Treatment Decision-Making Preferences of Older Depressed Minority Primary Care Patients.

Little research examined the decision-making preferences of older, racially and ethnically diverse minority patients with untreated depression. The study's aims were to identify decision-making preferences and the characteristics associated with a more active preference in the decision-making process for general medical and depression treatment decisions. We assessed the preferred involvement in making general medical and depression treatment decisions of 201 older primary care patients with untreated depression. Linear regressions examined the association of sociodemographic and clinical characteristics with decision-making preference for both decision types. Majority of patients preferred shared decision-making for general medical and depression treatments. Female gender was associated with a preference for active decision-making for depression treatment. For this sample older depressed patients preferred sharing the decision-making responsibilities with physicians. To improve communication and the initiation and adherence to mental health care, physicians must consider older, minority patients' preferences for involvement in the decision-making process.

Everyday discrimination and risk for clinical depression among a community sample of undocumented Latino immigrants in the United States.

Undocumented Latino immigrants in the United States face pervasive discrimination that increases their risk for experiencing depressive symptomatology. Although research has linked discrimination to depressive symptoms more broadly, we do not know whether everyday forms of discrimination are associated with elevated risk for clinical depression among this population. Using data collected from a community sample of undocumented Latino immigrants during the 2015 Trump campaign, we found that everyday discrimination was associated with significantly higher odds of being classified as higher risk for clinical depression. Findings indicate everyday discrimination as a risk factor for clinical depression among undocumented Latino immigrants.

Psychotherapies for Generalized Anxiety Disorder in Adults: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials.

Importance: Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified. Objective: To use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD. Data Sources: MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD. Study Selection: RCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion. Data Extraction and Synthesis: This study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results. Main Outcomes and Measures: Eight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated. Results: Data from 65 RCTs were included. Effect size estimates on data from 5048 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, -0.76 [95% CI, -1.15 to -0.36]; certainty, moderate), CBT (SMD, -0.74 [95% CI, -1.09 to -0.38]; certainty, moderate), and relaxation therapy (SMD, -0.59 [95% CI, -1.07 to -0.11]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.04 [95% CI, 0.64-1.67] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, -0.47; 95% CI, -1.18 to 0.23). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, -0.60; 95% CI, -0.99 to -0.21). Conclusions and Relevance: Given the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.

Understanding the disparate PTSD prevalence for U.S. and Mexico via social comparison effect types that inform perception of trauma difficulty.

OBJECTIVE: The United States (U.S.) and Mexico have vastly different lifetime prevalence of posttraumatic stress disorder (PTSD), despite similarly high rates of trauma exposure. To explain this disparate prevalence, we created the Perception of Trauma Difficulty Assessment Tool (PTDAT) to identify four social comparison effect types that inform perception of trauma difficulty (i.e., Upward Assimilation Effect, Downward Assimilation Effect, Downward Contrast Effect, Upward Contrast Effect) to determine whether there was a dominant effect type associated with respondents' perception of coping with trauma difficulty for a sample of U.S. Americans and Mexicans. We identified sociodemographic characteristics and the degree of trauma exposure that associated with PTSD, PTSD symptom severity, and functional impairment for each effect type. METHOD: This was a cross-sectional study of a sample of 898 U.S. Americans and 902 Mexicans. A chi-square test determined whether there was a dominant effect type for each national group. For each effect type, multiple regression analyses identified predictors of PTSD, PTSD symptom severity, and functional impairment. RESULTS: For U.S. Americans, trauma exposure was a predictor for PTSD for effect type Upward Contrast Effect, when respondents contrasted from an excellent appraisal of most people by making a poor self-appraisal. For Mexicans, all effect types had predictors for PTSD, with trauma exposure being a predictor for all. CONCLUSIONS: These preliminary findings provide support to consider patients' social context as it informs their perception of their capacity to cope, which may maintain PTSD. Future research is needed to determine whether perceptions of trauma difficulty are stable over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).