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Objective: To quantify the association between attributional ambiguity-the uncertainty of whether an experience is discrimination-and mental health., Methods: Using a nationally representative sample of U.S. adults recruited through an online survey by Ipsos (April 23 and May 3, 2021), attributional ambiguity was quantified by asking participants if they experienced anything in the past 6 months that they were unsure was discrimination. The survey also assessed the degree to which these experiences caused participants to feel bothered and to ruminate on them. Multiple linear regression models were used to analyze associations between attributional ambiguity and depressive symptoms and mental health status., Results: Black and Hispanic participants reported higher rates of attributional ambiguity than White participants. Experiencing attributional ambiguity was associated with higher levels of depressive symptoms and poorer self-reported mental health status. Among those who reported attributional ambiguity, increases in bother and rumination scores were positively associated with depressive symptoms., Conclusion: Attributional ambiguity is an important yet overlooked social determinant of mental health. More research is needed to fully understand the impact of this stressor on population health, particularly among minoritized populations., (© 2024. The Author(s).)

Background: To provide an overview of the empirical research linking self-reports of racial discrimination to health status and health service utilization., Methods: A review of literature reviews and meta-analyses published from January 2013 to 2019 was conducted using PubMed, PsycINFO, Sociological Abstracts, and Web of Science. Articles were considered for inclusion using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) framework., Results: Twenty-nine studies met the criteria for review. Both domestic and international studies find that experiences of discrimination reported by adults are adversely related to mental health and indicators of physical health, including preclinical indicators of disease, health behaviors, utilization of care, and adherence to medical regimens. Emerging evidence also suggests that discrimination can affect the health of children and adolescents and that at least some of its adverse effects may be ameliorated by the presence of psychosocial resources., Conclusions: Increasing evidence indicates that racial discrimination is an emerging risk factor for disease and a contributor to racial disparities in health. Attention is needed to strengthen research gaps and to advance our understanding of the optimal interventions that can reduce the negative effects of discrimination., (© 2019 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.)

This article provides an overview of research on race-related stressors that can affect the mental health of socially disadvantaged racial and ethnic populations. It begins by reviewing the research on self-reported discrimination and mental health. Although discrimination is the most studied aspect of racism, racism can also affect mental health through structural/institutional mechanisms and racism that is deeply embedded in the larger culture. Key priorities for research include more systematic attention to stress proliferation processes due to institutional racism, the assessment of stressful experiences linked to natural or manmade environmental crises, documenting and understanding the health effects of hostility against immigrants and people of color, cataloguing and quantifying protective resources, and enhancing our understanding of the complex association between physical and mental health.

Background: Police kill more than 300 black Americans-at least a quarter of them unarmed-each year in the USA. These events might have spillover effects on the mental health of people not directly affected., Methods: In this population-based, quasi-experimental study, we combined novel data on police killings with individual-level data from the nationally representative 2013-15 US Behavioral Risk Factor Surveillance System (BRFSS) to estimate the causal impact of police killings of unarmed black Americans on self-reported mental health of other black American adults in the US general population. The primary exposure was the number of police killings of unarmed black Americans occurring in the 3 months prior to the BRFSS interview within the same state. The primary outcome was the number of days in the previous month in which the respondent's mental health was reported as "not good". We estimated difference-in-differences regression models-adjusting for state-month, month-year, and interview-day fixed effects, as well as age, sex, and educational attainment. We additionally assessed the timing of effects, the specificity of the effects to black Americans, and the robustness of our findings., Findings: 38 993 (weighted sample share 49%) of 103 710 black American respondents were exposed to one or more police killings of unarmed black Americans in their state of residence in the 3 months prior to the survey. Each additional police killing of an unarmed black American was associated with 0·14 additional poor mental health days (95% CI 0·07-0·22; p=0·00047) among black American respondents. The largest effects on mental health occurred in the 1-2 months after exposure, with no significant effects estimated for respondents interviewed before police killings (falsification test). Mental health impacts were not observed among white respondents and resulted only from police killings of unarmed black Americans (not unarmed white Americans or armed black Americans)., Interpretation: Police killings of unarmed black Americans have adverse effects on mental health among black American adults in the general population. Programmes should be implemented to decrease the frequency of police killings and to mitigate adverse mental health effects within communities when such killings do occur., Funding: Robert Wood Johnson Foundation and National Institutes of Health., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

