The American journal of orthopsychiatry最新文献

Epistemic and social injustice occurs when therapists implicitly and explicitly impose personal, professional, and institutional power onto clients, and dismiss client experience which is embedded in cultural identity and social location. Despite research evidence highlighting the positive impact of broaching in cross-cultural psychotherapy, questioning the rationale and barriers to broaching is paramount. Drawing from scholarship on epistemic in/justice, we argue that the very existence of marginalization of a client in the life and in the therapy exemplifies epistemic injustice. Epistemic injustice bears two types-testimonial and hermeneutic injustice. When clients' experience of marginalization is decentered or discredited, testimonial injustice occurs. By not providing clients with opportunities to share this experience in therapy, there is little shared understanding cultivated in the cross-cultural dyad, contributing to hermeneutic injustice. Thus, epistemic in/justice requires broaching not as an option but as an integral part of therapy. Synthesizing scholarship in cultural competence, humility, intersectionality, and antioppressive practice, we define broaching as the therapist's tasks for intentional understanding of the cultural aspects and systemic oppression in the client's life-in-context. A therapist who is broaching is aware of cross-cultural similarities and differences and the workings of power in the therapy dyad and makes deliberate efforts to demonstrate this understanding to the client which includes explicit discussion in sessions. We propose pathways, dimensions, foci, and timing of ongoing broaching and bridging cross-cultural encounters in therapy. Lastly, we discuss the implications of broaching and bridging while situating this work as promoting epistemic and social justice in therapy encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychotherapy research has shown evidence of positive impacts of broaching cultural differences on the therapy process and outcomes. This increasing body of research also highlights a need to clarify clinical skills of broaching and subsequent bridging to guide therapists in cross-cultural psychotherapy. In articulating microskills to promote broaching and bridging, we critically reflect on cautions against slipping into a technocratic approach that is a mechanical prescriptive skill-based guideline. Using critical theory on epistemic injustice, we examine how to integrate cultural aspects into therapy conversations that are aligned with epistemic and social justice. Drawing from sociolinguistic and critical scholars on language and power, we interrogate epistemic domains of knowledge and power during broaching and bridging in everyday clinical talks. We focus on theorizing and illustrating "how-to-do" broaching and bridging to guide therapists in everyday cross-cultural encounters with selected microskills such as a therapist's self-disclosure, cultural immediacy, and reflective listening. Using case illustrations with detailed transcripts for each skill, we interrogate how a client's epistemic status can be managed in the moment-to-moment conversation between a client and therapist in the continuum from dismissing to deepening the client's experience. A series of detailed case illustrations are intended to guide therapists' self-reflection and/or train therapists toward meaningful cross-cultural work. Lastly, we discuss the implications of broaching and bridging while situating this work as promoting epistemic justice in cross-cultural therapy encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Resilience and empowerment are both strengths-based processes, which, while sharing commonalities, describe different goals, actions, and outcomes-one aimed at status quo; the other at status quake. The Transconceptual Model of Empowerment and Resilience (TMER; Brodsky & Cattaneo, 2013) outlines these similarities and differences in order to uncover the circumstances that lead to one or the other process. This study utilized TMER to explore resilience and empowerment in qualitative interviews of 99 first- and second-generation Latinx, Moroccan, and Albanian immigrants in the U.S. and Italy. Setting-based, macrolevel political and social issues, along with generational and locale variations, provided contextual counterpoints in participants' reported risks, resources, goals, actions, and outcomes. Individually held resources were the most common and were found to support resilience and empowerment actions. All participants, regardless of generation, locale, or context, reported more individually focused resilient actions than empowering ones. This study illustrates the difference between goals and actions that are resilient, thus maintaining the status quo, and empowerment goals and actions, which disrupt the status quo and thus are "status quake." It also adds to the evidence of TMER's contribution to understanding the processes by which immigrants' experiences, resources, and goals lead to resilience and empowering actions. Findings suggest how stronger coalitions might be built across community membership, which could use shared resources to address common concerns to benefit all. