Racial and Ethnic Disparities in Barriers to Mental Health Treatment Among U.S. College Students.

OBJECTIVE: Using a sample of U.S. college students, the authors evaluated whether barriers to mental health treatment varied by race and ethnicity. METHODS: Data were drawn from a large multicampus study conducted across 26 U.S. colleges and universities. The sample (N=5,841) included students who screened positive for at least one mental disorder and who were not currently receiving psychotherapy. RESULTS: The most prevalent barriers to treatment across the sample were a preference to deal with issues on one's own, lack of time, and financial difficulties. Black and Hispanic/Latine students reported a greater willingness to seek treatment than did White students. However, Black and Hispanic/Latine students faced more financial barriers to treatment, and Hispanic/Latine students also reported lower perceived importance of mental health. Asian American students also reported financial barriers and preferred to handle their issues on their own or with support from family or friends and had lower readiness, willingness, and intentionality to seek help than did White students. CONCLUSIONS: Disparities in unmet treatment needs may arise from both distinct and common barriers and point to the potential benefits of tailored interventions to address the specific needs of students of color from various racial and ethnic backgrounds. The findings further underscore the pressing need for low-cost and brief treatment models that can be used or accessed independently to address the most prevalent barriers for students.

Daily stress reactivity and risk appraisal mediates childhood parental abuse predicting adulthood psychopathology severity: An 18-year longitudinal mediation analysis.

Identifying mechanisms of childhood abuse-adulthood psychopathology relations could facilitate preventive efforts, but most prior studies used cross-sectional or two-wave designs and did not test the effects of childhood maternal and paternal abuse separately. Our 18-year three-wave study thus determined if Wave 2 daily stress reactivity and risk appraisal severity mediated Wave 1 retrospectively-reported childhood maternal and paternal abuse on Wave 3 generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD), alcohol (AUD), and substance use disorder (SUD) self-rated symptom severity. Longitudinal structural equation modeling was employed, adjusting for Wave 1 psychopathology severity. Higher childhood maternal and paternal abuse consistently predicted greater future daily stress reactivity and risk appraisal, and these mediators subsequently predicted increased GAD, MDD, and PD, but not AUD and SUD severity. Daily stress reactivity and risk appraisal consistently mediated the pathways between childhood maternal and paternal abuse predicting heightened adulthood GAD, MDD, and PD (Cohen's d = 0.333-0.888) but not AUD and SUD severity. Mediation effect sizes were stronger for childhood maternal (24.5-83.0%) than paternal (19.5-56.0%) abuse as the predictor. The latent interaction between Wave 1 childhood maternal and paternal abuse did not moderate the effect of Wave 1 maternal or paternal abuse on any Wave 3 adulthood psychopathology severity through Wave 2 daily stress reactivity and risk appraisal. Our research emphasizes the urgent requirement for continuous evaluation and intervention initiatives in trauma-informed care, both in inpatient and outpatient treatment settings.

Virtual reality mindfulness training for veterans in residential substance use treatment: Pilot study of feasibility and acceptability.

BACKGROUND: Mindfulness training is effective in recovery from substance use disorders; however, adoption can be difficult due to environmental and personal distractions. Virtual reality (VR) may help overcome these challenges by providing an immersive environment for practicing mindfulness, but there is currently limited knowledge regarding patient and provider perceptions of VR-based tools. OBJECTIVE: The present study investigated the feasibility and acceptability of VR mindfulness training for veterans in residential substance use treatment as well as potential benefits of VR mindfulness interventions in this population. We conducted a pilot feasibility/acceptability study as a first step toward conducting a larger randomized controlled trial (RCT). METHODS: The study recruited participants (N = 32) from a 30-day residential substance use program and collected both qualitative and quantitative feedback on the VR mindfulness intervention using a mixed-methods approach. Patients (n = 20) and providers (n = 12) rated the acceptability, usability, and satisfaction of the intervention. Using a within-subjects design, patients provided pre-post emotion ratings and reported on state mindfulness and VR presence after completing a single-session self-guided VR mindfulness intervention. Patients provided qualitative interview data on their overall impressions, while providers gave the same information via survey. RESULTS: Both patients and providers reported high satisfaction and confidence in the intervention. Moreover, within subjects t-tests showed that patients experienced significant reductions in negative affect and significant increases in positive affect from pre-post, along with high levels of state mindfulness and presence. Results of thematic analysis revealed that the intervention facilitated focused attention on the present moment, induced a state of calm and relaxation, and reduced negative thoughts and emotions. Participants requested improvements such as better integration of audiovisual elements, a more personalized and longer intervention, and more comfortable fitting headset. Finally, the intervention presented with several advantages compared to other mindfulness experiences including reduced distractions and a sense of safety and privacy. CONCLUSIONS: Self-guided VR mindfulness intervention is feasible and acceptable to patients and providers. VR mindfulness training provides an immersive experience that uplifts mood and reduces distractions. VR may provide a scaffolding tool to set the stage for deepening mindfulness skills. Results of the present study could inform further development and tailoring for future interventions.

