'Housing First' Increased Psychiatric Care Office Visits And Prescriptions While Reducing Emergency Visits.

Housing First is an approach to ending homelessness that recognizes permanent housing as a platform for stability and engagement in health services. As part of a randomized controlled trial to test the effects of permanent supportive housing with the Housing First approach in Denver, Colorado, we analyzed the intervention's impact on health care use, Medicaid enrollment, and mortality among people experiencing chronic homelessness who had frequent arrests and jail stays. Two years after assignment to the Housing First intervention, participants had an average of eight more office-based visits for psychiatric diagnoses, three more prescription medications, and six fewer emergency department visits than the control group. Although enrollment in Medicaid increased over the course of the study for both the intervention group and the control group, the intervention group was 5 percentage points less likely to be enrolled in Medicaid. Supportive housing had no significant impact on mortality. When considering pathways to scale up supportive housing, policy makers should recognize the potential of Housing First to facilitate the use of office-based psychiatric care and medications in a population with many health care needs.

Ethical applications of digital community-based research with Black immigrant and refugee youth and families.

The capacity to conduct psychology research online has expanded more quickly than have ethics guidelines for digital research. We argue that researchers must proactively plan ways to engage ethically in online psychological research with vulnerable groups, including marginalized and immigrant youth and families. To that end, this article describes the ethical use of internet and cell phone technologies in psychological research with Black immigrant and refugee youth and families, which demands efforts to both deepen and extend the Belmont principles of respect for persons, beneficence, and justice. We describe and apply four research frameworks-community-based participatory research, transdisciplinary team science, representational ethics, and cross-cultural psychology-that can be integrated to offer practical solutions to ethical challenges in digital research with Black immigrant and refugee youth and families. Then, as an illustration, we provide a case example of this approach using the Food, Culture, and Health Study conducted with Black Jamaican American and Somali American youth and families, who experience tridimensional acculturation due to their race and have been disproportionately impacted by the dual pandemics of COVID-19 and racism/Whiteness. We offer this article as a road map for other researchers seeking to conduct ethical digital community-based psychological research with Black immigrant youth and families and other marginalized communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Promoting positive development among refugee adolescents.

Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suárez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suárez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.

Depression and anxiety symptoms, subjective well-being, and happiness among Indian high school students.

Background: Mental health problems cause significant distress and impairment in adolescents worldwide. One-fifth of the world's adolescents live in India, and much remains to be known about their mental health and wellbeing. Aim: In this preregistered study, we aimed to estimate the rates of depressive and anxiety symptoms, examine their relationship with indicators of wellbeing, and identify correlates of mental health among Indian adolescents. Methods: We administered self-report measures of depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), wellbeing (WEMWBS), and happiness (SHS) to 1,213 Indian adolescents (52.0% male; Mage = 14.11, SDage = 1.48). Results: Findings from the PHQ-9 (M = 8.08, SD = 5.01) and GAD-7 (M = 7.42, SD = 4.78) indicated high levels of depressive symptoms and anxiety symptoms. Thirty seven percent of the sample scored above the clinical cutoff for depressive symptoms, and 30.6% scored above the cutoff for anxiety symptoms. Although measures of mental health symptoms (PHQ-9 and GAD-7) were associated with measures of wellbeing and happiness (WEMWBS and SHS), these associations were only modest (Correlation < 0.45). Female students reported higher symptoms (and worse wellbeing) compared to male students, and older students reported higher symptoms (and worse wellbeing and happiness) compared to younger students. Conclusion: This study highlights the high prevalence of depressive symptoms and anxiety symptoms among Indian high school students. Symptom measures correlated only modestly with measures of wellbeing and happiness, suggesting that wellbeing and happiness reflect more than the absence of internalizing symptoms. Future research is needed to identify effective and appropriate ways to promote mental health and wellness among Indian students.

Review article: controversies surrounding the use of carvedilol and other beta blockers in the management of portal hypertension and cirrhosis.