[Correction Notice: An Erratum for this article was reported in Vol 53(2) of Developmental Psychology (see record 2017-04475-001). In the article, there were several typographical errors in the Recruitment and Procedures section. The percentage of mothers who responded to survey items should have been 99.3%. Additionally, the youths surveyed at T2 and T3 should have been n 246. Accordingly, the percentage of youths surveyed in T2 and T3 should have been 91.4% and the percentage of mothers surveyed at T2 and T3 should have been 90.7%. Finally, the youths missing at T2 should have been n 23, and therefore the attrition rate for youth participants should have been 8.6. All versions of this article have been corrected.] Although prior research has consistently documented the association between racial/ethnic discrimination and poor mental health outcomes, the mechanisms that underlie this link are still unclear. The present 3-wave longitudinal study tested the mediating role of anger regulation in the discrimination-mental health link among 269 Mexican-origin adolescents ( M age = 1.6; 57% girls), 12 to 17 years old. Three competing anger regulation variables were tested as potential mediators: outward anger expression, anger suppression, and anger control. Longitudinal mediation analyses were conducted using multilevel modeling that disaggregated within-person effects from between-person effects. Results indicated that outward anger expression was a significant mediator; anger suppression and anger control were not significant mediators. Within a given individual, greater racial/ethnic discrimination was associated with more frequent outward anger expression. In turn, more frequent outward anger expression was associated with higher levels of anxiety and depression at a given time point. Gender, age, and nativity status were not significant moderators of the hypothesized mediation models. By identifying outward anger expression as an explanatory mechanism in the discrimination-distress link among Latino youths, this study points to a malleable target for prevention and intervention efforts aimed at mitigating the detrimental impact of racism on Latino youths' mental health during the developmentally critical period of adolescence. (PsycINFO Database RecordSD = 1.6; 57% girls), 12 to 17 years old. Three competing anger regulation variables were tested as potential mediators: outward anger expression, anger suppression, and anger control. Longitudinal mediation analyses were conducted using multilevel modeling that disaggregated within-person effects from between-person effects. Results indicated that outward anger expression was a significant mediator; anger suppression and anger control were not significant mediators. Within a given individual, greater racial/ethnic discrimination was associated with more frequent outward anger expression. In turn, more frequent outward anger expression was associated with higher levels of anxiety and depression at a given time point. Gender, age, and nativity status were not significant moderators of the hypothesized mediation models. By identifying outward anger expression as an explanatory mechanism in the discrimination-distress link among Latino youths, this study points to a malleable target for prevention and intervention efforts aimed at mitigating the detrimental impact of racism on Latino youths' mental health during the developmentally critical period of adolescence. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Objectives: We examined whether Black Americans and Hispanic Americans experienced greater mental health benefits from religious involvement than White Americans, and whether these benefits would be mediated through three psychosocial factors--social support, meaning, and forgiveness., Methods: Utilizing data from a probability sample of Chicago-based adults (n=3103), ethnicity-stratified multivariate regression models estimated the association of religiosity with depressive symptoms, anxiety symptoms, and major depressive disorder (MDD). Models controlled for potential confounders and psychosocial mediators., Results: Contrary to our hypotheses, religiously involved Black Americans and Hispanic Americans did not experience greater mental health benefits than their White counterparts. For White Americans alone, service attendance was inversely related to depressive symptoms, anxiety symptoms, and MDD. Religious saliency was consistently associated with worse mental health for Hispanic Americans only. However, both meaning and forgiveness conferred mental health benefits for all three groups., Conclusions: The benefits of specific aspects of religious involvement vary across ethnicity. Caution is necessary in any effort to bring religion into the health domain. Our findings, if replicated, suggest that initiatives that facilitate a sense of purpose or forgiveness are likely to prove promising in improving mental health, regardless of race or ethnicity.

