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Context: Depression in primary care remains challenging; patients with depression often do not seek help. Interventions to increase help-seeking (HS) behavior have been ineffective or decreased HS. Mental Contrasting and Implementation Intentions (MCII) is a behavioral intervention to create action plan in advance. It has been effective among patients seeking to increase exercise, reduce smoking, and other health behaviors. However, it has not been used for initiating help- seeking for depression. Objective: To assess whether an online MCII training program increases HS or the intention to seek help at 2 weeks post-intervention among those with elevated depressive symptoms, compared to information-only controls (C). Study Design and Analysis: RCT comparing HS and C at 2 weeks using pre-post survey. Analysis using t-test and ANOVA; intention to treat. Setting: MTurk online cloud research toolkit (Feb-March 2020). Population Studied: Adults with Beck Depression Inventory (BDI-II) score of 14 (mild depressive symptoms) or above and who were not seeking professional help at baseline. Intervention: Published online MCII intervention. Outcome Measures: Primary: Self-reported help seeking success (single-item). Secondary: Strength of Implementation Intentions Scale (SIIS), depressive symptoms (BDI-II), current perceived depression (single item). Results: Of the 2134 participants prescreened for depression and HS, 228 met eligibility criteria (37.2 [+ or -] 12.1 yrs, 65% F, 67% white). Demographics and disease severity were similar between groups at baseline. The HS group (n=105) reported greater HS success (p = .013) as well as intention to seek help (p = .001) 2 weeks post intervention compared to C (n=124). Further, perceived HS success was more likely for those who received the HS intervention and either did not perceive themselves as currently depressed at Time 2 (OR = 3.7) or individuals whose actual BDI-II score at follow up was below 14 points (OR = 10.6). Conclusions: Among participants with elevated depression symptoms, an online training in MCII effectively increased help-seeking behavior and intention to seek help compared to information-only control participants 2 weeks after delivery. The intervention is relatively brief and potentially scalable. Further research is warranted to determine clinical utility., Presenters Amanda Keeler, MA, Liesl Nydegger, PhD, [...]

People who are incarcerated are at heightened risk of overdose upon community reentry. Virtual reality (VR) may provide an innovative tool for overdose prevention intervention in corrections facilities. This mixed methods study sought to understand incarcerated individuals' perspectives on VR for overdose prevention and explore physiological arousal associated with use of VR equipment. Study participants were 20 individuals, stratified by gender, with an opioid use disorder at a county jail. Qualitative interviews assessed acceptability and perceived utility of VR in the jail setting. Thematic analysis indicated high levels of acceptability and potential utility in the following areas: (a) mental health and substance use interventions, (b) community reentry skills training, and (c) communication and conflict resolution skills. Heart rate variability (HRV) data were collected continuously during the interview and during VR exposure to explore whether exposure to the VR environment provoked arousal. Physiological data analyses showed a significant decrease in heart rate (HR) [b = −3.14, t(18) = −3.85, p < .01] and no arousal as measured by root mean square of successive RR interval differences (RMSSD) [b = −0.06, t(18) = −1.06, p = .30] and high frequency-HRV (HF-HRV) [b = −0.21, t(18) = −1.71, p = .10]. This study demonstrated high acceptability and decreased HR response of VR among incarcerated people who use drugs. [ABSTRACT FROM AUTHOR]

Physical and sexual intimate partner violence (IPV) among adolescents leads to adverse health behaviors, particularly suicidal ideation and attempts. Studies demonstrated the link between IPV and suicidal ideation and attempts among adolescents, yet there is conflicting evidence regarding differences between adolescent males and females; research evaluating the interaction of gender and the association between IPV and suicidal ideation and attempts is limited. The present study used a nationally representative sample from the Youth Behavioral Risk Surveillance questionnaire to determine whether there is an interaction of gender on the relationship between physical IPV, sexual IPV, and suicidal ideation and suicidal attempts. Weighted logistic regressions were fit using Stata 15.1 and multiple imputations were used to account for missing data. There is a significant gender by sexual IPV interaction (AOR = 0.66, CI = 0.51–0.84, p = 0.002) such that at low levels of sexual IPV there were no differences between genders in reported suicide attempts (t[33] = 1.19, p = 0.242). However, at moderate and high instances of sexual IPV, adolescent females were significantly less likely than males to report attempting suicide in the past year (t[33] = −2.71, p = 0.011; t[33] = −3.17, p = 0.003, respectively). The present study demonstrates the vital need for IPV and suicidal ideation and attempt screening, tailored multi-level interventions, and advocacy for adolescents. Policies are essential to increase screening among medical providers, and increase school- and community-based interventions and IPV and suicide awareness to decrease rates among adolescents. Female students were more likely than males to report suicidal ideation. Significant interaction between sex and sexual IPV on suicide attempts. Gender differences at medium and high levels of sexual IPV on suicide attempts. [ABSTRACT FROM AUTHOR]

