The American journal of orthopsychiatry最新文献

Black adolescents face the stressful experience of racism in their everyday lives, which has negative implications for their health and well-being. In the current study, we explored experiences of individual, institutional, and cultural racism in relation to anticipatory racism-related stress responses (e.g., prolonged negative thinking, arousal in expectation of future racism) among Black adolescents (N = 442). We also examined whether three dimensions of racial identity, centrality, private regard, and public regard, moderate those relationships. We found that more experiences of racism at each level were related to greater anticipatory racism-related stress responses, measured as more cognitive activation of racial stressors, appraisal of coping strategies, and anticipation of future racism. We also found that some relationships between experiences of racism and anticipatory stress varied by regard. The positive relation between individual racism and perseverative cognition was stronger for those with low public regard. Similarly, the positive association between cultural racism and psychological anticipation was stronger for those with low public regard. The positive association between institutional racism and physiological anticipation of future racism was stronger for those with higher private regard. These findings contribute to the growing literature on the pervasiveness of racism in the lives of Black youth and the utility of racial identity to reduce harm from racism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

For the African American healing journey, it is essential for cultural strengths that preceded and followed the original injury of enslavement, and consequent racially based trauma, to be recognized and elevated. Historical trauma has offered an important framework for understanding how the structural determinants of health are related to mass group-level subjugation for Indigenous people across generations, with a growing focus on protective factors. Here, we expand the application of the historical trauma framework to African Americans, with a focus on intergenerational healing. This exploratory study examined historical evidence of healing among enslaved people of African ancestry on Southern plantations. Two themes associated with how healing practices and strategies were used by healers and seekers of healing-figuring out what to do and fighting back/resisting-were developed using a thematic analysis of a historical text. A conceptual model is introduced illustrating the intergenerational transmission of healing and well-being across generations of African Americans. Implications for policy, practice, and research are explored. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Intimate partner violence (IPV) is a pressing issue, affecting nearly one-third of women in the U.S. over their lifetimes, and has been linked with a number of deleterious outcomes, including the development of posttraumatic stress disorder (PTSD). Although IPV is often chronic, few studies have prospectively examined trajectories of PTSD symptoms (PTSS) in this population. The goal of the present study was to assess the effects of the Moms' Empowerment Program-an IPV-specific intervention; as well as trauma exposure, domestic violence (DV) shelter use, and depression symptoms on PTSS trajectories in women with histories of IPV.

Method: Data were drawn from a sample of 118 women who participated in a randomized controlled trial (RCT) of an intervention specifically designed for women and children experiencing IPV. Sixty-seven women from the original sample completed an assessment 8 years following the conclusion of the intervention.

Results: On average, women's PTSS decreased over time. Intervention group assignment did not affect these trajectories; however, women who attended more sessions had significantly fewer PTSS at the 8-year follow-up. Greater IPV exposure, higher depression symptoms, and shelter use were all associated with higher PTSS over time, with some variation across PTSS subdomains.

