Session
Examining and Supporting Mental Health in Vulnerable Populations: A Roundtable
APHA 2022 Annual Meeting and Expo
Abstract
The Mental Wellness Index: an interactive zip code-based tool
APHA 2022 Annual Meeting and Expo
Background / Context:
The United States is facing a convergence of health crises: a mental health crisis and growing health disparities. There is no existing data tool that systematically captures selected factors that influence community mental wellness across the U.S. at the zip-code level in a way that is 1) consistent and comparable and 2) incorporates race-stratified data.
Description:
The Mental Wellness Index (MWI) is an open-sourced tool which allows users to examine measures that influence community-level mental wellness for the entire nation. The MWI’s organizing public health framework incorporates the three domains of Social Determinants of Health, Healthcare Access, and Health Status with two cross-cutting, dynamic factors of Community and Cultural Assets, and Structural Racism. The MWI is a composite of 28 measures from publicly available federal and non-federal datasets at the Zip Code Tabulation Area (ZCTA) level. Measures include nationally representative survey data, health outcomes data, and novel measure constructs identified in the literature as significant contributors to mental wellness. The MWI features an interactive heat map that enables state and local comparisons, community-specific data incorporation, and customized measure weighting. The MWI is available for the overall population and incorporates race-stratified data for Black populations as an initial priority sub-population.
Lessons Learned:
In creating the MWI as a tool for community advocacy and social justice, listening sessions with community key informants, subject matter experts, and federal and state stakeholders revealed that 1) a heat map approach provides a compelling depiction and easily visible distribution of facilitators and barriers, 2) national datasets need to capture positive health and well-being attributes that include assets, not just deficits, and 3) adopting features that allow user-modification (data-uploads, user-defined weights) is essential to creating a quantifiable score that resonates with a range of end users, including communities themselves.
Recommendations / Implications: The MWI is a transparent, quantitative index to supplement the expertise, knowledge, and lived experiences of community members and decision makers at community, state, and national levels. By quantifying community-level facilitators and barriers to mental wellness, the MWI can support the prioritization of equity in resource allocation and program and policy decisions.
Abstract
Rethinking screening: Are current perinatal depression standards effective in Black and immigrant communities?
APHA 2022 Annual Meeting and Expo
Background: Perinatal depression and anxiety disorders (PMAD) encompass mental health conditions diagnosed during pregnancy or within a year of delivery. The prevalence rates of postpartum depressive symptoms have been found to be higher among pregnant persons who are low-income, Black, Hispanic, from low- or middle-income countries, teenagers, and/or have experienced a high-risk or first-time birth. Screening for PMAD remains inconsistent, especially in lower income populations and communities of color. Furthermore, individuals from non-Western cultures may experience PMAD symptoms differently.
Methods: We conducted a cross-sectional study examining the positivity screen rate of PMAD among a predominantly Black and Afro-Caribbean population. The reported score based on the Edinburg Postpartum Depression screening (EPDS) was obtained from a database, which has 546 records of obstetric patients delivered in 2019.
Results: The EPDS is one of the most widely used screening tools with reported sensitivity values between 22.2% and 96%. The calculated positivity screen rate from the database was 1.83% for depression and 5.49% for depression and possible depression. The average score was a 2.81. A one sample T-test comparing the average EPDS score in our patient population to NYC’s average was statistically significant (p<0.001). This suggests possible undiagnosed depression.
Conclusions: Untreated PMAD are correlated with adverse outcomes in both birthing persons and their children. The long-term impacts include decreased parental/neonatal bonding, decreased infant cognitive and social-emotional development, and poorer health outcomes in both parent and child. Future studies aim to incorporate a participatory action research framework to understand how diverse patient populations define perinatal depression/anxiety.
Abstract
The impact of intersectional stigma on health outcomes among MSM living with HIV
APHA 2022 Annual Meeting and Expo
Background: Men who have sex with men (MSM) living with HIV are exposed to multiple layered stigmas, including but not limited to stigmas related to their HIV seropositive status and sexual and gender minority (SGM) identity. The synergistic effect of intersectional stigma may place MSM living with HIV at higher risk of adverse psychological and behavioral conditions, potentially exacerbating the progress of disproportionate clinical diseases. Instead of considering each stigmatized identity separately and simply summing the impacts, the stud examined the main effect and interactive effect of HIV-related stigma and SGM-related stigma on depression among MSM living with HIV.
Method: This cross-sectional survey study was designed to explore the effects of SGM status on HIV-related health outcomes among MSM living with HIV in Guangxi, China. Eligible participants were men aged 18-60 years; had a confirmed diagnosis of HIV/AIDS; and self-reported having sex with men in the last six months. HIV-related internalized stigma and SGM-related internalized stigma was assessed with 8 items derived from the Berger HIV Stigma Scale, and 14 items derived from the Chinese version internalized homophobia scale, respectively. HIV- and SGM-related stigma were treated as latent stigma constructs. Structural equation model in the Latent Moderated Structural Equations Approach was employed to examine the latent variable interaction.
