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Background: The necessary execution of non-pharmaceutical risk-mitigation (NPRM) strategies to reduce the transmission of COVID-19 has created an unprecedented natural experiment to ascertain whether pandemic-induced social-policy interventions may elevate collateral health risks. Here, we assess the effects on violence against women (VAW) of the duration of NPRM measures that were executed through jurisdictional-level orders in the United States. We expect that stay-at-home orders, by reducing mobility and disrupting non-coresident social ties, are associated with higher incident reporting of VAW. Methods: We used aggregate data from the Murder Accountability Project from January 2019 through December 2020, to estimate count models examining the effects of the duration of jurisdictional-level (N = 51) stay-at-home orders on femicide. Additionally, we used data from the National Incident-Based Reporting System to estimate a series of count models that examined the effects of the duration of jurisdictional-level (N = 26) stay-at-home orders on non-lethal violence against women, including five separate measures of intimate partner violence (IPV) and a measure of non-partner sexual violence. Results: Results from the count models indicated that femicide was not associated with COVID-19 mitigation strategies when adjusted for seasonal effects. However, we found certain measures of non-lethal VAW to be significantly associated in adjusted models. Specifically, reported physical and economic IPV were positively associated with stay-at-home orders while psychological IPV and non-partner sexual violence were negatively associated with stay-at-home orders. The combination measure of all forms of IPV was positively associated with the duration of stay-at-home orders, indicating a net increase in risk of IPV during lockdowns. Conclusions: The benefits of risk-mitigation strategies to reduce the health impacts directly associated with a pandemic should be weighed against their costs with respect to women's heightened exposure to certain forms of violence and the potentially cascading impacts of such exposure on health. The effects of COVID-19 NPRM strategies on IPV risk nationally and its immediate and long-term health sequelae should be studied, with stressors like ongoing pandemic-related economic hardship and substance misuse still unfolding. Findings should inform the development of social policies to mitigate the collateral impacts of crisis-response efforts on the risk of VAW and its cascading sequelae. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic led to increase in mental health problems and substance misuse. Yet, little is known about its impact on rates of deaths of despair (death by suicide and drug overdose). Our objective was to determine the impact of COVID-19 stay-at-home orders on deaths of despair using population-level data. We hypothesized that the longer duration of stay-at-home orders would increase rates of deaths of despair. Methods Utilizing quarterly suicide and drug-overdose mortality data from the National Center for Health Statistics from January 2019 through December 2020, we estimated fixed-effects models to examine the effects of the duration of stay-at-home orders as differentially implemented in 51 jurisdictions in the United States on each outcome. Results Controlling for seasonal patterns, the duration of jurisdictional-level stay-at-home order was positively associated with drug-overdose death rates. The duration of stay-at-home orders was not associated with suicide rates when adjusting for calendar quarter. Conclusions Findings suggest an increase in age-adjusted drug-overdose death rates in the United States from 2019 to 2020 possibly attributable to the duration of jurisdictional COVID-19 stay-at-home orders. This effect may have operated through various mechanisms, including increases in economic distress and reduced access to treatment programs when stay-at-home orders were in effect. [ABSTRACT FROM AUTHOR]

Psychological science offers frameworks for understanding and solving diverse and vexing problems such as disaster response, climate change, community violence, and the science of the brain. Yet limited attention has been paid to effective ways for psychologists to engage in public com­munication and the value of doing so. This article discusses what it means to translate psychological science to the public, provides a rationale for such science communica­tion, and details the major audiences that should be the recipients of such efforts. Traditional and more innovative mechanisms and formats for the translational of psycho­logical science are delineated. The attitudinal and logisti­cal barriers associated with these efforts are examined. Finally, recommendations for improving and advancing psychologists' efforts at translating psychological science to the public are proffered, with considering given to changing the culture, providing training, forging commu­nication collaborations, and evaluating the efficacy of psychological science communications.

