Social Identities of Persons With Schizophrenia and Social Functioning: Individual and Family Caregiver Perspectives.

ABSTRACT: We apply social identity theory and self-categorization theory to examine the role of social identities in relation to the recovery of persons with schizophrenia. We assess whether illness-based and non-illness-based identities held by both those with schizophrenia and their caregivers explain additional variance in social functioning in persons with schizophrenia beyond the previously established predictors of negative symptoms and theory of mind. Sixty Mexican-origin adults diagnosed with schizophrenia and their family caregivers were obtained through an outpatient mental health clinic located in either Los Angeles, CA, or in Puebla, Mexico. A three-step hierarchical regression indicated that identity endorsements, from both the perspective of the person with schizophrenia and their caregiver, and negative symptomatology are significant independent predictors of social functioning. Specifically, greater endorsement of nonillness identities both for the person with schizophrenia and also their caregiver is associated with higher social functioning. Illness identity plays an important role in the path to recovery.

Towards the sustainability of information campaigns: training Promotores to increase the psychosis literacy of Spanish-speaking communities.

PURPOSE: To assess the acceptability and efficacy of training community health workers (promotores) in Mexico to both recognize psychosis and to teach others to recognize psychosis. METHODS: Two studies were carried out utilizing a single-group design. In Study 1, promotores watched a DVD-based psychosis literacy training. In Study 2, promotores were trained to administer a flip-chart version of the program and they then administered it to community residents. RESULTS: Significant increases in the post-training assessment of psychosis literacy were observed. CONCLUSION: Promotores can be an important resource in identifying psychosis early and enhancing the sustainability of psychosis literacy information campaigns.

The duration of untreated psychosis among U.S. Latinxs and social and clinical correlates.

Purpose: This study (a) documents the duration of untreated psychosis (DUP) and (b) examines both social and clinical correlates of DUP in a sample of U.S. Latinxs with first-episode psychosis (FEP). Methods: Data were collected for a longitudinal study evaluating a community education campaign to help primarily Spanish-speaking Latinxs recognize psychotic symptoms and reduce the DUP, or the delay to first prescribed antipsychotic medication after the onset of psychotic symptoms. Social and clinical variables were assessed at first treatment presentation. A sequential hierarchical regression was conducted using √DUP to identify independent predictors of the DUP. A structural equation model was used to explore the association between DUP predictors, DUP, and clinical and social correlates. Results: In a sample of 122 Latinxs with FEP, the median DUP was 39 weeks (M = 137.78, SD = 220.31; IQR = 160.39-5.57). For the full sample, being an immigrant and having self-reported relatively poor English-speaking proficiency and self-reported strong Spanish-speaking proficiency were related to a longer delay to first prescribed medication after psychosis onset. For the immigrant subgroup, being older at the time of migration was related to a longer delay. Self-reported English-speaking proficiency emerged as an independent predictor of the DUP. Although the DUP was not related to symptomatology, it was associated with poorer social functioning. Low self-reported English-speaking ability is associated with poorer social functioning via the DUP. Conclusion: Latinxs with limited English language skills are especially at high risk for experiencing prolonged delays to care and poor social functioning. Intervention efforts to reduce the delay in Latinx communities should pay particular attention to this subgroup.

Toward reducing the duration of untreated psychosis in a Latinx community.

OBJECTIVE: To carry out and evaluate a communications campaign (La CLAve) to reduce the duration of untreated psychosis (DUP) in a U.S. Latinx community. METHOD: We employed evidence-based messaging in multiple media outlets. We recruited 132 Latinxs with first-episode psychosis (FEP) and caregivers seeking mental health care within a high-density Latinx community. We evaluated the campaign's dissemination, the extent to which the community received the campaign message, and the campaign outcome. We tested whether DUP (number of weeks) changed across three time periods (16-month baseline, 2-year campaign, and 16-month postcampaign) and whether participants' language background (primarily Spanish speaking or English speaking) moderated change in DUP. RESULTS: The campaign was disseminated widely. During the height of the campaign over a 1-year period, our team distributed 22,039 brochures and performed 740 workshops. The campaign message was received by the community as noted for example by increases in the number of unduplicated weekly calls to the campaign's 1-800 number. Applying square root transformations to DUP, we found a significant main effect for language background but not for campaign period nor their interaction. The unadjusted mean DUP for Spanish-speaking persons with FEP was more than twice as high as the mean DUP for English-speaking persons with FEP. CONCLUSION: Spanish-speaking Latinxs with FEP are especially in need of early psychosis treatment. The campaign reached the community but additional steps are needed to reduce treatment delay. Greater attention is needed to increase access to early intervention services for communities of color. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Defining and assessing key behavioral indicators of the Shifting Cultural Lenses model of cultural competence.

