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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]

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. [ABSTRACT FROM AUTHOR]

Many patient education guidelines for teaching heart failure patients recommend inclusion of the family; however, family-focused interventions to promote self-care in heart failure are few. This article reviews the state of the science regarding family influences on heart failure self-care and outcomes. The literature and current studies suggest that family functioning, family support, problem solving, communication, self-efficacy, and caregiver burden are important areas to target for future research. In addition, heart failure patients without family and those who live alone and are socially isolated are highly vulnerable for poor self-care and should receive focused attention. Specific research questions based on existing science and gaps that need to be filled to support clinical practice are posed. [ABSTRACT FROM AUTHOR]

This study used quantitative and qualitative methods to examine psychological factors that influence links between intimate partner violence (IPV) and suicidality in a sample of low-income African American women. Quantitative results demonstrated greater general coping, more efficacious behavioral strategies in response to IPV, more effective use of resources, greater use of social support, and less substance use among women who did not attempt suicide compared with those who did. Qualitative findings showed that suicide attempters showed less adaptive coping strategies aimed at accommodating the abuser, whereas nonattempters were more focused on strategies that supported leaving the relationship and/or avoiding further harm. [ABSTRACT FROM AUTHOR]

Although women are often criticized for not leaving abusive relationships, most abused women actively attempt to protect themselves. This study proposed an ecological model to explain strategic responses to abuse, evaluating factors at four levels: Childhood, Relationship, Individual Impact of Abuse, and Community. Data was retrospectively collected from 85 incarcerated women, a population that is disproportionately affected by trauma and has unique intervention needs. A series of hierarchical multiple regression analyses confirmed that the proposed ecological model accounts for variance in six strategic response categories: placating, resisting, safety, legal, formal, and informal. Findings are discussed in terms of intervention implications. [ABSTRACT FROM AUTHOR]

This study utilized a large clinical dataset of patients representative of those in routine U.S. psychiatric practice to assess the influence of sociodemographic variables and diagnostic class on health plan membership (public or private). Data on patients with schizophrenia or other psychotic disorders (n=288) and patients with mood or anxiety disorders (n=1304) were obtained from a cross-sectional practice-based survey conducted by the American Psychiatric Institute for Research and Education. The likelihood of health plan membership was lower among males and among those from a minority race/ethnicity. Health plan membership was also affected by educational attainment and employment status. Even after controlling for these sociodemographic determinants of health plan membership, individuals with schizophrenia/other psychotic disorders were significantly less likely to belong to a health plan than those with mood/anxiety disorders. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The purpose of this pilot study was to compare the relative efficacy of a manualized family psychoeducational intervention versus treatment as usual in enhancing disease knowledge, and improving the psychological and psychosocial functioning of youth with SCD and their primary caregivers. Thirty-nine (39) 7-16 year old males and females with SCD were randomly assigned to participate in the 6-session experimental intervention (n=20) or the treatment as usual control condition (n=19). Each youth with SCD and primary caregiver completed measures assessing key constructs at pre- and post-intervention, as well as at 6-month follow-up for those in the experimental condition. Findings revealed that the family psychoeducational intervention yielded more improvements in child and primary caregiver disease knowledge than did the treatment as usual group and the children in the experimental group maintained their disease knowledge at 6-month follow-up. No additional findings evidenced statistical significance. Implications of these findings and suggestions for future research are discussed. [ABSTRACT FROM AUTHOR]

Anti-Black racism including structural racism and racism-related disparities have come to the foreground in recent years with the increasingly frequent and brutal police killings of innocent African Americans, the disproportionate impacts of the pandemic on the Black community, and the effectiveness of the Black Lives Matter movement. There have been calls to action to ensure cultural effectiveness of couples and family therapy for African Americans. As one response to these calls, this article provides recommendations for culturally humble and anti-racist couple and family interventions. These best practices focus on the necessity of embracing a systemic stance and a strengths-based culturally responsive lens when assessing and intervening with African American couples and families. They focus on the need for therapists to be intentional about and consistent in engaging in self-exploration and taking the necessary steps to be not just competent but also capable. The final set of best practices detailed relate to assessing and intervening using a strengths-based approach in a culturally responsive, anti-racist, and socially attuned fashion. The article concludes with recommendations for couple/family therapists to develop a critical consciousness, engage in anti-racist practices, and address oppression while advancing healing and liberation, all of which are essential to ensuring the resilience and well-being of African American couples and families., (© 2023 Family Process Institute.)

