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BACKGROUND During the COVID-19 pandemic, the general public were concerned about the mental health impacts of unemployment due to COVID and the stress essential workers experienced during this time. Several reports indicated that people in distress were turning to digital technology, but there was very little evidence about the impact of these tools on mitigating distress. OBJECTIVE This study sought to determine the acceptability, feasibility, usability, and effectiveness of mobile mental health apps for decreasing mental health symptoms in essential workers and unemployed individuals with suicide risk. METHODS We recruited participants who indicated that they were unemployed because of COVID-19 or were COVID-19 designated essential workers. Participants were randomized to one of four free commercial mobile applications for managing distress that were (1) highly rated by PsyberGuide and (2) met criteria for intervention features these participants indicated were desirable in a previous survey. Participants used the apps for 4 weeks and completed baseline and 4-weeks self-assessments of depression, anxiety emotional regulation and suicide risk. RESULTS We found no differences between the apps in any outcome but did find significant changes in depression and anxiety over time (PHQ9: estimate= -1.5, SE 0.2, 95% CI -1.1--1.8; P < .001; GAD-7: estimate= -1.3, SE 0.2; 95% CI -1.0--1.6; P < .001). We found no significant changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF) for the 4 weeks. We did find a significant dose-response pattern for changes in depression and anxiety. Using the app at least once a week resulted in greater improvements in treatment conditions over time on depression (estimate = -0.6; SE 0.2; 95% CI 1.0--0.2; P = .003) and anxiety (estimate= 0.1; SE 0.2; 95% CI 0.4-0.6; P = .78). There was no association between app frequency and changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF). We further found a significant difference between the conditions with regard to app usability, with the control app being the most usable (mean(Beautiful Mood) 72.9, SD 16.7; mean(Covid Coach) 71.2, SD 15.4; mean(Calm) 66.8, SD 17.3; mean(7 Cups) 65.2, SD 17.7). We found no significant differences on app acceptability or appropriateness. CONCLUSIONS Few studies evaluate prospectively the utility and usability of commercial apps for mood. This study finds that free, self-guided commercial mobile mental health apps are seen as usable, but no one app is superior to the other. Although we found that regular use is indicated for effects on depression and anxiety to occur in those who are more symptomatic, regression to the mean cannot be ruled out. CLINICALTRIAL Mobile Mental Health Apps for Suicide Prevention, NCT04536935, https://clinicaltrials.gov/ct2/show/NCT04536935

Introduction: Minimal research has examined how witnesses identify and respond to ethnic microaggressions including the role of colorblind racial attitudes. Method: University student participants (N = 401) were randomly assigned to one of three experimental conditions in which they witnessed a research decoy experiencing an ethnic microaggression, an overt discriminatory interaction, or a neutral interaction (control). Results: The study findings showed that 46% of participants who witnessed an ethnic microaggression identified it as unfair or differential treatment compared to 84% of those who observed an overt form of discrimination. Multilevel model analyses revealed a 3-way interaction (time × experimental condition × colorblind racial attitudes) such that participants with low colorblind racial attitudes had significant increases in negative affect and systolic blood pressure after witnessing overt discrimination. Discussion: Key differences exist in the identification and responses associated with witnessing an ethnic microaggression compared to overt discrimination. Findings suggest that shifting colorblind racial attitudes may be a promising area of intervention to improve detection of ethnic microaggressions.

The current study is a secondary analysis that tested whether difficulties with emotion regulation (DER) would statistically mediate cultural risk factors of suicide and depression symptoms or suicidal behaviors among a) Black, Indigenous, and People of Color (BIPOC) and b) lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. BIPOC (n = 246) and LGBTQ (n = 203) participants completed measures on cultural risk factors of suicide, DER, depression symptoms, and suicidal behaviors at three time-points from a larger remote randomized controlled trial. Simple and parallel mediation explored whether there were indirect effects of cultural risk of suicide on depression or suicidal behaviors via DER. Hypotheses were partially supported: simple mediation revealed that cultural risk factors of suicide at time 1 predicted only depression symptoms at time 3 via DER at time 2 among BIPOC (indirect effect=.09, SE=.04, 95% CI [.01, .17]) and LGBTQ individuals (indirect effect=.05, SE=.02, 95% CI [.02, 08]). Parallel mediation revealed an indirect effect of cultural stressors of suicide and depression via lack of emotional awareness, difficulty with goal-directed behavior, and difficulty accessing emotion regulation strategies for BIPOC, whereas it was via difficulties with goal-directed behavior for LGBTQ persons. With replication, these findings support the importance of cultural risk factors when screening for suicide and inform tailoring of psychosocial interventions targeting emotion regulation with BIPOC and LGBTQ individuals.