Models of cultural competence highlight the importance of the sociocultural world that is inhabited by patients, and the question of how best to integrate sociocultural factors into clinical assessment and intervention. However, one significant limitation of such approaches is that they leave unclear what type of in-session therapist behaviors actually reflect cultural competence. We draw on the Shifting Cultural Lenses model to operationalize culturally competent in-session behaviors. We argue that a key component of cultural competence is the collaborative relationship between therapists and patients, in which therapists shift between their own cultural lenses and those of their clients, as they co-construct shared narratives together. Accordingly, we propose that culturally competent therapist behaviors include accessing the client's views, explicitly presenting their own views as mental health care professionals, and working towards a shared understanding. We further specify the latter set of behaviors as including the practitioner's integration of the patient's view, their encouragement of the patient to consider their professional view, and the negotiation of a shared view. We developed a coding system to identify these therapist behaviors and examined the reliability of raters across 11 couple and 4 individual therapy sessions. We assessed whether the behavioral codes varied in expected ways over the first 3 sessions of 2 therapists' couple therapy as well. Operationalizing the behavioral indicators of the Shifting Cultural Lenses model opens the door to the integration of both process- and content-oriented approaches to cultural competence.

Lessons Learned in Clinical Research Recruitment of Immigrants and Minority Group Members with First-Episode Psychosis.

Recruitment of immigrants and racial and ethnic minorities with first-episode psychosis (FEP) for research studies presents numerous challenges. We describe methods used to recruit 43 U.S. Latinos with FEP and their family caregivers (n = 41) participating in a study to reduce duration of untreated psychosis. A key challenge was that patients were not continuing treatment at an outpatient clinic, as initially expected. To facilitate identification of patients prior to outpatient care, we collaborated with clinic and hospital administrators. Many patients and families were grappling with the aftermath of a hospitalization or adjusting to a diagnosis of a serious mental illness. A considerable amount of time was devoted to addressing participants' concerns and when possible, facilitating needed services. Our experience underscores the importance of establishing long-term relationships through multiple contacts with patients, families, and stakeholders to address recruitment barriers among underserved groups with FEP.

Community determinants of Latinos' use of mental health services.

OBJECTIVE: This study examined the role of community in understanding Latino adults' (18-64 years of age) use of community mental health services. METHODS: Service utilization data from the Los Angeles County Department of Mental Health were analyzed from 2003 in two service provider areas. Demographic data, including foreign-born status, language, education, and income for the Latino population, were obtained from the 2000 U.S. Census. The study sample consisted of 4,133 consumers of mental health services in 413 census tracts from an established immigrant community and 4,156 consumers of mental health services in 204 census tracts from a recent immigrant community. Negative binomial regression analyses were conducted to examine associations between locales, community characteristics, and use of services. RESULTS: Community of residence and foreign-born status were significantly associated with Latinos' service use. Latinos from the established immigrant community were more likely to use services than Latinos from the recent immigrant community. Across both communities, census tracts with a higher percentage of foreign-born noncitizen residents showed lower service use. Within the established immigrant community, as income levels increased there was little change in utilization. In contrast, in the recent immigrant community, as income levels increased utilization rates increased as well (beta=.001, p<.001). CONCLUSIONS: The findings point out the importance of locale and community determinants in understanding Latinos' use of public mental health services.

Norm comparisons of the Spanish-language and English-language WAIS-III: Implications for clinical assessment and test adaptation.

