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Black women are among the most undertreated groups for depression in the United States. Few studies have addressed perceptions of help-seeking for depression among Black women. In this study, we interviewed 30 Black women and explored the help-seeking process for depression vis-a-vis social constructivism, intersectionality theory, and the Strong Black Woman (SBW) role, a gendered and racialized role consisting of adherence to strength through independence, emotion regulation, and caretaking. Qualitative analysis revealed that despite positive attitudes toward help-seeking, many participants declined or hesitated to seek treatment. We identified three themes that informed the help-seeking process: (a) You should see somebody; I just would not; (b) Do I really need to go and see somebody; and (c) Self-care despite what others may say. With regard to the influence of the SBW role, we also identified three themes: (a) Masking or ignoring pain, (b) Inability to ask for help, and (c) Lack of self-care. Our findings emphasized the importance of considering how the SBW role may be associated with help-seeking for depression among Black women.

Despite the existence of numerous efficacious treatments for mental disorders, many individuals in need do not receive adequate treatment particularly racial and ethnic minorities. Community stakeholders can provide: (1) a more nuanced understanding of community mental health needs, and in (2) informing the planning and provision of mental health services. Qualitative data for this mental health needs assessment come from 61 individuals who represent local residents and/or consumers of mental health services, Executive Directors, providers of mental health and non-mental health community based services. We identified systems-related and psychosocial barriers to seeking mental health services: difficulty navigating the mental health system, language barriers, dearth of culturally competent providers; and mental health stigma and mental health literacy and non-Western notions of mental health. Collaborative efforts across stakeholders are called for to address the mental health needs of racial and ethnic minorities in a local community.

We examined dimensions of Superwoman Schema as predictors of both depression and resilience. We also investigated if social isolation and gendered racial centrality mediated these relationships.We used path analysis to investigate the direct and indirect effects of an obligation to display an image of strength, emotional suppression, and resistance to vulnerability on depressive symptoms through social isolation. We also explored the direct and indirect effects of an intense motivation to succeed and an obligation to help others on resilience through gendered racial centrality.Emotional suppression and an obligation to help others were directly associated with depression. Emotional suppression, resistance to vulnerability, and an obligation to help others were indirectly associated with depression through social isolation. In contrast, an obligation to display an image of strength and an intense motivation to succeed was associated with resilience and gendered racial centrality.Findings highlight the unique complexity of Superwoman Schema as suggested within qualitative research. Black women's endorsement of Superwoman Schema may be both adaptive in navigating interlocking systems of oppression and psychologically distressing. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Few studies have examined the association between maternal and youth mental health among US Latinos, or its variation by nativity, country of origin, ethnic subgroup, and time in the mainland US. Using 2007–2014 Medical Expenditure Panel Survey data linking Latino youth (N = 15,686 aged 5–17 years) and their mothers, we estimated multivariate models of the relationship between probable maternal mental illness (a composite of measures) and youth mental health impairment (Columbia Impairment Scale). Children of mothers with probable mental illness were more than three times as likely to have impairment as children of mothers without mental illness (p

