Objectives: This study assessed serious psychological distress (SPD), unmet mental health treatment needs, and help-seeking behaviors among Asian Americans (AAs) in New York City (NYC), examining their associations with psychosocial factors. We also identified barriers to mental health care and help-seeking sources.

Methods: The 2023 Neighborhood Wellness Survey data, a representative sample of NYC adults, were analyzed. SPD was assessed using the Kessler Psychological Distress Scale (K6≥13). Multivariable logistic regression using backward stepwise selection, adjusted for demographics, examined associations between psychosocial factors, SPD, unmet needs, and help-seeking behaviors.

Results: Among 6,648 AAs, the weighted and age-adjusted prevalence of SPD, unmet needs, and help-seeking were 7.4%, 9.2%, and 39.1%, respectively. Racial/ethnic discrimination and social isolation were linked to higher odds of SPD and unmet needs, and greater probabilities of help-seeking. Financial strain was associated with higher odds of SPD; stop/search/questioning by police was associated with higher odds of unmet needs; and witnessing neighborhood violence was associated with higher likelihood of help-seeking. Intimate partner violence and higher psychological distress were associated with higher odds of unmet needs and help-seeking. Main barriers to mental health care among those with unmet needs were self-reliance (51.1%), cost (46.4%), and unawareness of available resources (41.7%). Family/friends (30.0%) were the primary support sources.

Conclusions: AAs with higher levels of SPD reported higher unmet needs and less help-seeking behaviors. Enhancing mental health literacy and awareness of available resources, along with improving access to affordable care is crucial, particularly for AAs facing violence, racial/ethnic discrimination, and police interactions.

Introduction: Psychotic symptoms, including delusions, are prevalent in Alzheimer’s disease and depression, where they are associated with poorer outcomes. Cognitive Load Theory posits that depression impairs cognitive function by increasing rumination and negative thought patterns, depleting cognitive resources. The role of delusions as a mediator between depression and cognitive outcomes remains unexplored.

Methods: We analyzed National Alzheimer’s Coordinating Center data (2015–2024; n=14,588) to examine whether paranoid delusions mediate the relationship between depression severity and cognitive outcomes. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). Depression severity was proxy-reported via the Neuropsychiatric Inventory Questionnaire, and delusions were self-reported based on beliefs about others stealing or causing harm. Structural equation modeling estimated direct, indirect, and total effects, adjusting for sex, age, race, education, BMI, living arrangement, independence, residence type, alcohol and tobacco use, diabetes, heart failure, hypertension, and stroke.

Results: Participants had a mean age of 69.3 years, and 57.4% were female. The average MoCA score was 23 (median=24, SD=5.8). Overall, 26% had depressive symptoms, and 4.6% exhibited delusions. Delusion prevalence increased with depression severity: 1.3% in those without depressive symptoms, 7.7% in mild, 14.5% in moderate, and 28% in severe depression. Depression severity was significantly associated with delusions (β=0.092, p<0.001), poor cognitive outcomes (β=−0.79, p<0.001), and indirectly via delusional severity (β_indirect=−0.188, p<0.001). Delusions mediated 19.3% of the total effect of depression on cognitive outcomes.

Conclusions: Findings highlight the need for integrated screening, early intervention, and prospective studies to address depression and psychosis in improving cognitive outcomes among older adults.

Background: There is growing recognition that those in high-stakes occupations are at risk of exposure to potentially morally injurious events (PMIEs) and moral injury, yet research with first responders has been scarce.

Objective: This study aimed to understand the types of PMIEs and moral injury symptoms reported in an occupational group of first responders, and to assess the prevalence of moral injury and association with other mental health symptoms.

Methods: Firefighters, EMTs, and paramedics working for a large urban Fire Department in California were surveyed using the validated Moral Injury and Distress Scale (MIDS) and brief symptom screening measures for PTSD, depression, anxiety, alcohol use and burnout. We calculated item frequencies for all items and conducted correlation and reliability analyses for moral injury and other mental health symptoms.

Results: First responders that participated in the survey (n = 292) were predominantly male (73%), White (61%), and heterosexual (88%); nearly half worked as EMTs or paramedics (45%). Participants endorsed a range of PMIEs. Average MIDS symptom score was 16 (SD = 12), and 19% were considered to have clinically meaningful moral injury (a MIDS symptom score of 27 or greater). MIDS symptom score was strongly correlated with each of the mental health measures (r= 0.49-0.59), with the exception of alcohol use (r=.08).

Conclusion: This study, the first to examine rates of exposure to PMIEs and moral injury symptoms among first responders in the fire service, including paramedics, EMTs, and firefighters, fills a critical knowledge gap.