Result: The main effect of HIV-related stigma on depression was significant (b=.24, 95% CI [.16-.31], p<.001), while the main effect of SGM-related stigma was not significant (b=.04, 95% CI [-.03-.12], p=.25). The interactive effect of HIV- and SGM-related stigma on depression was significant (b=.15, 95% CI [.04-.27], p=.01), indicating that the association between HIV-related stigma and depression was stronger with a greater level of SGM-related stigma. Simple slope tests suggested that when SGM-related stigma was one standard deviation below the mean, the association between HIV-related stigma and depression was significant but weaker (b=.18, 95% CI [.10-.27], p<.001), while when SGM-related stigma was one standard deviation above the mean, the association between HIV-related stigma and depression was stronger (b=.33, 95% CI [.22-.44], p<.001).
Conclusion: The study indicated that the relationship between HIV-related stigma and depression could be aggravated among MSM who reported higher SGM-related stigma, which may provide important contributions to understanding the well-being of stigmatized sexual and gender minorities by highlighting intersectional stigma as a mechanism of adverse health outcomes and health inequities between MSM and other MLWH in China.
Abstract
Cultural Adaptation of a CBT Group Intervention for Chinese Immigrant Mothers
APHA 2022 Annual Meeting and Expo
Background: Asian Americans are estimated to be the fastest growing ethnic group in the United States and are projected to become the largest immigrant group in the country by 2055. Parallel to this growth is a concern among healthcare practitioners regarding how to appropriately provide culturally relevant and accessible mental health support to Asian Americans and Asian immigrants. In the field of mental health treatment, there is a broad recognition that culture and context play a prominent role, and there is emerging evidence that culturally adapted interventions are beneficial for ethnic minority clients. Among individuals of Asian heritage, recent research suggests that mental health treatment effects are enhanced by tailoring to a particular Asian subgroup.
Description: This project involves the cultural adaptation and feasibility testing of an evidence-based treatment (EBT), previously shown to decrease depressive symptoms in several samples of English-speaking U.S. mothers. The treatment—an 8-week, group program that teaches cognitive behavioral therapy (CBT) skills for mood management—was culturally adapted for a new population of immigrant mothers of Chinese descent. The project is conducted through an academic-community partnership between treatment developers/researchers and a Federally Qualified Health Center (FQHC), whose mission is to provide high quality and affordable health care services to the underserved, with a focus on Asian Americans and Asian immigrants.
We describe systematic procedures undertaken to culturally adapt and translate the EBT, drawing from two established frameworks: (1) Formative Method for Adapting Psychotherapy (FMAP); (2) Cultural Adaptation Process Model (CAP). The adaptation entailed a phased, iterative process designed to increase ecological validity by involving consumers, community stakeholders, and collaborators. We present interim results from an ongoing pilot study, which examines key indicators of feasibility and acceptability of the culturally adapted treatment and its delivery via live-online/remote (telehealth) methods.
Lessons Learned/Recommendations: We discuss practical takeaways encountered in applying conceptual models for cultural adaptation to a specific treatment, population, and context. We examine challenges and successes pertaining to early phases of adapting and implementing mental health services for Chinese-immigrant communities. We present process-oriented recommendations for future cultural adaptations of existing mental health interventions for underserved, ethnic minority populations.
Abstract
Racial Disparities in Mental Health: An Internal Look
APHA 2022 Annual Meeting and Expo
Background: In 2020, the Summer of Racial Reckoning, events surrounding George Floyd’s murder, and known racial disparities in access to mental healthcare inspired faculty in a large, urban academic medical center to investigate if there were racial disparities in their outpatient pediatric psychiatry service.
Methods: In this descriptive quality improvement study, we analyzed data from 6-18 year-old patients seen by the psychiatry service in 2019. We used the Children’s Hospital Association Mental Health Disorder Codes to categorize ICD-10 codes and categorized psychotropic medications into 7 classes based on their primary psychiatric use. We compared the racial/ethnic distributions of the clinic and county populations. We used logistic regression to compare odds of having an internalizing or externalizing diagnosis by race/ethnicity and multiple regression to assess the relationship between the number of drug classes prescribed and race/ethnicity.