An increasing number of culturally adapted family-level interventions address mental health disparities with marginalized populations in the United States. However, with these developments many barriers have arisen, such as challenges with degree of cultural fit, engagement, and sustainability. We conducted 12 elite phenomenological interviews with mental health scholars involved in prevention and intervention family research with various Latinx communities within and outside of the United States. These scholars discussed their experiences of overcoming barriers in their research. We used thematic analysis to code and analyze participant responses, and our findings support the gaps in previous literature and highlight potential pathways to overcoming barriers in cultural adaptation research. Themes included the need for: (a) better understanding of the intersection between culture and context; (b) community-centered approaches to addressing implementation challenges; and (c) structural changes within institutional, governmental, and political levels. We discuss implications for researchers and practitioners working with Latinx families.Un número cada vez mayor de intervenciones adaptadas culturalmente a nivel familiar abordan las desigualdades en la salud mental con poblaciones marginadas en los Estados Unidos. Sin embargo, con estos avances han surgido muchos obstáculos, como las dificultades con el grado de integración cultural, la participación y la sostenibilidad. Realizamos veinte entrevistas fenomenológicas selectas con investigadores de la salud mental dedicados a la investigación familiar en materia de prevención e intervenciones con varias comunidades latinas dentro y fuera de los Estados Unidos. Estos investigadores comentaron sus experiencias de superación de los obstáculos en su investigación. Utilizamos el análisis temático para decodificar y analizar las respuestas de los participantes; nuestros resultados respaldan la falta de datos en publicaciones previas y destacan las posibles vías para superar los obstáculos en la investigación sobre la adaptación cultural. Los temas incluyeron la nacesidad de: (a) una mejor comprensión del enlace entre la cultura y el contexto; (b) enfoques centrados en la comunidad para abordar las dificultades de implementación; y (c) cambios estructurales dentro de los niveles institucionales, gubernamentales y políticos. Debatimos las implicancias para los investigadores y los profesionales que trabajan con familias latinas.针对特定文化族群的家庭层面干预来解决处于美国社会边缘的人群心理健康差距问题的做法越来越多,但是在其发展过程中也会遇到一些障碍,比如文化适应程度方面的困难,如何让病人配合和治疗措施持续性的问题等等。我们对12名顶级的心理健康学者进行了现象学的访谈,这些学者均参与过针对很多在美国境内和境外的拉丁美洲社群家庭进行预防和干预的家庭研究。他们都谈到了他们在研究过程中克服障碍的经历。我们使用主题分析法来解码和分析参与者的访谈内容,我们的结果显示在以前的文献中此类研究选题确实存在空白,并指出了克服这些文化调适研究中的障碍的可能路径。主题包括有必要:(a)更好地理解文化和具体生活环境共同的相互作用;(b)以社群为中心的方法来讨论实施过程中的困难;(c)在体制、政府和政治层面进行结构化变革。我们给出了研究者和从业者在跟拉丁美洲家庭打交道时的一些建议。.

In this chapter, we review important cultural considerations in the treatment of depression for racial/ethnic minorities. We accomplish this by first reviewing the epidemiology of depression among different racial/ethnic groups in the USA, focusing on Latinx, Black and African Americans, Asian Americans, and American Indians. We then review research that has investigated variability in depression along important contextual factors within racial/ethnic minority groups. Afterwards, we review the literature on psychotherapy for depression with racial/ethnic minorities, highlighting commonalities and differences across different treatment adaptations and approaches. Finally, we conclude with recommendations for clinicians and researchers, including the integration of therapist cultural competence and therapy cultural adaptations, as well as attention to heterogeneity within different racial/ethnic groups and the role that systems of privilege and oppression play in shaping these differences.

In this study, we conducted a path analysis on data from the National Latino and Asian American Study to investigate the role of religious attendance on mental health among Mexican populations. Using data from 868 Latinos of Mexican origin, we further investigated the extent to which religious attendance mediated the direct path between generation status and lifetime prevalence rates of any substance use disorder, depressive disorder, and anxiety disorder. Results indicate that Mexican immigrants endorsed lower lifetime prevalence rates of depressive disorder, anxiety disorder, and substance use disorder and endorsed higher levels of religious attendance. Second, results indicate a significant negative relationship between religious attendance and prevalence rates for depressive disorder, anxiety disorder, and substance use disorder. Third, results indicate that religious attendance was a mediator for the relationship between generation status and the lifetime prevalence rates of substance use disorder only. These results provide a contribution toward the discussion of the immigrant health paradox and further highlight the role that religious attendance plays in the relationship between generational status and the lifetime prevalence rates of substance use disorder. (PsycINFO Database Record

In the past 40 years, there has been a significant increase in Black students’ enrollment at predominantly White institutions (PWIs). Meanwhile, research shows that Black students often experience difficulty with transitioning and adjusting to PWIs. Previous research has effectively documented the challenges facing a significant number of Black students at PWIs; however, less is known about the experiences of Black women in particular. This study examined stress from racial tension experienced among 129 Black undergraduate women at PWIs in the Northeast region of the United States, as well as the potential moderating factors of the theorized Strong Black Woman concept and the Africultural coping theory. Hierarchical regression analyses indicated a significant positive association between racial tension experienced on campus and stress. Results also indicated that only Africultural coping was a significant moderator of this relationship, such that there was a weaker relationship between racial tension and stress among the participants who engaged more in Africultural coping. Policy implications for improving the campus racial climate and the academic experiences of Black college women at PWIs are discussed.

