Invited Commentary: Mental health services utilization disparities at the intersection of Asian ethnoracial identity and limited English proficiency.

Nguyen et al. (Am J Epidemiol. 2024;XXX(XX):XXX-XXX) analyzed data from the U.S. National Survey of Drug Use and Health (NSDUH) to show that Asian American Native Hawaiian/Pacific Islander (AANHPI) adults with limited English proficiency have substantially lower levels of mental health services utilization compared with White adults without limited English proficiency. The findings add to the growing literature using an intersectionality framework to understand health and healthcare disparities. We comment on the authors' notable examination of intersecting minoritized identities in mental health services utilization and the welcome emphasis on AANHPI health. We discuss the limitations of the NSDUH data, which is administered in English and Spanish only, and its limited ability to support analyses disaggregated by ethnoracial subgroups. We conclude by identifying gaps related to funding, training, and data disaggregation, and highlight the role of mixed methods approaches to advance our understanding of intersectionality and health disparities research.

A daily diary study of discrimination and distress in Mexican-origin adolescents: Testing mediating mechanisms.

The present 21-day daily diary study (conducted 2021-2022) tested anger and racism-related vigilance as potential transdiagnostic mediators linking exposure to racial and ethnic discrimination (RED) to distress (negative affect and stress, respectively). The data analytic sample included N = 317 Mexican-origin adolescents (Mage = 13.5 years; 50.8% male, 46.7% female; 2.5% non-binary) from the Midwestern United States. Results from longitudinal mediation models revealed significant mediation effects through anger and racism-related vigilance, respectively, in the association between daily RED and daily distress, both within and across adolescents. Implications for theory, research, and practice are discussed so that future work can leverage these novel findings toward promoting the well-being of Mexican-origin adolescents, especially those who live in contexts of ethnoracial adversity.

Family-level moderators of daily associations between discrimination and distress among Mexican-origin youth.

The current study evaluated cultural values and family processes that may moderate associations between daily racial-ethnic discrimination and distress among Mexican-origin youth. Integrating micro-time (daily diary) and macro-time (longitudinal survey) research design features, we examined familism, family cohesion, and ethnic-racial socialization from youth-, mother-, and father- reports as potential buffers of daily associations between youth racial-ethnic discrimination and youth distress (negative affect and anger). The analytic sample, drawn from the Seguimos Avanzando study, included 317 Mexican-origin adolescents (Mage = 13.5 years) and their parents, recruited from the Midwestern United States. Results indicated that youth-reported familism and family cohesion significantly buffered daily associations between youth racial-ethnic discrimination and youth distress. In contrast, parent-reported familism and family cohesion and some aspects of ethnic-racial socialization exacerbated the discrimination to distress link. The implications of these results are discussed to inform efforts supporting the healthy development of Mexican-origin youth and their families.

Attitudes and perceptions toward the COVID-19 risk-mitigation strategies among racially and ethnically diverse older adults in the United States and Puerto Rico: a qualitative study.

OBJECTIVES: There is limited qualitative research investigating how risk-mitigation strategies during the COVID-19 pandemic impacted the lives of diverse older adults, who met criteria for mild to severe generalized anxiety or depression and minor to moderate disability. This study aims to address this gap by examining how racially and ethnically diverse older adults with at least mild mental health symptoms and minor physical disability in the United States and Puerto Rico adapted to guidelines during COVID-19. It aims to inform the medical community and policymakers of potential threats to these older adults' well-being given the COVID-19 burden. DESIGN: Based on descriptive qualitative inquiry and phenomenological perspectives, we conducted semi-structured interviews over the phone with a racially and ethnically diverse sample of older (age 60+), predominantly minoritized adults (N = 100) in four states and territories across the United States and Puerto Rico in 2021. Interviews were recorded, coded, and analyzed using a thematic analysis approach. RESULTS: Findings centered on five themes: (1) Previous experiences with the healthcare system and cultural beliefs related to trust and distrust led to mixed attitudes toward COVID-19 risk-mitigation strategies; (2) Compliance with COVID-19 mitigation strategies ensured safety and addressed fear of illness; (3) Compliance led to isolation due to interrupted social relations; (4) Isolation and disrupted social networks negatively impacted mental health and finances, and (5) Coping strategies and embracing support reduced the effects of social isolation. CONCLUSION: This study underscores the importance of increasing support and social connectedness during a pandemic and beyond to ensure the well-being of older adults in racially and ethnically diverse communities. It highlights the resiliency of older adults in identifying strategies to cope with negative impacts. We recommend safeguarding economic security through policy efforts toward financial safety nets during health crises and collaborative approaches with community-based organizations to mitigate social isolation.