Many people enrolled in drug diversion programs are not receiving evidence-based prevention for HIV or hepatitis. This study translated basic research from cognitive science to increase screening for infection and condom use in this population. A parallel three-condition randomized trial was conducted in a drug diversion sample (N = 358), comparing a memory practice condition with two active control conditions. Outcomes were condom use frequency and testing for infection (hepatitis B/C, HIV). At 3-month follow-up, participants in the memory practice condition were at least twice as likely (OR = 2.10 or greater, p < .01) to self-report testing compared to those in the control conditions and also reported more frequent condom use compared to a health education condition [B = .37, t(1) = 2.02, p = .02]. Basic research on memory can be effectively translated to brief interventions on infection screening and risk prevention in existing drug diversion programs., Author(s): Alan W. Stacy [sup.1] , Liesl A. Nydegger [sup.2] , Yusuke Shono [sup.3] Author Affiliations: (Aff1) 0000 0004 0389 8602, grid.254271.7, School of Community and Global Health, Claremont Graduate [...]

The Superwomen Schema (SWS) describes a social framework that encompasses the role that many Black women adopt in response to chronic stress, financial pressures, and an intersection of oppression. Woods-Giscombé (Superwoman Schema: African American Women's Views on Stress, Strength, and Health. Qualitative Health Research 20 (5): 668–683, 2010) characterizes SWS using five tenets: obligation to manifest strength, obligation to suppress emotions, resistance to vulnerability or dependency, determination to succeed despite a lack of resources, and an obligation to help others. The goal of this study is to determine the connection between SWS among Black women and substance use as a means of maintaining mental health, garnering resilience, and coping with external pressures. We aimed to highlight systemic and infrastructural racism and prejudice and how they relate, not only to the adoption of SWS, but also how they may contribute to substance use. This study is a secondary analysis of a larger study on HIV prevention Black and Latine women at high risk for HIV. Only Black participants (n = 10) were included in this secondary analysis. The interviews were conducted 3 times across 3 months. Interviews were coded and analyzed using thematic content analysis in NVivo. Themes of undiagnosed mental health symptoms, medical mistrust, institutional distrust, and aversion to help-seeking were recurrent in our data. Our research confirmed and assessed dual repercussions of SWS among Black women both as a defense that granted resilience in the face of seemingly insurmountable odds and as a construct that encouraged substance use as a coping mechanism for compromised mental health. This study contextualized this subset of coping and substance use to address and dismantle systemic contributors. [ABSTRACT FROM AUTHOR]

Background: There are many reasons why individuals with depression may not seek help. Among those with elevated depressive symptomatology, some previous interventions aimed at increasing help-seeking have unintentionally decreased help-seeking intentions. Beck's cognitive theory of depression posits that individuals with elevated depressive symptomatology process information differently from those without depression (i.e., increased cognitive errors, negative bias); potentially explaining the iatrogenic results of previous interventions. Mental contrasting and implementation intentions (MCII; a self-regulatory strategy) interventions have successfully influenced physical and mental health behaviors. However, MCII has not been used specifically for initiating help-seeking for depression. The goal of this research was to ascertain whether an online MCII intervention could increase actual help-seeking or the intention to seek help for depression. Method: Two online randomized pre-post experiments were conducted to measure the primary outcome measures 2 weeks post-intervention (Study 1 collected Summer 2019: information-only control ["C"], help-seeking MCII intervention ["HS"], and comparison MCII intervention ["E"]; Study 2 collected Winter 2020: "C" and "HS"). At Time 1, adults recruited from MTurk had a minimum Beck Depression Inventory (BDI-II) score of 14 (mild depressive symptoms) and were not seeking professional help. Results: Study 1 (N =74) indicated that the intervention was feasible, provided preliminary support, and clarified intervention components for Study 2. Study 2 (N=224) indicated that the HS group reported greater intentions to seek help and actual help-seeking than the C group. Proportionally, actual help-seeking was more likely among individuals who received the HS intervention and either did not perceive themselves as depressed at Time 2 or had BDI-II scores indicating that their depressive symptomatology decreased from Time 1. Limitations: Participation was limited to US residents who self-reported data. Discussion: These studies indicate that a brief online MCII intervention to encourage help-seeking is feasible and preliminarily successful. Future studies should consider using ecological momentary assessment measurements to establish the temporal precedence of intervention effects and whether MCII is effective for encouraging help-seeking among individuals prone to experiencing cognitive errors who may not be experiencing negative bias (e.g., bipolar disorder or anxiety). Clinicians may find this method successful in encouraging ongoing treatment engagement. [ABSTRACT FROM AUTHOR]