Conclusions: These results provide preliminary evidence that brief intervention may have long-term effects. They also demonstrate how addressing ongoing IPV and concurrent symptoms of depression is likely an essential component of treating PTSS in this population. Finally, these results underscore the need for more research on relations between formal DV services and mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives: Current best practice approaches suggest that to address secondary traumatic stress (STS) a two-pronged perspective that considers individual and organizational factors over time is warranted. However, research documenting the impact of organizational efforts on individual experience with STS is lacking. In this study, it was hypothesized that as an organization becomes more STS informed, there would be decreases in reported levels of STS and burnout (BO) in individuals over time; and these changes would be associated with higher levels of implementation activity and increased use of interventions to improve physical and psychological safety. Methods: This study uses data from 2,345 responses, representing 7 groups involved in an organizational change process aimed at creating STS informed organizations in a department of health and human services. The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA), the Secondary Traumatic Stress Scale (STSS), and the Professional Quality of Life-5 BO subscales measured variables of interest. Using a longitudinal design, baseline, post, and follow-up data were collected. Results: One-way ANOVAs revealed significant improvements in STSI-OA, STSS, and BO scores across time (p-value < .05). Linear mixed models reveal that significant declines in STSS scores were associated with improved STSI-OA scores (p = <.001), after adjusting for age, gender, time, and level of implementation activity. Implications: These results support the hypothesis that organizational efforts can improve an individual's perceived level of distress, and that focused attention to the issue of secondary trauma in an organization can improve organizational and individual outcomes using a data-driven change approach. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The disproportionate prescribing of high-risk antipsychotic medication for youth in foster care is a significant social problem across the U.S. This qualitative study examined stakeholder perceptions of prescribing, being prescribed, or overseeing prescriptions for youth in foster care. Interviews and focus groups were conducted with clinicians, child welfare caseworkers, foster caregivers, and foster care alumni. The overall aim was to systematically explore their understanding of and experiences with the Informed Consent to treatment and shared decision-making processes related to prescribing and monitoring of antipsychotic medications for youth in foster care. Participants were recruited from around the country; data collection using structured interview or focus group guides occurred via telephone and web-based formats. This study is rooted in the lived experiences of stakeholders in addressing recent federal legislative mandates and guidelines for the oversight and co-ordination of mental health service delivery to youth in foster care. Numerous themes emerged that provide context in employing a team-based approach for youth engaged with multiple child-serving systems. Eight themes emerged that illustrate the necessary components of successfully implementing Informed Consent and shared decision-making as well as the barriers and concerns germane to this process. The findings address the nuanced complexity of and tensions with the trade-offs inherent in delivering mental health care to youth involved in foster care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Loneliness is a growing public health concern that is associated with poor mental health (e.g., social anxiety, depression) and increased physical health problems (e.g., cardiovascular disease, sleep disturbances). Socially vulnerable groups such as the elderly, migrants, and asylum seekers are more susceptible to the effects of loneliness. We examined loneliness severity in lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual orientation and gender identity diverse (LGBTQIA+) communities. The relationships between loneliness, mental health, social support, belongingness, and quality of life in a sample of LGBTQIA+ (n = 238) and non-LGBTQIA+ (n = 270) adults aged 18-73 years (N = 508) were examined. Overall, LGBTQIA+ adults experienced higher levels of loneliness, depression, and social anxiety than the non-LGBTQIA+ comparison group. LGBTQIA+ adults also reported lower perceived social support and were at higher risk of social isolation than the non-LGBTQIA+ group. Thus, LGBTQIA+ adults may be at greater risk of loneliness and social isolation than has previously been recognized. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Biden/Harris Administration faces many challenges, from systems and policies that do not work for or benefit all Americans to stark social and political divisions. Multiple courses of action will be necessary, and there must be commitment and investment for the "long haul." When considering the nation's challenges, overarching themes emerge that must be addressed. For instance, recommendations for justice reform cannot be followed without significant focus on race and equity. This focus will also be needed in considering solutions to affordable housing shortages, economic crises, and social and economic immobility concerns. In a similar vein, if the interests and rights of our nation's children are not recognized now, the social consequences will impact every aspect of their livelihoods-and those of future generations. The recommendations put forward by the Global Alliance are bold and will take time to fully implement. The implementation of these recommendations will challenge our systems and our policymakers to acknowledge our past and reenvision the future-and they will help address the multifaceted behavioral health and well-being needs of our nation, its communities, and its people. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Transforming communities to be healthier and more equitable prosents a systemic challenge best addressed by those with native knowledge of the system. Community coalitions are a promising structure for tackling local health inequities, if they approach the change process with multiple local stakeholders and with systemic change in mind. Maturity models offer a framework for system assessment by defining sequential stages toward ideal development. Providing coalitions with a structure for self-assessing community change, the Community Transformation Map (CTM) is a maturity model that operationalizes concepts hypothesized to foster systemic change. This 40-item tool encourages self-assessment, dialogue, and reconciliation of community transformation priorities via an appreciative inquiry process. The CTM was created and applied with 18 community coalitions participating in the 100 Million Healthier Lives initiative. It was iteratively drafted with representatives from across the initiative. These coalitions self-administered the CTM four times over 24 months. Coalitions used the CTM to reconcile perspectives, identify priorities, and create transformation action plans. After the fourth administration, ten semistructured interviews were conducted with coalition members. Thematic analysis revealed good contextual validity. Coalitions saw value in the CTM's productive dialogue and the shared understanding it created, but reported perceived burden in conducting repeated administration. The CTM's value is in structuring community members' reflection on complex, systemic problems. The CTM is rooted in international improvement and change principles and continues to be adapted for other change initiatives. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The objectives of this study were: (a) to assess the prevalence of disability among homeless women; (b) to compare homeless women with and without a disability in key variables (e.g., sociodemographic, homelessness history, physical and mental health, etc.); (c) to examine paths between disability, perceived discrimination, mental health, and quality of life. The methodology was a longitudinal study of homeless women in Madrid, who were followed for a 12-month period. There were 136 interviewees at baseline and 85 interviewees at follow-up. Prevalence of self-reported disability was 36.6% at baseline and 58.8% at follow-up. Approximately, in three out of four cases, disability existed prior to becoming homeless. Participants with a disability had been homeless for a longer time at baseline compared to participants without a disability. Moreover, they presented worse mental health, worse overall health status, and lower health-related quality of life at follow-up. Mediation analyses showed that disability at baseline had direct effects on health-related quality of life, but also indirect effects mediated by perceived discrimination and mental health. This study shows the prominent prevalence rates of disability among homeless women in comparison with the general population, and the links to discrimination and negative health outcomes. These findings have significant implications for planning community services for homeless women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The current study applied the General Strain Theory (GST), Social Disorganization Theory (SDT), and Social Control Theory (SCT) to examine the association between exposure to verbal conflict between a mother and her intimate partner, and aggressive behavior of urban adolescents. The sample included 518 urban adolescents (96% Black), aged 14 to 17 years. Descriptive statistics, structural equation modeling (SEM), and moderation analyses were conducted. Consistent with GST, exposure to verbal conflict between the mother and her intimate partner was indirectly associated with aggression, as mediated by emotional distress. Also, consistent with SDT, neighborhood violence was positively associated with aggression. Neighborhood violence was associated with exposure to verbal conflict between their mother and her intimate partner, which was related to aggressive behavior in urban adolescents. (PsycInfo Database Record (c) 2021 APA, all rights reserved).