American Journal of Orthopsychiatry

Goodkind, Jessica R.; Hess, Julia Meredith; Vasquez Guzman, Cirila Estela; Hernandez-Vallant, Alexandra

doi: 10.1037/ort0000754pmid: 38780608

Eliminating mental health disparities requires simultaneously addressing numerous determinants of health, including social inequities. Although emphasis on multilevel change is growing, interventions typically involve separate efforts or people focusing on each level. We propose a trans-level conceptual model for mental health intervention that simultaneously facilitates change across multiple intersecting levels with four guiding principles: (1) emphasis on structural change; (2) involvement of people experiencing health and social inequities in achieving structural change by addressing the necessary preconditions of access to resources for basic needs, community membership and belonging, and knowledge or information to participate in social change efforts; (3) valuing and building on the expertise and strengths of individuals, families, and communities experiencing health inequities; and (4) dismantling unequal power dynamics of helping relationships through a focus on mutual learning and support and cocreation of change. Tracing the trajectory of a 23-year community-based mental health intervention partnership (the Refugee and Immigrant Well-Being Project), we illustrate the trans-level intervention model and describe its impact on individual mental health and sustainable change at multiple levels.

Békés, Vera; Starrs, Claire J.

doi: 10.1037/ort0000758pmid: 38842895

The intergenerational impact of genocide has been studied in various contexts, however, the mechanisms of trauma transmission remain unclear. The present study aimed to better understand the relationship between parental trauma and offspring mental health by exploring mechanisms of trauma transmission in the children (n = 599) and grandchildren (n = 311) of Holocaust survivors (HS) in Hungary. In a cross-sectional online survey study, we used the paradigm developed by Danieli, Norris, Lindert, Paisner, Engdahl, et al. (2015) and Danieli, Norris, Lindert, Paisner, Kronenberg, et al. (2015) to assess HS parental styles (i.e., parenting impacted by efforts to cope with past traumatic experiences), as reported by offspring participants, as well as participants’ reported level of adaptational impact, that is, their efforts to cope and adapt, and current mental health symptoms posttraumatic stress disorder (PTSD, complex PTSD [C-PTSD], anxiety, depression). We found differences in parental styles reported by generation; however, the mechanism of how it impacted offspring mental health was similar. Mediation analyses showed that more intense parental styles were associated with higher adaptational impact, which, in turn, was related to more mental health symptoms, in both generations. This is the first study to apply the Danieli paradigm in a third-generation sample and the first to assess the psychological impact of the Holocaust in an Eastern European country (Hungary), using systematic quantitative assessment. Our findings highlight the Holocaust’s continued impact on the third generation, and the importance of raising awareness of the impact of collective traumas through educational programs, enhancing culturally sensitive and transgenerational trauma-informed mental health services, and fostering tolerance and diversity in public policy.

Birger Sagiv, Irit; Goldner, Limor; Carmel, Yifat

doi: 10.1037/ort0000759pmid: 38661653

The present study explored the developmental trajectories and increased well-being of socially excluded young Israeli adult women participating in civic engagement peer groups. Twenty-one women participated in a qualitative longitudinal study design comprising 50 in-depth semistructured interviews at four assessment times. The interoperative phenomenological analysis approach revealed three main themes demonstrating a shift from survival to thriving. The first theme, “group connectedness,” describes participants’ positive feelings from participating in the group. The second theme, “exploring and practicing civic engagement,” covers the gains in women’s civic engagement abilities and definitions. The third theme, “From flaws to sparks,” describes women’s changes in mindset and their growing ability for reflection and making plans. The findings are discussed through the lens of the social justice paradigm to suggest a developmental model which sees developmental well-being as a human right.

Prior, Ayelet; Peled, Einat

doi: 10.1037/ort0000760pmid: 38780606

This study is about the role of the addiction discourse in the self-identity of Israeli men who pay women for sex (MPWS). Using the theoretical framework of symbolic interaction, we identified two main contradictory themes regarding the role of the addict identity in the self-narratives of the participants: one presenting the addict identity as contributing to the participants’ positive self-perception and the second as challenging it. Within a social context that often portrays MPWS as perpetrators and abusers, the addiction discourse was a useful source in helping the participants negotiate the dilemma of how to engage in “deviant” acts and still appear to be decent men. While not dismissing the reality of addiction or the distress experienced by some of the participants, we suggest that being “sick” and “having no control over one’s actions” might be considered by some MPWS as preferable explanations to being an outlaw, or villain. However, the inconclusive nature of the sex addiction discourse intimidated some of the participants’ self-identity, thus stressing the need for a clear definition and further theorization of sex addiction, particularly in the context of sex for pay.