Background: Both mental illness and food insufficiency are common in low and middle income countries. However, there are limited data on the relation between food insufficiency and mental disorders, despite the potential relevance of such data for the development of policy-level interventions. The relationship between food insufficiency and mental disorders within a nationally representative sample of South African adults was examined., Methods: A national survey of 4185 South African adults was conducted using the WHO Composite International Diagnostic Interview to generate psychiatric diagnoses. The survey included a widely used single-item measure of household food insufficiency. The independent effects of food insufficiency and demographic characteristics on 12-month and lifetime DSM-IV diagnosis were assessed using logistic regression., Results: 29% of respondents reported that their household 'sometimes' did not have enough to eat while 9% reported that they 'often' did not have enough to eat. After controlling for conventional socioeconomic and sociodemographic variables, food insufficiency was associated with having any 12-month (OR 1.44, 95% CI 1.1 to 1.9) and lifetime (OR 1.35, 95% CI 1.1 to 1.7) DSM-IV disorder., Conclusions: In South Africa the prevalence of household food insufficiency is very high compared with studies conducted in the developed world, and is independently associated with having a 12-month and lifetime DSM-IV diagnosis. The relationship between food insufficiency and mental health has implications for reducing the burden of common mental disorders in South Africa since, unlike a number of major risk factors for mental illness, food insufficiency may be relatively amenable to intervention.

Objective: Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a large cross-national epidemiologic survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries., Method: Data come from the World Health Organization (WHO) World Mental Health (WMH) Surveys (conducted 2001-2007), in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview. The survey assessed suicidal behaviors and potential risk factors across multiple domains, including sociodemographic characteristics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior., Results: Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4%, respectively, for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (area under the receiver operating characteristic curve = 0.74-0.80)., Conclusions: Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors., (© Copyright 2010 Physicians Postgraduate Press, Inc.)

Background: Community and clinical data have suggested there is an association between trauma exposure and suicidal behavior (i.e., suicide ideation, plans and attempts). However, few studies have assessed which traumas are uniquely predictive of: the first onset of suicidal behavior, the progression from suicide ideation to plans and attempts, or the persistence of each form of suicidal behavior over time. Moreover, few data are available on such associations in developing countries. The current study addresses each of these issues., Methodology/principal Findings: Data on trauma exposure and subsequent first onset of suicidal behavior were collected via structured interviews conducted in the households of 102,245 (age 18+) respondents from 21 countries participating in the WHO World Mental Health Surveys. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and subsequent suicidal behavior. A range of traumatic events are associated with suicidal behavior, with sexual and interpersonal violence consistently showing the strongest effects. There is a dose-response relationship between the number of traumatic events and suicide ideation/attempt; however, there is decay in the strength of the association with more events. Although a range of traumatic events are associated with the onset of suicide ideation, fewer events predict which people with suicide ideation progress to suicide plan and attempt, or the persistence of suicidal behavior over time. Associations generally are consistent across high-, middle-, and low-income countries., Conclusions/significance: This study provides more detailed information than previously available on the relationship between traumatic events and suicidal behavior and indicates that this association is fairly consistent across developed and developing countries. These data reinforce the importance of psychological trauma as a major public health problem, and highlight the significance of screening for the presence and accumulation of traumatic exposures as a risk factor for suicide ideation and attempt.

To assess the levels of perceived acute and chronic racial and non-racial discrimination in South Africa, their association with health, and the extent to which they contribute to racial differences in physical and mental health, data were used from a national probability sample of adults, the South African Stress and Health Study (SASH). All Black groups in South Africa (African, Coloured and Indian) were two to four times more likely than Whites to report acute and chronic experiences of racial discrimination. Africans and Coloureds report higher levels of ill health than Whites, but acute and chronic racial discrimination were unrelated to ill health and unimportant in accounting for racial differences in self-rated health. In contrast, all Black groups had higher levels of psychological distress than Whites, and perceived chronic discrimination was positively associated with distress. Moreover, these experiences accounted for some of the residual racial differences in distress after adjustment for socioeconomic status. Our main findings indicate that, in a historically racialized society, perceived chronic racial and especially non-racial discrimination acts independently of demographic factors, other stressors, psychological factors (social desirability, self-esteem and personal mastery), and multiple SES indicators to adversely affect mental health.