This article describes a Diversity Dialogue Facilitator Training Program for Trainees, an innovative project that prepares psychology and psychiatry learners to facilitate diversity dialogues with healthcare professionals (i.e., clinical and research faculty, staff, and learners) in academic healthcare settings. Through participating in this program, trainees learn to facilitate discussions in which participants reflect upon oppression, discrimination, and disparities; explore their biases; connect and exchange views with colleagues regarding challenging societal events; and delineate action steps for advancing equity, inclusion, social responsivity, and justice in their professional and personal lives. After outlining contextual factors that informed project development, implementation, and dissemination, the iterative process of creating and implementing the training curriculum is detailed, with the aim of offering a model for other academic health center-based training programs interested in establishing a similar initiative. Lessons learned also are shared with the hope of contributing to future efforts to advance training in diversity dialogue facilitation and expand the role of psychologists in medical settings., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In lower-and middle-income countries (LMICs), studies of interventions to reduce intimate partner violence (IPV) perpetration are expanding yet measurement equivalence of the construct has not been established. We assessed the measurement equivalence of physical and sexual IPV perpetration used in recent trials in LMICs and tested the impact of non-invariance on trial inference., Methods: With data from three recent intervention trials among men (sample size 505-1537 across studies), we calculated tetrachoric correlations among items and used multiple-group confirmatory factor analysis to assess invariance across arms and over time. We also assessed treatment effects adjusting for covariate imbalance and using inverse probability to treatment weights to assess concordance of invariant measures with published results, where warranted., Findings: The average correlation among items was high and increased over time with several items in two studies showing correlations ≥0.85 at endline. Increases in correlation for physical IPV were concentrated in the treatment arm in two of the studies. The increase in correlation in sexual IPV differed by arm across studies. Across all studies, a correlated two-factor solution was the best fitting model according to the EFAs and CFAs. One study demonstrated measurement invariance across arms and over time. In two of the studies, longitudinal measurement non-invariance was detected in the intervention arms. In post hoc testing, one study attained invariance with a one-factor model and study inference was concordant with published findings. The other study did not attain even partial invariance., Conclusion: Common measures of physical and sexual IPV perpetration cannot be used for valid effect estimation without further refinement. The study highlights the need for an expanded item set, content validity assessments, further measurement invariance testing, and then consistent use of the item sets in future intervention trials to support accurate inference on the effectiveness of IPV perpetration prevention interventions., (© 2024 The Authors.)

Mindfulness-based cognitive therapy (MBCT) offers promise as a group-based intervention to alleviate posttraumatic stress disorder (PTSD) and depression symptoms in traumatized Black adults. Given the high level of barriers that exist for low-income Black adults, virtual delivery of MBCT may be helpful. This pilot randomized controlled trial assessed feasibility and acceptability of an adapted 8-week virtual MBCT group intervention for Black adults screening positive for PTSD and depression. Forty-six participants (89.3% women) recruited from an urban safety net hospital were randomized to MBCT or waitlist control (WLC). Overall feasibility was fair (70%); however, completion rates were higher for WLC than MBCT (90% vs. 54%). Group acceptability was high across quantitative and qualitative measures for study completers. Perceived barriers to psychological treatment were high (>9). While showing potential via improved coping skills and positive health changes, this intervention's success hinges on mitigating engagement barriers for future delivery; additional studies are warranted.

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.

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., (© 2023. The Author(s).)

Background: Dissociative symptoms can emerge after trauma and interfere with attentional control and interoception; disruptions to these processes are barriers to mind-body interventions such as breath-focused mindfulness (BFM). To overcome these barriers, we tested the use of an exteroceptive augmentation to BFM, using vibrations equivalent to the amplitude of the auditory waveform of the actual breath, delivered via a wearable subwoofer in real time (VBFM). We tested whether this device enhanced interoceptive processes, attentional control and autonomic regulation in trauma-exposed women with dissociative symptoms., Methods: 65 women, majority (82%) Black American, aged 18-65 completed self-report measures of interoception and 6 BFM sessions, during which electrocardiographic recordings were taken to derive high-frequency heart rate variability (HRV) estimates. A subset ( n = 31) of participants completed functional MRI at pre- and post-intervention, during which they were administered an affective attentional control task., Results: Compared to those who received BFM only, women who received VBFM demonstrated greater increases in interoception, particularly their ability to trust body signals, increased sustained attention, as well as increased connectivity between nodes of emotion processing and interoceptive networks. Intervention condition moderated the relationship between interoception change and dissociation change, as well as the relationship between dissociation and HRV change., Conclusions: Vibration feedback during breath focus yielded greater improvements in interoception, sustained attention and increased connectivity of emotion processing and interoceptive networks. Augmenting BFM with vibration appears to have considerable effects on interoception, attention and autonomic regulation; it could be used as a monotherapy or to address trauma treatment barriers.