Results: Throughout 2019, there were 3,379 psychiatry patients. The patient population was 3% Asian, 17% Black, 29% Hispanic, 43% White, and 9% another race. The county population for the same age range was 6% Asian, 18% Black, 52% Hispanic, 21% White, and 3% another race. All racial groups had lower odds of an internalizing diagnosis when compared to White patients, while controlling for age. Specifically, Black patients had 68% (95% CI: .26-.40, p<.001), Hispanic patients had 18% (95% CI: .69-.99, p<.05), and Asian patients had 42% (95% CI: .37-.90, p<.01) lower odds of having an internalizing diagnosis. For externalizing conditions, Black patients had 49% higher odds (95% CI: 1.18-1.88, p<.01), while Hispanic patients had 35% (95% CI: .56-.79, p<.001) and Asian patients had 57% lower odds (95% CI: .27-.67, p<.001) of externalizing diagnoses when compared to White patients, controlling for age. Finally, White children had prescriptions in more drug classes than other race/ethnic groups while controlling for age and number of mental health and developmental diagnoses (F(6, 3372)=98.33, Adj. R-squared=0.1474, p<.001).
Conclusions: We found disproportionality in the patient population and disparities in internalizing and externalizing diagnoses and medication management. These results are an important first step to investigate racial inequities in pediatric psychiatric care and develop an equitable response to identified disparities.
Abstract
Mental health care perceptions, experiences, and needs of gender minority adults living in rural and urban counties in Nevada
APHA 2022 Annual Meeting and Expo
Introduction: Transgender, gender non-conforming, and gender diverse adults (referred to as “gender minority adults throughout) have unique health care needs. Measuring access and experience with mental health care perceptions, experiences, and needs is necessary in order to provide adequate and competent access to care and resources for this population.
Methods: In December of 2020, a convenience sample of 850 gender minority adults living and working in Nevada completed a comprehensive health needs assessment that included several indicators related to mental health care access, experience, and needs. Of the 850 participants who completed the assessment, 616 participants were from urban counties, 90 participants were from rural counties, 130 participants were from the Quad County region in Nevada.
Results: Across the state of Nevada, just under half (47.7%) of participants identified as a woman/transgender woman, 38.5% identified as a man/transgender man, and 13.8% identified as another gender identity, including gender queer, non-binary, and agender. In general, participants living in rural counties reported more barriers to access and more negative perceptions of care. For example, a lower percentage of participants from rural counties (38.0%) and the quad counties (44.4%) agreed that there was a place that they could receive mental health services that are sensitive to the needs of gender minority adults compared to participants from urban counties (55.8%). Similarly, the percentage of adults who usually or always get the social and emotional support they need was lower among participants in rural (54.9%) counties compared to those living in the quad counties (62.7%) and urban counties (66.7%).
Conclusions: The findings demonstrate that some inequality to access to mental health care exists between rural and urban communities. Continued efforts to provider education and training to providers about the unique health needs of the gender minority community is essential for fostering health equity.
Abstract
Beyond the Stigma: Community-based strategies to combat a mental health crisis among youth of color
APHA 2022 Annual Meeting and Expo
Increasing rates of mental health challenges among youth were exacerbated by the COVID-19 pandemic causing the nation’s leading experts to declare a national emergency. Key factors included widespread school closures, lack of socialization and increased isolation compounded by existing intergenerational poverty, structural racism and lack of resources. Among those most impacted were black youth demonstrated by the significant increase in suicide rates.
Innovative community-based interventions informed by the theory of change were implemented aimed to destigmatize mental health and build the capacity of local community leaders to better understand and proactively address youth mental health challenges. To do this, a community-based participatory approach was applied to co-design and implement a culturally tailored curriculum, trainings and workshops reaching nearly 700 diverse youth, families and community members throughout Central Brooklyn.
A well-designed evaluation using a mixed methods approach was conducted to assess the program’s impact. Data from key informant interviews, focus groups and a survey three (3) months post-project were collected and analyzed. Main findings among participants included improved knowledge and awareness, increased confidence discussing mental health, and increased knowledge of local resources and services.
Community-based interventions that are collaboratively designed and implemented are effective strategies to build and strengthen local support systems, destigmatize and proactively address youth mental health and wellness.