In the USA, Black women are at disproportionately higher risk for HIV compared to women of other races/ethnicities, which can be explained by the Substance Abuse, Violence and AIDS (SAVA) syndemic. Disparities in HIV, substance use and violence are driven by multiple influences, including structural factors (e.g. housing and poverty), which exacerbate social- and individual-level factors leading to more sex partners, engaging in unprotected sex, having sex for money, experiencing forced sex from an intimate partner or increased substance use, all of which increase HIV risk. Pre-exposure prophylaxis (PrEP), a pill that can prevent HIV, is a discreet and underutilised method that Black women experiencing syndemics can use to decrease their risk. This study explored Black women's interest in, and barriers to adopting PrEP over 6 months. Thirty Black women (age M = 32.2) who experienced multiple substance use, violence and HIV-related syndemic factors were interviewed four times over a 6-month period. Results demonstrated that experiencing intimate partner violence, substance use, community violence and other structural factors (poor access to social services, transport and childcare) all acted as barriers to PrEP adoption. Future research should consider multi-level interventions that include methods such as media campaigns, providing PrEP or referrals where women who experience syndemic and structural factors seek help, and implement a PrEP adherence programmes and interventions in support group settings. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exacerbated the health disparities and structural racism among African Americans. We examined overlaps between the COVID-19 pandemic and HIV epidemic using an intersectional stigma framework through the lens of Critical Race Theory. Intersectional stigma, medical mistrust, and decreased likelihood of referral for HIV and COVID-19 testing leads to decreased engagement in the healthcare system. Social inequities increase health disparities and lead to increased rates of chronic diseases, which increases the risk and severity of COVID-19. Solutions to mitigate impact among African Americans include increasing engagement regarding African American health, funding, and providers of color. [ABSTRACT FROM AUTHOR]

Sexual minority (SM) youth are at high risk for intimate partner violence (IPV) and suicidal ideation/attempts compared to their heterosexual peers. We examined whether SM identity enhanced the relationship between experiences of IPV and suicidal ideation/attempts. Weighted logistic regression models were run using the 2017 Youth Risk Behavior Survey. All main effects were significant; each SM identity and both physical and sexual IPV were significantly associated with suicidal ideation and suicide attempts. The interaction between bisexual identity and physical IPV was significant for suicidal ideation; as physical IPV experiences increased, the difference between bisexual identity and heterosexual youth was non-significant. Findings suggest exploring trauma and suicidal ideation by aggregate groups and increasing support for SM youth in schools and communities. [ABSTRACT FROM AUTHOR]

Black women who use alcohol, marijuana, and other drugs are disproportionately affected by health disparities. Black women's HIV diagnosis rates are 15 times higher than White women, and is among the leading causes of death among Black women in the US. Previous studies support the association between substance use and HIV risk, yet it is essential to better understand the specific factors experienced within the context of substance misuse and recovery among vulnerable Black women at-risk for substance misuse, HIV, and adverse life experiences. We conducted qualitative interviews with 31 black women (age M = 32.13, range 18–57) four times over six months. Eligible participants were 18+ years, identified as a Black/African-American woman, had unprotected vaginal or anal sex with a man in the past 30 days, and spoke fluent English. All transcripts were transcribed verbatim and were analyzed used thematic content analysis. Two groups of participants emerged: 1) those in recovery from their drug of choice (n = 11, 7 of whom misused alcohol or marijuana during the study), and 2) those who misused their drug of choice during the study (active use group; n = 20). Four themes emerged in the context of substance use: cultural factors, structural factors (i.e., housing and employment), past and present adverse life experiences, and individual factors (i.e., substance use to cope with stress, self-medicating with substances for mental health symptoms, intimate partner violence, and sex exchange). While participants in both groups used substances to cope with regard to these factors, the recovery group tended to use substances at lower frequencies and did not relapse with their drug of choice during the study. The active use group reported more substance use with regard to structural factors and recent adverse life events, had more difficulty regarding employment, and less instances of intimate partner violence (IPV) but were more likely to cope using substances. Substance use interventions tailored to vulnerable Black women should consider including trauma-informed interventions and support groups that address the structural, social, and individual factors to better serve their needs. [ABSTRACT FROM AUTHOR]