Childhood maltreatment places individuals, including African American women who are undereducated and economically disadvantaged, at risk for developing posttraumatic stress disorder (PTSD) symptoms. Participants were 192 African American women with a history in the prior year of both a suicide attempt and intimate partner violence (IPV) exposure. They were recruited from a public hospital that provides medical and mental health treatment to mostly low-income patients. A simple mediator model was used to examine if (a) existential well-being (sense of purpose) or religious well-being (relationship with God) mediated the link between childhood maltreatment and adult PTSD symptoms. Sequential multiple mediator models determined if physical and nonphysical IPV enhanced our understanding of the mediational association among the aforementioned variables. Findings suggest that existential well-being mediated the association between childhood maltreatment and adult PTSD symptoms in a simple mediator model, and existential well-being and recent nonphysical IPV served as sequential multiple mediators of this link. However, religious well-being and physical IPV were not significant mediators. Findings underscore the importance of enhancing existential well-being in the treatment of suicidal African American women with a history of childhood maltreatment and IPV. [ABSTRACT FROM AUTHOR]

This study examined social support and attachment in women with and without drug misuse. Data were collected from 146 African American female suicide attempters who presented at an inner-city hospital. MANOVAs revealed that compared to their counterparts who did not misuse drugs, women who reported drug misuse had lower levels of family and friend support (Social Support Behaviours Scale), lower scores on secure attachment and higher scores on fearful and dismissive attachments (Relationship Style Questionnaire). Low-social support and less secure attachments make treatment engagement challenging and require interventions designed to enhance participation. [ABSTRACT FROM AUTHOR]

Protective factors for fostering reasons for living were examined among low-income, suicidal, African American women. Bivariate logistic regressions revealed that higher levels of optimism, spiritual well-being, and family social support predicted reasons for living. Multivariate logistic regressions indicated that spiritual well-being showed unique predictive value for reasons for living. Further, the multivariate model accurately predicted reasons for living 72% of the time. Partial support was found for a cumulative protective model hypothesizing a linear relationship between the number of protective factors endorsed and increased reasons for living. Implications for community-based preventive and recovery-oriented intervention efforts and future research are discussed. [ABSTRACT FROM AUTHOR]

This investigation identifies unique risk and protective factors for internalizing and externalizing problems among 8- to 12-year-old, low-income, African American children and tests cumulative risk and protective models. A total of 152 mother—child dyads complete questionnaires. Receipt of food stamps, mother's distress, and child maltreatment increase children's risk for internalizing and externalizing problems and family functioning (adaptability, cohesion), and after-school program participation (externalizing only) are protective against internalizing and externalizing problems. A cumulative risk model reveals that compared with youth with no risk factors, having one risk factor confers three- and fivefold risk for internalizing and externalizing symptoms, respectively. Having two or three risk factors confers 12 and 19 times greater risk for internalizing and externalizing symptoms, respectively. Compared with no protective factors, youth with two protective factors are 4 and 6 times less likely to display internalizing and externalizing problems, respectively. Implications for community-based preventive intervention efforts and future research are discussed. [ABSTRACT FROM AUTHOR]

Absence of a conceptually grounded, comprehensive measure for family violence in older women has hindered attempts to define the extent of the problem and its effects on older women's health. This article reports the development and psychometrics of the Family Violence in Older African American Women Scale, a comprehensive scale to measure family violence in older women. The scale demonstrates two distinct factors: (a) "Abuse" and (b) "Caregiving Failure," which measure abusive behaviors in the context of a family relationship and caring for older women, respectively. Implications for the use of this scale in research and practice settings are discussed. [ABSTRACT FROM AUTHOR]

A growing body of work has begun to recognize that the problem of older women affected by family violence (FV) deserves special consideration. Because risk and protective factors for FV can vary by social and cultural context, it is imperative that more focused attention be paid to vulnerable populations such as older African American women. This article reports on the results of a qualitative inquiry into individual, dyadic, and community-level variables that influence the risk of FV among older African American women receiving primary care at an inner-city hospital. An explanatory model that integrates these variables is presented. [ABSTRACT FROM AUTHOR]

