Making an MPCT: Building and Sustaining a Multicultural Psychology Consultation Team (MPCT) Within an Academic Medical Center.

ABSTRACT: The synergistic epidemics of COVID-19, racial injustice, and health inequities sparked an unprecedented commitment from US hospital systems and treatment settings to address health disparities by increasing access to care for historically oppressed and underserved communities. However, the inability of hospital systems to actually provide multiculturally responsive care and, more broadly, to consistently practice cultural humility will only exacerbate patient distrust and the deleterious health and social outcomes we seek to mitigate. This perspective article describes the development of a multidisciplinary team of mental health providers committed to delivering culturally responsive mental health treatment while promoting inclusive workplace environments. We outline the Multicultural Psychology Consultation Team's (MPCT) origin, design, process, and structure and discuss successes and challenges in maintaining the model in its first two years. We recommend that systemic infusion of cultural humility, multiculturally responsive clinical care, and support for providers delivering care be prioritized in concert with efforts to increase access to care for diverse patients. We offer MPCT as a model for supporting these aims.

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.

Leveraging community-based mental health services to reduce inequities for children and families living in United States who have experienced migration-related trauma.

OBJECTIVE: Trauma systems therapy for refugees (TST-R) is a trauma-focused, culturally responsive mental health prevention and intervention model designed to meet the needs of children and families who are fleeing their home countries and seeking humanitarian refuge. TST-R provides trauma-focused mental health treatment and addresses problems in part exacerbated by harsh U.S. immigration policies (e.g., poor mental health, stigma, fear) that have implications for the psychosocial well-being of immigrant children and families, especially those who have experienced migration-related trauma. METHOD: Informed by a community-based participatory research approach, TST-R was developed as an adaptation of trauma systems therapy to address common barriers to care experienced by those of refugee and immigrant backgrounds, including mental health stigma, distrust of service systems, and cultural and linguistic barriers. RESULTS: TST-R is a multitiered and phase-based intervention that strategically addresses stressors and needs across levels of the social ecology. Most TST-R services are delivered in easily accessible, nonstigmatizing settings (e.g., school) by a cultural broker and a clinician who work in partnership. TST-R has been disseminated and implemented with multiple cultural groups (e.g., Somali, Bhutanese) across the United States and Canada. CONCLUSIONS: Given the unique stressors, strengths, and needs of immigrant children and their families, mental health services must be equitable, community based, and sustainable. TST-R demonstrates promise as a prevention and intervention model especially for those experiencing immigration policy-related stressors and may serve as a guide for developing child mental health policies and immigration policies that promote mental well-being for immigrant families. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Factor structure and concurrent validity of the Cognitive Fusion Questionnaire (CFQ) in a sample of Somali immigrants living in North America.

The process of resettlement in a new country and culture is commonly one of intense stress. Somali immigrants and refugees living in North America represent a large ethnocultural group navigating the complexities of forced displacement and resettlement. Despite the immense resilience exhibited by Somali communities in resettlement, the behavioral health needs of these communities require effective and culturally appropriate psychological assessment tools that can be used across service and research sectors. Given this need, we sought to examine the psychometric properties and concurrent validity of the Cognitive Fusion Questionnaire (CFQ), a transdiagnostic measure of cognitive fusion, in a sample of 233 (M age = 25.35; female = 45%) Somali young adults living in North America. Results using confirmatory factor analysis demonstrated that the one-factor structure of the CFQ previously found in other diverse populations held in the present sample. The structure and related item loadings were invariant across three key variables: gender, age, and location of resettlement in North America. Importantly, cognitive fusion was meaningfully associated with aspects of clinical and psychosocial functioning thought to be highly relevant to this population, including posttraumatic stress, anxiety, and depression symptoms, thwarted belongingness and perceived burdensomeness, and experiences of discrimination. Building upon the growing body of evidence supporting the CFQ's strong psychometric properties across cultural groups, researchers, and clinicians should have an added degree of confidence and enthusiasm in utilizing this measure to support immigrant and refugee communities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Childhood family adversity and adult cortisol response: The role of observed marital conflict behavior.

Childhood family adversity predicts adult interpersonal behavior and physiological responses to interpersonal stress. Additionally, negative marital behaviors (e.g., hostility and distress maintaining attributions) predict maladaptive stress responses and mental health problems, whereas positive marital behaviors (e.g., acceptance and relationship enhancing attributions) predict adaptive physiological and psychological outcomes. The present study examined potential marital behavior mediators and moderators of the link between childhood adversity and cortisol responses to conflict. In a sample of 218 different-sex newlywed couples, we examined (a) actors' marital conflict behaviors as candidate mediators of the link between childhood adversity and cortisol responses to marital conflict discussions, and (b) partners' marital conflict behaviors as candidate moderators of the relation between childhood adversity and cortisol responses to marital discussions. Path analysis using actor-partner interdependence modeling did not confirm mediation. Instead, wives' childhood family adversity directly predicted husbands' attenuated cortisol responses, and wives' negative behavior predicted wives' attenuated cortisol responses. As hypothesized, wives' negative behaviors moderated the association between husbands' childhood family adversity and husbands' cortisol in response to conflict; husbands showed higher cortisol if they had experienced greater family adversity and if their wives displayed more negative behavior. Results suggest that childhood family adversity may carry forward to shape adult cortisol responses to conflict and highlights the importance of wives' negative behavior for both husbands and wives. These findings add to the family psychology literature by further clarifying how the interaction of stressful childhood experiences and conflict behaviors in marriage are associated with adult physiological responses to conflict. (PsycINFO Database Record

Comparing treatment response between LGBQ and heterosexual individuals attending a CBT- and DBT-skills-based partial hospital.