In this study, we examined the relationship between religiosity and attitudes towards professional mental health services. We further examined whether internal religious coping and external...

While prior research has well documented racial and ethnic disparities in mental health care broadly, significantly less attention has been given to possible disparities existing in the transition to aftercare. Grounded in Klinkenberg and Calsyn's (1996) framework, we review current research on aftercare, identify commonalities between the prior and current reviews, and highlight gaps for future research. We focus on variables pertinent to our understanding of racial/ethnic disparities. Articles were retrieved via PsycINFO, PubMed, PsycARTICLES, and Google Scholar. We targeted those written in English and conducted in the United States after 1996 that examined aftercare and disparities-related variables. Accumulating evidence across the 18 studies that we reviewed suggests that disparities exist in aftercare engagement. We found clear support for significant racial/ethnic effects on aftercare engagement, such that racial/ethnic minorities are typically more vulnerable to disengagement than Whites. In addition, we found modest support for the association between aftercare engagement and other individual- and community-level variables, including sex, insurance status, prior outpatient treatment, and residence in an urban versus rural setting. Moreover, extant qualitative research has identified barriers to aftercare engagement including stigma, low mental health literacy, and negative attitudes toward treatment. Finally, systems-level variables including assertive outreach efforts and reduced length of time on waitlists were identified as consistent predictors of engagement. Suggestions for future research and clinical implications are explored. (PsycINFO Database Record

Objective(s) This qualitative study aimed to elucidate barriers and facilitators faced by individuals with serious mental illness in establishing positive therapeutic relationships within the public sector. Method Twenty-two individuals, receiving inpatient treatment and near discharge from three state psychiatric facilities, participated. The sample was diverse with respect to gender (60 % male) and race/ethnicity, with a mean age of 40 years (standard deviation = 12.91). Thematic analysis and a contextualist lens were used to analyze the data. Results Results indicated that inadequate meeting time, lack of clinically relevant communication, and discrepancies in client/provider perspectives, impeded positive therapeutic relationships. Facilitators to therapeutic relationships included feelings heard and understood by providers, comprehensive, timely discharge plans, and thinking broadly about aftercare. Conclusions Cultivating positive therapeutic relationships is especially difficult in resource-challenged settings. Enhanced client-provider communication and individually tailored aftercare planning can enhance inpatient therapeutic relationships, convey a greater sense of understanding of clients, and facilitate client-provider collaboration.

Objective. The Self-Report Habit Index (SRHI) was originally reported as one-dimensional (Verplanken and Orbell, 2003). Nevertheless, habit has been described as characterized by several features, and one-dimensional models for the SRHI have shown poor fit. Therefore, we aimed to compare multi-dimensional models with a one-dimension model in both snacking and physical activity habits, besides examining further instrument characteristics. Design. A cross-sectional study was conducted with high school and university students (n = 555). Main outcome measure. The SRHI adapted for physical activity and for snaking habits was applied at one single time. Results. Nested models with one factor, two factors, and three factors were compared. Then, a hierarchical second-order model was tested, and further validity issues, as well as invariance between habits, were examined. Three-dimensional models represented a better fit for both habits. However, fit was still non-adequate in the snacking version. Also, discriminant validity concerns raised for the physical activity SRHI. Also, invariance between the snacking and the physical activity versions was not confirmed. Conclusions. Considering the SRHI as composed by the dimensions of “lack of awareness”, “lack of control”, and “history of behavioural repetition” seems to be more accurate. Nevertheless, our findings suggest that further research is needed. Universidad de Costa Rica/[723-B7-306]/UCR/Costa Rica UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP)

In this qualitative study, we examined perceptions of the strong Black woman (SBW) or superwoman role in a sample of 30 Black women. We found that participants conceptualized the SBW/superwoman role through five characteristics: independent, taking care of family and others, hardworking and high achieving, overcoming adversity, and emotionally contained. Most participants were ambivalent about their relationship with this role, given historical accounts and familial examples of Black women. Many participants appropriated the SBW/superwoman role by redefining it in ways that were more empowering and freeing. Several participants were critical of and rejected the SBW/superwoman role, focusing on its problematic and rigid view of strength. All of these perspectives underscore the importance of increasing awareness of restrictive gendered and racialized role expectations as well as the desire to maintain connections to the cultural legacy of Black women. Several important contextual factors (e.g., social status, family relationships) emerged that are relevant to the identified themes. Results from this study highlight how the discourse of strength and familiarity with the SBW/superwoman role are pervasive among Black women. Our findings underscore the need for practitioners to understand the complexity in how Black women make meaning of this role relative to help seeking for physical and mental health. Online slides for instructors who want to use this article for teaching are available on PWQ 's website at http://pwq.sagepub.com/supplemental