Background: Family violence among older women encompasses intimate partner violence (IPV) and elder maltreatment, both linked to poor health status. Little is known about the association between family violence and the health status of older innercity African American women. Methods: One hundred fifty-eight African American women, aged ≥50, were interviewed in the ambulatory clinics of a large public hospital. Lifetime family violence exposure as an adult was measured by the Family Violence against Older Women (FVOW) scale; physical and mental health status were measured by the physical and mental component summary scores of the Short Form 8® scale. Results: Mean participant age was 61.5 years (SD 7.1). Participants with FVOW scores in the top quartile were considered to have high lifetime family violence exposure. Participants with higher family violence exposure and those younger, unemployed, or disabled reported worse physical and mental health status. Lower income and not having Medicare were associated with worse physical and mental health status, respectively. Using stepwise linear regression techniques, only employment status and high family violence exposure were associated with worse physical ( F = 7.16, p = 0.0011) and mental health ( f = 7.09, p = 0.0012) status. Women with high FVOW scores reported physical and mental component summary scores that were 4.18 and 4.6 points lower, respectively, than those of women with lower FVOW scores. Conclusions: Among older, innercity, African American women, lack of employment and high levels of family violence exposure as an adult are associated with worse physical and mental health status. Clinicians caring for older African American women need to be cognizant of the role both current and prior violence exposure may play in their patients' current health status. [ABSTRACT FROM AUTHOR]

The article presents a study on the associations between intimate partner violence (IPV) and comorbid health conditions in the U.S. The study was conducted to sequential emergency department patients who were urban, male, and aged 18 to 55 years. The results showed that a cumulative risk of poor mental health and adverse health behaviors was associated with IPV disclosures.

Background: Studying pathways to care, or contacts made during the period of time from the onset of illness until the first initiation of treatment, is critical for understanding how to improve the early recognition and treatment of mental disorders. However, little is known about pathways to care among patients with first-episode psychosis in the United States. The objectives of this study were to examine the pathways to care and number of help contacts prior to hospitalization in first-episode patients, and to ascertain the frequency of contact with primary care providers and police.Method: Pathways to care, including all contacts for help from the onset of prodromal symptoms until first hospital admission, were assessed in 25 urban African American patients. Other measures were obtained as part of an ongoing study of predictors of the duration of untreated psychosis.Results: The median durations from the onset of illness to hospital admission and from the emergence of positive psychotic symptoms to hospital admission were 128.0 weeks (range 0.6-476.9) and 32.9 weeks (range 0.4-337.7), respectively. Of the 83 total contacts, 17 were with police, whereas only four were with primary care providers. While the number of contacts per patient ranged from one to eight, 16 of the 25 patients were admitted within 1 week of their first contact for help.Conclusions: The findings indicate that pathways to care in this population are highly variable, and there is a need for additional research to better understand the nature and determinants of these pathways. Such investigations may provide insights into service enhancements that can promote early detection and intervention, thus improving illness outcomes. [ABSTRACT FROM AUTHOR]

A case-control study was conducted to examine a broad array of potential social risk and protective factors for suicide attempt among 200 African American men and women receiving care at a large, public, urban hospital. Specifically, we examined the effect of the following potential risk factors for suicide attempt: life hassles, partner abuse, partner dissatisfaction, and racist events; as well as the following potential protective factors: effectiveness of obtaining resources, social embeddedness, and social support. Using logistic regression, suicide attempter status was predicted by two independently significant social variables: one risk factor (life hassles) and one protective factor (social support). Male versus female suicide attempters were not distinguished by the social variables. These findings, which support the utility of an ecological conceptualization of risk and protective factors for suicide attempt, help to clarify the independently significant social environment risk and protective factors for suicide attempts among economically disadvantaged African Americans in particular. Research on both risk factors and protective factors provide a basis for culturally competent interventions aimed at reducing both the risk of future suicide attempts and completions. [ABSTRACT FROM AUTHOR]

Investigates the mediating roles of perceived social support and resources in the self-efficacy-suicide attempts relation among African American abused women in the U.S. Risk factor of suicide attempts; Association between suicidal behavior and self-efficacy; Characterization of the mental health consequences among women with low self-efficacy.