BACKGROUND: Advanced chronic liver disease is an increasing cause of premature morbidity and mortality in the UK. Portal hypertension is the primary driver of decompensation, including the development of ascites, hepatic encephalopathy and variceal haemorrhage. Non-selective beta blockers (NSBB) reduce portal pressure and are well established in the prevention of variceal haemorrhage. Carvedilol, a newer NSBB, is more effective at reducing portal pressure due to additional α-adrenergic blockade and has additional anti-oxidant, anti-inflammatory and anti-fibrotic effects. AIM: To summarise the available evidence on the use of beta blockers, specifically carvedilol, in cirrhosis, focussing on when and why to start METHODS: We performed a comprehensive literature search of PubMed for relevant publications. RESULTS: International guidelines advise the use of NSBB in primary prophylaxis against variceal haemorrhage in those with high-risk varices, with substantial evidence of efficacy comparable with endoscopic band ligation (EBL). NSBB are also well established in secondary prophylaxis, in combination with EBL. More controversial is their use in patients without large varices, but with clinically significant portal hypertension. However, there is gathering evidence that NSBB, particularly carvedilol, reduce the risk of decompensation and improve survival. While caution is advised in patients with advanced cirrhosis and refractory ascites, recent evidence suggests that NSBB can continue to be used safely, and that premature discontinuation may be detrimental. CONCLUSIONS: With increasing evidence of benefit independent of variceal bleeding, namely retardation of decompensation and improvement in survival, it is time to consider whether carvedilol should be offered to all patients with advanced chronic liver disease.

The role of discrimination, assimilation, and gender in the mental health of resettled Somali young adults: A longitudinal, moderated mediation analysis.

Acculturation styles have important associations with future adjustment among immigrants and refugees, yet less is known about the individual and interpersonal factors that influence the strategy an individual adopts. High rates of discrimination may signal the receiving community's rejection of one's ethnic group, increasing pressure to assimilate and suppress one's heritage identity. Within a sample of Somali young adults (18-30, N = 185) resettled in North America, this study tested whether two acculturation styles (assimilation and integration) longitudinally mediate the relation between discrimination and three mental health outcomes (i.e., anxiety, depression, and posttraumatic stress disorder), and whether gender moderated these relations. Discrimination had a direct, positive relation with future mental health symptoms for females, which was not mediated by acculturation strategy. By contrast, the association between discrimination and mental health outcomes for males was fully mediated by increased endorsement of assimilation, but not integration. Experiences of marginalization may erode connections to both the Somali community and to the nation of resettlement, which have been identified as particularly strong protective forces within this community. Interventions targeted at the receiving community to reduce the rates of discrimination toward immigrants and refugees and interventions to strengthen youth's sense of belonging in both the predominant culture and their culture of origin may improve transdiagnostic mental health outcomes.

A Novel Blueprint Storyboarding Method Using Digitization for Efficient Cultural Adaptation of Prevention Programs to Serve Diverse Youth and Communities.

There is a pressing need for prevention programs that address increasing rates of epidemics and pandemics, including noncommunicable diseases. However, many populations face substantial systemic barriers to accessing traditional prevention programs. To minimize persistent service utilization gaps for underserved populations, the field requires effective, efficient, and sustainable methods to increase accessibility and cultural relevance of prevention programming to multiple audiences. Cultural adaptation is one such strategy, but it can be daunting for many preventionists. Therefore, this paper presents a step-by-step guide to streamline the cultural adaptation of prevention programs through digitization and use of a novel application of storyboarding methodology, called "blueprint storyboarding." This innovative approach to cultural adaptation is designed to increase systematicity through manualization, efficiency, cost-effectiveness, and adaptability for multiple cultures and developmental stages. We illustrate this novel method by describing how we applied the blueprint storyboarding approach after digitization to culturally adapt the JUS Media? Programme, a food-focused media literacy program designed to buffer media-related obesity risks for diverse youth.

Risk stratifying gastric ulcers: development and validation of a scoring system.