Review Title: Receipt of medications for opioid use disorder among minoritized racial and ethnic groups in the United States: A systematic review and meta-analysis Anticipated or actual start date: 1 February 2022. Anticipated completion date: 15 December 2022. Stage of the review at time of this submission. a. The review has not yet started: No b. Preliminary searches: Yes c. Piloting of the study selection process: No d. Formal screening of search results against eligibility criteria: No e. Data extraction: No f. Risk of bias (quality assessment): No g. Data analysis: No h. Provide any other relevant information about the stage of the review here: We have examined preliminary searches, search terms, ways to find gray literature within our topic, consulted with a librarian about our proposed methodology/search, and identified a screening tool for biases (JBI Tool). The review seeks to answer the following questions: i. What is the range of prevalence of MOUD receipt and retention among minoritized racial and ethnic groups in the U.S.? ii. Are there inequitable outcomes in the availability/delivery/receipt of or retention in MOUD between minoritized groups and non-Hispanic Whites in the U.S? 1. If so, then what are the magnitudes of the inequities for different racialized and ethnic groups and different medication types? iii. How do contextual factors influence receipt of MOUD among minoritized populations and inequities? Searches a. Sources: PubMed (includes all of MEDLINE), EMBASE, PsycINFO, and CINAHL Complete. b. Grey Literature: We will use Web of Science to search for grey literature (e.g., organizational health equity reports, theses/dissertations, conference abstracts, and other unpublished evidence). We will reach out to researchers through listservs for SUD, multicultural, and health equity research (call for evidence sharing). We will hand-search included articles and their references to look for mentions of unpublished datasets. c. Search dates: February – March 2022. d. Restrictions: Exclusion criteria will include: (a) non-U.S. setting, (b) data do not report race or ethnicity or do not include people of color, or include people of color and White patients but do not report by race and ethnicity, (c) non-English language study, (d), not related to opioid use disorder, (e) non-human study, (f) includes children. URL to search strategy; Search strategy added as a supplementary PDF file. Will not be made publicly available until the review is complete. Condition or domain being studied: Opioid use disorder (OUD). Opioids include both synthetic and natural chemicals that reduce the sensation of pain. Some opioids are commonly prescribed to relieve pain after particular procedures or in the context of certain medical conditions. Opioid use disorder occurs when an individual has a problematic pattern of use for 12 months. For example, problematic use may include craving, problems completing day-to-day responsibilities, using in dangerous scenarios, and experiencing tolerance, to name a few (American Psychiatric Association, 2013). Drug overdoses are linked to approximately 92,000 deaths each year, with the number of deaths linked to opioids increasing dramatically each year. Of note, opioid use was named a nationwide crisis in October 2017 (American Psychiatric Association, 2018). Participants/population. a. Inclusion criteria includes: (a) adults (ages 18 and older), (b) populations with opioid use disorder (OUD) or at risk of OUD, and (c) persons residing in the U.S. Exclusion criteria includes (a) individuals not living in the U.S., (b) persons that do not have their racial and/or ethnic background specified, and (c) minors (17 years old and younger). Intervention(s), exposure(s): Exposure to racism is the exposure of interest. Therefore, the project centers on individuals identifying as part of a racial or ethnic group in the U.S. at risk for experiencing racism or ethnic discrimination (e.g., Black/African American, Latinx/Hispanic American, American Indian/Native American/Alaska Native, Native Hawaiian/Pacific Islander, Asian/Asian-American). Comparator(s)/control: When data are available, comparisons will be made between minoritized racial/ethnic