This study examines the association between exposures to multiple forms of childhood abuse (emotional, physical, sexual) and adult suicidal behavior in a sample of low-income, African American women. We hypothesized a linear relation between childhood abuse and risk for making a suicide attempt, such that the more forms of childhood abuse to which a woman was exposed, the greater her risk would be to make a suicide attempt. Logistic regression analyses revealed that, compared to women who did not report any experiences of childhood abuse, women who experienced one, two, or three forms of abuse were 1.83, 2.29, or 7.75 times more likely to attempt suicide, respectively (all statistically significant). Furthermore, compared to women who reported one or two types of abuse, women who reported all three types of abuse were statistically more likely to attempt suicide. These findings have implications for clinicians working with African American women who report either childhood abuse or exhibit suicidal behavior. [ABSTRACT FROM AUTHOR]

Examines the risk and protective factors for suicidal behavior among abused African women in the U.S. History of child maltreatment; High levels of psychological distress and depression, hopelessness about the future, alcohol and drugs; Link between protective factors and nonattempter status.

Family therapy is often the treatment of choice for culturally diverse clients. This article provides a critical review of culturally competent assessment and intervention strategies for use with ethnic minority families in the U.S. A culturally informed view of the definition of family health and dysfunction is presented, basic structure and goals of family therapy are delineated, and family therapy process and techniques are addressed. Clinical vignettes are provided to illustrate critical points. [ABSTRACT FROM AUTHOR]

Examines the role of social support in the partner violence-distress relation among African American women seeking medical care in the United States. Need for service providers to screen for partner violence in nontraditional sites; Main effects of partner violence on distress; Impact of low levels of social support on the increasing distress among battered women.

The independent and combined roles of childhood maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect) and current post-traumatic stress disorder (PTSD) were examined in predicting nonfatal suicide attempts among 335 African American women. It was hypothesized that suicide attempters (n = 157) would evidence higher rates of all forms of childhood maltreatment and higher rates of current PTSD than controls (n = 178). The authors predicted that women with both current PTSD and a ltfetime history of child maltreatment would be at greatest risk for making a nonfatal suicide attempt. Results revealed that current PTSD and all five forms of childhood maltreatment were independently related to risk for suicide attempts. PTSD in combination with any o. f the five forms of childhood maltreatment increased a woman's risk for making a nonfatal suicide attempt. This suggests interventions designed to reduce suicidal behavior should focus on women with PTSD and a history of child maltreatment. [ABSTRACT FROM AUTHOR]

This study examined the psychological consequences and secondary stressors associated with death of a parent. The sample (N = 116) consisted of 26 youths who had lost a parent to homicide, 45 youths who had lost a parent to natural death, and 45 nonbereaved youths. Youngsters completed face-to-face interviews, while their guardians completed measures assessing the children's functioning. Results based on both child and guardian reports indicated that parental death was associated with an increase in secondary stressors, regardless of the mode of death. Findings based on guardian reports also revealed that parental death was related to increased internalizing distress, and that parental death due to homicide was related to increased externalizing distress. Furthermore, secondary stressors mediated the parental death-child distress relation such that parental death led to an increase in stressors, which in turn led to increased child distress. Implications for secondary and tertiary preventive interventions are discussed. [ABSTRACT FROM AUTHOR]

Examines the effects of weight lifting on the psychological well-being of individuals with serious psychiatric disabilities. Patients' improvement in physical and psychological well-being; Improvement in objective measures of strength and endurance.

Historically, the rates of completed suicide among African American individuals have been relatively low. However, the past 50 years have witnessed a significant rise in suicide rates among this population. In an effort to understand this trend, this article reviews relevant demographic data and empirical and clinical findings regarding the clinical presentations of suicidal behavior among African Americans across the life span. The major psychodynamic, psychosocial and sociocultural theories offered as explanations for the incidence and nature of suicidal behavior among African Americans also are discussed. It is hoped that this systematic review will lead to more meaningful empirical investigations of the myriad factors associated with the unfortunate increase in suicidal behaviors in this population. [ABSTRACT FROM AUTHOR]