Objective: Debate is ongoing regarding the need for universal endoscopic follow-up to ensure gastric ulcer healing. We aimed to assess the value of follow-up oesophago-gastro-duodenoscopies (OGDs) for gastric ulcer healing and stratify patients according to risk of malignancy by developing a risk score. Design/method: All patients in National Health Service (NHS) Lothian with an index OGD and a diagnosis of gastric ulcer between 1 January 2014 and 31 December 2018 were identified. Data were analysed with logistic regression to identify factors significantly associated with a diagnosis of cancer; a risk score was derived and externally validated. Results: 778 patients were identified and 60.3% (469/778) of patients had a follow-up OGD. 8.6% (66/778) of patients were diagnosed with cancer. No cases of cancer were found on follow-up OGD of a benign appearing ulcer with negative biopsies. Macroscopic suspicion of malignancy was present at index OGD in 100% (3/3) of those diagnosed with cancer on subsequent OGDs. Older age (p=0.014), increased ulcer size (p<0.001) and non-antral location (p=0.030) were significantly associated with malignancy. A risk score (area under the curve (AUC) 0.868, p<0.001, minimum score=0, maximum score=6) was derived from these variables. 78.0% of patients with malignant ulcers scored ≥3, only 15.8% with benign ulcers scored ≥3 (negative predictive value (NPV) 97.4%). External validation yielded an AUC of 0.862 (p<0.001) and NPV of 98.6%; 84.0% of those with malignant ulcers scored ≥3. Conclusion: Ulcers with a combination of macroscopically benign appearances, at least six negative biopsies and a low risk score do not necessarily need endoscopic follow-up.

Parenting Interventions for Refugees and Forcibly Displaced Families: A Systematic Review.

Globally, an estimated 79.5 million individuals have been displaced, nearly 40% of whom are children. Parenting interventions may have the potential to improve outcomes for displaced families. To investigate this, we conducted a systematic review to identify the types of caregiver or parenting interventions that have been evaluated among displaced families, to assess their efficacy across a range of contexts, and to describe their cultural and contextual adaptations. The review followed PRISMA guidelines. At stage one, all articles describing caregiver/parenting interventions for forcibly displaced families were included to provide a scoping review of the state of the literature. At stage two, only randomized controlled trials (RCTs) and quasi-experimental designs were included, allowing for quantitative analysis of program effects. A total of 30 articles (24 studies) were identified in stage one. 95.8% of these articles were published in the past 10 years. Of these, 14 articles (10 studies) used an RCT or quasi-experimental design to assess program efficacy or effectiveness. Relative to control groups, those assigned to caregiving programs showed significant, beneficial effects across the domains of parenting behaviors and attitudes, child psychosocial and developmental outcomes, and parent mental health. Cultural adaptations and recruitment and engagement strategies are described. The evidence base for caregiving programs for displaced families has expanded in recent years but remains limited. Caregiving/parenting programs show promise for reducing the negative effects of forced displacement on families, but future studies are needed to understand which programs show the greatest potential for scalability.

'Us-Versus-Them': Othering in COVID-19 public health behavior compliance.

OBJECTIVE: We explored public perceptions about the COVID-19 pandemic to learn how those attitudes may affect compliance with health behaviors. METHODS: Participants were Central Pennsylvania adults from diverse backgrounds purposively sampled (based on race, gender, educational attainment, and healthcare worker status) who responded to a mixed methods survey, completed between March 25-31, 2020. Four open-ended questions were analyzed, including: "What worries you most about the COVID-19 pandemic?" We applied a pragmatic, inductive coding process to conduct a qualitative, descriptive content analysis of responses. RESULTS: Of the 5,948 respondents, 538 were sampled for this qualitative analysis. Participants were 58% female, 56% with ≥ bachelor's degree, and 50% from minority racial backgrounds. Qualitative descriptive analysis revealed four themes related to respondents' health and societal concerns: lack of faith in others; fears of illness or death; frustration at perceived slow societal response; and a desire for transparency in communicating local COVID-19 information. An "us-versus-them" subtext emerged; participants attributed non-compliance with COVID-19 behaviors to other groups, setting themselves apart from those Others. CONCLUSION: Our study uncovered Othering undertones in the context of the COVID-19 pandemic, occurring between groups of like-minded individuals with behavioral differences in 'compliance' versus 'non-compliance' with public health recommendations. Addressing the 'us-versus-them' mentality may be important for boosting compliance with recommended health behaviors.