This study provides a systematic comparison of the norms of 3 Spanish-language Wechsler Adult Intelligence Scales (WAIS-III) batteries from Mexico, Spain, and Puerto Rico, and the U.S. English-language WAIS-III battery. Specifically, we examined the performance of the 4 normative samples on 2 identical subtests (Digit Span and Digit Symbol-Coding) and 1 nearly identical subtest (Block Design). We found that across most age groups the means associated with the Spanish-language versions of the 3 subtests were lower than the means of the U.S. English-language version. In addition, we found that for most age ranges the Mexican subsamples scored lower than the Spanish subsamples. Lower educational levels of Mexicans and Spaniards compared to U.S. residents are consistent with the general pattern of findings. These results suggest that because of the different norms, applying any of the 3 Spanish-language versions of the WAIS-III generally risks underestimating deficits, and that applying the English-language WAIS-III norms risks overestimating deficits of Spanish-speaking adults. There were a few exceptions to these general patterns. For example, the Mexican subsample ages 70 years and above performed significantly better on the Digit Symbol and Block Design than did the U.S. and Spanish subsamples. Implications for the clinical assessment of U.S. Spanish-speaking Latinos and test adaptation are discussed with an eye toward improving the clinical care for this community. (PsycINFO Database Record

Ethnicity, expressed emotion, attributions, and course of schizophrenia: family warmth matters.

The authors examined the role of family factors and the course of schizophrenia by carrying out additional assessments and analyses in 2 previously published studies of Mexican American and Anglo American patients and families. The authors found partial support for an attributional model of relapse for families who are low in emotional overinvolvement. Attributions of control, criticism, and warmth together marginally predicted relapse. The data also indicated that for Mexican Americans, family warmth is a significant protective factor, whereas for Anglo Americans, family criticism is a significant risk factor. These findings suggest that the sociocultural context shapes the pathways by which family processes are related to the course of illness. Moreover, the warmth findings suggest that families may contribute to preventing relapse.

A research agenda to improve the accessibility and quality of mental health care for Latinos.

Given the persistent underutilization of mental health services by Latino persons, the mental health research agenda for this population should be shaped by a single practical issue: how to get quality mental health services to Latino consumers and their families. To address this issue, studies are needed that are longitudinal in design, that assess social factors in Latino communities, and that evaluate new and existing interventions. Collaborative investigations that draw on multidisciplinary perspectives and that are informed by multiple stakeholders (service providers, consumers, and policy makers) will increase the likelihood that such research has an impact on existing services. Moreover, careful planning of dissemination and implementation of research findings will enhance the influence that these findings have. A research agenda focused on questions that can be directly translated into accessible high-quality mental health care is needed to address the mental health needs of the nation's growing Latino communities.

The expression of depression in Asian Americans and European Americans.

Past studies of the expression of depression in people of Asian descent have not considered whether observed ethnic differences in somatization or psychologization are a function of differences in the expression of the disorder or of group differences in the degree of depressive symptomatology. In the present study, we carried out χ(2) and Item Response Theory (IRT) analyses to examine ethnic differences in symptoms of Major Depressive Disorder in a nationally representative community sample of noninstitutionalized Asian Americans (n = 310) and European Americans (n = 1,763). IRT analyses were included because they can help discern whether there are differences in the expression of depressive symptoms, regardless of ethnic differences in the degree of depressive symptomatology. In general, although we found that Asian Americans have lower rates of depression than European Americans, when examining specific symptoms, there were more similarities (i.e., symptoms with no ethnic differences) than differences. An examination of the differences using both χ(2) and IRT analyses revealed that when there were differences, Asian Americans were less likely to endorse specific somatic and psychological symptoms than European Americans, even when matched in degree of depressive symptomatology. Together, these community-based findings indicate that depression among Asian Americans is more similar than different to that of European Americans. When differences do occur, they are not an artifact of the degree of depressive symptomatology but instead a true difference in the expression of the disorder, specifically a lesser likelihood of expressing specific somatic and psychological symptoms in Asian Americans compared with European Americans.

Toward the early recognition of psychosis among Spanish-speaking adults on both sides of the U.S.-Mexico border.