There is substantial evidence from developed countries that lower socioeconomic status (SES) is associated with increased occurrence of mental illness, and growing interest in the role of social support and social capital in mental health. However, there are few data on social determinants of mental health from low- and middle-income nations. We examined the association between psychological distress and SES, social support and bonding social capital in a nationally-representative sample of South African adults. As part of a national survey of mental health, a probability sample of 4,351 individuals was interviewed between 2002 and 2004. Non-specific psychological distress was measured using the Kessler K-10 scale. SES was assessed from an aggregate of household income, individual educational and employment status, and household material and financial resources. Social support, bonding social capital and traumatic life events were measured using multi-item scales. The mean age in the sample was 37 years and 76% of participants were black African. Measures of SES and social capital were inversely associated (p<0.001). Both recent and traumatic life events were more common among individuals with low levels of SES and social support. After adjusting for participant demographic characteristics and life events, high levels of psychological distress were most common among individuals with lower levels of SES and social capital. There was no independent association between levels of social support and psychological distress. The occurrence of recent life events appeared to partially mediate the association between SES and psychological distress (p=0.035) but not the association involving social capital (p=0.40). These data demonstrate persistent associations between levels of SES, social capital and psychological distress in South Africa. The increased frequency of recent life events appears to only partially explain higher levels of psychological distress among individuals of lower SES. Additional research is required to understand the temporality of this association as well as mechanisms through which SES and social capital influence mental health in low- and middle-income settings where high levels of poverty and trauma may contribute to excess burden of mental illness.

This study investigates the association between self-reported physical and mental health and both perceived racial discrimination and skin color in African American men and women. We used data from the longitudinal coronary artery risk development in young adults study (CARDIA) in African American men and women (n=1722) in the USA. We assessed self-reported mental and physical health status and depressive symptoms at the Year 15 (2000-2001) follow-up examination using the Medical Outcomes Study Short Form (SF-12) and the Center for Epidemiologic Studies Depression scale. Skin color was measured at the Year 7 examination (1992-1993). To assess racial discrimination, we used a summary score (range 0-21) for 7 questions on experiencing racial discrimination: at school, getting a job, getting housing, at work, at home, getting medical care, on the street or in a public setting. Self-reported racial discrimination was more common in men than in women (78.1% versus 73.0%, p<0.05) and in those with higher educational attainment, independent of gender. Discrimination was statistically significantly associated with worse physical and mental health in both men and women, before and after adjustment for age, education, income, and skin color. For example, mental health (0-100 scale) decreased an average of 0.29 units per unit increase in racial discrimination score in men; this became 0.32 units after adjustment. There was no association between self-reported physical and mental health and skin color. Further studies of the health consequences of discrimination will require investigation of both the upstream determinants of discrimination and the downstream mechanisms by which perceived discrimination affects health outcomes.

Guided by a risk and resilience framework, the current study examined the associations between Latino adolescents' ("n" = 219; "M" [subscript age] = 14.35; "SD" = 1.75) perceptions of ethnic discrimination in multiple settings (e.g., online, school) and several domains of adjustment (e.g., mental health, academic), and tested whether developmentally salient cultural assets (i.e., ethnic identity) directly promoted youth adjustment or moderated the negative impact of discrimination on adjustment. Each of the 3 ethnic identity components (i.e., exploration, resolution, affirmation) demonstrated evidence of promoting positive outcomes among Latino youth; furthermore, there was some evidence that the promotive effects of affirmation and resolution were significantly stronger for older versus younger adolescents. In addition, with the exception of experiences with discrimination from adults outside of the school setting, there was evidence of ethnic identity interacting with each type of discrimination to predict Latino adolescents' self-esteem, depressive symptoms, and externalizing problems. Findings suggest directions for future research and identify potential targets for intervention that may prove fruitful in programming efforts with Latino adolescents.

Research on discrimination and risks for violence and mental health issues under the pandemic is notably absent. We examined the relative effects of perceived everyday discrimination (e.g., poorer service, disrespectful treatment in a typical week) and major experiences of race-based discrimination (e.g., racial/ethnic discrimination in housing or employment at any point in the lifetime) on experiences of violence and the PHQ-4 assessment of symptoms of depression and anxiety under the pandemic. We analyzed state-representative cross-sectional survey data from California adults (N = 2114) collected in March 2021. We conducted multivariate regression models adjusting for age, race/ethnicity, gender, sexual identity, income, and disability. One in four Californians (26.1%) experienced everyday discrimination in public spaces, due most often to race/ethnicity and gender. We found that everyday discrimination was significantly associated with past year physical violence (single form Adjusted Odds Ratio [AOR] 5.0, 95% CI 2.5-10.3; multiple forms AOR 2.6, 95% CI 1.1-5.8), past year sexual violence (multiple forms AOR 2.5, 95% CI 1.4-4.4), and mental health symptoms (e.g., severe symptoms, multiple forms AOR 3.3, 95% CI 1.6-6.7). Major experiences of race-based discrimination (reported by 10.0% of Californians) were associated with past year sexual violence (AOR 2.0, 95% CI 1.1-3.8) and severe mental health symptoms (AOR 2.7, 95% CI 1.2-6.2). Non-race-based major discrimination (reported by 23.9% of Californians) was also associated with violence and mental health outcomes Everyday discrimination, more than major experiences of discrimination, was associated with higher risk for violence and poor mental health outcomes during the pandemic. Non-race-based forms of major discrimination independently were also associated with these negative outcomes. Findings indicate that efforts to reduce and ultimately eliminate discrimination should be a focus of public health and COVID-19 rebuilding efforts.