groups and the dominant racial group in the U.S. that is not at risk for experiencing racism (non-Hispanic White). Types of studies to be included: The types of studies that we will include are: empirical journal articles, including longitudinal/cohort, retrospective, prospective, and cross-sectional observational studies as well as clinical trials. Context. a. There are no other inclusion or exclusion criteria other than what is listed above. b. We will also be extracting information on various contextual factors beyond the exposure & comparator, such as study characteristics (e.g., time period, data source), treatment setting, etc. Main outcome(s): Availability, delivery, and receipt of medications for opioid use disorder (MOUD) and retention in MOUD. MOUD includes first-line opioid agonist (buprenorphine or methadone) and second-line injectable naltrexone. Measures of effect: Measures of frequency and/or association: ex., counts, proportions, rates, odds ratios Additional outcome(s): When available, we will also extract data on MOUD clinical outcomes (e.g., abstinence, overdose, mortality) to examine associations with receipt of care and retention to further contextualize the impact of racism on patients with OUD. The primary goal is not to evaluate the efficacy of MOUD. Measures of effect: ex., rates, days, survival probabilities, relative risk, odds ratios Data extraction (selection and coding). a. Study selection i. We will conduct a preliminary study audit and abstract review (N=20) to confirm the validity of the search strategy and PICOTS/ inclusion and exclusion specification. ii. All search results will be imported into systematic review software, such as Covidence, for de-duplication and review. Two reviewers (JC, FMG, or MB) will independently screen titles and abstracts against the eligibility criteria. Full-text articles will be reviewed for all records that potentially meet the inclusion criteria, and final inclusion will be determined by full-text review. Researchers will be not see each other’s decisions prior to screening. When there are discrepancies, they will be resolved by mutual discussion and/or discussion with a third reviewer. There will also be ongoing group consultation. b. Data extraction i. Extracted data will include the study purpose, characteristics, and sample characteristics and size; main findings; and outcome measures relevant to availability/delivery/receipt of or retention in MOUD. Other data that may be extracted include: other treatment characteristics (e.g., different buprenorphine formulations), other patient characteristics (e.g., gender, age) ii. Two people will independently extract data. Risk of bias (quality assessment): Reviewers (JC, FMG, and MB) will use the critical appraisal tools provided by Joanna Briggs Institute. Strategy for data synthesis: A systematic review will be performed using a systematic review software (Covidence). If enough studies are available that include the relevant outcomes reported by race/ethnicity and include the relevant comparator group (minimum k=4), then we will conduct a meta-analysis on measures of effect (e.g., odds ratios) and calculate pooled effect sizes with 95% confidence intervals. Analysis of subgroups or subsets. Planned subgroup analyses include comparisons of minoritized racial groups (both individually and as a single group) vs. non-Hispanic White. Another planned subgroup analysis is to examine results by medication type (buprenorphine vs. methadone). Exploratory analyses may include how study characteristics, community characteristics, treatment setting, and patient characteristics influence the associations of interest. Type and method of review: Meta-analysis, Systematic review Health areas: alcohol/substance misuse/abuse; health inequalities/health equity; mental health and behavioural conditions; service delivery Language: English Country: United States of America Dissemination plans. Do you intend to publish the review on completion? Yes. Keywords: Systematic review; meta analysis; opioid use disorder; opioid use disorder treatment; racial disparities Details of any existing review of the same topic by the same authors: N/A Current review status: Ongoing