Abstract
Racial discrimination and fear during the pandemic
APHA 2022 Annual Meeting and Expo
Background: Asian Americans have been unfairly blamed for the spread of the novel coronavirus (COVID-19) pandemic and branded as “perpetual foreigners. Discrimination can lead to chronic health conditions and prevent social support and connectedness during this trying time. Discrimination may continue negatively affecting the current lived experiences of Asian Americans in various aspects of life, especially as this pandemic is still ongoing. There has been limited experimental research on the role of race in blame attribution regarding COVID-19 transmission and COVID-19-related mental distress (e.g., anxiety, fear). It is critical to conduct timely research to examine such discrimination and relevant factors to help further efforts to address this phenomenon during and post-pandemic. Therefore, the present study aimed to examine the effect of race on COVID-19 blame attribution, anxiety, and fear. Methods: In this experimental study, we use vignettes and images to manipulate three variables: the race of a character (Asian or White), vaccination status of the character (fully vaccinated or not fully vaccinated), and mask-wearing behavior of the character (mask or no mask). This yields eight conditions; each participant is shown a vignette with a corresponding image depending on the condition to which they are randomly assigned. We also assessed participants’ blame attribution regarding COVID-19 transmission and COVID-19-related anxiety and fear. Data collection is ongoing; 158 participants (mean age=27.44; age range=18-53; female=72.7%; Hispanic/Latinx=42.9%; White/European American=34.8%) have completed this study thus far. Results: Preliminary analyses showed that masked or fully vaccinated characters received significantly less blame than characters that were not masked or vaccinated, p<.05. The main effect of race on blame attribution was marginally significant, p=.067. Furthermore, non-White participants showed higher levels COVID-19-related fear compared to White participants, p=.013. Conclusions: Significant effects of masking behavior and vaccination status on blame attribution regarding COVID-19 transmission have been found. Preliminary data analyses also suggest that sociodemographic characteristics may play a role in individuals’ blame attribution and COVID-19-related mental distress. The findings may assist health professionals, researchers, and educators in developing and implementing targeted education for the general public or specific subpopulations to help alleviate the potential COVID-19-related discrimination and its negative effects.
Abstract
Criminal-legal involvement among US adults with serious psychological distress and differences by race/ethnicity
APHA 2022 Annual Meeting and Expo
Objective: To examine associations between criminal-legal involvement and serious psychological distress (SPD), and how these associations differ by racial/ethnic group.
Methods: Conducting a retrospective analysis of multiple cross-sections from the National Survey on Drug Use and Health (2015-2019) and using multivariable linear probability regression models, we assessed criminal-legal involvement (having a lifetime arrest or conviction of a crime, being on probation or parole in the past-year, or being on supervised release, or other conditional release from prison in the past year) among a nationally representative sample of non-institutionalized US adults, that were 18 years or older (n=214,505), with and without SPD.
Results: Adults with SPD had higher rates of criminal-legal involvement than adults without SPD (+4.1%, 95%CI: 3.3%-4.8%, p<0.001). The rate of criminal-legal involvement increased as psychological distress severity increased from mild (+3.2%, 95%CI: 2.6%-3.8%, p<0.00) to high (+7.2%, 95%CI: 6.4%-8.0%, p<0.001), relative to none. The risk of criminal-legal involvement for those with SPD was even greater for Black and Latinx adults compared with White adults (+1.8%, 95%CI: 0.1%-3.5%, p<0.05 and +3.2%, 95%CI: 1.3%-5.2%, p<0.01, respectively).
Conclusions: Rates of criminal-legal involvement are higher for adults with SPD. Efforts are needed to equitably triage individuals with acute mental health needs to timely psychiatric care as opposed to carceral settings. State and federal governments should consider increased investment in collaborative models of care that commingle resources from mental health and law enforcement organizations to prevent the unnecessary incarceration of individuals experiencing mental health crises and increase their likelihood of obtaining community-based treatment.
Abstract
“Stop! I like you gordita!” The plight of Latinas striving to attain a healthy weight
APHA 2022 Annual Meeting and Expo
Background/context: Latino women (Latinas) have some of the highest rates of obesity and are less likely to be successful when enrolled in weight management programs (WMPs). Many Latinas experience resistance by their spouses to their weight loss plans resulting in hostile home environments. Mental health support is critical to help address this barrier to weight management, but Latinas have less access to such support, especially during the COVID-19 pandemic. In this study, community health workers (CHWs) incorporated Community Resiliency Model (CRM) stress-management techniques in a WMP to help the women deal with these pressures.
Description: Latinas enrolled in an eight-week lifestyle/WMP held via zoom received weekly support calls and sessions teaching them stress-reduction skills. Participants completed surveys (demographics, mental health) and biometric measurements at baseline and immediately following the intervention. A focus group discussion was conducted with participants who encountered constant opposition from their mates. Discussions were audio-recorded, transcribed verbatim, coded and themed.
Lessons learned: Participants’ spouses did not like them losing weight and preferred them “chubby , refusing to acknowledge their need for health improvements and opposing their progress, sometimes even resorting to intimidation and emotional abuse. Despite this, many women lost weight and attributed weekly calls, the support of CHWs and of other women in the program, and CRM skills, to their ability to succeed despite the hostile and unsupportive environment they were facing at home.
Recommendations/implications: incorporating stress-reduction skills in WMPs for Latinas may provide them the type of support they need to increase their success in WMP, in spite of opposition and lack of support from the women’s partners. The women also felt that their partners should be more informed about the need for, and the changes necessary in, changing one’s lifestyle to be more healthy. Future interventions should consider providing separate but parallel programming for their spouses to help support Latinas attempting to reduce their risks of chronic diseases. Long-term follow-up should determine whether or not results are sustainable.