Associations between day-level affect profiles and same-day substance use among young adults.

OBJECTIVE: Emotions play a critical role in health risk behaviors, including substance use. However, current research often focuses exclusively on average levels of positive and negative affect, neglecting the complexity of daily emotional patterns. By capturing multiple dimensions of affect, including arousal and discrete states, we can improve our understanding of proximal predictors of substance use. The present study demonstrates the utility of a novel methodological approach for assessing affect patterns in daily life in relation to alcohol and cannabis use. METHOD: Daily diary data from N = 154 young adults who reported recent heavy episodic drinking and simultaneous use of alcohol and cannabis were analyzed using a mixed-indicator latent profile analysis to identify and describe day-level affective patterns and outcomes. RESULTS: Results revealed five distinct day-level profiles of affect: undifferentiated negative affect days, undifferentiated positive affect days, high-arousal positive affect days, mixed affect days, and low reactivity days. Undifferentiated positive affect days, high-arousal positive affect days, and low reactivity days were associated with significantly greater odds of same-day alcohol use compared to days characterized by undifferentiated negative affect (χ² = 10.55, p = .032). CONCLUSIONS: Findings suggest that daily affect patterns differentially impact alcohol use and can inform the development of interventions for problematic substance use. Additionally, the innovative methodological approach employed herein could be applicable for investigating the role of emotion in other health behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

COVID-19 pandemic effects on college student mental health: A cross-sectional cohort comparison study.

OBJECTIVE: Evaluate COVID-19 pandemic impacts on college student mental health. PARTICIPANTS: Three cohorts of college students (2018 n = 466; 2019 n = 459; 2020, n = 563; N = 1488) from three American universities. Participants were 71.4% female, 67.5% White, and 85.9% first-year students. METHODS: Multivariable regression models and bivariate correlations were used to compare anxiety, depression, well-being, and search for meaning before and during the pandemic, and the relationships between pandemic health-compliance behaviors and mental health. RESULTS: Anxiety, depression, and well-being did not significantly worsen during compared to before (2019) the pandemic (ps = .329-.837). During the pandemic, more frequent in-person social interactions were correlated with lower anxiety (r = -0.17, p < .001) and depressive symptoms (r=-0.12, p = .008), and higher well-being (r = 0.16, p < .001), but also less handwashing (r = -0.11, p = .016) and face mask-wearing (r = -0.12, p = .008). CONCLUSIONS: We observed little evidence for pandemic impacts on college student mental health. Lower compliance with pandemic health guidelines was associated with better mental health.

Stress and Affect as Daily Risk Factors for Substance Use Patterns: an Application of Latent Class Analysis for Daily Diary Data.

At the population level, use of multiple substances (or "co-use") is prevalent in young adulthood and linked with increased risk for experiencing substance-related harms. Less understood is the heterogeneity of substance use behaviors within individuals and across days, as well as the proximal predictors of these daily use patterns. The present study applied latent class analysis to daily diary data to identify daily substance use patterns and compare day-level class membership based on day-level stress and positive and negative affect among a higher-risk sample of young adult substance users. Participants (n = 152) completed up to 13 daily assessments of stress, affect, and substance use behavior. Among substance use days, five classes of days were identified: cannabis (some alcohol; 43% of days), alcohol-only (26%), vaping (some alcohol, cannabis; 24%), stimulant + alcohol (some cannabis, vaping; 4%), and cigarette-only (3%) days. Days with lower levels of perceived stress were significantly more likely to be alcohol-only Days relative to being days characterized by cigarette use, cannabis use, or multiple drug combinations. Days with higher levels of stress and negative affect were more likely to be cigarette-only days relative to cannabis and vaping days. Study findings document the wide range of substance use and co-use behaviors exhibited among young adults in daily life and highlight the importance of considering risk factors that correspond to days of problematic use patterns.

Cross-cultural and gender invariance of emotion regulation in the United States and India.

BACKGROUND: The ability to effectively regulate one's emotions has been established as an important transdiagnostic mechanism in the development and maintenance of psychopathology. To date, much of the research on emotion regulation (ER) has been conducted in Western, educated, industrialized, rich, and democratic (WEIRD) samples. Specifically, there is a dearth of cross-cultural construct equivalence studies on measures of ER. Establishing measurement equivalence is an important first step to facilitate future research on ER in culturally diverse samples. METHODS: The present study sought to validate the latent structures of three commonly used ER measures: the Emotion Regulation Questionnaire (ERQ), Ruminative Responses Scale (RRS-10), and Acceptance subscale of the Five-Facet Mindfulness Questionnaire (FFMQ-AS). Measurement equivalence was examined across 123 American and 121 Indian participants (Mage = 36.60) and across gender. RESULTS: Cross-cultural confirmatory factor analyses revealed configural equivalence (i.e., same factor structures) in both cultural groups across all three measures. The RRS-10 met weak invariance across cultures; however, factor loadings were not equal across the two samples for all items on the ERQ or FFMQ-AS. Consequently, a partial invariance solution was identified, and all measures subsequently met criteria for Level 2 strict cross-cultural invariance. Across gender, full invariance was found on all measures except the FFMQ-AS. CONCLUSION: Findings suggest that the structure of ER processes is largely invariant across these two cultural groups, with a few notable exceptions, pointing to the importance of continued work in this area.