Background COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. Objective The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. Methods A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. Results The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=–3.89, P Conclusions Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons.

Research supports that people of color in the U.S. have poorer outcomes after burn injury compared to White individuals. The current study sought to explore burn health disparities by testing the relationship between racial and ethnic minority status, a proxy for systemic discrimination due to race and ethnicity, with two key constructs linked to functional outcomes, satisfaction with appearance and social community integration. Participants included 1,318 burn survivors from the Burn Model System National Database (mean age = 40.2, SD = 12.7). Participants completed measures of satisfaction with appearance and social community integration at baseline, 6-, 12-, and 24-months post burn injury. Linear regressions revealed that racial and ethnic minority status significantly related to lower satisfaction with appearance and social community integration compared to White individuals at all time points. In addition, satisfaction with appearance continued to significantly relate to greater social community integration even while controlling for race and ethnicity, age, sex, burn size, and physical disability at 6-, 12-, and 24-month time points. Overall, the study supports that racial and ethnic minority burn survivors report greater dissatisfaction with their appearance and lower social community reintegration after burn injury.

Experiencing discrimination or rejection from one's own ethnic group can have adverse effects on mental health above and beyond general ethnic discrimination alone. Intragroup marginalization is a term that involves being marginalized by members of one's own ethnic group for acting in concordance with the mainstream culture (Castillo, Conoley, Brossart, & Quiros, 2007). Minimal research has examined rejection by one's own ethnic group for acting too enculturated to one's home culture, or intragroup separation. In the current study, a community sample of Latina/o adults (N = 233), primarily women of Mexican descent, were recruited and completed self-report surveys. Using 3 hierarchical regressions, results demonstrated that intragroup marginalization and intragroup separation predicted symptoms of depression, anxiety, and alcohol misuse above and beyond that of general ethnic discrimination alone. Moreover, family and ethnic group intragroup marginalization and intragroup separation uniquely predicted different symptoms of mental health. Additional findings suggested that nativity status served as a moderator for intragroup separation and alcohol misuse, such that the relationship strengthened for U.S.-born Latina/os. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

BACKGROUND COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. OBJECTIVE The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. METHODS A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. RESULTS The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=–3.89, Pt69.0=–3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0%), information or education (1254/1987, 63.1%), distraction tools (1170/1987, 58.9%), symptom tracking for mood and sleep (1160/1987, 58.4%), link to mental health resources (1140/1987, 57.4%), and positive psychology (1131/1986, 56.9%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9%). CONCLUSIONS Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons.

Objectives This study examined the emotional distress and loneliness during COVID-19 and the roles of resiliency and activities. Design A cross-sectional national survey. Setting Amazon Mechanical Turk (mTurk) and Prolific Research Platforms. Participants Five hundred and one U.S. dwelling English-speaking adults 60 years old and older. Measurements Participants completed an online survey with the PHQ-9; GAD-7; Short Health Anxiety Inventory; 3-item UCLA Loneliness scale; PROMIS measures of global health, instrumental, and emotional support; 10-item Connor-Davidson Resilience Scale; and COVID-19 needs assessment. Results Across the sample 13% reported moderate depressive symptoms, 9% reported moderate anxiety symptoms, and 26% endorsed being “lonely.” The emotionally distressed group endorsed more loneliness, lower resiliency, less physical exercise, and worse physical health. The low Socio-Economic Status group endorsed less loneliness, less likely to engage in physical exercise and worse physical health.The lonely group endorsed less resilience, less physical exercise, and worse physical health. A multiple logistic regression found that resilience, socioeconomic status, and physical health were significant predictors of loneliness, whereas global health was the best predictor of emotional distress. Conclusions Even after prolonged social distancing, older adults in this study did not report greater psychological distress compared to earlier studies of older adults during COVID-19. Older adults with lower SES, worse physical health, and less resiliency, were more likely to report more loneliness. It is this group that should be the focus of intervention.

The older adult population has seen marked demographic changes with racial and ethnic minority individuals constituting the fastest-growing segment within this group. Mental health difficulties are an area of concern among the older adult population with significant disparities noted across ethnic groups. The purpose of the current chapter is to provide an overview of the mechanisms and factors likely to influence mental health and access to care of ethnic minority older adults. First, cultural factors, namely racial/ethnic discrimination, cultural adaptation, and religion/spirituality, will be discussed in relation to mental health and cognition. Second, the chapter will review access and barriers to mental health care, specifically attitudes toward treatment, mental health stigma, cultural mistrust, and structural inequities. These topic areas are not intended to be exhaustive but instead provide an overview of key experiences and systems that are associated with the mental health of ethnic minority older adults.