Depression, a major contributor to the global burden of disease, is an outcome of interest in clinical trials. Researchers and clinicians note that depression often presents differently across cultures, posing challenges in the accurate measurement of depressive symptoms across populations. A commonly used self-administered screening tool to measure depressive symptoms, the Center for Epidemiologic Studies Scale-Depression (CES-D), has been translated into dozens of languages and used in thousands of studies, yet gaps remain in our understanding of its factor structure and invariance across studies and over time in the context of interventions. In this secondary analysis, we sampled six recent trials from lower- and middle-income countries to (a) establish the factor structure of the CES-D, (b) assess measurement invariance of the CES-D across treatment versus control arms and over time, (c) examine cross-study invariance, and (d) identify items that may be driving potential noninvariance. We performed exploratory/confirmatory factor analysis to establish the factor structure of the CES-D within each trial and used multiple group confirmatory analysis to assess within-study cross-arm/cross-time and cross-study invariance. After removal of positive affect items, a unidimensional model performed equivalently over time and across arms within trials, but exhibited noninvariance across trials, supporting prior literature describing differences in factor structure of the scale across populations. While our findings suggest that the CES-D without positive affect items is a valid measure of depressive symptoms within trials in our sample, caution is warranted in interpreting the findings of meta-analyses and multisite/multicountry studies using the CES-D as an outcome measure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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., (© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In lower- and middle-income countries (LMICs), studies of interventions to reduce intimate partner violence (IPV) are expanding, yet measurement equivalence of the IPV construct-the primary outcome in these investigations-has not been established. We assessed the measurement equivalence of physical and sexual IPV item sets used in recent trials in LMICs and tested the impact of noninvariance on study inference. With data from four intervention trials ( N = 3,545) completed before 2020, we used multiple-group confirmatory factor analysis to assess invariance across arms, over time, and across studies. We also calculated average treatment effects adjusting for covariate imbalance to assess concordance with published results. Most items functioned equivalently within studies at baseline and end line. Some evidence of longitudinal noninvariance was observed in at least one study arm in three studies, but did not meaningfully affect latent means or effect-size estimates. Evidence of partial invariance across studies at baseline and strict invariance over time was observed. Common measures of physical and sexual IPV were valid for measuring intervention impact in these samples. The study highlights the need for harmonized use of the tested scale, content validity assessments, and routine measurement equivalence testing to ensure valid inferences about intervention effectiveness.

Objective: There is support for the use of mindfulness-based approaches with trauma-exposed adults. However, limited data are available on feasibility and acceptability of group-based mindfulness interventions in urban medical clinics serving primarily Black adults with low socioeconomic resources, where rates of trauma exposure are high. The present randomized pilot study evaluated the feasibility and acceptability of an 8-week adapted mindfulness-based cognitive therapy (MBCT) group for trauma-exposed Black adults who screened positive for posttraumatic stress disorder (PTSD) and depression in an urban primary care clinic setting., Method: Participants were randomized to waitlist control (WLC) or MBCT. Feasibility and acceptability were assessed through examination of retention rates, measures of group satisfaction and treatment barriers, and qualitative interview. Forty-two Black adults (85% women) were consented; of those, 34 (81%) completed preassessment and randomization., Results: Feasibility of study design was shown, with > 75% ( n = 26) of randomized participants completing the study through postassessment. Twenty-four individuals (70.5%) completed through 1-month follow-up. Results showed high levels of group acceptability across quantitative and qualitative measures. Perceived barriers to psychological treatment were high, with an average of > 6 barriers present., Conclusions: The findings indicate feasibility and acceptability of MBCT group interventions in urban primary care settings with trauma-exposed patients with significant psychopathology. However, substantial barriers to treatment engagement were endorsed and to improve numbers for successful engagement in the intervention, continued efforts to reduce treatment barriers and increase access to mindfulness-based interventions in underresourced communities are needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Although many African American IPV survivors need services, they often do not access care. Hopelessness may partially explain low rates in help-seeking for this population and serve as a significant barrier to care for African American IPV survivors particularly those who have had prior legal system involvement. In a sample of 185 African American women, we first examined whether hopelessness mediated the relation between IPV and barriers to services. If such a mediation effect was found, we then would explore whether legal system involvement moderated the mediated effect of hopelessness on the relation between IPV and barriers to services. As anticipated, hopelessness partially served to explain (i.e., mediated) the relation between IPV and barriers to services. Further, this mediated effect was moderated by legal system involvement such that when legal system involvement was included as a moderator, hopelessness mediated the association between IPV and barriers to services only for those survivors who had been involved with the legal system. These results underscore the critical role of hopelessness as a barrier to accessing services for African American IPV survivors, especially those with prior involvement with the legal system. Recommendations are offered that underscore the importance of interventions that empower African American women who have survived violence instead of penalizing them.