Adolescent gang members are at high risk for polytraumatization (i.e., experiencing two or more types of trauma), which may contribute to behavioral problems, such as delinquency or drug distribution, and mental health symptoms, such as posttraumatic stress disorder (PTSD) and depression. The present study examined the associations between polytraumatization and these behavioral and mental health outcomes. We hypothesized that increased polytraumatization would lead to increased (b) mental health symptoms, (b) delinquency, and (c) drug distribution. Participants included 441 adolescent gang members (57.8% male; age range: 14-19 years) from a midsized city in the Midwestern United States. A path model was used to test hypotheses. A total of 88.0% of participants experienced polytraumatization, such as physical and sexual assault, involvement in accidents, or witnessing a death or injury. Polytraumatization was uniquely and positively associated with depressive and PTSD symptoms, delinquency, and drug distribution, βs = .25-.50, ps < .001, explaining an additional 5.9%-22.5% of the variance in these outcomes beyond covariates. Untreated traumatic exposure among adolescent gang members may subsequently lead to poor behavioral and mental health outcomes. These results may inform prevention and intervention efforts focused on mental health and social justice among a high-risk adolescent population. [ABSTRACT FROM AUTHOR]

Background: HIV infection is problematic among all drug users, not only injection drug users. Drug users are at risk for contracting HIV by engaging in risky sexual behaviors. Objective: The present study sought to determine whether inhibitory processes moderate the relationship between problematic drug use and HIV-risk behaviors (unprotected sex and multiple sex partners). Methods: One hundred ninety-six drug offenders enrolled in drug education programs were administered a battery of computer-based assessments. Measures included a cued go/no-go assessment of inhibitory processes, the Drug Abuse Screening Test (DAST) assessment of problematic drug use, and self-report assessment of condom use and multiple sex partners. Results: Findings revealed that response inhibition assessed by the proportion of false alarms on the cued go/no-go moderated the relationship between problematic drug use and an important measure of HIV risk (condom nonuse) among drug offenders. However, response inhibition did not moderate the relationship between problematic drug use and another measure of HIV risk: multiple sex partners. Conclusions: Among this sample of drug offenders, we have found a relationship between problematic drug use and condom nonuse, which is exacerbated by poor control of inhibition. These findings have implications for the development of HIV intervention components among high-risk populations. [ABSTRACT FROM AUTHOR]

Approximately 36% of HIV cases are related to substance abuse. Substance abusers, including non-injection drug users, are at a high-risk for contracting HIV due to risky behaviors, including unprotected sex. Due to these behavioral and infection risks, feasible interventions that focus on condom use within this population are imperative. The current study involved the development of brief intervention designed to increase implementation intentions (situation-linked action plans) to use condoms in convicted non-violent drug offenders participating in drug diversion programs in Southern California. Participants (n= 143) were randomized at the individual level to either waitlist control or experimental conditions. The randomized waitlist control group received the HIV survey for the pre-test before the intervention, while the experimental group received a neutral, non-HIV-related, survey at pre-test. The experimental group received the HIV survey as the post-test after the intervention (waitlist control group received the neutral, non-HIV-related, survey). One-tailed Mann Whitney U tests were used to compare the waitlist control and experimental groups. The experimental group was more likely to report stronger implementation intentions to use condoms (p<0.001). These results indicate in the short term that a brief, easily disseminated HIV intervention can be effective for increasing implementation intentions to use condoms in an extremely high HIV-risk population. [ABSTRACT FROM PUBLISHER]

Purposes: This study examined the prevalence of addictive Internet use and analyzed the role of parental relationship in affecting this behavior among a random sample of adolescents in Wuhan, China. Methods: Students (n = 1,101) were randomly selected from four schools, including 638 boys and 463 girls with a mean age of 13.8 (standard deviation = 1.2) years. Addictive Internet use, parental relationship, hyperactivity-impulsivity were measured by validated instruments. Prevalence rate, ANOVA and multiple linear regression method were used to analyze the level of Internet addiction and its association with parental relationship, hyperactivity-impulsivity, as well as the interaction of parental relationship with chronological age and hyperactivity-impulsivity. Results: The prevalence rate of Internet addiction was 13.5% (16.5% for boys and 9.5% for girls, p<0.01). Compared to non-addictive users, addictive Internet users were scored significantly lower on parental relationships and significantly higher on hyperactivity-impulsivity. Interaction analysis indicated that better parental relationship was associated with more reductions in risk of addictive Internet use for younger students than for older students, and with more risk of Internet addiction among higher than among lower hyperactivity-impulsivity students. Conclusions: Findings of this study indicate that adolescent addictive Internet use is a significant public health threat in China. Prevention interventions targeting parental relationship must consider adolescent’s age and hyperactivity-impulsivity tendency. [ABSTRACT FROM AUTHOR]