Racial and Ethnic Disparities in COVID-19-Related Stressor Exposure and Adverse Mental Health Outcomes Among Health Care Workers.

OBJECTIVE: Racial and ethnic disparities in exposure to COVID-19-related stressors, pandemic-related distress, and adverse mental health outcomes were assessed among health care workers in the Bronx, New York, during the first wave of the pandemic. METHODS: The authors analyzed survey data from 992 health care workers using adjusted logistic regression models to assess differential prevalence of outcomes by race/ethnicity and their interactions. RESULTS: Compared with their White colleagues, Latinx, Black, Asian, and multiracial/other health care workers reported significantly higher exposure to multiple COVID-19-related stressors: redeployment, fear of being sick, lack of autonomy at work, and inadequate access to personal protective equipment. Endorsing a greater number of COVID-19-related stressors was associated with pandemic-related distress in all groups and with adverse mental health outcomes in some groups; it was not related to hazardous alcohol use in any of the groups. These associations were not significantly different between racial and ethnic groups. Latinx health care workers had significantly higher probabilities of pandemic-related distress and posttraumatic stress than White colleagues. Despite greater exposure to COVID-19-related stressors, Black, Asian, and multiracial/other health care workers had the same, if not lower, prevalence of adverse mental health outcomes. Conversely, White health care workers had a higher adjusted prevalence of moderate to severe anxiety compared with Asian colleagues and greater hazardous alcohol use compared with all other groups. CONCLUSIONS: Health care workers from racial and ethnic minority groups reported increased exposure to COVID-19-related stressors, suggestive of structural racism in the health care workforce. These results underscore the need for increased support for health care workers and interventions aimed at mitigating disparities in vocational exposure to risk and stress.

Longitudinal Associations of Psychiatric Risk Factors with Non-psychiatric Hospitalization in a Large Cohort of People Living with HIV in New York City.

Hospitalizations among people living with HIV (PLWH) are frequent and costly. This study examined the association between psychiatric, HIV-related, and demographic factors and hospitalization rates among PLWH using data from the Einstein-Rockefeller-City University of New York Center for AIDS Research Clinical Cohort Database. Of the 10,215 PLWH included in the sample, 45% had at least one non-psychiatric hospitalization between 2009 and 2018, with significant risk factors including prior psychiatric outpatient visits, depression, or alcohol-related disorder diagnoses, female sex, older age, CD4 count < 500 cells/uL, and detectable viral load. Additionally, 14% had an HIV-related hospitalization, with significant risk factors including prior psychiatric outpatient visits, alcohol- and substance-related disorder diagnoses, female sex, older age, CD4 count < 500 cells/uL, and detectable viral load. The study emphasizes the need for tailored interventions, including integrated treatment and comprehensive case management, for PLWH with comorbid psychiatric disorders, women, and older adults.

RESUMEN: Las hospitalizaciones son frecuentes y costosas entre las personas que viven con VIH (PVVIH). Este estudio examinó la asociación entre factores psiquiátricos, relacionados con el VIH y demográficos, y las tasas de hospitalización en 10,215 PVVIH. Entre 2009 y 2018, el 45% de los pacientes tuvieron al menos una hospitalización no psiquiátrica. Los factores de riesgo significativos incluyeron más visitas previas a la consulta psiquiátrica ambulatoria, diagnóstico previo de depresión o trastorno relacionado con el alcohol, sexo femenino, edad avanzada, conteo de células CD4 < 500 células/uL, y carga viral detectable. De las 10,215 PVVIH, el 14% tuvo una hospitalización relacionada con el VIH. Los resultados destacan la necesidad urgente de apoyo dirigido a PVVIH con trastornos psiquiátricos comorbilidades, y para mujeres y adultos mayores que viven con VIH.

Examining tradeoffs between cognitive effort and relief among adults with self-injurious behavior.

BACKGROUND: People engage in nonsuicidal self-injury (NSSI) to reduce negative affect, but it is not clear why they engage in this harmful type of behavior instead of using healthier strategies. The primary goal of this study was to evaluate whether people choose NSSI to reduce negative affect because they perceive it to be less cognitively costly than other available strategies. METHOD: In experiment one, 43 adults completed a novel, relief-based effort discounting task designed to index preferences about exerting cognitive effort to achieve relief. In experiment two, 149 adults, 52 % with a history of NSSI, completed our effort discounting task. RESULTS: Our main results suggest that people will accept less relief from an aversive experience if doing so requires expending less effort, i.e. they demonstrate effort discounting in the context of decisions about relief. We also found and that effort discounting is stronger among those with a history of NSSI, but this association became nonsignificant when simultaneously accounting for other conditions associated with aberrant effort tradeoffs. LIMITATIONS: The use of a control group without NSSI or other potentially harmful relief-seeking behaviors limits our ability to draw specific conclusions about NSSI. The ecological validity of our task was limited by a modestly effective affect manipulation, and because participants made hypothetical choices. CONCLUSIONS: This study demonstrates that preferences about exerting cognitive effort may be a barrier to using healthier affect regulation strategies. Further, the preference not to exert cognitive effort, though present in NSSI, is likely not unique to NSSI. Instead, effort discounting may be a transdiagnostic mechanism promoting an array of harmful relief-seeking behaviors.