Psychiatric nurses often experience burnout and other mental health symptoms. However, few studies have examined these phenomena and gender-specific associated factors during the COVID-19 pandemic. We surveyed a national sample of psychiatric nurses (N = 8971) from 41 tertiary psychiatric hospitals in China as part of a large national survey conducted during the pandemic. The Maslach Burnout Inventory-Human Service Survey was used to assess burnout and the Depression, Anxiety, and Stress Scale-21 was used to assess mental health symptoms. Binary logistic regression analyses were used to explore factors associated with burnout in the entire sample and separately by gender. The overall prevalence of burnout was 27.27%, with the rate in male psychiatric nurses (32.24%) being significantly higher than that in female psychiatric nurses (25.97%). Many key demographic factors (such as the male gender and marital status), work-related variables (such as a mid-level professional title, having an administrative position, longer working hours, more monthly night shifts, and the perceived negative impact of the COVID-19 pandemic on medical work) were significantly associated with burnout in the whole sample. Moreover, burnout was associated with depression, anxiety, and stress symptoms in the whole sample. Gender-specific factors associated with burnout were also identified: burnout was associated with night shifts in male psychiatric nurses, whereas it was associated with single or married marital status, a mid-level professional title, and having an administrative position among female psychiatric nurses. The high rates of burnout and mental health symptoms in psychiatric nurses need attention from hospital administrators. While mental health symptoms, longer working hours, and the perceived impact of COVID-19 are associated with burnout in both genders, gender-specific factors also warrant special attention when developing gender-specific interventions., (© 2022 John Wiley & Sons Australia, Ltd.)

Although optimal trauma-informed care in inpatient settings is relationally oriented, gender-sensitive, racially and culturally responsive treatment, this often is not the reality. Instead, inpatient settings frequently create experiences of retraumatization, which likely are associated with poor outcomes. This article extends the literature on trauma-informed care by drawing from existing models for working with trauma and providing culturally responsive treatment to apply an integrated approach to the inpatient care setting with a focus on the unique needs and experiences of marginalized survivors of gender-based violence and racial trauma. It details the rationale for and key elements of three related frameworks for trauma-informed care and then offers recommendations for guiding its conceptualization and implementation. Ideally, these practices will be embraced on all inpatient units and particularly with women from marginalized communities who have survived interpersonal and racial trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objectives: The COVID-19 pandemic has negatively affected wellbeing. However, the impact on the mental health status of Chinese psychiatrists and their relationship with quality of life (QOL) has not been examined., Methods: This was a national cross-sectional survey performed between January 11 and March 15, 2021. Demographic and work-related data were collected anonymously using an online questionnaire. Common mental health symptoms and QOL were assessed using the Depression Anxiety Stress Scale-Chinese version and the World Health Organization Quality of Life Schedule-Brief, respectively., Results: A total of 3,783 psychiatrists completed this questionnaire. The prevalence of depressive, anxious, and stress symptoms were 26.7% (95%CI = 25.3-28.1%), 24.1% (95%CI = 22.8-25.5%), and 11.6% (95%CI = 10-12%), respectively. Moreover, 11.1% of the participants endorsed both depressive and anxious symptoms, and 8% endorsed symptoms in all three domains. Binary logistic regression showed that aged 30-39 years (OR = 1.5, P = 0.03), male gender (OR = 1.2, P = 0.04), single (OR = 1.44, P = 0.01), and having a negative perception of the COVID-19 on healthcare (OR = 2.34, P <0.001) were factors associated with higher levels of depressive symptoms. Participants who were divorced and widowed (OR = 1.56, P = 0.03), worked more than 4 night shifts/month (OR = 1.33, P <0.001) and/or longer working years (OR = 1.71, P < 0.001), and had a negative perceived impact of the COVID-19 on healthcare (OR = 2.05, P < 0.001) were more inclined to experience anxious symptoms. In addition, psychiatrists with high QOL scores had lower odds of experiencing depressive, anxious, and stress symptoms (all P < 0.001). Multivariate analysis showed that the presence of each of the three types of mental health symptoms was independently associated with lower QOL (all P < 0.05). In addition, the depression × anxious × stress interaction was significantly correlated with lower QOL ( P < 0.05)., Conclusion: Approximately one-fourth of psychiatrists in China experienced depressive and anxious symptoms during the COVID-19 pandemic, and more than one-tenth reported stress. Mental health symptoms were significant contributors to lower QOL. The psychological wellbeing of psychiatrists during the pandemic requires more attention, and interventions are needed to improve the psychological wellbeing and QOL of physicians who care for individuals with mental disorders., 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., (Copyright © 2022 Li, Xia, Yang, Zhang, Zhang, Liu, Liu, Kaslow, Jiang, Tang and Liu.)