Decades of masculinity research have concluded that society places higher demands on males to adhere to norms for low emotional expression; yet, countless studies find that emotional expression is integral to well-being. Unfortunately, this contradiction places boys and men in a tenuous position as they must navigate a bombardment of societal messages about the importance of emotional stoicism and invincibility. For urban adolescents, the situation is more complicated as they encounter environmental stressors that place greater emphasis on projecting a tough façade. Thus, our primary aim was to assess to what degree dyads of close adolescent male friends from urban, low-income neighborhoods are able to engage in emotional expression and response and to explore some of the underlying mechanisms and interpersonal processes. Qualitative findings from our sample suggest that urban boys exhibit a wide range of behaviors when participating in dyadic emotional disclosure and response, including being highly emotionally expressive and supportive in the context of close male friendship.

Aim Intervention during the clinical high-risk phase for psychosis (CHR) can reduce duration of untreated psychosis and associated negative outcomes. Early treatment access and sustained engagement are important to understand for effective intervention. Understanding stigma and help-seeking processes is particularly important for groups that experience mental healthcare disparities such as those of Chinese heritage living in the United States. Methods Chinese and Taiwanese participants (N = 215) residing in the United States were randomly assigned to one of three CHR vignette conditions based on the "what matters most" stigma framework for Chinese groups, which identifies capacities that define "personhood" and thereby shapes stigma for members of a particular cultural group. Participants completed measures of help-seeking attitudes, family stigma and individual stigma. Results More stigma towards the CHR vignette character's family was associated with positive CHR help-seeking attitudes. Participants who read the vignette describing CHR affecting family obligations, "what matters most" and participants who read the vignette describing CHR symptomology only had more positive CHR help-seeking attitudes compared to participants who read the vignette describing CHR affecting individual aspirations. Conclusions Chinese and Taiwanese residing in the United States may perceive professional mental healthcare to be especially relevant for persons with CHR when symptoms are particularly stigmatizing for the person's family and when symptoms threaten the person's ability to fulfil family obligations (ie, "what matters most"). Clinical implications of findings include the importance of emphasizing positive treatment outcomes that increase an individual's ability to engage in valued life domains.

Different conceptions and understanding of the terms diversity and inclusion contribute to the slow progress in advancing principles of equity and social justice on college campuses. In particular, diversity and inclusion efforts must address national-level inequities with local instantiations of these inequities. In this chapter, Esteban Cardemil focuses on the critical role that assessment can play in helping advance university diversity and inclusion efforts by highlighting some forms of assessment. Further, he discusses some of the important limitations of assessment that must be acknowledged when conducting this work. Finally, he concludes by arguing that the very weaknesses inherent in assessment can spur the advancement of diversity efforts by encouraging diversity advocates to conceptualize diversity and inclusion as a process, not as an outcome.

Over 20 years of research have documented racial and ethnic disparities in depression treatment. To date, however, this research has not led to substantive improvements. In this article, the authors argue for a broader perspective on disparities that encompass individual-level help-seeking processes in addition to the more traditional structural-level analyses. Cultural and contextual factors influence the entire range of help-seeking behaviors, from initial expressions and conceptualizations of distress, to perspectives on depression and depression treatment, to experiences with depression treatment. Understanding these influences, and their connections to the persistent disparities affecting racial and ethnic minorities, offers clinicians and researchers opportunities for targeted interventions that have potential to improve quality healthcare for all.

This commentary examines how the adoption of benchmarking can promote the internationalization of evidence-based practice. Given the increasing evidence documenting the role of culture and context in the shaping of experiences and expressions of distress, as well as influencing attitudes and conceptions of mental health services, benchmarking may not represent the best approach to addressing global public health agendas. A brief overview of the sequential approach to developing, evaluating, and disseminating treatments in novel cultural contexts is presented, in which benchmarking can play an important, albeit secondary role. It is argued that in a global context, benchmarking's role may better function to promote dissemination within particular contexts, rather than between them.