BackgroundMany studies have evaluated the stress-cognition association, but few have captured the cumulative nature of stress or distinguished the influences of stressors occurring in childhood versus adulthood. Using a lifecourse approach, we investigated whether cumulative stress exposures are associated with poorer cognitive function and faster cognitive decline.MethodsWe used data from the Midlife Development in the United States Study (N = 3,954, mean baseline age: 56 years). We fit marginal structural generalized estimating equations models to estimate the difference in baseline cognitive function per SD increment in the continuous stressor score, and, separately, between persons in each life course stressor profile and those who did not experience high stress in either childhood or adulthood. We also characterized differences in cognitive decline across levels of stress exposures.ResultsHigher cumulative stress exposure was associated with lower executive function (difference per SD in continuous stressor score = -0.12 SD units, 95% CI = -0.16, -0.08) and episodic memory (difference = -0.09 SD units, 95% CI = -0.13, -0.05). Baseline executive function and episodic memory were lower among those with high stress only in childhood, only in adulthood, and both, than among those without high stress in childhood or adulthood. There was little evidence that rate of change in executive function and episodic memory differed across levels of cumulative stress exposures.ConclusionsThese findings offer support to the hypothesis that stress exposures, accumulated over the life course, worsen cognitive performance, but limited support for the hypothesis that these exposures promote cognitive decline.

Although race/ethnicity is associated with substantial differences in risk for depression and other diseases of aging in the United States, the processes underlying these health disparities remain poorly understood. We addressed this issue by examining how levels of a robust marker of inflammatory activity, C-reactive protein (CRP), and depression symptoms varied across racial/ethnic groups. Additionally, we tested whether the inflammation-depression association differed across groups. Data were drawn from the Chicago Community Adult Health Survey, an epidemiological survey examining biopsychosocial factors affecting health and well-being. Participants were 3105 Chicago community adults, of which 610 provided blood samples and were included in analyses. C-reactive protein was assayed from blood samples, and depression symptoms were assessed using the 11-item Center for Epidemiologic Studies-Depression scale. Race/ethnicity was self-reported and consisted of Black, Hispanic, White, and other racial/ethnic groups. Results revealed that these racial/ethnic groups differed in terms of both their CRP and depression levels. Specifically, Black Americans exhibited higher levels of CRP as compared to White and other race/ethnicity Americans. Moreover, Black Americans exhibited more depression symptoms than Hispanic Americans. Finally, we found that inflammatory levels were strongly related to depression symptoms but only for Black Americans, with CRP alone accounting for 8% of the variance in depression symptoms in this subgroup. These data thus point to a biological process that may help to explain disparities in mental health outcomes across race/ethnicity in the United States. At the same time, additional research is needed to understand the social and structural factors driving these effects.

PurposeThe purpose was to use Twitter to conduct online surveillance of negative sentiment towards Mexicans and Hispanics during the 2016 United States presidential election, and to examine its relationship with mental well-being in this targeted group at the population level.MethodsTweets containing the terms Mexican(s) and Hispanic(s) were collected within a 20-week period of the 2016 United States presidential election (November 9th 2016). Sentiment analysis was used to capture percent negative tweets. A time series lag regression model was used to examine the association between percent count of negative tweets mentioning Mexicans and Hispanics and percent count of worry among Hispanic Gallup poll respondents.ResultsOf 2,809,641 tweets containing terms Mexican(s) and Hispanic(s), 687,291 tweets were negative. Among 8,314 Hispanic Gallup respondents, a mean of 33.5% responded to be worried on a daily basis. A significant lead time of 1 week was observed, showing that negative tweets mentioning Mexicans and Hispanics appeared to forecast daily worry among Hispanics by 1 week.ConclusionSurveillance of online negative sentiment towards racially vulnerable population groups can be captured using social media. This has potential to identify early warning signals for symptoms of mental well-being among targeted groups at the population level.