Capturing emotion coherence in daily life: Using ambulatory physiology measures and ecological momentary assessments to examine within-person associations and individual differences.

While emotion coherence has long been theorized to be a core feature of emotion, to date, studies examining response coherence have been conducted in laboratory settings. The present study used a combined approach of ambulatory physiology measures and ecological momentary assessment conducted over a 4-week period to examine the extent to which emotional experience and physiology show coherence in daily life within-persons; and whether individual differences in response coherence are associated with between-person differences in well-being, negative emotionality, and gender. Results revealed that, on average, individuals exhibited coherence between subjective experience and physiology of emotion, but that there was substantial between-person variation in coherence in daily life. Exploratory analyses revealed no credible link between levels of response coherence and well-being, negative emotionality, or gender. Findings contribute to the literature by demonstrating a novel methodological approach to measuring coherence in daily life and supporting the generalizability of coherence to ecologically valid contexts.

Paying the price for anger: Do women bear greater costs?

Prior research shows that the social costs of expressing anger may be greater for women than for men. However, less is known about whether anger expression is also associated with greater intrapersonal costs for women relative to men. We tested the hypothesis that outward anger expression would be related to greater depressive symptoms over time for women, but not men. A nationally representative sample of 942 community-dwelling adults reported on their frequency of anger expression and completed diagnostic interviews to assess depressive symptoms at baseline and 9-year follow-up. Moderation analyses using bootstrapping revealed a significant main effect of anger-out on depression. As predicted, gender moderated the effects of anger-out on depression, such that greater anger-out at baseline predicted greater depression in women 9 years later, even after controlling for baseline depression. Findings add to the literature by revealing the intrapersonal costs women may incur from anger expression.

Simultaneous alcohol and marijuana use in daily life: Implications for level of use, subjective intoxication, and positive and negative consequences.

Simultaneous alcohol and marijuana (SAM) use is prevalent among young adult drinkers and associated with increased risk for harms. Less understood about SAM use is whether increased risk is incurred on SAM use occasions relative to occasions in which individuals used only 1 substance. From a sample of young adult SAM users, we compared occasions in which individuals simultaneously used alcohol and marijuana so that the effects overlapped ("SAM days"), occasions involving only alcohol ("alcohol days"), and occasions involving only marijuana ("marijuana days") on level of use, level of subjective intoxication, and negative and positive consequences. Eligible participants (N = 154; 57.8% female, 72.7% non-Hispanic/Latinx White) were 18-25 years old, reported past-month SAM use, and reported past 2-week binge drinking. Participants completed up to 14 daily assessments on their substance use behavior. Multilevel models indicated that, relative to alcohol days, SAM days had more negative consequences. SAM and alcohol days were not statistically different on level of use, level of subjective alcohol intoxication, or positive consequences. Relative to marijuana days, SAM days had more negative consequences and more positive consequences. Level of use (number of hits) and level of marijuana intoxication were not statistically different. In addition to SAM users being a more at-risk group, SAM occasions are associated with greater risk within this vulnerable population. Fine-grained ecological momentary assessments are needed to better understand perceptions and behavior throughout a SAM use episode. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Coherence between subjective experience and physiology in emotion: Individual differences and implications for well-being.

Emotion theorists have characterized emotions as involving coherent responding across various emotion response systems (e.g., covariation of subjective experience and physiology). Greater response system coherence has been theorized to promote well-being, yet very little research has tested this assumption. The current study examined whether individuals with greater coherence between physiology and subjective experience of emotion report greater well-being. We also examined factors that may predict the magnitude of coherence, such as emotion intensity, cognitive reappraisal, and expressive suppression. Participants (N = 63) completed self-report measures of well-being, expressive suppression, and cognitive reappraisal. They then watched a series of emotionally evocative film clips designed to elicit positive and negative emotion. During the films, participants continuously rated their emotional experience using a rating dial, and their autonomic physiological responses were recorded. Time-lagged cross-correlations were used to calculate within-participant coherence between intensity of emotional experience (ranging from neutral to very negative or very positive) and physiology (composite of cardiac interbeat interval, skin conductance, ear pulse transit time, finger pulse transit time and amplitude, systolic and diastolic blood pressure). Results indicated that individuals with greater coherence reported greater well-being. Coherence was highest during the most emotionally intense film and among individuals who reported lower expressive suppression. However, coherence was not associated with reappraisal. These findings provide support for the idea that greater emotion coherence promotes well-being and also shed light on factors that are associated with the magnitude of coherence. (PsycInfo Database Record (c) 2020 APA, all rights reserved).