Background: Primary care providers (PCP) are the entry point for public sector depression treatment for many Latino patients. However, many Latino patients do not initiate their PCPs’ recommended treatment, which likely contributes to ethnic disparities in depression treatment. This study examined factors related to Latino patients’ uptake of their PCPs’ recommendations for depression treatment. Method: Ninety Latino primary care patients who received a depression treatment recommendation from their PCP participated in a telephone interview. Patients rated their working alliance with their PCP and their PCP’s cultural competence. They also reported their treatment preference, the type of recommendation, and their intended and actual uptake of the recommendation. Patients were contacted at two time points (Time 1: M 14 days after PCP appointment; Time 2: M 84 days after PCP appointment) to report their uptake status. Results: At Time 1, 23% of patients had initiated uptake of the treatment recommendation, increasing to 53% at Time 2. Patients who received a medication recommendation were more likely to have followed though on the recommendation, compared with patients who received a psychotherapy recommendation. The working alliance was positively associated with intention to follow up on a treatment recommendation, and also mediated the relationship between cultural competence and intention of following up on the recommendation. Conclusion: PCP’s treatment recommendation and the PCP– patient alliance play a role in Latino primary care patients intention to follow a treatment recommendation for depression. An improved understanding of this role could enhance efforts to improve depression treatment uptake.

This study examined parents' provision of academic structure, and whether they implement it in an autonomy supportive or controlling manner, in relation to children's competence-related beliefs, motivation, and academic behavior over the transition to middle school. Interviews with 160 sixth-grade children were coded on parental structure and autonomy support. Children reported on their competence-related beliefs, motivation, and engagement in sixth and seventh grades. Regression analyses showed that higher structure predicted seventh-grade perceived competence, intrinsic motivation, engagement, and English grades, controlling for these same outcomes at sixth grade. Autonomy support predicted perceived competence, autonomous motivation, and English grades, controlling for prior outcomes. Structural equation models indicated that relations between structure and engagement and between autonomy support and grades were mediated by perceived competence.

En este estudio cualitativo, examinamos la religiosidad, el manejo con la adversidad, y facilitadores en la busqueda de diferentes tipos de servicios de salud mental en una muestra de 17 hombres y mujeres Latinos religiosos. El analisis tematico revelo que los participantes tendian a enfrentar problemas con metodos consistentes con sus practicas religiosas. La mayoria de los participantes, especialmente los de mayor edad, identificaron las practicas religiosas/ espirituales organizadas e informales como metodos importantes y preferidos al manejar la adversidad. Ademas, muchos participantes mostraron preferencias hacia los servicios religiosos que eran consistentes con sus creencias religiosas y complementaban sus formas existentes de lidiar con la adversidad. Finalmente, nuestro estudio indica que habia ideas comunes acerca de las circunstancias en las que los participantes buscan los servicios formales de salud mental, incluyendo sentirse comprendido, el experimentar problemas graves de salud mental, y el enfrentar problemas que se piensa son de origen biologico. Es importante destacar dos factores contextuales que surgieron relevantes para entender estas razones, que los participantes que compartieron estas opiniones tienden a ser mas aculturados y a tener mas educacion formal. Los resultados de este estudio ilustran como la religiosidad esta relacionada con el manejo de problemas y con las actitudes hacia los servicios formales de salud mental entre los Latinos religiosos, asi como la importancia del contexto en la comprension de estos procesos. References Alegria, M., Canino, G., Rios, R., Vera, M., Calderon, J., Rusch, D., & Ortega, A. N. (2002). Mental health care for Latinos: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino Whites. Psychiatric Services, 53, 1547–1555. doi:10.1176/appi.ps

Treatment goals and preferences of depressed patients are important, but they are rarely empirically studied. Although clinicians are likely to discuss goals with individual patients, research that clarifies overall patterns in the treatment goals of depressed patients could be useful in informing new interventions for depression. Such research could also potentially help address problems such as poor adherence and psychotherapy drop-out. In this preliminary qualitative investigation, we examined treatment goals established by depressed outpatients in the context of a trial of behaviorally oriented psychotherapy. The treatment goals that were most commonly articulated included improving social and family relationships, increasing physical health behaviors, finding a job, and organizing one’s home. These results underscore the fact that, in addition to improvement in the symptoms of depression, functional improvements are viewed as key treatment goals by depressed individuals.