Although a growing body of evidence indicates strong links between psychological stress (stress) and untoward cardiovascular disease (CVD) outcomes, comprehensive examination of these effects remains lacking. The "Cumulative Psychological Stress and Cardiovascular Disease Risk in Middle Aged and Older Women" study is embedded within the landmark Women's Health Study (WHS) follow-up cohort and seeks to evaluate the individual and joint effects of stressors (cumulative stress) on incident CVD risk, including myocardial infarction, stroke, coronary revascularization and CVD death. GWAS data will be used for exploratory analyses to identify any genes associated with stress and CVD. This study prospectively follows 25,335 women (mean age 72.2 ± 6.04 years) without CVD who returned a short mailed stress questionnaire at baseline and 3 years of follow-up inquiring about their experiences with stress including perceived stress, work stress, work-family spillover, financial stress, traumatic and major life events, discrimination and neighborhood environment/stressors. Other domains ascertained were sleep, anger, cynical hostility, depression, anxiety, social support, intimate partner relations, and volunteer and social activities. Higher levels of cumulative stress were associated with younger age and black race/ethnicity, divorced or separated marital status, increased prevalence of obesity, smoking, diabetes, depression and anxiety (p

The Liberian civil wars led to widespread destruction and devastation for its individuals, communities, and economy. However, individuals' subjective trauma experiences and long-term psychological impact remain relatively understudied. This study aims to explore context-specific traumatic events and examine how risk and protective factors combine with traumas to influence trajectories of suffering and recovery over time. We conducted 43 semi-structured interviews with Liberian adults who were present during the Liberian civil wars, and we used line-by-line open coding, thematic analysis, and axial coding to analyze and contextualize the data. Eight key trauma themes emerged: Abuse (emotional, physical, and sexual), Captivity, Combat, Killings, Physical Illness, Resource Loss, Family Separation, and War Environment. The risk and protective factors that were reported as salient were: Age, Biological Sex, Socioeconomic Status, and Community Support. Further, key patterns emerged across interviews that indicated greater risk for long-term suffering: 1) exposure to multiple traumatic events, 2) certain types of traumatic events (like killing of a close family member), and 3) the combination of specific traumatic events and risk and protective factors (like older women witnessing the killing of their children). This study provides culturally relevant information on trauma, suffering, and resilience in post-conflict Liberia, with the aim of guiding the development of screening tools and targeted psychological interventions that improve well-being over time. [ABSTRACT FROM AUTHOR]

BackgroundDespite the widespread use of the Progressive Supranuclear Palsy Rating Scale (PSPRS), it is not known what change in this scale is meaningful for patients.MethodsWe analyzed data from a large clinical trial in PSP-Richardson's syndrome (AL-108-231) to calculate minimal clinically important worsening. This was defined as the difference in mean change of PSPRS in subjects rated "a little worse" and those rated "unchanged" on the Clinicians' Global Impression of Change Scale. A multivariate analysis using logistic regression assessed the relationship between clinical worsening, PSPRS, depression, and activities of daily living.ResultsThe minimal clinically important worsening on the PSPRS was 5.7 points, corresponding to the mean decline over 6 months in the trial. Changes in activities of daily living and PSPRS were significantly associated with clinical worsening.ConclusionsClinically meaningful change is measurable on the PSPRS over 6 months. © 2016 International Parkinson and Movement Disorder Society.

ObjectiveTo determine whether greater emotional and instrumental support during childhood is associated with less dysregulation across multiple physiological systems in midlife.MethodsData are from participants in the second wave of the Midlife in the United States study (2004-2005) who participated in a clinic-based assessment of health status. Emotional and instrumental support was measured using a seven-item scale (α=0.89) based on participant retrospective self-report. Biological dysregulation was assessed using an allostatic load (AL) score constructed from 24 measures across seven physiological systems (N=1236, aged 34-84 years).ResultsEmotional and instrumental support in childhood was associated with lower AL in a monotonic fashion: compared to individuals in the lowest quartile of support, respondents in the second, third, and fourth quartiles had -0.08 (standard deviation (SD)=0.08), -0.13 (SD=0.08) and -0.21 (SD=0.08) units lower AL, adjusting for age, sex, and race. This pattern was maintained after adjustment for reporting bias, childhood socioeconomic disadvantage, past-year depression, and physician-diagnosed cardiovascular disease or diabetes (p≤0.01). The inflammation and metabolic-lipid subscales showed the strongest associations.ConclusionsGreater emotional and instrumental support in childhood was associated with less biological dysregulation in midlife, even after accounting for socioeconomic disadvantage in childhood and other potential confounders.