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The coronavirus disease (COVID-19) pandemic has had a collateral effect on marginalized populations, including individuals in the sex trade (IST). In addition, the literature of the past year has documented a significant impact of the pandemic on healthcare providers. However, there is a lack of research on the new challenges and existing hardships facing aid organizations working with IST populations. This naturalistic qualitative study used semi-structured interviews with 33 IST aid organization workers in Israel between May and July 2020 to capture their perceptions and experiences within broader social-relational contexts. Data analysis revealed that the pandemic impacted three different arenas: The assistance systems and the quality of care; The relationship between aid organizations and state authorities; and The intraorganizational and interorganizational relationship. These findings add to the knowledge about the impacts of the COVID-19 pandemic on aid organizations, particularly the need for greater collaboration between aid organizations during health crises and governmental support for these organizations. In addition, the study highlights the opportunities that a global and local health crisis can create advancing new knowledge and practices used by aid organizations in their work to assist IST populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Suicide is an urgent public health problem. The purpose of this study was to determine if adverse childhood experiences (ACEs) increased the risk for suicide ideations and attempts approximately 22 years later, and if sexual victimization (SV) in adulthood mediated these associations. Prospective data from a nationally representative sample of 10,914 participants in the National Longitudinal Study of Adolescent to Adult Health were used to test direct associations of ACEs (physical, sexual, and emotional abuse, neglect, family history of suicide attempts, and parental death, alcoholism, and incarceration) with suicide ideation and attempts and their indirect effects through sexual victimization in adulthood. All but one ACE significantly predicted increased odds of making a suicide attempt. Physical, sexual, and emotional abuse as well as family history of suicide attempts and parental incarceration predicted seriously considering suicide. All forms of childhood abuse and family history of suicide attempts predicted increased odds of sexual victimization. In multivariate longitudinal models controlling for age, race, and gender, the odds of seriously considering suicide and making a suicide attempt increased as the number of ACEs increased. Experiencing two or more ACEs also was associated with an increased likelihood of experiencing sexual victimization in adulthood, which in turn mediated the effects of ACEs on suicide ideation but not suicide attempts. Findings indicate that reducing ACEs is an important strategy for suicide prevention not only due to ACEs' direct association with suicide ideation and attempts, but also due to their indirect association via subsequent sexual victimization. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A recurrent observation in poverty research is the association between many attendant stress factors and the high incidence of maternal distress. In this study, we reason that such risk factors do not preclude mothers from possessing adaptive capacities, through perceived parenting efficacy and family hardiness, as buffers against two common distress sources in low socioeconomic status (SES) households-perceived children's emotional and behavioral problems, and family's economic hardship. Using classification and regression tree analysis, we examined the moderating roles of these maternal factors in emotional distress with 513 Singaporean mothers of elementary school-age children on government financial scheme. The study affirmed that this low-resource population is not homogeneous in their perceived levels of distress and adaptive resources. These factors moderated mothers' distress along different pathways. Parenting efficacy emerged as the most important predictor across different maternal distress levels. Perceived family hardiness behaved in a unique way, evident only with mothers who reported moderate-severe distress levels. Almost half the respondents reported normal-mild distress levels. Economic hardship did not emerge as a significant predictor. The findings reiterate the usefulness of attending to both situation-specific personal efficacy beliefs and trait-like family hardiness in their potential values to buffer mothers living under economic strain. Research and practice implications were identified. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Major depressive episode (MDE) and alcohol use disorder (AUD) often co-occur and the presence of one doubles the risk for the other, which brings disabling social and health consequences. Increasing evidence supports integrated treatment of co-occurring MDE and AUD, including combined medications for both conditions as well as behavioral therapies. While young adults suffer disproportionately from these co-occurring conditions, little is known about their treatment utilization. Using nationally representative data from the National Survey on Drug Use and Health (NSDUH), 2011-2019, this study examined temporal trends and disparities in the prevalence and treatment use for co-occurring MDE and AUD among young adults aged 18-25 in the U.S. Across the survey time, an increasing trend of MDE was revealed, whereas the prevalence of AUD decreased significantly. Meanwhile, the prevalence of co-occurring MDE and AUD remained steady. Among young adults with co-occurring MDE and AUD, while treatment use for MDE increased from 2011 to 2019, treatment use for AUD and co-occurring conditions remained stable. Observed widening disparities in co-occurring treatments utilized among young adults ages 18-25 are further perpetuated by gender, emerging adulthood, and socioeconomic status, warranting immediate action. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