In this study, we examined help-seeking pathways and help-receiving experiences among Latinos, a population that has been shown to underutilize mental health services. We used the qualitative approach of dual mode of analysis to explore the experiences of 13 Latino men and women who utilized formal as well as informal treatment and support resources. We explored three specific themes: (a) individual and family help-seeking perspectives intersecting with Latino cultural norms; (b) referral source and style, needs identification, and prior help-seeking experiences as key motivational factors for help seeking; and (c) client—therapist match and client—therapist relational style as integral to mental health treatment satisfaction. We discuss clinical implications for efforts to improve the cultural sensitivity and accessibility of mental health services.

This paper describes the experiences of the first author and his colleagues in the development and implementation of a depression prevention program that specifically targets Latina mothers. Building on the earlier papers that highlight the underutilization of mental health services by Latinos in general, this paper will make the case that the situation is particularly concerning with regards to depression. In addition to the fact that depression is a highly prevalent disorder among Latino adults, the potential consequences for children of parents with depression are significant. Thus, the underutilization of formal mental health services by Latinos makes depression a critical public health problem that calls for creative solutions. One possible solution is the careful development and implementation of prevention programs. Depression prevention programs have some advantages over formal mental health treatment in that they can be offered at a relatively low cost, can be packaged in ways that make them less stigmatizing, and if effective, can reduce the incidence of cases that develop into clinical depression. This paper will describe the process of developing a novel depression prevention program, with a particular focus on the attention paid to cultural sensitivity. We describe the complexity inherent in defining cultural sensitivity and illustrate in concrete ways its implementation in the development and evaluation of the prevention program. In addition, we explore some of the challenges that emerge when attempting to balance the creation of a program that is culturally sensitive with the demands of rigorous quantitative evaluation.

This study examines the associations among parent-child relationship characteristics, acculturation and enculturation, and child externalizing symptoms in a sample of 40 Latino parent-adolescent dyads. Specifically, the associations between parent-child relationship characteristics (i.e., communication and parental involvement) and adolescents' externalizing symptoms are examined. Also examined is whether the relationship between these two aspects of the parent-child relationship and adolescent functioning would be moderated by acculturation and enculturation differences between parents and their children. Significant relationships are found among parent-child communication, parental involvement, and child externalizing behaviors; however, neither the acculturation nor enculturation gap moderates these associations.

Research on the mechanisms by which interparental conflict (IPC) affects child depression suggests that both parenting and children's conflict appraisals play important roles, but few studies have explored the role of general cognitive style or included both parenting and cognitions in the same design. Moreover, the effects of IPC on minority children are not well understood. In this longitudinal study, parenting was examined as a mediator of the relation between increasing IPC and change in depression. General cognitive style was included as a moderator. The combined influence of parenting and cognitions was also explored. A racially and ethnically diverse sample of 88 fifth and sixth graders from two urban schools reported their cognitive style, depressive symptoms, and perceptions of conflict and parenting at two time points separated by one year. Parental warmth/rejection mediated the relation between IPC and depression, and general cognitive style acted as a moderator. Parenting, cognitive style, and IPC did not significantly interact to predict change in depression over time. Findings indicate that both parenting and children's general cognitive style play a role in understanding the impact of increasing IPC on children's well-being.

Increased understanding of the treatment goals of depressed patients may lead to improved treatments and assist researchers and program evaluators in choosing clinically relevant outcome measures. To characterize patients' depression treatment goals, we interviewed hospitalized depressed patients about their treatment goals. Common responses included improving relationships, decreasing sadness or anxiety, and finding a job or improving job performance. On a written questionnaire, patients also ranked decreasing suicidal thoughts highly. These results suggest that for many severely depressed individuals, primary treatment goals include improvements in social and occupational functioning in addition to symptomatic improvement.

In this article, we present the results of a local needs assessment of the mental health experiences, service needs, and barriers to treatment-seeking of the Latino population in Worcester, Massachusetts. Overall, participants reported relatively high rates of experiences with symptoms of mental health problems, they indicated using a range of both formal and alternative mental health services, and they noted a variety of instrumental, attitudinal, and culturally-specific barriers to seeking mental health services. Findings are discussed with regards to the role that community-driven research can play in advancing efforts to provide relevant services to underserved populations.