PurposeYear-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9-10 years among adults in the United States (n = 4,938, ages 25-74).MethodsUsing information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work-family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up.ResultsHigh stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit.ConclusionsInterventions to address psychosocial stress may be important components within smoking cessation efforts.

Life course-informed theories of development suggest it is important to integrate information about positive and negative aspects of the social environment into studies of child and parental wellbeing, including both stressors that compromise health and resources that promote well-being. We recruited a sample of 169 pairs of caregivers and young children (birth to 5 years) from a community health clinic and administered survey questions to assess stressors and resources. We constructed inventories of stressors and resources and examined the relationships between these inventories and caregivers' depressive symptoms, anxiety symptoms, and sleep problems, and young children's medical diagnoses derived from electronic health records. Cumulative stressors and resources displayed bivariate and adjusted associations with caregivers' depressive symptoms, anxiety symptoms, and sleep problems. For depressive and anxiety symptoms, these associations were evident in models that included stressors and resources together. Caregivers with high stressors and low resources displayed the highest levels of depressive and anxiety symptoms and sleep problems. In terms of children's health outcomes, only modest trends were evident for developmental/mental health outcomes, but not other diagnostic categories. Future studies are needed to examine stressors and resources together in larger samples and in relation to prospectively assessed measures of child well-being. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine multiple direct and indirect pathways of the association between older age and mental health through COVID-19-related stress perceptions, meaning in life, and forgiveness of situations. Participants were 1,382 U.S. adults who were part of the Harvard Digital Lab for the Social Sciences panel who volunteered to complete a 12 min survey in the spring of 2020. The sample had an average age of 56 years, was slightly more male (55%) than female (44%) or other (2%), mostly White (88%), well-educated (70% bachelors degree or more), and middle-income ($60,000–$75,000 annually). Measures included: COVID-19-related stress perceptions (e.g., concerns about infection, job, lack of necessities), presence of and search for meaning in life, forgiveness of situations, psychological distress, hopelessness, and optimism. A latent mental health variable was created that was comprised of psychological distress, hopelessness, and optimism. All hypothesized direct effects were in evidence, and all but one indirect effect were observed. Specifically, older age was related to better mental health through higher presence of meaning and lower search for meaning. Older age was also related to better mental health through a serial indirect pathway from lower COVID-19-related stress perceptions to higher presence of and lower search for meaning and higher forgiveness of situations to mental health. The proposed model was largely supported and confirms existing theory and research on aging, positive psychological processes, and mental health. Findings also offer new insights on the unique potential role of forgiveness of situations and its theoretical relevance to offending situations such as the COVID-19 pandemic. The present study offers a beginning for theorists, researchers, and practitioners to consider the connections between aging and mental health and the intricate interconnections between stress appraisal and positive coping resources that may serve to support it. [ABSTRACT FROM AUTHOR]

Background and Objectives Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults. Research Design and Methods Data were analyzed from a subsample of black Health and Retirement Study respondents (2006–2018, N = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested. Results Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49–1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06–1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29–1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point. Discussion and Implications Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination. [ABSTRACT FROM AUTHOR]

In recent decades, there has been remarkable growth in scientific research examining the multiple ways in which racism can adversely affect health. This interest has been driven in part by the striking persistence of racial/ethnic inequities in health and the empirical evidence that indicates that socioeconomic factors alone do not account for racial/ethnic inequities in health. Racism is considered a fundamental cause of adverse health outcomes for racial/ethnic minorities and racial/ethnic inequities in health. This article provides an overview of the evidence linking the primary domains of racism-structural racism, cultural racism, and individual-level discrimination-to mental and physical health outcomes. For each mechanism, we describe key findings and identify priorities for future research. We also discuss evidence for interventions to reduce racism and describe research needed to advance knowledge in this area. [ABSTRACT FROM AUTHOR]

Abstract Background Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. Method Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. Results Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels. Conclusion Nativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites. Highlights • Non-Latino Whites most likely to have 12-month disorders, even with SES controls. • Link between race/ethnicity and mood disorder varied by nativity among Whites. • Race/ethnicity interacted with education, but not income, to predict prevalence. • Racial/ethnic minority groups had more persistent mood disorders than Whites. • Observed links to persistent mood and substance disorders varied by education level. [ABSTRACT FROM AUTHOR]