National epidemiological data indicate that nearly 4 in 10 victims of recent sexual assaults have physical, cognitive/developmental, or mental health disabilities, which can make navigating postassault help seeking more challenging. To streamline services, many communities have created sexual assault nurse examiner (SANE) programs for comprehensive health care, crisis intervention, medical forensic evidence collection, victim advocacy, and legal referrals. SANE programs are recommended as the national best practice for postassault care, but there is virtually no U.S.-based research on whether survivors with disabilities seek these services. The present study sought to identify the disclosure and referral pathways that successfully connected sexual assault survivors with disabilities to SANE programs for postassault care. Forensic nurses in one midwestern state recorded information about all adult sexual assault patients (N = 755) who sought care during a 9-month window of data collection. Survivors with disabilities were significantly less likely than those who did not have disabilities to disclose to informal support providers (e.g., family, friends) and those individuals were unlikely to suggest to survivors with disabilities that they seek postassault health care. Survivors with disabilities were significantly more likely than survivors who did not have disabilities to disclose to formal help sources and to be referred to SANE programs by other formal community services, typically the police. A strong referral network from law enforcement to SANE programs is important, but survivors who do not wish to pursue criminal investigation need reliable pathways to postassault health care. Strategies for promoting community awareness of SANE services are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In the United States, citizens opposed to stricter gun control laws as a response to mass shootings frequently reframe the problem of gun violence as a mental health issue. As a result, it has been suggested that pro-gun attitudes (i.e., pro-gun rights attitudes and favorable attitudes toward the National Rifle Association) might be associated with stigmatizing attitudes toward people with mental illness. In three studies (total N = 756), we assessed gun attitudes as predictors of mental illness stigma among college students in the United States (data collected in 2018 and 2019). While zero-order correlations revealed that pro-gun attitudes predict more negative attitudes toward people with mental illness, they were not unique predictors after adjusting for political affiliation. These findings replicate previous research on the relationship between conservatism and mental illness stigma and provide a starting point for future research assessing relationships between gun attitudes, political affiliation, and mental illness stigma. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Persons living with mental health challenges are at increased risk of stigma, social isolation, and social exclusion. Due to its emphasis on member participation and community, the clubhouse model of mental health may help address these issues. In this study, we examined experiences of social belonging and of various social determinants of mental health among members attending a psychosocial clubhouse. Twelve members of a large psychosocial clubhouse were interviewed regarding their experiences of community life and belonging. Phenomenological qualitative methods were utilized to examine the meaning and structure of these experiences. Members overwhelmingly experienced the clubhouse as a central site of belonging ("an oasis"), but members also recounted devastating portraits of life in the outside world ("a desert"). This world presented fundamental restrictions on their movement and speech and held deeply sedimented norms pertaining to who is considered valuable, productive, and even human, which they were reminded of through an endless tyranny of questions ("what do you do," "where do you live," etc.). Life in the clubhouse presented an alternative world for members to experience nourishment, dignity, reaffirmed personhood, and a sense of beauty. And yet, the desert outside remained. Implications of these findings for clubhouses, mental health practice, and sociopolitical and community engagement are discussed, including the need to address profound deprivations and power imbalances within the wider world, beyond the walls of humane spaces such as these. (PsycInfo Database Record (c) 2021 APA, all rights reserved).