Digital bibliotherapy as a scalable intervention for suicidal thoughts: A randomized controlled trial.

OBJECTIVE: Suicide is a major public health concern in the United States, but few effective and scalable interventions exist to help those with suicidal thoughts. We hypothesized that reading first-person narratives about working through suicidal thoughts would reduce the desire to die among adults and that this effect would be mediated by increased perceived shared experience and optimism. METHOD: Using a randomized waitlist-controlled trial, we tested the effect of digital narrative-based bibliotherapy among 528 adults visiting a social media platform dedicated to providing mental health support. Participants were randomized to either a treatment condition (n = 266), in which they read one suicide narrative per day for 14 days or to a waitlist control condition (n = 262). The primary outcome was a measure of desire to die assessed daily for the 14-day trial period and at 2-week follow-up. RESULTS: Participants in the treatment condition reported lower desire to die than participants in the control condition during the 14-day trial period (ß = -0.26, p = .001) and at 2-week follow-up (t = -2.82, p = .005). Increased perceived shared experience (indirect effect b = -0.55, p < .001) and optimism (indirect effect b = -0.85, p < .001) mediated the effect of treatment on desire to die. CONCLUSIONS: Digital narrative-based bibliotherapy may be an effective intervention for those at risk for suicide, and may work in part by increasing feelings of perceived shared experience and optimism. Future research is needed to test the generalizability of these results to other platforms, groups, and conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining implicit positive affect toward suicide among suicidal and nonsuicidal adults and adolescents.

OBJECTIVE: The purpose of this study was to examine implicit affect toward suicide (i.e., how good/bad suicide is perceived). Some people might be more likely to think about/choose suicide because they perceive it as a good option (to gain relief) relative to available alternatives. METHOD: Implicit affect toward suicide among adults (N = 72) and adolescents (N = 174) with and without suicidal thoughts was examined using first-person (FP) perspective suicide pictures in the affect misattribution procedure (AMP). RESULTS: Suicidal adults' implicit positive affect toward suicide was associated with STB variables, such as explicit valence (r = 0.34) and arousal (r = 0.44) ratings of suicide pictures, and implicit affect differentiated groups above and beyond explicit valence ratings. Contrary to our hypothesis, suicidal participants did not display higher implicit positive affect toward suicide than nonsuicidal participants. However, suicidal participants displayed consistent implicit affect toward different suicide pictures, whereas nonsuicidal participants evaluated some pictures as more pleasant than others (ORs = 1.92-2.27). CONCLUSIONS: Implicit affect toward suicide may relate to STB, but stimuli characteristics (e.g., color) likely influence the accuracy of assessment with the AMP and should be a focus of future research involving this and other implicit measures.

Positive and negative uses of social media among adolescents hospitalized for suicidal behavior.

INTRODUCTION: There is public concern about potential associations between adolescent social media/smartphone use and risk for suicide. However, no prior studies leverage qualitative methods to explore the experiences of adolescents currently at-risk for suicide. METHODS: This study examined social technology use from the perspectives of adolescents (n = 30; Mage = 16.1 years) currently hospitalized for a recent suicide attempt or severe ideation. We conducted in-depth interviews and coded transcripts using thematic analysis. We had three research questions: What (1) negative and (2) positive experiences do suicidal adolescents report related to their use of social media/smartphones? (3) How do adolescents describe their disconnection from these technologies use during inpatient hospitalization and views on a subsequent return to digital connectivity after discharge? RESULTS AND CONCLUSIONS: Results reveal both positive and negative social technology uses, with most participants reporting mixed (positive and negative) experiences. Negatives/risks included trouble regulating use, stress related to social media metrics, encounters with "triggering" content, hostility and meanness, self-denigrating comparisons, and burdensome friendship expectations. Positives/benefits included social connection, social support, affect-enhancing content, shared interests, and resources for mental health and coping. Overall, the documented risks and benefits of social technology use correspond with established (offline) risk and protective factors for suicidal thoughts and behaviors. Participants generally valued the break from social technologies during hospitalization, and also viewed them as integral to social re-entry and identified related concerns. Future studies should test well-being focused 'digital hygiene' interventions for maximizing potential benefits and minimizing potential harms of social technologies for at-risk adolescents.

Using Topic Modeling to Detect and Describe Self-Injurious and Related Content on a Large-Scale Digital Platform.