Investigating the role of interpersonal relationships on low-income SUD patients' recovery: a qualitative analysis of various stakeholders in New York State.

Background: While positive impacts of recovery capital and social capital in facilitating substance use disorder (SUD) recovery is increasingly documented, research has shown that low-income and marginalized individuals have lower social capital and may rely on different networks. A more comprehensive approach is needed to understand the social capital of low-income individuals with SUD and how these relationships impact their treatment and recovery. Methods: Qualitative data were gathered through semi-structured interviews and analyzed employing thematic analysis. Participants included individuals with SUD (n=10), clinicians (n=12), and policy leaders (n=13). Results: Three themes emerged: 1) Patients' positive and negative interpersonal relationships with friends and family influenced decisions to seek treatment; 2) strong patient-provider relationships, often defined by the quality of SUD providers and treatment settings, were perceived as crucial for staying in treatment; and 3) justice involvement facilitated treatment access yet deteriorated treatment engagement. Themes emphasized social and structural factors that inhibit patients from fostering support and treatment engagement. Conclusions: Our study underscores the importance of interpersonal relationships in SUD treatment-seeking and recovery and the need for positive interactions across the care continuum within broader social networks. Opportunities for positive interpersonal relationships include increasing access to language-concordant treatment; provider training to enhance cultural humility and patient-provider relationships; and mechanisms that improve interpersonal relationships between patients, parole officers, and other justice system members. Accentuating the role of interpersonal relationships and expanding social support interventions can pave the way for structural changes that improve recovery by harnessing different types of social capital.

Parental psychopathology and posttraumatic stress in Puerto Ricans: the role of childhood adversity and parenting practices.

BACKGROUND: Parental psychopathology is associated with their children's posttraumatic stress symptoms (PTSS). However, the mechanisms through which this occurs remain unclear. We hypothesized that exposure to childhood adversities is the mechanism linking parental psychopathology to child PTSS and that parenting practices moderated these associations. METHODS: Participants (N = 1,402) with an average age of 24.03 years old (SD = 2.20), were all Puerto Ricans (50% Male and 50% Female) from the Boricua Youth Study, which is a four-wave longitudinal study spanning almost 20 years, following individuals from childhood (ages 5-13 at Wave 1) to young adulthood. Measured variables include parental psychopathology at Wave 1, childhood adversities and parenting practices at Waves 2-3, and PTSS at Wave 4. A traditional mediation model estimated the association between parental psychopathology and child PTSS via childhood adversities. A moderated mediation model was used to examine whether parenting practices moderated this mediation model. RESULTS: Results showed that the total effect of parental psychopathology at Wave 1 on PTSS at Wave 4 was fully mediated by childhood adversities at Waves 2-3 (direct effect b = 1.72, 95% CI = [-0.09, 3.83]; indirect effect b = 0.40, 95% CI = [0.15, 0.81]). In addition, the magnitude of this pathway varied by levels of parenting practices (i.e. parental monitoring and parent-child relationship quality). Specifically, the indirect effect of additional adversities in the psychopathology-PTSS link was stronger with higher levels of parental monitoring but weaker with higher parent-child relationship quality scores. CONCLUSIONS: Intergenerational continuity of psychopathology may be mitigated through the prevention of additional childhood adversities via upstream interventions, emphasizing providing parents with mental health needs with parenting tools. Family-based interventions focused on providing families with the tools to improve parent-child relationships may reduce the negative impact of childhood adversities on mental health across the life course.

Redefining the Role of Public Health Professionals Serving Black Youths Seeking Mental Health Care: Implications for Training and Mentoring.

Attrition rates for Black youths in mental health treatment settings are high, and the extant literature suggests this may be because treatment is not meeting their unique needs. Public health professionals, defined here as all individuals who work to increase the well-being of youths, can play a major role in changing these outcomes. The purpose of this article is to suggest a broader scope of practice, or a redefined role, for public health professionals who work with Black youths seeking outpatient mental health care and to explicate ways in which training and mentoring can help accomplish this goal. Bolstered by a socioecological conceptual model, we suggest 3 standards of practice that we believe must be satisfied to meet the requirement for this redefined public health professional role: using a sociocultural framework, exercising flexibility in one's assigned role, and understanding and incorporating culturally specific strengths and protective factors into care. (Am J Public Health. 2023;113(S2):S140-S148. https://doi.org/10.2105/AJPH.2022.307194).

