implications, and offers recommendations for psychological practice at the level of providers, training programs, and child-serving systems. For example, providers might incorporate family-based and trauma-focused interventions to enhance resilience and psychological well-being, in addition to support in navigating interactions with the legal system. Clinical training programs can provide education about the experiences of UIMs, while clinicians can advocate at the systems level to promote social integration of UIMs into school systems and a more humane immigration system focused on meeting the needs of these vulnerable children.

A comparison of the prevalence of psychiatric disorders in Puerto Rico with the United States and the Puerto Rican population of the United States.

PURPOSE: The manuscript compares the rates of psychiatric disorder among island Puerto Ricans, the US population and US Puerto Ricans in order to examine whether social support explains differences in psychiatric disorder among these three groups. METHODS: Unadjusted and adjusted rates for sociodemographic factors and social support of main psychiatric disorders are compared among three population-based psychiatric epidemiology studies carried in Puerto Rico (PR) and the United States (US) as part of the NCS-R and NLAAS studies. RESULTS: Comparison of adjusted rates showed island Puerto Ricans had similar overall rates of psychiatric disorder as those of the US, lower rates of anxiety disorders, but higher rates of substance use disorders. US Puerto Ricans had higher rates of adjusted anxiety and depression but not of overall psychiatric disorder, as compared to the island. When the rates of disorder were adjusted also for social support, the differences between these two groups disappeared. CONCLUSIONS: The findings suggest that social support is a variable worthy of further exploration for explaining differences in disorder prevalence particularly among Puerto Ricans depending on where they live.

Racial/ethnic differences in 12-month prevalence and persistence of mood, anxiety, and substance use disorders: Variation by nativity and socioeconomic status.

BACKGROUND: Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. METHOD: Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. RESULTS: Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels. CONCLUSION: Nativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.

Social Determinants of Mental Health: Where We Are and Where We Need to Go.

PURPOSE OF REVIEW: The present review synthesizes recent literature on social determinants and mental health outcomes and provides recommendations for how to advance the field. We summarize current studies related to changes in the conceptualization of social determinants, how social determinants impact mental health, what we have learned from social determinant interventions, and new methods to collect, use, and analyze social determinant data. RECENT FINDINGS: Recent research has increasingly focused on interactions between multiple social determinants, interventions to address upstream causes of mental health challenges, and use of simulation models to represent complex systems. However, methodological challenges and inconsistent findings prevent a definitive understanding of which social determinants should be addressed to improve mental health, and within what populations these interventions may be most effective. Recent advances in strategies to collect, evaluate, and analyze social determinants suggest the potential to better appraise their impact and to implement relevant interventions.