The Whiteness pandemic behind the racism pandemic: Familial Whiteness socialization in Minneapolis following #GeorgeFloyd's murder.

Family socialization into the centuries-old culture of Whiteness-involving colorblindness, passivity, and fragility-perpetrates and perpetuates U.S. racism, reflecting an insidious Whiteness pandemic. As a poignant case study, this mixed methods study examined Whiteness socialization among White mothers (N = 392, M = 37.99 years, SD = 4.34) in Minneapolis, Minnesota in the month following the May 2020 police killing of unarmed Black resident, George Floyd. Using Helms' (1984, 2017) White racial identity development theory (WRID), content analyses of qualitative responses classified participants into lower versus higher levels of WRID, after which thematic analyses compared their Whiteness socialization beliefs/values, attitudes, practices, and emotions, and analyses of variance compared their demographics, multiculturalism, and psychological distress. There was strong convergence across qualitative and quantitative findings and results aligned with the WRID model. Racially silent participants (i.e., no mention of Floyd's murder or subsequent events on open-ended questions: 53%) had lower multiculturalism scores and lower psychological distress. Among mothers who were racially responsive (i.e., mentioned Floyd's murder or subsequent events: 47%), those with more advanced WRID (17%) had higher multiculturalism scores; lower ethnic group protectiveness scores; a more effective coping style featuring empathy, moral outrage, and hope; more color- and power-conscious socialization beliefs/values; and more purposeful racial socialization practices than their less advanced peers (30%). Collectively, color-evasion and power-evasion-pathogens of the Whiteness pandemic-are inexorably transmitted within families, with White parents serving as carriers to their children unless they take active preventive measures rooted in antiracism and equity-promotion. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

In Their Own Words: Using Open-Ended Assessment to Identify Culturally Relevant Concerns among Kenyan Adolescents.

Standardized assessment tools developed in western contexts may systematically miss certain problems that are considered important in non-western cultures. In this mixed-methods study, we used an open-ended assessment tool (the Top Problem Assessment; TPA) to identify culturally relevant concerns among low-income Kenyan youth. We then (a) applied thematic analysis to identify the most frequently reported problems and (b) examined the extent to which these problems were reflected in standardized mental health measures. Using the TPA, we identified common social, academic, and economic problems facing Kenyan youths. Specifically, 61% of the sample reported a social problem, 38% an academic problem, and 35% an economic problem. By contrast, the standardized assessments revealed that worrying and difficulty concentrating were the most commonly reported symptoms. However, the emotional and behavioral problems assessed via the standardized measures were only reported as top problems by 17% of the sample. Overall, our findings are consistent with the idea that standardized measures can miss certain culturally-salient concerns that can be acquired through open-ended assessments. We discuss how brief open-ended assessment tools could complement standardized measures, inform the development of culturally relevant standardized measures, and offer rich data about the experiences of people in understudied cultural contexts.

Family resilience and psychological distress in the COVID-19 pandemic: A mixed methods study.

Many changes were thrust upon families by the COVID-19 pandemic, including mandated quarantines, social distancing, transitions to distance learning for children, and remote work. The current study used mixed methods to examine the challenges and resilience of families in the United States during the pandemic (May-July 2020), as well as predictors and moderators of parent/child psychological distress. Our sample included 469 parents (459 mothers) of children aged ∼2-13 years (239 girls, 228 boys, one nonbinary child, one "prefer not to answer" selection), who completed an online survey with closed-ended and open-ended portions. The sample had middle-to-high socioeconomic status and 86% of families were White/non-Hispanic. Qualitative (content and thematic analyses) and quantitative (descriptive statistics and regressions) findings revealed that, even in this relatively privileged sample, parents and families were experiencing struggles in many life domains (e.g., family, school) and shifts in family dynamics and routines, which were related to emotional and mental health. Families experienced many changes in their lives, some positive and some negative, and often exhibited resilience through managing these changes. Our moderation analyses indicated that COVID-19's daily impact was significantly associated with psychological distress for children and parents, and this association was stronger for older versus younger children. Less active/instructive parental media mediation was also related to less child psychological distress. Moving forward, practitioners can focus on preventive efforts including psychoeducation regarding healthy outlets for negative emotions during COVID-19, and practical help troubleshooting childcare and health care challenges impacting many families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Which symptoms of depression and anxiety are most strongly associated with happiness? A network analysis of Indian and Kenyan adolescents.