A social interaction learning model approach to understand adverse childhood experiences and drug use among Latinx youth.

Latinx youth, members of an ethnic minority group growing faster than the national growth rate, are at increased risk of experiencing adverse childhood experiences (ACEs) but it remains unclear how ACEs relate to externalizing behaviors, such as substance use and behaviors leading to injury and violence, in this population. In a sample of 100 Latinx youth, the current study examined how ACEs related to drug use and behaviors leading to injury and violence. Exposure to ACEs was associated with increased drug use, and that association was significantly moderated by behaviors leading to injury and violence for Latina adolescents. Given these findings, more attention needs to be diverted to screening for ACEs and externalizing behaviors in Latina girls.

Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City: The Role of Plan and Geography.

OBJECTIVE: The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC). DATA SOURCE: Medicaid claims and managed care plan enrollment files for 2015-2017 in NYC. RESEARCH DESIGN: We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015-2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities. RESULTS: We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures. CONCLUSIONS: Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.

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

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

Adaptation of an Evidence-Based Intervention for Disability Prevention, Implemented by Community Health Workers Serving Ethnic Minority Elders.

INTRODUCTION: Changing demographics have created substantial unmet needs for mental health and physical disability services for immigrant and racial/ethnic minority elders. Workforce shortages can be reduced by task-shifting to community health workers (CHWs) who speak the same language and share the culture of these elders. Yet, implementation of interventions offered by CHWs requires adaptations of content and delivery, ideally under clinical supervision. OBJECTIVE: To culturally adapt two evidence-based interventions, offered in community settings, to address mental health and physical disability prevention for diverse minority elders. METHODS: We followed the Castro-Barrera stepped model for cultural adaptation of two evidence-based interventions into one combined program of disability management and prevention delivered by CHWs. We used feedback from key stakeholders, including four clinical supervisors, 16 CHWs, 17 exercise trainers, and 153 participants, collected at three time points to further adapt the intervention to a diverse population of elders. RESULTS: Adaptations for administration by CHWs/exercise trainers included: systematization of supervision process, increased flexibility in sessions offered per participants' needs, inclusion of self-care content, modification of materials to better reflect elders' daily life experiences, and greater focus on patient engagement in care. Areas for additional adaptation included enhancing examples with culturally relevant metaphors, incorporating visual aids, and training CHWs in the importance of building trust. CONCLUSION: This study identifies key aspects of the cultural adaptation process that facilitates broader cultural sensitivity of service delivery by CHWs to diverse elders in community settings.

Boricua de pura cepa: Ethnic identity, cultural stress and self-concept in Puerto Rican youth.

OBJECTIVES: The available literature on ethnic identity among Puerto Ricans has focused on those living in the United States, with little to no attention placed on examining ethnic identity and psychological constructs among youth living in Puerto Rico. Using a colonial mentality framework, the current study examined the associations between ethnic identity, cultural stress, and self-concept among adolescent boys and girls living in Puerto Rico. METHOD: The current cross-sectional study surveyed participants (N = 187) recruited from several junior high schools in the metropolitan area in Puerto Rico. RESULTS: Relations between ethnic identity, cultural stress, and self-concept differed by gender. First, cultural stress was associated with self-concept for boys, such that higher cultural stress predicted lower self-concept. Second, among girls, cultural stress moderated the relation between ethnic identity and self-concept. Specifically, for girls experiencing high cultural stress, exploration and resolution of their ethnic identity was associated with higher ratings of self-concept. CONCLUSIONS: Although cultural stress has been widely understood as a phenomena associated with immigrants, our study indicated that cultural stress is important in understanding self-concept of youth living in Puerto Rico. For boys, cultural stress, but not ethnic identity, is particularly important to their self-concept. Among girls experiencing high cultural stress, exploration and resolution of ethnic identity was associated with higher self-concept. Results suggested that the cultural stress associated with the colonial context of Puerto Rico is salient in ethnic identity and self-concept development, even though Puerto Rican youth are the ethnic majority in the island. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Demographic Characteristics Associated With Barriers to Health Care Among Mexican and Guatemalan Immigrants in a Nontraditional Destination Area.