Background: The persistence and impacts of violence against women motivated Sustainable Development Goal (SDG) 5.2 to end such violence. Global psychometric assessment of cross-country, cross-time invariance of items measuring intimate partner violence (IPV) is needed to confirm their utility for comparing and monitoring national trends., Methods: Analyses of seven physical-IPV items included 377,500 ever-partnered women across 20 countries (44 Demographic and Health Surveys (DHS)). Analyses of five controlling-behaviors items included 371,846 women across 19 countries (42 DHS). We performed multiple-group confirmatory factor analysis (MGCFA) to assess within-country, cross-time invariance of each item set. Pooled analyses tested cross-country, cross-time invariance using DHSs that showed configural invariance in country-level multiple-group confirmatory factor analysis (MGCFAs). Alignment optimization tested approximate invariance of each item set in the pooled sample of all datasets, and in the subset of countries showing metric invariance over at least two repeated cross-sectional surveys in country-level MGCFAs., Results: In country-level MGCFAs, physical-IPV items and controlling-behaviors items functioned equivalently in repeated survey administrations in 12 and 11 countries, respectively. In MGCFA testing cross-country, cross-time invariance in pooled samples, neither item set was strictly equivalent; however, the physical-IPV items were approximately invariant. Controlling-behaviors items did not show approximate cross-country and cross-time invariance in the full sample or the sub-sample showing country-level metric invariance., Conclusion: Physical-IPV items approached approximate invariance across 20 countries and were approximately invariant in 11 countries with repeated cross-sectional surveys. Controlling-behaviors items were cross-time invariant within 11 countries but did not show cross-country, cross-time approximate invariance. Currently, the physical-IPV item set is more robust for monitoring progress toward SDG5.2.1, to end IPV against women., Competing Interests: The authors have declared that no competing interests exist.

Despite the value of family-centered care (FCC) in intensive care units (ICUs), this approach is rarely a reality in this context. This article aims to increase the likelihood that ICU-based care incorporates best practices for FCC. Consistent with this goal, this article begins by overviewing FCC and its merits and challenges in ICUs. It then offers a systemic framework for conceptualizing FCC in this challenging environment, as such a model can help guide the implementation of this invaluable approach. This systemic framework combined with previous guidelines for FCC in the ICU are used to inform the series of recommended best practices for FCC in the ICU that balance the needs and realities of patients, families, and the interprofessional healthcare team. These best practices reflect an integration of the existing literature and previously published guidelines as well as our experiences as healthcare providers, family members, and patients. We encourage healthcare leaders and interprofessional ICU healthcare teams to adopt these best practices and modify them for the specific healthcare needs of the patients they serve and their families., 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., (Copyright © 2022 Schwartz, Dunn, Simon, Velasquez, Garner, Tran and Kaslow.)

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.

This article highlights the profound and far-reaching impact of the Coronavirus disease 2019 (COVID-19) health crisis on persons with serious mental health conditions. To understand and mitigate against the negative effects of the crisis on this population, we offer a resilience intervention framework that attends to three key resilience processes, namely control, coherence, and connectedness (3Cs). We then detail interventions and associated evidence-informed intervention strategies at the individual, interpersonal, and systemic levels that behavioral health professionals can employ to bolster each of the 3Cs for persons with serious mental health conditions. These intervention strategies, which must be implemented in a flexible manner, are designed to enhance the biopsychosocial functioning of persons with serious mental health conditions during the COVID-19 pandemic and beyond and strengthen their interpersonal and systemic environments. We conclude with recommendations for future directions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: Childhood maltreatment (CM) is a public health crisis that results in negative physical, mental health, and psychosocial (e.g., resource attainment) outcomes. Resource attainment is a critical outcome for marginalized populations, such as low-income African American women. This study addresses the gap in the literature regarding the association between CM and effectiveness of resource attainment and the potential mediating role of self-esteem in this association for African American women., Method: Data were gathered from a large public inner-city, university-affiliated health care system in the Southeastern United States. Participants selected were low-income African American women who have experienced intimate partner violence (IPV) and have attempted suicide in the prior year. The participants for this study completed the Childhood Trauma Questionnaire, the Beck Self-Esteem Scale, and the Effectiveness in Obtaining Resources Scale., Results: Mediation analyses using bootstrapping with 213 women revealed the powerful role self-esteem plays in explaining the link between CM and resource attainment in low-income African American women. Specifically, overall CM and four of its subtypes (emotional abuse, physical abuse, emotional neglect, and physical neglect) were all associated with decreased resource attainment via the effect of decreased self-esteem. Sexual abuse was the only subtype of CM not significantly associated with self-esteem nor effectiveness of resource attainment., Conclusion: This research highlights the importance of screening for CM, its subtypes, and resource attainment in this population and bolstering self-esteem through psychological interventions to increase women's capacity to effectively secure necessary community resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Posttraumatic stress symptoms (PTSS) are associated with both childhood physical abuse (CPA) and antisocial (AS) traits, yet their potential as mediators of the CPA-AS traits link is understudied and the specific roles of individual symptom clusters in this relation is unknown. The current study aimed to examine the mediational role of PTSS in the relation between CPA and AS traits in a sample of low-income African American women with histories of intimate partner violence (IPV). It was hypothesized that avoidance would emerge as a significant mediator, whereas reexperiencing, numbing, and hyperarousal would not. Participants ( N  = 150) were recruited from a level-1 trauma public hospital and evaluated as part of a randomized controlled trial of a group therapy intervention for low-income, African American women suicide attempters with histories of IPV. The Childhood Trauma Questionnaire ( CTQ), Posttraumatic Diagnostic Scale (PDS), and International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were used to measure variables of interest. Using bootstrapping analyses, a parallel mediation model compared PTSS clusters as potential mediators of the CPA-AS traits relation, controlling for IPV. When reexperiencing, avoidance, numbing, and hyperarousal were entered simultaneously as potential mediators, only avoidance emerged as a significant mediator of the CPA-AS traits link. Avoidance symptoms may play a unique role in the link between early experiences of CPA and later AS traits among multiply traumatized African American women. Findings have implications for understanding AS traits in the context of early life trauma and suggest that targeting specific PTSS clusters (e.g., avoidance) may improve treatment outcomes for women in this population., Competing Interests: Conflict of InterestOn behalf of all authors, the corresponding author states that there is no conflict of interest., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2021.)