The patient-centered medical home (PCMH) is an increasingly common model of health care delivery with many exciting opportunities for psychologists. The PCMH reflects a philosophy and model of care that is highly consistent with psychological science and practice. It strives to provide patient-centered, comprehensive, team-based, coordinated, accessible, and quality and safety-oriented health care delivery to individuals and families. Moreoever, in keeping with changes in the health care system more broadly, the PCMH model prioritizes the integration of behavioral and physical health care, and this emphasis lays the foundation for active and full engagement of psychologists in this context. This article provides an overview of the PCMH and the evidence and roles for psychologists across a range of pediatric, adult, and geriatric health care populations and settings. Current challenges to the necessary expansion of psychology in the PCMH are discussed, with particular attention to the needs for training and advocacy to support the contributions of behavioral health care in the PCMH. Psychology must embrace its rightful place as a health profession and appreciate and highlight the ways in which psychologists can play unique and critical roles in transforming present and future health care delivery models. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of research on depressive symptoms and their correlates among Black women, which may contribute to underdiagnosis, misdiagnosis, and inappropriate treatment. Methods: Data were analyzed from the 2006 Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit–dialed telephone survey of the noninstitutionalized U.S. population aged ≥18 years. A total of 10,783 Black women aged 18 to 64 years were interviewed from 38 states, 2 U.S. territories, and the District of Columbia (DC). There were 8,412 (78.0%) women who provided complete responses to questions regarding demographic characteristics, psychosocial variables, current depressive symptomatology, and a lifetime diagnosis of a depressive disorder. Weighted prevalence estimates and 95% confidence limits of current depressive symptomatology and self-reported lifetime diagnosis of depression were derived. Multiple logistic regression models were used to examine the association of each correlate with the depression outcomes. Results: Overall, 13.8% of Black women reported current depressive symptoms, and 14.9% reported a lifetime diagnosis of a depressive disorder by a health care provider. Significant correlates of both outcomes included rarely/never receiving social support, being unable to work, having physical health problems for 14 or more days in the past month, and dissatisfaction with life. Conclusions: This study indicates that a substantial number of Black women suffer from significant symptoms of depression and report that they have been diagnosed with depressive disorders in their lifetime. Health care providers should assess Black women with poor physical health and life dissatisfaction for depressive disorders and not dismiss somatic complaints as solely physically based. [Copyright &y& Elsevier]

Background information is provided on the link between intimate partner violence and suicidal behavior, as this association sets the stage for interventions for this population. Attention then is paid to the theoretical components of an innovative culturally competent intervention for abused and suicidal, low-income African American women, entitled Grady Nia Project. The intervention is guided by the theory of triadic influence. Cultural competence components essential to implementing. an intervention with this unique population and guided by this model are articulated. The Grady Nia Project is then described in detail, focusing on the context in which the intervention is conducted, the content of the 10 sessions, and treatment satisfaction and outcome data. Implications for culturally informed practice with abused, suicidal African American women are noted. [ABSTRACT FROM AUTHOR]

The authors provide a recitation of events in recent years that document an increased focus on competency-based models of education, training, and assessment in professional psychology, particularly clinical, counseling, and school psychology, based on the work of the American Psychological Association's (APA's) Task Force on Assessment of Competence in Professional Psychology. The article begins with the inclusion of competencies as part of the "Ethical Principles of Psychologists and Code of Conduct" (APA, 2002). Next, accreditation practices in the United States and Canada are summarized. Competency-based education, training, and credentialing efforts in professional psychology are reviewed, including graduate, practicum, internship, and postdoctoral levels; licensure; postlicensure certifications; and board certification. General and specialty credentialing efforts both in North America and internationally follow. The Competencies Conference: Education and Credentialing in Professional Psychology and work on developing competencies for the profession are discussed. Then initiatives focused specifically on the assessment of competence are delineated. Implications for continued progress toward a culture of the assessment of competence are discussed in light of the historical origins within the profession of the competency-based movement. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

The study explored associations among childhood abuse, post-traumatic stress symptoms (PTSS), and alcohol misuse in a sample of low-income African-American women ( N  = 172). Using bootstrapping techniques, a mediation effect was found of childhood physical and emotional abuse on alcohol misuse via PTSS symptom severity, avoidance, and hyperarousal, as well as for childhood sexual abuse on alcohol misuse via PTSS symptom severity and hyperarousal. Our results suggest that PTSS indicators, particularly symptom severity and hyperarousal, may be important mechanisms underlying the association of experiences of abuse during childhood and alcohol misuse in adulthood.