The purpose of this study was to examine demographic factors associated with health care barriers among Mexican (n = 258) and Guatemalan (n = 143) immigrants in Cincinnati, a nontraditional destination (new migration area). Three primary results emerged: length of US residence was not associated with fewer health care barriers, Mexican women and younger Guatemalans endorsed fewer skills-related barriers, and childless Guatemalans reported more barriers to care the longer they reside in the United States, when compared with Guatemalans with children. Our study highlights the importance of disaggregating data to create more tailored interventions to eliminate health disparities for Latinos.

The use of an ecodevelopmental approach to examining substance use among rural and urban Latino/a youth: peer, parental, and school influences.

Using an ecodevelopmental framework, we examined how peer, parent, and student variables influence substance (tobacco, alcohol, and marijuana) use among rural and urban Latino/a adolescents (N = 2,500). Generally speaking, Latino/a adolescents in rural areas endorsed higher levels of substance use. Among the primary variables of study, there were a number of nuanced differences noted based on location, gender, and type of substance. Peer use was related to individual substance use in both rural and urban areas. However, peer use was a significantly stronger predictor of tobacco use among rural Latinas than urban dwelling. Parental monitoring was not predictive of urban marijuana use, yet was negatively associated with substance use for all subgroups and was especially pronounced for female alcohol use. Parental emotional involvement predicted higher alcohol use among urban boys. School achievement was negatively associated with substance use for all subgroups while, conversely, school involvement was associated with higher alcohol use for rural boys. Cultural and contextual implications for intervention and prevention are discussed.

Partnering With Immigrant Patients and Families to Move Beyond Cultural Competence: A Role for Clinicians and Health Care Organizations.

The delivery of culturally competent health care is recognized as critical to providing quality, equitable care for marginalized groups. This includes immigrant patients and families who experience significant barriers to health care and poor health outcomes. However, operationalization of cultural competence challenges health care delivery. Complementary concepts have also emerged such as cultural humility, cultural safety, and structural competence, recognizing the need for multi-level approaches involving patients, families, clinicians, health care organizations, the larger community, and policymakers. In this review, we define cultural competency and related frameworks and their applicability to immigrant patients and families. The evolution in terminology reflects an increasingly more comprehensive approach to understanding culture as multidimensional and shaped by social and structural factors. We then highlight strategies at each level, focusing on clinicians and organizations to leverage loci of control most directly within clinicians' reach. Community-level strategies include community engagement (ie, vis-à-vis community health workers or community advisory boards) for clinical and research practice. Organization-level strategies include "immigrant-friendly," or "immigration-informed" policies aimed at reducing immigration-related stressors, like limiting cooperation with immigration enforcement agencies or developing medical-legal partnerships to assist with patients' legal needs. Lastly, policy-level strategies seek to change local and federal policies to address needs beyond health care (eg, education, housing, other social services), taking a "Health in All" policies approach that articulates health considerations into policymaking across sectors. Finally, we conclude with suggestions for future directions that center the experiences of immigrants, with the ultimate goal of sustainably meeting the complex needs of immigrant patients and families.

Yearly and Daily Discrimination-Related Stressors and Mexican Youth's Mental Health and Sleep: Insights From the First Wave of a Three-Wave Family Study.

OBJECTIVE: Research is needed to examine discrimination-related stressors and their social and psychological shaping of mental health and sleep outcomes of Latinx youth. The background, design, and methodology of a longitudinal study of Mexican families in Indiana and the initial findings of associations between discrimination-related stressors and youth mental health and sleep outcomes are presented. METHOD: Initiating wave 1 of a 3-wave (yearly) longitudinal study, investigators surveyed an ethnically homogeneous sample of 344 Mexican-origin adolescents (ages 12-15) and their primary caregivers, assessing risks and protective factors for mental health and sleep outcomes. Youth also completed a one-time 21-day daily diary after wave 1. Self-reported measures of youth mental health, sleep, and discrimination across wave 1 and the daily diary were evaluated to compare the cross-sectional (wave 1) and daily associations between discrimination and youth mental health and sleep outcomes. RESULTS: Of youth, 88.1% reported at least one incident of lifetime discrimination. Almost one-third had elevated depressive symptoms, 44.5% had probable generalized anxiety disorder, and 50.9% had poor sleep quality. Between-youth correlations at wave 1 and in the daily diary were consistent in that perceived racial discrimination was positively correlated with worse mental health and poorer sleep quality. Smaller within-youth correlations were observed in the daily diary, but there was striking variability in the effect of discrimination across youth. CONCLUSION: The present results illustrate the powerful methods of combining yearly and daily time data to investigate how and for whom discrimination-related stressors lead to adverse outcomes. DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. CLINICAL TRIAL REGISTRATION INFORMATION: Seguimos Avanzando - Latino Youth Coping With Discrimination; https://clinicaltrials.gov/; NCT04875208.