BACKGROUND: Network analyses have been applied to understand the relationships between individual symptoms of depression and anxiety. However, little is known about which symptoms are most strongly associated with "positive" indicators of mental health, such as happiness. Furthermore, few studies have examined symptom networks in participants from low- and middle-income countries. METHODS: To address these gaps, we applied network analyses in a sample of Indian adolescents (Study 1; n=1080) and replicated these analyses in a pre-registered study with Kenyan adolescents (Study 2; n=2176). Participants from both samples completed the same measures of depressive symptoms, anxiety symptoms, and happiness. RESULTS: Feeling sad and feeling like a failure had the strongest (negative) associations with happiness items. These two symptoms, as well as worrying and feeling nervous, had the strongest associations with other symptoms of depression and anxiety. Symptoms of depression and anxiety formed a single cluster, which was distinct from a cluster of happiness items. Main findings were consistent across the two samples, suggesting a cross-culturally robust pattern. LIMITATIONS: We used cross-sectional data, and we administered scales assessing a limited subset of symptoms and happiness items. CONCLUSIONS: Our findings support the idea that some symptoms of depression and anxiety are more strongly associated with happiness. These findings contribute to a body of literature emphasizing the advantages of symptom-level analyses. We discuss how efforts to understand associations between individual symptoms and "positive" mental health indicators, like happiness, could have theoretical and practical implications for clinical psychological science.

Children's screen and problematic media use in the United States before and during the COVID-19 pandemic.

This mixed methods study examined parent-reported child screen media use before and during the COVID-19 pandemic by examining 2019-2020 changes in parent perceptions of media, screen media use (SMU), and problematic media use (PMU) in children aged 2-13 years (N = 129; 64 boys, 64 girls, 1 nonbinary; 90.7% White, 4.6% Hispanic/Latino, 0.8% Black, 8.5% multiethnic; primarily middle-to-high income). Quantitative analyses showed a significant SMU and PMU increase (medium effect size). There was a steeper increase in PMU among school-age (older) children. Together, the qualitative and quantitative results suggest that the PMU and SMU increase were influenced by distal, proximal, and maintaining factors including the COVID-19 pandemic, distance learning, child behaviors, other children, parental mediation, and positive media reinforcement.

Uptake of Clinical Prognostic Tools in COPD Exacerbations Requiring Hospitalisation.

Clinical prognostic tools are used to objectively predict outcomes in many fields of medicine. Whilst over 400 have been developed for use in chronic obstructive pulmonary disease (COPD), only a minority have undergone full external validation and just one, the DECAF score, has undergone an implementation study supporting use in clinical practice. Little is known about how such tools are used in the UK. We distributed surveys at two time points, in 2017 and 2019, to hospitals included in the Royal College of Physicians of London national COPD secondary care audit program. The survey assessed the use of prognostic tools in routine care of hospitalized COPD patients. Hospital response rates were 71/196 in 2017 and 72/196 in 2019. The use of the DECAF and PEARL scores more than doubled in decisions about unsupported discharge (7%-15.3%), admission avoidance (8.1%-17%) and readmission avoidance (4.8%-13.1%); it more than tripled (8.8%-27.8%) in decisions around hospital-at-home or early supported discharge schemes. In other areas, routine use of clinical prognostic tools was uncommon. In palliative care decisions, the use of the Gold Standards Framework Prognostic Indicator Guidance fell (5.6%-1.4%). In 2017, 43.7% of hospitals used at least one clinical prognostic tool in routine COPD care, increasing to 52.1% in 2019. Such tools can help challenge prognostic pessimism and improve care. To integrate these further into routine clinical care, future research should explore current barriers to their use and focus on implementation studies.Supplemental data for this article is available online at https://dx.doi.org/10.1080/15412555.2021.1959540.