This study assessed the efficacy of 1) matching patients to treatments and 2) adding additional family therapy or cognitive therapy in a group of recently discharged patients with major depression.Patients with major depression were recruited during a psychiatric hospitalization. After discharge, they were randomly assigned to one of four treatment conditions that were either "matched" or "mismatched" to their pattern of cognitive distortion and family impairment. The four treatment conditions were 1) pharmacotherapy alone; 2) combined pharmacotherapy and cognitive therapy; 3) combined pharmacotherapy and family therapy; and 4) combined pharmacotherapy, cognitive therapy, and family therapy. Randomly assigned treatment continued for 24 weeks on an outpatient basis.Among patients with at least moderate depressive symptoms at hospital discharge, low rates of remission (16%) and improvement (29%) were obtained. Matched treatment led to a significantly greater proportion of patients who improved and greater reductions over time in interviewer-rated depressive symptoms than mismatched treatment. However, matched treatment did not produce greater change in self-reported depression or interviewer-rated suicidal ideation. Treatment that included a family therapy component also led to a greater proportion of patients who improved and to significant reductions in interviewer-rated depression and suicidal ideation than treatment without family therapy.These results suggest that 1) current treatments are not very efficacious in the aftercare of hospitalized depressed patients, 2) treatment matching moderately improves outcome for patients who are symptomatic at hospital discharge, and 3) inclusion of family therapy improves the outcome of posthospital care for depressed patients.

Depression is a disorder that can have particularly deleterious effects on individuals from racial/ethnic minority and low-income backgrounds. Culturally appropriate prevention programs offer a way to provide accessible and effective mental health services to these underserved populations. The authors introduce the Family Coping Skills Program (FCSP), a novel depression prevention program developed specifically for low-income Latina mothers. The authors present the theoretical underpinnings of the FCSP and describe their efforts to make the program culturally appropriate and to enhance recruitment and retention of participants. Initial outcome data from an uncontrolled trial were promising and support continued development and evaluation of the FCSP and other similar programs.

The ability to conduct psychotherapy effectively with racially and ethnically diverse populations is becoming increasingly important given the changing demographics of this country. Recent estimates of population trends suggest that by the year 2050, non-Hispanic Caucasian Americans will constitute approximately 50% of the United States population, as compared with the current 72% of the population (U.S. Census Bureau, 2001). The American Psychological Association (APA) has recognized the critical nature of integrating issues of race and ethnicity into the field of psychology by encouraging attention to these issues in clinical training programs (APA, Committee on Accreditation, 2002), creating therapist competency guidelines for working with racial and ethnic minority populations (APA, 1993), and sponsoring professional meetings to identify strategies to promote sensitivity to diversity in psychology (McGuire, 1999). It is likely that most clinical psychologists have acquired an intellectual appreciation of the salience of race and ethnicity in the

Research suggests that group cognitive-behavioral therapy (CBT) can be an efficacious and potentially cost-effective treatment for major depression. Yet despite evidence of efficacy, there may be limitations to the effectiveness of group CBT in actual clinical practice. We introduce the Group, Individual, and Family Treatment (GIFT) program that builds upon current CBT theory and technology, but has been modified to create a potentially more effective version of group CBT. In this article, we describe the emotional fitness model of mental health upon which the GIFT program is based. We then describe how the GIFT program attempts to build upon existing group CBT programs by using an open-group format and repeated-group session format, and by the integration of individual and family-based interventions.

This study examined the relationships among cognitive variables, family immigration history, negative life events, and depressive symptoms in a sample of 306 low-income, urban fifth- and sixth-grade children. Explanatory style and negative automatic thoughts were the cognitive variables examined. There were three key findings. First, children who were immigrants reported significantly more depressive symptoms, more negative life events, and more negative automatic thoughts than children who were not immigrants. Second, both explanatory style and negative automatic thoughts were significantly associated with depressive symptoms above and beyond the effects of child immigration history and negative life events. Finally, negative automatic thoughts mediated the relationship between child immigration history and depressive symptoms. We discuss the clinical and research implications of these findings.