Laughney, Caitlin I.; Lee, Yong Gun; Paine, Emily Allen; Wu, Elwin

doi: 10.1037/ort0000761pmid: 38829335

Transgender people experience an excess burden of child sexual abuse (CSA), mental health concerns, and substance use compared to cisgender populations. Posttraumatic stress disorder (PTSD) has been found to mediate the association between CSA and substance use behaviors in cisgender populations, but this dynamic has not been previously examined among transgender adults. The aim of this study is to test if PTSD may mediate a relationship between CSA and substance use among transgender adults. Data were analyzed from the U.S. Transgender Population Health Survey (2016–2018), a national probability sample of transgender adults (N = 274). CSA was measured using the Adverse Childhood Experiences subsection for sexual abuse. Past-month PTSD was measured using the Primary Care-PTSD Diagnostic and Statistical Manual of Mental Disorders, fourth edition screening tool. Substance use was determined by lifetime binge drinking, polydrug use, and the Drug Use Disorders Identification Test. Baron and Kenny’s approach was used to assess PTSD as a mediator between CSA and substance use. Within our sample, nearly half (45%) of the transgender adults experienced CSA. Lifetime binge drinking (40%), polydrug use (20%), and indications of drug-use-related problems (Drug Use Disorders Identification Test x¯ = 4.52) were frequently reported. Transgender adults who have experienced CSA had increased risk of PTSD and substance use, and PTSD was a mediator in all models. Results suggest that adult transgender CSA survivors are at increased risk of drug and alcohol use, and that PTSD may be an important contextual factor for substance use.

Carr, Erika R.; Hamlett, Nakia; Hillbrand, Marc

doi: 10.1037/ort0000762pmid: 38842896

Positive behavioral support plans have been employed since the 1980s in the service of those with developmental disabilities and in school systems and show efficacy for decreasing challenging behaviors and facilitating skill building. Recent years have seen an increased use of positive behavior support (PBS) technology with adults who experience serious mental illness. Inpatient psychiatric units can be traumatizing places as a consequence of the acuity of units and their use of containment methods to address challenging behaviors, such as aggression against others and self-injury. This has resulted in socially just movements from coercive measures in inpatient care, informed by psychotherapeutic, trauma-informed, and recovery-oriented principles that emphasize safety, person-centered values, and developing a life of meaning while ensuring trustworthiness, collaboration, and empowerment. This article describes the effectiveness of a trauma-informed and recovery-oriented PBS approach, informed by psychotherapeutic principles, in the treatment of individuals with serious mental illness on an inpatient unit in decreasing the frequency and intensity of challenging behaviors. The PBS approach is also founded on the ideals of social justice that all individuals have the right to equity and to the pursuit of a meaningful life in society. This is especially true of persons who experience the most marginalization, such as those who are involuntarily hospitalized and who face coercive measures, and who deserve interventions to help them live a life of meaning. Findings suggest that this psychotherapy integration approach leads to significant decreases in aggressive behaviors while decreasing the likelihood of exposure to traumatic experiences for patients and staff alike.

Lassri, Dana; Khoury-Kassabri, Mona; Gottfried, Ruth; Desatnik, Alex

doi: 10.1037/ort0000763pmid: 38913754

Teaching staff have been especially vulnerable to experiencing psychopathology and compassion fatigue during COVID-19, given the significant demands they have experienced. Yet, research on risk and resilience factors is scant. We assessed the psychological status of Israeli teaching staff during COVID-19, focusing on psychopathology (depression, anxiety, somatization), compassion fatigue (burnout, secondary traumatic stress), and compassion satisfaction. We also examined the role of transdiagnostic risk and resilience factors—mentalizing, self-compassion, self-criticism, social support, and specialized trauma training—in predicting psychological status and mitigating the link between COVID-19-related distress and psychological status. An online questionnaire was completed by 350 teaching staff. Analyses included outlining the distributions of psychological status outcomes and running a series of moderation models using hierarchical robust regression. While 48% of the participants exhibited moderated-to-high levels of anxiety and 28.27% had no somatization, only 13% exhibited moderate-to-severe levels of depression; 60% had moderate levels of burnout, 48% had moderate levels of secondary traumatic stress, and 52% had low levels of compassion satisfaction. COVID-19-related distress, self-criticism, prementalizing modes, low socioeconomic status, and being in an intimate relationship emerged as key risk factors positively associated with psychological status, while self-compassion, general mentalizing, interest and curiosity about mental states, and social support were negatively linked with these outcomes. Teacher’s mentalizing about students’ mental states and social support moderated the link between COVID-19-related distress and psychological status. The findings highlight the importance of risk and resilience factors for assessing and preventing teaching staff’s psychopathology and compassion fatigue during COVID-19.