OBJECTIVE: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ+), no prior study has examined mental health treatment outcomes for LGBQ+ populations receiving standard care. We compared individuals identifying as LGBQ+ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). METHOD: A total of 441 participants (19% LGBQ+; mean age = 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ+ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment. RESULTS: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ+ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities. CONCLUSIONS: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ+ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ+ affirmative treatments for specific LGBQ+ subgroups are superior to traditional treatments. (PsycINFO Database Record

Pubertal Timing and Youth Internalizing Psychopathology: The Role of Relational Aggression.

The current study examined relational aggression as a potential mechanism that explains the association between off-time pubertal development and internalizing problems in youth. Youth gender was also examined as a moderator for the association between these variables. It was hypothesized that early pubertal maturation would be associated with higher levels of relationally aggressive behavior which, in turn, would be associated with elevated levels of internalizing problems. Parents of 372 children between the ages of 8 and 17 were recruited through Amazon's Mechanical Turk. Parents responded to demographic information about themselves, as well as information about their child's pubertal timing, relationally aggressive behavior, and anxiety and depressive symptoms. Findings indicated that early pubertal timing was associated with higher levels of anxiety directly, and higher levels of both anxiety and depressive symptoms indirectly through higher levels of relational aggression. In all but one of the pathways examined, gender was not found to moderate the associations between the study variables of interest. This study is the first to examine relational aggression as a mechanism by which early pubertal timing leads to internalizing problems. The findings suggest that relational aggression could be a target for intervention among early developing youth who are at risk for internalizing problems.

Early Pubertal Timing and Childhood Family Adversity Interact to Predict Newlywed Women's Anxiety Symptoms.

The contextual amplification hypothesis posits that girls' early pubertal timing will predict anxiety and depression symptoms most strongly when early puberty occurs under adverse conditions. Research supporting this hypothesis has consistently linked early pubertal timing occurring in adverse contexts to symptoms during adolescence, but little is known about the link to adult symptoms. The present study examined the extent to which women's reports of early pubertal timing and childhood family adversity interact to predict symptoms of anxiety and depression during the first two years of marriage. Married women (N = 226) completed questionnaires within 7 months into their first marriage (Time 1) and approximately 19 months later (Time 2). Analyses indicated that at both Time 1 and 2, women's reports of earlier pubertal timing predicted anxiety symptoms only when women reported a history of greater childhood family adversity. Additional analyses indicated that the interaction of earlier pubertal timing and greater childhood family adversity predicted symptoms of traumatic intrusions and panic, but not social anxiety, at Time 1, and panic symptoms at Times 1 and 2. These findings expand our understanding of the relation of early pubertal timing to adult emotional health and the family conditions that moderate this relation.

Do unto others: How cognitive fusion shapes the transmission of moral behavior.

Moral transmission is the concept that moral behaviors can be contagious, spreading from person to person like a pathogen of social influence. We investigated how cognitive fusion-a transdiagnostic vulnerability to diverse mental health problems-influences moral transmission across 3 studies (N = 891) using real behavioral outcomes, including economic game decisions and donations to charity. The findings suggest that cognitively fused individuals are more susceptible to moral transmission because (a) they are more likely to pay forward or pay back moral behavior, and (b) they are more likely to engage in compensatory moral behavior. In fact, (c) our analyses revealed a more direct association between these 2 psychological processes, supporting our argument that moral transmission can integrate a variety of seemingly discrete social phenomena. As predicted, participants with more depression and anxiety symptoms revealed patterns of behavior similar to those high in cognitive fusion. Implications for research in both social and clinical psychology are discussed. (PsycINFO Database Record

Interactive Effects of Psychosocial Stress and Early Pubertal Timing on Youth Depression and Anxiety: Contextual Amplification in Family and Peer Environments.