Intergenerational Continuity of Child Maltreatment, Parenting, and Racism: Commentary on Valentino et al., (2012).

Recent editorials published in Child Maltreatment bring much needed attention to racism in child maltreatment reporting and investigation. In this commentary, we extend these efforts by responding to Valentino et al., (2012) and addressing prior omissions in our race-related work by explicitly discussing the role of racism in our explanation of key study findings. Together with scholars with expertise in the impact of racism on children and families, this commentary (a) discusses theoretical models of child maltreatment and of the influence of racism on parenting and child development; (b) discusses parental responses to racism in relation to the Valentino et al., (2012) findings; and (c) highlights future research directions.

Psychiatric emergencies among urban youth during COVID-19: Volume and acuity in a multi-channel program for the publicly insured.

This study sought to characterize changes in the utilization of psychiatric emergency services among children and adolescents during distinct phases of 2020, as compared with prior years. We conducted a retrospective review of electronic health records from January 2018 through December 2020 that included all encounters made by patients under age 21. We then analyzed data for the 15,045 youth psychiatric encounters during the study period. Encounter volume in 2020 was significantly lower than prior years in March through May (IRR, 0.44; 95% CI, 0.40-0.49), May through July (IRR, 0.63; 95% CI, 0.56-0.71), and October through December (IRR, 0.76; 95% CI, 0.70-0.83). Encounters for youth with primary psychotic disorders remained at typical levels throughout 2020. Among older adolescents and youth with anxiety disorders, pervasive developmental disorders, and substance use disorders, encounter volume was significantly lower than prior years only during the initial lockdown period. There were significantly more encounters than normal conducted by mobile crisis units, including via telehealth, in July through October (IRR, 1.31; 95% CI, 1.06-1.62) and October through December (IRR, 1.28; 95% CI, 1.05-1.55) of 2020. Differences in patterns of encounter volume based on sociodemographic and clinical characteristics highlight subgroups of youth who may have been particularly vulnerable to acute mental health problems during periods of social distancing and isolation. Proactive efforts to engage vulnerable youth in outpatient treatment during periods of increased infectivity may help prevent increasing symptoms from reaching the point of crisis.

Adverse Childhood Experiences and alcohol use among U.S.-born and immigrant Latinx youth: the roles of social support and stress hormones.

The biobehavioral correlates of Adverse Childhood Experiences (ACEs) among Latinx youth have been strikingly understudied. The purpose of this study was to 1) examine the effects of T-ACEs (e.g., maltreatment, family dysfunction) and E-ACEs (e.g., family deportation, community violence) in alcohol use, 2) test whether social support moderated these associations and 3) explore whether ACEs and alcohol use were related via adrenocortical hormones (i.e., cortisol, dehydroepiandrosterone [DHEA]). A total of 100 Latinx youth, between the ages of 13 and 19, participated in this study (53% female). Community samples of United States (U.S.)-born (N = 54) and immigrant Latinx (N = 46) youth provided morning saliva samples and completed self-report questionnaires. Results highlighted that for immigrant youth, social support buffered the effects of E-ACEs on alcohol use, F(9,89)= 3.34, p = .01, R2 = .25. Although our mediation hypothesis was not supported, the direct effects of T-ACEs (ß = .25, t (94) = 2.21, p = .03) and E-ACES (ß = -.24, t (94) = -2.23, p = .03) on DHEA were significant for the entire sample. Preventing maltreatment and reducing community-level adversities seem critical for optimal child development, as exposure to these may increase alcohol use risk and affect HPA Axis functioning. Increasing extrafamilial support may be particularly salient for immigrant Latinx youth, as many experience extended immigration-related periods of separation from family members.