Intimate partner violence (IPV) against women, particularly those living in poverty who have multiple marginalized identities, is a significant public health issue. IPV is associated with numerous mental health concerns including depression, hopelessness, and suicidal behavior. The present study examined the ecological determinants of these mental health outcomes in a high-risk sample of 67 low-income, African American women survivors of IPV. Based on an ecological framework that conceptualizes individuals as nested in multiple, interactive systems, we examined, longitudinally, the main and interactive effects of self-reported neighborhood disorder and social support from family members and friends on participants' mental health (i.e., self-reported depressive symptoms, hopelessness, and suicide intent). In multiple regression analyses, neighborhood disorder interacted with social support from family members to predict depressive symptoms and hopelessness over time. Neighborhood disorder also interacted with social support from friends to predict hopelessness and suicide intent over time. High levels of social support buffered against the dangerous effects of neighborhood disorder on depressive symptoms, hopelessness, and suicide intent; at low levels of social support, there was no significant association between neighborhood disorder and those mental health outcomes. Neighborhood disorder and social support did not yield significant main effects. These findings underscore the importance of interventions that target individuals, families, and communities (e.g., community empowerment programs). Group interventions may also be important for low-income, African American women survivors of IPV, as they can help survivors establish and strengthen relationships and social support.

Adverse childhood experiences (ACEs) disproportionately impact African Americans because of profound subjection to historical-systemic oppression in addition to personal and intergenerational trauma exposure. This article utilizes a biopsychosocial-cultural framework to understand the correlates of ACE exposure in African Americans and attends to the cultural factors that contribute to resilience. We review the evidence base for culturally informed, preventive-interventions, as well as strategies for bolstering this work by capitalizing on cultural strengths that are salient in the African American community. We also highlight pertinent policy initiatives guided by recent strategic outlines by the Centers for Disease Control and Prevention. These policies provide the backdrop for the recommendations offered to facilitate the healthy biopsychosocial development of individuals and families. These recommendations can contribute to the expansion and creation of new policies that aim to strengthen individual coping in the face of adversity, enhance family bonds and resilience, and promote community capacity to reduce ACE exposure in African Americans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Historically rates of death by suicide in African Americans have been lower than in other communities, although no ethno-racial differences have emerged in rates of suicidal ideation. Despite the fact that suicidal ideation impacts millions of people every year and is commonly reported by individuals who have attempted suicide, it has not been a focus of investigation among African American adults. One major predictor of suicidal ideation is depressive symptoms, although this association in African Americans has received little empirical attention. This study examines the impact of one potential culturally relevant moderator, social support, on the link between depressive symptoms and suicidal ideation in a sample of low income, African American adults with a recent suicide attempt ( n = 267). Correlational analyses confirmed a positive, significant relation between depressive symptoms and suicidal ideation among the entire sample and separately for women and men. Linear regression analyses revealed that friend, but not family, support moderated the association between depressive symptoms and suicidal ideation, when controlling for homelessness. This moderating effect, however, was only found for the women ( n = 152) in the sample. The results highlight the value of social support from friends in fostering resilience against suicidal ideation in high-risk low-income African American women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This article highlights one department's efforts to bolster diversity, equity, and inclusion as an exemplar for other academic departments. It offers an approach for building an infrastructure and leadership group and details accomplishments associated with strategic plan priorities related to visibility, values, stakeholder education, recruitment, retention, promotion, and community engagement. It also delineates challenges encountered in transforming a departmental culture to one that is more diverse, equitable, and inclusive and strategies for overcoming these challenges. Finally, it discusses next steps and recommendations for other academic departments., Competing Interests: The authors report no financial relationships with commercial interests., (Copyright © by the American Psychiatric Association.)