The Refugee and Immigrant Core Stressors Toolkit (RICST): Understanding the Multifaceted Needs of Refugee and Immigrant Youth and Families Through a Four Core Stressors Framework.

Research indicates that refugee and immigrant youth commonly face four core stressors during resettlement in a new country and culture: trauma, acculturative stress, resettlement stress, and isolation. This Four Core Stressors framework can be used to educate providers about these populations' unique needs and support assessment of relevant socioecological factors influencing health. To facilitate education, training, and dissemination of this framework and complement existing provider resources, we developed the Refugee & Immigrant Core Stressors Toolkit (RICST), a free, web-based toolkit that provides an overview of the Four Core Stressors framework, assessment questions across the four domains, scaffolding to identify needs and points of triage, and recommended interventions. Public hosting of the RICST via REDCap began in March 2018. In addition to the toolkit, users are prompted to provide location of service delivery, intended purpose of use, and interface feedback. Between March 2018 and October 2020, the RICST was used over 2300 times across 6 continents. Most providers used the toolkit to learn more about the needs of refugee and immigrant youth in general, and several noted that it is a valuable educational tool for staff unfamiliar with these populations. Open-ended qualitative feedback indicated high usability. Amidst historically high levels of forced displacement, tools to support provider effectiveness in working with these populations are increasingly needed. The RICST shows promise as an educational, assessment, and treatment-planning tool for providers working with refugee and immigrant families globally. Future directions include location-specific resource mapping and culture-specific intervention strategies.

You Have to Pay to Live: Somali Young Adult Experiences With the U.S. Health Care System.

There is increasing documentation that refugees face experiences of interpersonal or structural discrimination in health care and employment. This study examines how Somali refugees understand various forms of discrimination in employment and health care related to their health, utilization of, and engagement with the health care system in the United States. We draw on semistructured qualitative interviews (N = 35) with Somali young adults in three U.S. states-Minnesota, Massachusetts, and Maine. Using modified grounded theory analysis, we explore how experiences of discrimination in employment and health care settings impact health care access, utilization, and perceptions of health among Somali young adults. Discrimination was identified as a major barrier to using health services and securing employment with employer-sponsored insurance coverage. These findings highlight how interpersonal and structural discrimination in employment and health care are mutually reinforcing in their production of barriers to health care utilization among Somali refugees.

Commonly Reported Problems and Coping Strategies During the COVID-19 Crisis: A Survey of Graduate and Professional Students.

BACKGROUND: The COVID-19 crisis has introduced a variety of stressors, while simultaneously decreasing the availability of strategies to cope with stress. In this context, it could be useful to understand issues that people find most concerning and ways in which they cope with stress. In this study, we explored these questions with a sample of graduate and professional students. METHOD: Using open-ended assessments, we asked participants (n = 305) to identify their biggest challenge or concern ("top problem"), their most effective way of handling stress ("effective strategy"), and their most common way of handling stress ("common strategy"). We applied thematic analysis and evaluated whether participants' strategies corresponded with evidence-based practices (EBPs). RESULTS: Participants frequently reported top problems relating to productivity (27% of sample), physical health (26%), and emotional health (14%). Distraction was the most frequently classified common strategy (43%), whereas behavioral activation was the most frequently identified effective strategy (50%). Participants who reported a common strategy classified as an EBP reported lower depressive and anxiety symptoms. In contrast, there was no evidence of an association between symptom levels and whether or not participants' effective strategy was an EBP. Participants who reported the same strategy as both their common and effective strategy (29%) reported lower depressive symptoms than those whose common and effective strategies were different. CONCLUSION: Our findings highlight stressors that students are experiencing and ways they are coping during the COVID-19 crisis. We discuss how these findings can inform mental health promotion efforts and future research on coping with stressors.