Depressive symptoms and hopelessness as mediators of the daily hassles-suicidal ideation link in low-income African American women exposed to intimate partner violence (n = 100) were investigated. As hypothesized, daily hassles, depressive symptoms, and hopelessness were each significantly and positively associated with suicidal ideation. Moreover, the relation between daily hassles and suicidal ideation was, in part, accounted for by depressive symptoms and hopelessness. This study demonstrates the importance of assessing for the presence of these risk factors when determining the likelihood that an abused African American woman will consider suicide. The findings further highlight the value of designing and implementing interventions that target the reduction in depressive symptoms and hopelessness in abused African American women exposed to daily hassles to reduce their suicide risk., (© 2014 The American Association of Suicidology.)

This report examines the protective role of motherhood against suicidal ideation among low-income African American women with a history of suicide attempts. Findings from previous studies examining the relations between family factors and suicide risks are inconsistent in this population, indicating that family could both exacerbate and reduce risks. Research on the link between motherhood-status specifically and suicide risk is rare, but family and child-related concerns have been identified as unique reasons for living associated with reduced risk of suicide attempt. Self-identified African American women (N = 146), ages 18-64, who attempted suicide within the previous 12 months were recruited from a large urban public hospital. A bootstrapping mediation model was tested using motherhood status from the demographics measure as the predictor, the Reasons for Living (RFL) scales as the mediator, and the Beck Suicidal Ideation Scale as the outcome. The model accounted for 41% of the variance in suicidal ideation and the indirect effect of RFL was statistically significant. These findings provide empirical support for the hypothesis that motherhood is protective against suicidal ideation among African American women with a history of suicide attempts. Future research should seek to determine how incorporating the protective function of motherhood status in clinical interventions with this high-risk population might help to improve treatment effectiveness., (© 2013 American Psychological Association)

In August 2012, the American Psychological Association (APA) Council of Representatives voted overwhelmingly to adopt as APA policy a Resolution on the Recognition of Psychotherapy Effectiveness. This invited article traces the origins and intentions of that resolution and its protracted journey through the APA governance labyrinth. We summarize the planned dissemination and projected results of the resolution and identify several lessons learned through the entire process.

Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes with a summary and directions for future research., (© 2012 American Association for Marriage and Family Therapy.)

Objective: Duration of untreated psychosis (DUP) has been associated with poor early course outcomes of nonaffective psychotic disorders; however, less is known about predictors of DUP. This study examined patient-level predictors of DUP and clinical correlates of both DUP and duration of untreated illness (DUI), both of which have been implicated as prognostic indicators., Method: Participants included 109 first-episode patients hospitalized in 3 public-sector inpatient psychiatric units serving an urban, socially disadvantaged, predominantly African American community. DUP, DUI, and a number of clinical and psychosocial variables were measured using standardized methods. Patients were diagnosed with schizophrenia and related psychotic disorders according to the Structured Clinical Interview for DSM-IV Axis I Disorders., Results: The median DUP and DUI were 22.3 and 129.9 weeks, respectively. Survival analyses revealed that, at any given time point, patients not living with family members were, on average, about 1.5 times as likely to be hospitalized as those living with family when controlling for mode of onset of psychosis. Patients not living in poverty were, on average, about 1.6 times as likely to be hospitalized as those living in poverty when controlling for mode. A greater burden of negative symptoms was associated with longer DUP (r = 0.23, P = .02), and poorer insight was associated with longer DUI (r = -0.24, P = .01). Longer DUP and DUI were associated with diverse adverse clinical characteristics, such as greater impairment in global functioning, poorer social functioning, and more psychosocial problems., Conclusions: There is a need for early intervention efforts to be directed to families (and their loved ones who live with them with emerging psychotic disorders or frank untreated psychotic syndromes), particularly families facing major socioeconomic challenges., (© Copyright 2011 Physicians Postgraduate Press, Inc.)