OBJECTIVE: Self-injurious thoughts and behaviors (SITBs) are a complex and enduring public health concern. Increasingly, teenagers use digital platforms to communicate about a range of mental health topics. These discussions may provide valuable information that can lead to insights about complex issues like SITBs. However, the field of clinical psychology currently lacks an easy-to-implement toolkit that can quickly gather information about SITBs from online sources. In the present study, we applied topic modeling, a natural language processing technique, to identify SITBs and related themes online, and we validated this approach using human coders. METHOD: We separately used topic modeling software and human coders to identify themes present in text from a popular online Internet support forum for teenagers. We then determined the degree to which results from the software's topic model aligned with themes identified by human coders. RESULTS: We found that topic modeling detected SITBs and related themes in online discussions in a way that accurately distinguishes between relevant and irrelevant human-coded themes. CONCLUSIONS: This approach has the potential to drastically increase our understanding of SITBs and related issues discussed on digital platforms, as well as our ability to identify those at risk for such outcomes.

Longitudinal changes in brain structures related to appetitive reactivity and regulation across development.

In the United States over one-third of the population, including children and adolescents, are overweight or obese. Despite the prevalence of obesity, few studies have examined how food cravings and the ability to regulate them change throughout development. Here, we addressed this gap in knowledge by examining structural brain and behavioral changes associated with regulation of craving across development. In a longitudinal design, individuals ages 6-26 completed two structural scans as well as a behavioral task where they used a cognitive regulatory strategy to decrease the appetitive value of foods. Behaviorally, we found that the ability to regulate craving improved with age. Neurally, improvements in regulatory ability were associated with cortical thinning in medial and lateral prefrontal cortex. We also found that models with cortical thickness measurements and age chosen by a lasso-based variable selection method could predict an individual's regulation behavior better than age and other behavioral factors alone. Additionally, when controlling for age, smaller ventral striatal volumes were associated with higher body mass index and predicted greater increases in weight two years later. Taken together, these results demonstrate a role for structural brain changes in supporting the ability to resist cravings for appetitive foods across development.

Social influence shifts valuation of appetitive cues in early adolescence and adulthood.

Other people can profoundly affect one's opinions and decisions. In the current study, we compared the effects of peer influence on responses to a primary reward-food-in both young adolescents and adults. Food is critical for survival, and in addition to its rewarding properties, habits and practices surrounding eating are heavily influenced by social and cultural norms. To address the impact of peer influence on food valuations, young adolescents ages 10-14 and young adults ages 18-22 rated the desirability of foods before and after seeing peer opinions about those foods. We then compared the degree to which participants changed their ratings of food desirability as a function of the type of social information received (e.g., peers liking a food more or less than did the participant). We found that all participants' ratings conformed to the peer ratings and that adolescents had less stable valuations across all conditions over time. These results provide evidence for the effectiveness of peer influence in shifting valuations of appetitive stimuli and can inform interventions aimed at improving healthy eating choices. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Are suicidal thoughts reinforcing? A preliminary real-time monitoring study on the potential affect regulation function of suicidal thinking.

BACKGROUND: Theoretical work and clinical observation suggest that many patients experience relief from negative affect after thinking about suicide, which may increase the likelihood of future suicidal thoughts. Accordingly, our objective was to examine whether the occurrence of suicidal thinking was followed by decreased negative affect and increased positive affect. METHODS: Participants were 43 adults who attempted suicide at least once in the past year (78% female, 78% White, M age = 23.28 years, SD age = 4.38 years) who completed 28 days of smartphone-based real-time monitoring, where they were signaled four times/day to report on current affect and whether they were having suicidal thoughts. Participants could initiate a survey whenever they had a suicidal thought. RESULTS: First, we examined changes in affect that occurred when suicidal thinking at the current time (T) but not at T + 1 (approximately 4-8 h later). Negative affect decreased and positive affect increased when participants went from a period when they were experiencing suicidal thoughts to a period where they were not. Second, to assess the time course of changes in affect, we examined changes in affect before and after participant-initiated reports of suicidal thinking. Positive affect increased and sadness decreased. LIMITATIONS: Given its preliminary nature, the study has some limitations including insufficient power to expand beyond a 4-8 h timespan. CONCLUSIONS: Findings provide preliminary evidence that suicidal thinking leads to shifts in affect. These shifts in affect may be reinforcing, helping to explain (in part) why suicidal thinking is so persistent for some patients.

Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment.

BACKGROUND: Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts. RESULTS: We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behaviors among youth varies across countries and sociodemographic populations. Despite this, studies are rarely conducted cross-nationally and do not uniformly account for high-risk populations. Regarding etiology, the majority of risk factors have been identified within the realm of environmental and psychological factors (notably negative affect-related processes), and most frequently using self-report measures. Little research has spanned across additional units of analyses including behavior, physiology, molecules, cells, and genes. Finally, there has been growing evidence in support of select psychotherapeutic treatment and prevention strategies, and preliminary evidence for technology-based interventions. CONCLUSIONS: There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.