While off-time pubertal development has emerged as a potential risk factor for both symptoms of depression and anxiety in youth, the literature is mixed and inconsistent as to (1) how early versus late pubertal timing confers risk for both boys and girls, (2) if the conferred risk is distinct between symptoms of anxiety and depression, and (3) under what social contexts (e.g., family environment, peer relationships) off-time pubertal development may emerge as a potent risk factor for these symptoms. The present study examined the impact of perceived pubertal timing on symptoms of anxiety and depression in two distinct psychosocial contexts: parent's perceptions of their own harsh parenting and parent's perceptions of their child's peer problems. The sample consisted of 412 parents (M = 38.6 years old, SD = 7.8, 60.4% mothers) of children between the ages of eight and seventeen (M = 12.13, SD = 2.97, 45.4% girls). All constructs were assessed by parent reports. Linear multiple regression analyses revealed that the interaction between earlier pubertal timing and greater peer problems was significantly related to higher youth depressive and anxiety symptoms. The interaction between earlier pubertal timing and greater harsh discipline was significantly related to higher youth anxiety but not depressive symptoms. Youth gender did not qualify findings. Results suggest that the contextual amplification process of early pubertal timing may occur in both high stress family and peer environments and impact both girls and boys.

Citicoline Treatment Improves Measures of Impulsivity and Task Performance in Chronic Marijuana Smokers: A Pilot BOLD fMRI Study.

OBJECTIVE: Citicoline is an endogenous nucleotide that has historically been used to treat stroke, traumatic brain injury, and cognitive dysfunction. Research has also shown that citicoline treatment is associated with improved cognitive performance in substance-abusing populations. We hypothesized that marijuana (MJ) smokers who received citicoline would demonstrate improvement in cognitive performance as well as increased neural efficiency during tasks of cognitive control relative to those who received placebo. METHOD: The current study tested this hypothesis by examining the effects of citicoline in treatment-seeking chronic MJ smokers. In an 8-week double-blind, placebo-controlled study, 19 MJ smokers were randomly assigned via a double-blind procedure to the citicoline (8 Males, 2 Females) or placebo group (9 Males, 0 Females). All participants completed fMRI scanning at baseline and after 8 weeks of treatment during two cognitive measures of inhibitory processing, the Multi Source Interference Test (MSIT) and Stroop Color Word Test, and also completed the Barratt Impulsiveness Scale (BIS-11), a self-report measure of impulsivity. RESULTS: Following the 8 week trial, MJ smokers treated with citicoline demonstrated significantly lower levels of behavioral impulsivity, improved task accuracy on both the MSIT and Stroop tasks, and exhibited significantly different patterns of brain activation relative to baseline levels and relative to those who received placebo. CONCLUSIONS: Findings suggest that citicoline may facilitate the treatment of MJ use disorders by improving the cognitive skills necessary to fully engage in comprehensive treatment programs.

Zolpidem increases GABA in depressed volunteers maintained on SSRIs.

Individuals with major depressive disorder (MDD) often use hypnotics like zolpidem (Ambien(®)) to improve sleep in addition to their selective serotonin reuptake inhibitor (SSRI) regimen. SSRIs act in part to restore disrupted GABAergic activity, but benzodiazepines and related drugs have been shown to lower GABA in a way that may be counter to these therapeutic effects. The present within-subject, single-blind, placebo-controlled study measured changes in GABA in the anterior cingulate (ACC) and thalamus of volunteers maintained on SSRIs for the treatment of MDD (n=14) following zolpidem (10mg) administration. In addition to neurochemical measurements obtained using proton magnetic resonance spectroscopy ((1)H MRS) at 4 T, a series of questionnaires were administered to assess subjective effects associated with acute zolpidem exposure. Zolpidem elevated GABA levels in both voxels of interest (P<0.05) in the depressed participants, which could imply normalization, given the lower baseline levels associated with depression. The subjective drug experience in the depressed cohort was similar to that reported previously by healthy volunteers, and no relationships existed between GABA increases and the observed behavioral effects. Aside from treating insomnia, using zolpidem in the presence of SSRIs may have some unidentified therapeutic effects for depressed individuals.

Perceptions and management approaches of physicians who care for women with ductal carcinoma in situ.

PURPOSE: Limited previous data suggest that heterogeneity exists in the treatment approaches for women with ductal carcinoma in situ (DCIS). We sought in a longitudinal cohort study of women with DCIS to assess the attitudes and management approaches toward DCIS among physicians who provide care to women. MATERIALS AND METHODS: Eligible physicians were invited to participate in a 1-time mailed survey. A financial incentive and reminders were used to enhance the response rate. Physician perception of risks associated with DCIS for patients and management approaches were evaluated. RESULTS: Two hundred and eight physicians were identified, and 151 (73%) completed the survey. Respondents had a median age of 49 years (range, 32-75 years), and most were surgeons or medical oncologists (66%). Eighty-eight percent reported seeing an average of >or= 1 new patient with DCIS per month. In a multivariable model, physicians who cared for proportionately fewer patients with breast cancer were more likely to view DCIS as a riskier disease to a patient's overall health compared with physicians who cared for more women with breast cancer (odds ratio, 2.2; 95% CI, 1.1-4.6; P = .036). Physicians exhibited differences in management approaches when considering theoretical patients with DCIS and did not use consistent terms when speaking with patients with DCIS. CONCLUSION: Substantial variation exists among physicians regarding perceptions and management approaches for women with DCIS. In some settings, risks of physician-recommended therapy might outweigh benefits. Further evaluation of the effects of physician management approaches and attitudes about DCIS on patient outcomes is warranted.