Objective: Previous research on mental health disparities shows that persons from racial-ethnic minority groups have less access to mental health care, engage in less treatment, and receive poorer-quality treatment than non-Hispanic whites. Attitudes and beliefs about mental health treatment were examined to determine whether they contribute to these disparities., Methods: Data from the National Comorbidity Survey Replication (NCS-R) were analyzed to determine attitudes toward treatment-seeking behavior among people of non-Hispanic white, African-American, and Hispanic or Latino race-ethnicity. Additional sociodemographic variables were examined in relation to attitudes and beliefs toward treatment., Results: African-American race-ethnicity was a significant independent predictor of greater reported willingness to seek treatment and lesser reported embarrassment if others found out about being in treatment. These findings persisted when analyses adjusted for socioeconomic variables. Hispanic or Latino race-ethnicity also was associated with an increased likelihood of willingness to seek professional help and lesser embarrassment if others found out, but these differences did not persist after adjustment for the effects of socioeconomic variables., Conclusions: Contrary to the initial hypothesis, African Americans and Hispanics or Latinos may have more positive attitudes toward mental health treatment seeking than non-Hispanic whites. To improve access to mental health services among racial-ethnic minority groups, it is crucial to better understand a broader array of individual-, provider-, and system-level factors that may create barriers to care.

Objective: To assess physical and mental functional health status as associated with the severity of intimate partner violence (IPV) and perceived danger., Methods: Prospective cross-sectional survey of all patients aged 18-55 in an urban emergency department during a convenience sample of shifts. Instruments included the George Washington Universal Violence Prevention Screening protocol, administered by computer during the initial visit, the Short-Form 12 Health Survey (SF-12), the Conflict Tactics Scale (CTS2), and the Revised Danger Assessment (DA), administered by interview at 1 week follow-up., Results: In total, 548 (20%) participants screened disclosed IPV victimization. Of those, 216 (40%) completed the follow-up assessment 1 week later. This cohort was 91% African American, 70% single, and 63% female, with a mean age of 35 (SD 10.41). Both physical and mental health functioning scores were lower than normative levels (50) compared with national averages: Physical Component Summary (PCS) scale 43.64 (SD 10.86) and Mental Component Summary (MCS) scale 37.46 (SD 12.29). As physical assault, psychological aggression, and reported injury increased on the CTS2, mental health functioning diminished (p < 0.01). Increased physical assault and psychological aggression were also associated with diminished physical health functioning (p < 0.05). As victim-perceived danger increased on the DA, both physical and mental health functioning decreased (p < 0.01, p < 0.001, respectively). Greater self-advocacy activities were associated with lower mental (but not physical) health functioning as well. Females experienced worsening mental health functioning as both physical assault and psychological aggression increased, whereas male victims experienced worsening mental health functioning only as psychological aggression increased., Conclusions: These findings suggest that IPV takes a greater mental than physical toll (for both sexes) and that as IPV severity increases, mental health functioning diminishes and self-advocacy behaviors increase. Additionally, as perceived danger increases, both physical and mental health status worsens. This has important implications for clinicians to assess and consider IPV victims' perceptions of their situations relative to danger, not just the levels of abuse they are experiencing.

An ecological model is used to explore the moderating effects of community-level variables on the relation between childhood sexual, physical, and emotional abuse and adult intimate partner violence (IPV) within a sample of 98 African American women from low incomes. Results from hierarchical, binary logistics regressions analyses show that community-level variables (perceived neighborhood disorder and community cohesion) moderated the relation between childhood emotional abuse and adult physical IPV. Findings support the use of an ecological approach in examining the phenomena of revictimization. Clinical implications from a community and ecological perspective are discussed.

Unemployment and depression are problematic at both individual and societal levels, and research suggests that the two phenomena are related. More thorough and longitudinal analyses, particularly ones within low-income minority populations, are needed to guide the development of programs to increase employment in persons with mental health problems. The current study aimed to specify the relations over time between depressive symptoms and employment status within a sample of 46 low-income African American women participating in an intervention study for intimate partner violence and suicidal behavior. Hierarchical logistic regression analysis indicated that baseline levels of depressive symptoms predicted employment status at the end of a 10-week intervention period, controlling for baseline employment status. Chi-square analysis and qualitative analyses of trends in depression scores showed that changes in employment status during the 10-week intervention period predicted 6-month and one-year follow-up levels of depressive symptoms. Results imply that, for women in the currently sampled population, depressive symptoms create vulnerability for job loss, but the ability to gain employment despite high levels of depressive symptoms is linked to lowered depression levels over the long term. Community programs assisting such women could therefore not just lower the vulnerability to job loss by treating depressive symptoms, but they could potentially lower long-term depression levels through interventions that enhance employability and motivation to pursue work.