Low-income, racial-minority, high-risk populations have limited access to evidence-based treatments for posttraumatic stress disorder (PTSD), and their acceptance of complementary interventions is unknown. Trauma Center Trauma-Sensitive Yoga (TC-TSY), which has demonstrated efficacy in community samples, has not yet been widely used with ethnic minority low-income individuals. This article presents a culturally tailored version of a TC-TSY intervention delivered as a drop-in service in a public hospital-based clinic to patients with histories of interpersonal violence and suicide attempts. TC-TSY was iteratively tailored to meet the unique clinical needs of individuals within this setting. Group facilitator observations are summarized; they describe a successful initial implementation and culturally informed adaptation of the group intervention. The facilitators' observations illustrated that group members accepted the integration of this structured, gentle yoga practice into outpatient behavioral health programming and identified site-specific modifications to inform formal study. The process by which TC-TSY was adapted and implemented for Black individuals with a history of interpersonal trauma at risk for suicidal behavior can serve as a guide for tailoring other complementary, integrative interventions to meet the needs of unique clinical settings. This process is offered as a foundation for future systematic testing of this complementary, integrated, culturally adapted trauma therapy in high-risk clinical populations.

This article proposes a framework for managing the behavioral health impacts of the COVID-19 global pandemic. This framework aligns and should be integrated with an existing public health pandemic intervals model. It includes six phases of a behavioral health pandemic response strategy: preplanning, response readiness, response mobilization, intervention, continuation, and amelioration. The ways behavioral health specialists can capitalize on their competence in the leadership, prevention, education, service, research, and advocacy domains within each behavioral health pandemic response phase are articulated. Behavioral health expertise can help ensure a more comprehensive, effective pandemic response that facilitates the flattening of the curve of disease spread, along with the corresponding emotional distress curve. A case illustration, the Caring Communities (CC) initiative, is offered as an exemplar of action steps in the leadership, prevention, education, service, research, and advocacy domains that behavioral health professionals can take within each of the behavioral health pandemic response phases. Key CC action steps include providing support groups, offering virtual wellness breaks, participating in educational outreach, creating and disseminating wellness guides, launching and leading a virtual behavioral health clinic for health care staff, participating in behavioral health research and program evaluation, and engaging in advocacy initiatives aimed at improving behavioral health care and addressing and reducing health disparities. Finally, recommendations for optimizing behavioral health contributions to future pandemic responses are proffered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Intimate partner violence (IPV) exposure can increase alcohol use. Although African Americans use less alcohol compared with European Americans, African American women experience disparate rates of IPV, potentially intensifying their alcohol abuse. We used data from 171 African American women to test if IPV was related to alcohol abuse and if psychosocial factors-loneliness, embarrassment, fear of harm, hope, social support, childcare needs, and finances-mediated this link. IPV and alcohol abuse were related, and several factors were related to either IPV or alcohol abuse. Social support was related to both, and it mediated the IPV-alcohol abuse link, explaining women's alcohol abuse relating to IPV.

Traditionally, hospital medicine services have been dominated by the physician and hospital team, with significant barriers to patient- and family-centered care. This article offers principles and associated strategies to reduce those barriers and guide implementation of systemically informed, collaborative, and culturally responsive patient- and family-centered care provided by hospitalist care teams, especially regarding collaborative decision-making for treatment and discharge planning. Such an approach is associated with reduced lengths of stay and hospital costs and lowered rates of medical errors and mortality. It also is linked to improved patient and family cooperation and adherence; enhanced quality of care and clinical outcomes; and increased levels of satisfaction among health care professionals, patients, and families. Such care uses resources wisely and is effective and ethical. We hope articulating and illustrating these principles and strategies will facilitate efforts to shift the health care culture from being physician-centered to truly team-, patient-, and family-centered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Engaging in advocacy is an ethical responsibility for behavioral health professionals, as reflected in professional competencies across disciplines and in personal accounts of wanting to affect change at various levels of patients'/clients' and communities' ecologies. However, the literature is replete with examples of barriers to routine advocacy engagement, including lack of an organized structure into which efforts can be embedded. There exists the desire among behavioral health professionals to engage in more advocacy work, yet a shared sense of not knowing how to incorporate this work into existing professional roles. One way to address these barriers is to establish more collaborative advocacy work environments within the public sector settings that employ behavioral health professionals. This article offers the first descriptive account of developing, implementing, and maintaining such a collaborative interprofessional advocacy workgroup. To that end, this case study is one example of such a group, the Atlanta Behavioral Health Advocates, based within the Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences and situated also within Grady Health System, a public health care system. This paper details our experiences forming and engaging in this group, which we believe can serve as a model for others developing similar advocacy workgroups in public sector settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In recent years, behavioral health professionals have expressed increased interest in engaging in social justice advocacy in public health care systems. In this article, we use an ecological framework to explore opportunities for social justice advocacy in such systems and challenges associated with such efforts. We propose that ecological models are well-suited to conceptualize and address the various contexts that affect behavioral health needs, and we emphasize the importance of considering the multitude of increasingly superordinate systems within which behavioral health professionals work when pursuing advocacy initiatives. We outline the central tenets of ecological models, apply them to social justice advocacy, and provide examples of advocacy within and across ecological systems. Finally, we reflect on future directions for behavioral health professionals interested in using an ecological framework to guide their own advocacy efforts, with and on behalf of patients and communities, in public health care systems and affiliated institutions.