Christopher, Gail C.

doi: 10.1037/ort0000765pmid: 38829336

This article stemmed from an acceptance speech for the Global Alliances’ 2022 Presidential Award made by Dr. Gail Christopher and her daughter, Heather McGhee. Heather McGhee is a New York Times best-selling author of the book The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together. The history, transformative impact, and importance of the truth, racial healing, and transformation movement in exposing and eradicating the fallacy of a hierarchy of human value are outlined. Dr. Christopher shares insights into the past and provides hope for the future through her Rx Racial Healing model for authentic storytelling and changes in perspective. The article also discusses the momentum of public health jurisdictions declaring racism as a public health crisis and presents a resource, Healing Through Policy: Creating Pathways to Racial Justice, that has been developed to assist jurisdictions in related work.

Ichimura, Emi; Shelby, Tara; Taone, Trevor; Kim, Paul Youngbin; Jin, Joel

doi: 10.1037/ort0000766pmid: 38913755

The adversity faced by Asian Americans (AAs) due to discrimination is a testament to the ongoing fight for human rights. At the crux of social activism, familial and religious ethnic–racial socialization (ERS) instills cultural values, ethnic identity, belonging to one’s racial group, and a meaningful outlook, navigating generations through these challenges. This study examined the role of family and religion in amplifying social advocacy among AAs by assessing the relationship between race-related stress and social activism, as well as the mediating role of familial and religious ERS via a parallel mediation. Our research, utilizing a cross-sectional, nonexperimental design, involved 254 AA emerging adults identifying as Christian (Mage = 29.06, SDage = 7.55), sourced from Prolific (n = 203) and community sampling (n = 51). Linear regression findings revealed significant positive associations between familial ERS and social action (β = .226, p < .001), as well as religious ERS and social action (β = .085, p = .033). Nevertheless, parallel mediation analysis through bootstrapping demonstrated that neither familial nor religious ERS fully mediated the effects of race-related stress on social activism. These results underscore the significance of applying culturally imbued insights from different contexts to address discrimination within the AA Christian community. Scrutinizing these pathways can safeguard AA Christians, while promoting the amalgamation of Christian theology and psychological science. Future research should address the spectrum of beliefs and practices within Christianity that intersect with AA families and culture, unraveling the foundations of the call for social action.

Brown, Kanila L.; Banks, Devin E.; Zapolski, Tamika C. B.

doi: 10.1037/ort0000767pmid: 38976390

Racism is multidimensional with three main domains: individual, cultural, and institutional. Much of the research linking racism/race-related stress to negative health outcomes have focused on race-related stress based on full-scale scores or within the individual domain of racism. Far less research has examined the cultural and institutional domains. Thus, the present study examined whether (a) there is a direct positive effect of cultural and institutional race-related stress on anxiety and depressive symptoms among a sample of ethnic/racially minoritized (ERM) young adults and whether (b) ethnic identity affirmation, belongingness, and commitment (EI-ABC), which has been identified as a protective factor of racism, buffers the effect of cultural and institutional race-related stress on symptoms of anxiety and depression. A total of 515 ERM young adults (58.5% females, Mage = 23.94, SD = 5.86) completed an online study examining stress and health outcomes among ERM young adults. A series of multiple regression analyses were used to examine the relationship between race-related stress and anxiety and depressive symptoms and the moderating role of EI-ABC. Cultural and institutional race-related stress were found to significantly predict symptoms of depression and anxiety. Further, EI-ABC significantly buffered the effect of cultural (but not institutional) race-related stress on anxiety symptoms. Interventions for cultural race-related stress among ERMs that target anxiety symptoms should include building high EI-ABC. Additional research should identify factors that may alleviate symptoms of anxiety or depression associated with experiencing cultural and institutional race-related stress among ERM young adults.