Following a brief introduction to response planning for terrorism and other disasters, the authors present their experiences in developing a grassroots, interdisciplinary group charged with incorporating a mental health response component into the bioterrorism response plan for the metropolitan Atlanta area. This group was organized and supported by the Center for Public Health Preparedness at the DeKalb County Board of Health. Various viewpoints of key participating agencies are presented. Recommendations are provided for other localities and stakeholders who plan to incorporate a community mental health component into local disaster response plans.

There is a dearth of research on risk/protective factors for posttraumatic stress disorder (PTSD) among low-income African American women with a history of intimate partner violence (IPV), presenting for suicidal behavior or routine medical care in a large, urban hospital. We examined self-esteem, social support, and religious coping as mediators between experiences of child maltreatment (CM) and IPV and symptoms of PTSD in a sample (N = 134) of low-income African American women. Instruments used included the Index of Spouse Abuse, the Childhood Trauma Questionnaire, the Taylor Self-Esteem Inventory, the Multidimensional Profile of Social Support, the Brief Religious Coping Activities Scale, and the Davidson Trauma Scale. Both CM and IPV related positively to PTSD symptoms. Risk and resilience individual difference factors accounted for 18% of the variance in PTSD symptoms over and above IPV and CM, with self-esteem and negative religious coping making unique contributions. Both variables mediated the abuse-PTSD symptom link. In addition, we tested an alternate model in which PTSD symptoms mediated the relationship between abuse and both self-esteem and negative religious coping.

The study was a cross-sectional examination of African American women positive for intimate partner violence (IPV) who presented to the medical or psychiatric emergency department (ED) for treatment. African American women with a recent history of IPV who presented following an attempted suicide (n = 100) were compared to demographically comparable African American women who were IPV positive who had not attempted suicide and presented for treatment of another condition(n= 100). Women completed face-to-face interviews on several measures, including demographics and the Beck Depression Inventory-II (BDI-II). Overall, there were no demographic differences between cases and controls. Attempters reported statistically significant higher scores on all 21 BDI-II items than did nonattempters. Four BDI-II items had effect size values in the medium range: sadness, self-dislike, suicidal thoughts, and feelings of worthlessness. These four items can be used as a brief screen in the ED to detect female patients positive for IPV at increased risk for suicidal behavior.

Background: Suicide and suicide attempts are important public health concerns, and recent decades have witnessed a rising rate of suicide among African Americans. A history of prior attempts is a leading risk factor for completed suicide. Further research is needed into the social environment risk factors for suicide attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor--depressive symptoms., Method: Data were obtained from a case-control study of 200 African American men and women aged 18-64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for suicide attempt among the cases and controls. The role of depressive symptoms was also studied., Results: Lower levels of family adaptability and family cohesion increased the relative rate of suicide attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of suicide attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models., Conclusions: Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with suicide attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for suicide attempts and suicide, appears to mediate the association between social environment factors and suicide attempt.

This study compared person risk factors among the following groups of low-income, African American adults in an urban, public hospital: (a) suicide attempters and nonattempters, (b) male and female attempters, and (c) all 4 groups (50 female attempters, 50 female nonattempters, 50 male attempters, and 50 male nonattempters). Participants completed psychological distress, aggression, substance use, cognitive processes, religiosity/spirituality, and ethnic identity measures. Compared with nonattempters, attempters reported more psychological distress, aggression, substance use, and maladaptive coping strategies; less religiosity/spirituality; and lower levels of ethnic identity. Male attempters endorsed more substance use than female attempters. No person risk factors differentiated among the 4 groups. Assessment of person risk factors and implementation of commensurate culturally competent interventions are recommended.