Self-compassion is gaining recognition as a resilience factor with implications for positive mental health. This study investigated the role of self-compassion in alleviating the effect of self-criticism on depressive symptoms. Participants were 147 urban, low-income African Americans with a recent suicide attempt. They were administered measures of self-criticism, depressive symptoms, and self-compassion. Results from this cross-sectional investigation showed that self-criticism was positively associated with depressive symptoms and negatively associated with self-compassion, and self-compassion was negatively associated with depressive symptoms. Bootstrapping analysis revealed that self-compassion mediated the self-criticism-depressive symptoms link, suggesting that self-compassion ameliorates the negative impact of self-criticism on depressive symptoms. Our findings suggest that low-income African Americans with recent suicide attempt histories may benefit from interventions that focus on enhancing self-compassion. These results also highlight self-compassion as a positive trait with promise to improve people's quality of life and suggest that self-compassion-focused interventions are consistent with a positive psychology framework.

Objectives: Both Cognitively-Based Compassion Training (CBCT) and support-based group intervention have been found to be effective for African American suicide attempters in reducing suicidal ideation and depression, as well as enhancing self-compassion. This study aims to further our understanding of effective interventions by exploring participants' responses to both interventions., Methods: Exploratory analyses were conducted in a sample of low-income African Americans who had attempted suicide ( n =82) to determine how baseline demographic and psychological characteristics would (1) predict outcomes (i.e., suicidal ideation, depression, and self-compassion) regardless of intervention conditions, and (2) moderate outcomes in interaction with intervention condition., Results: Non-reactivity, a mindfulness facet, was identified as an intervention moderator for suicidal ideation and depressive symptoms, suggesting that CBCT outperformed the support group for African American suicide attempters who had low baseline non-reactivity (or high reactivity). Individuals who had high non-reactivity at baseline appeared to benefit more from both conditions in self-compassion as an outcome. There was a pattern that homeless individuals benefited less in terms of their levels of depressive symptoms and self-compassion as outcomes regardless of the assigned condition. When applying Bonferroni corrections, only non-reactivity as an intervention moderator for depressive symptoms was significant., Conclusions: Findings reveal the relevance of mindfulness and to a lesser extent socioeconomic status in informing compassion-based intervention outcomes with this underserved population and the importance of intervention matching and tailoring to maximize treatment effects. Future large trials are needed to replicate findings and directions indicated from the current pilot study., Competing Interests: Conflict of Interest: None of the authors have any conflict of interest to declare.

Personality psychodynamics have been shown to influence individual responses to psychiatric treatments, including medication. Increasingly, neuromodulation therapies have become available for severe and treatment-resistant depression. This study aims to evaluate patient response to an implanted neurostimulator battery within the framework of relational versus self-definitional personality traits. Relational development is interpersonally oriented and disruptions along this pathway lead to dependency on others for a sense of security and self-worth. Self-definitional development is characterized by autonomy strivings and disruptions lead to self-critical feelings of failing to meet expectations. Patients drawn from a larger study of deep brain stimulation (DBS) for treatment-resistant depression were switched from a non-rechargeable to a rechargeable battery type to maintain stimulation therapy. This switch entailed taking greater personal responsibility for device maintenance and allowed for fewer battery replacement surgeries. Twenty-six patients completed the Depressive Experiences Questionnaire (DEQ) and a questionnaire surveying their preference for DBS battery type. Results show that the DEQ dependency subscale, and more specifically the neediness component of the subscale, is associated with patient preference for the non-rechargeable battery. This suggests that individuals with higher relational needs prefer treatment options that increase contact with and need for medical caregivers and may prioritize this aspect of an intervention over alternative considerations. In contrast, individuals with more self-critical personality traits did not have a battery type preference, indicating that self-definitional needs were not predictive of battery preference. The link between an individual's personality psychodynamics and response to biomedical interventions, including neuromodulation and treatments that incorporate medical devices, deserves further attention.

Research has identified the experience of shame as a relevant predictor of depressive symptoms. Building upon resilience theory, this is the first study to investigate if self-compassion and/or contingent self-worth (i.e., family support and God's love) mediate the link between shame and depressive symptoms. Participants were 109 African Americans, within the age range of 18 and 64, who sought service following a suicide attempt from a public hospital that serves mostly low-income patients. Findings suggest that shame was related to depressive symptoms through self-compassion but not through contingent self-worth, underscoring the significant role that self-compassion plays in ameliorating the aggravating effect of shame on depressive symptoms. Results highlight the value of incorporating self-compassion training into interventions for suicidal African Americans in an effort to reduce the impact of shame on their depressive symptoms and ultimately their suicidal behavior and as a result enhance their capacity for resilience.