Purpose Using a life course perspective, the present study tested the concept of “linked lives” applied to the problem of not only how racial/ethnic discrimination may be associated with poor mental health for the target of discrimination but also how discrimination may exacerbate the discrimination-distress link for others in the target's social network—in this case, the family. Methods The discrimination-distress link was investigated among 269 Mexican-origin adolescents and their parents both cross-sectionally and longitudinally. It was hypothesized that parents' discrimination experiences would adversely affect their adolescent children's mental health via a moderating effect on the target adolescent discrimination-distress link. The converse was also hypothesized for the target parents. Multilevel moderation analyses were conducted to test the moderating effect of parents' discrimination experiences on the youth discrimination-distress link. We also tested the moderating effect of youths' discrimination experiences on the parent discrimination-distress link. Results Parents' discrimination experiences significantly moderated the longitudinal association between youths' discrimination stress appraisals and mental health, such that the father's discrimination experiences exacerbated the youth discrimination-depression link. Youths' discrimination stress appraisals were not a significant moderator of the cross-sectional parent discrimination-mental health association. Conclusions Implications of these findings are discussed from a linked lives perspective, highlighting how fathers' discrimination experiences can adversely affect youths who are coping with discrimination, in terms of their mental health. [ABSTRACT FROM AUTHOR]

Background: Although the quality of life (QoL) experienced by patients with schizophrenia has been recognized, few studies have assessed the relationship between the caregivers' QoL and patients' QoL.Methods: The study included 253 stabilized outpatients with schizophrenia and their caregivers from 3 Mental Health Services in Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Caregivers' and patients' QoL were respectively assessed using two specific QoL questionnaires (S-CGQoL and S-QoL 18). We collected socio-demographic information and clinical data. Multiple linear regressions were performed to determine which variables were associated with patient's QoL. We tested the following hypothesis using structural equation modeling (SEM): caregivers' QoL may have an indirect effect on patients' QoL mediated by their influence of the severity of psychotic symptoms.Results: In the multivariate analysis, the caregivers' QoL was not significantly associated with the patients' QoL, except for one QoL dimension about relationship with family (Beta = 0.23). Among patients' characteristics, being a woman and Aymara, having lower educational level, unemployment and severity of symptoms was significantly associated to a lower QoL. The SEM revealed a moderate significant association between caregivers' QoL and psychotic symptoms severity (path coefficient = -0.32) and a significant association between psychotic symptoms severity and patients QoL (path coefficient = -0.40). The indirect effect of caregivers' QoL on patients' QoL was significant (mediated effect coefficient = 0.13).Conclusion: Improvement of caregiver's QoL may have a direct impact on the psychotic symptoms of patients and indirectly on patient's QoL, confirming the need for ongoing family interventions in these regions. [ABSTRACT FROM AUTHOR]

Objective Disparities in tobacco use persist despite successful policies reducing use within the United States. In particular, the prevalence of tobacco use in rural and certain minority communities is significantly higher compared to that of their counterparts. In this work, we examine the impact of rurality, mental health, and racial discrimination on tobacco use. Methods Data come from the 2003 California Health Interview Survey (n = 42,044). Modified Poisson regression models were adjusted for age, sex, race/ethnicity, birth origin, education, income, insurance, and marital status. Results Compared to urban residents, rural residents had a significantly higher risk for smoking after adjustment (RR = 1.10, 95% CI: 1.01-1.19). Those who reported having experienced racial discrimination also had a significantly greater risk for smoking compared to those who did not (RR = 1.17, 95% CI: 1.07-1.27). Additionally, those who reported higher stress had a significantly greater risk for smoking (RR = 1.61, 95% CI: 1.07-1.67). There was evidence of interaction between rurality and race/ethnicity, and rurality and gender ( P < .05). Conclusion Residing in rural areas was associated with an increased risk for smoking, above and beyond sociodemographics. There were no significant differences across rural-urban environments for the relationship between stress and tobacco use-an indication that the impact of stress and discrimination is not buffered or exacerbated by environmental characteristics potentially found in either location. Mechanisms that explain rural-urban tobacco use disparities need to be explored, and smoking cessation programs and policies should be tailored to target these factors within rural communities. [ABSTRACT FROM AUTHOR]