Lack of knowledge about psychosis, a condition oftentimes associated with serious mental illness, may contribute to disparities in mental health service use. Psychoeducational interventions aimed at improving psychosis literacy have attracted significant attention recently, but few have focused on the growing numbers of ethnic and linguistic minorities in countries with large immigrant populations, such as the United States. This paper reports on 2 studies designed to evaluate the effectiveness of a DVD version of La CLAve, a psychoeducational program that aims to increase psychosis literacy among Spanish-speaking Latinos. Study 1 is a randomized control study to test directly the efficacy of a DVD version of La CLAve for Spanish speakers across a range of educational backgrounds. Fifty-seven medical students and 68 community residents from Mexico were randomly assigned to view either La CLAve or a psychoeducational program of similar length regarding caregiving. Study 2 employed a single-subjects design to evaluate the effectiveness of the DVD presentation when administered by a community mental health educator. Ninety-three Spanish-speakers from San Diego, California completed assessments both before and after receiving the DVD training. Results from these 2 studies indicate that the DVD version of La CLAve is capable of producing a range of psychosis literacy gains for Spanish-speakers in both the United States and Mexico, even when administered by a community worker. Thus, it has potential for widespread dissemination and use among underserved communities of Spanish-speaking Latinos and for minimizing disparities in mental health service use, particularly as it relates to insufficient knowledge of psychosis.

Social processes underlying acculturation: a study of drinking behavior among immigrant Latinos in the Northeast United States.

STUDY GOALS: To identify social processes that underlie the relationship of acculturation and heavy drinking behavior among Latinos who have immigrated to the Northeast United States of America (USA). METHOD: Community-based recruitment strategies were used to identify 36 Latinos who reported heavy drinking. Participants were 48% female, 23 to 56 years of age, and were from South or Central America (39%) and the Caribbean (24%). Six focus groups were audiotaped and transcribed. RESULTS: Content analyses indicated that the social context of drinking is different in the participants' countries of origin and in the United States. In Latin America, alcohol consumption was part of everyday living (being with friends and family). Nostalgia and isolation reflected some of the reasons for drinking in the USA. Results suggest that drinking in the Northeastern United States (US) is related to Latinos' adaptation to a new sociocultural environment. Knowledge of the shifting social contexts of drinking can inform health interventions.

Teaching culturally informed psychological assessment: conceptual issues and demonstrations.

Multicultural assessment requires a strong conceptual foundation to address the complex and dynamic nature of culture. I present 3 conceptual issues as well as the demonstrations or exercises that I use to teach these concepts to students in a doctoral program of clinical psychology. The first conceptual issue is that multicultural assessment requires a solid foundation in traditional assessment theory and methods. Second, culturally informed assessors specify and test what about the social and cultural world matters to avoid making inferences based on group labels associated with ethnicity or race. Third, culturally responsive assessors must formulate and test both culture-specific and alternative (impairment or dysfunction) hypotheses, which refers to shifting cultural lenses (Kleinman & Kleinman, 1991). I then review exercises and demonstrations to illustrate these conceptual ideas. My aim is to help instructors guide students of assessment toward integrating a process-oriented way of thinking about culture, one that promotes a critical approach to our understanding of the role of culture in human behavior and its assessment.

Reflections on the Surgeon General's Report on Mental Health, Culture, Race, and Ethnicity.

The main goal of this paper is to evaluate the Supplement to the Surgeon General's Report on Mental Health, with an eye toward informing future efforts to prevent and treat mental illness among racial and ethnic minorities. I first briefly discuss the historical background of the Supplement. I then present its strengths, which include the authority and visibility of the Office of the Surgeon General, the organization of the report by racial/ethnic group, the examination of the social and historical context of each of the racial/ethnic groups, and the emphasis on science. Last, I identify three major tensions within the Supplement, focusing on groups versus cultural processes, situating culture within individuals or social worlds, and examining differences between minority groups and whites versus examining conceptually informed processes. The Supplement makes a significant contribution to advancing our understanding of the mental health of racial and ethnic minority groups. The actions that follow (or don't follow), however, will determine the import of this document.