The Costs of Silencing the Self and Divided Self in the Context of Physical Abuse,Racial/Ethnic Identity,and Medication Adherence in Women Living with HIV

Racial/ethnic minority status and physical abuse history are risk factors for higher mortality rates and lower adherence to antiretroviral therapy (ART) in women living with HIV (WLWH) in the United States. The current study tested the hypotheses that minority status and physical abuse history might lead women to silence the self (minimize and hide thoughts and feelings in order to avoid relational conflict, loss, and/or abuse) as measured by the Silencing the Self Scale (STSS), and that STSS might mediate and moderate relationships of physical abuse and racial/ethnic minority status with ART adherence. Divided Self (DS; acting in ways inconsistent with inner thoughts and feelings), an STSS subscale, was targeted for study along with the total STSS score. Participants were 513 women from the U.S. Women’s Interagency HIV Study (M_age?=?46; 387, 75%, Black; 66, 13%, Hispanic; 60, 12%, White). Multiple logistic regressions indicated that across all racial/ethnic groups, physical abuse history related to higher DS and lower adherence. DS significantly mediated relationships between abuse and adherence. Compared to White women, Black women demonstrated worse ART adherence, but had lower total STSS. Racial/ethnic minority women and women with a physical abuse history who had higher DS had lower adherence than other groups. Results indicate that being a racial/ethnic minority or having a history of physical abuse may increase vulnerability to the deleterious effects of DS on ART adherence, findings that can help inform interventions to decrease health disparities in WLWH.

     

Sex, race/ethnicity, and romantic attractions: multiple minority status adolescents and mental health

This study examined the association between multiple minority statuses and reports of suicidal thoughts, depression, and self-esteem among adolescents. Data from the National Longitudinal Study of Adolescent Health were used to examine mental health outcomes across racial/ethnic groups for same-sex-attracted youths and female youths. Hispanic/Latino, African American, and White female adolescents reported more suicidal thoughts, higher depression, and lower self-esteem compared with male adolescents in their racial/ethnic group. Same-sex-attracted youths did not consistently demonstrate compromised mental health across racial/ethnic groups. Follow-up analyses show that White same-sex-attracted female adolescents reported the most compromised mental health compared with other White adolescents. However, similar trends were not found for racial/ethnic minority female youths with same-sex attractions.     

Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study

Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were deduced from the late-life depression literature, culturally adapted CBT protocols for racial minorities, and the emerging social and developmental psychological theories for lesbian, gay, and bisexual populations. Specific treatment interventions, processes, and outcomes are described to illustrate how these literatures may be used to provide more culturally appropriate and effective health care for the growing, older sexual minority population.     

Racial/ethnic disparities in therapist effectiveness: a conceptualization and initial study of cultural competence

As a result of mental health disparities between White and racial/ethnic minority clients, researchers have argued that some therapists may be generally competent to provide effective services but lack cultural competence. This distinction assumes that client racial/ethnic background is a source of variability in therapist effectiveness. However, there have been no direct tests of the therapist as a source of health disparities. We provided an initial test of the distinction between general and cultural competence by examining client racial/ethnic background as a source of variability in therapist effectiveness. We analyzed cannabis use outcomes from a psychotherapy trial (N = 582) for adolescent cannabis abuse and dependence using Bayesian multilevel models for count outcomes. We first tested whether therapists differed in their effectiveness and then tested whether disparities in treatment outcomes varied across therapist caseloads. Results suggested that therapists differed in their effectiveness in general and that effectiveness varied according to client racial/ethnic background. Therapist effectiveness may depend partially on client racial/ethnic minority background, providing evidence that it is valid to distinguish between general and cultural competence.     

Extending the bases of subjective attitudinal ambivalence: interpersonal and intrapersonal antecedents of evaluative tension

Researchers have conceptualized ambivalence as resulting from the conflicting positive and negative thoughts and feelings that a person holds toward an attitude object (intrapersonal discrepancy). The authors investigated the hypothesis that perceived interpersonal attitudinal discrepancies can also contribute to feelings of subjective ambivalence beyond that determined by intrapersonal discrepancy. Study 1 revealed that the perception of attitudinal discrepancy with one's parents was associated with greater feelings of ambivalence. Studies 2 and 3 found increased ambivalence as a function of manipulated interpersonal discrepancies. Study 4 replicated and reversed the effect, revealing that interpersonal attitudinal discrepancy with a disliked other was associated with less ambivalence. Together, these studies provide support for the proposition that, because of balance processes, interpersonal relationships influence feelings of subjective ambivalence.     

Race/ethnicity and mental health in the first decade of the 21st century

Recent empirical studies on mental health generally report racial/ ethnic differences in depression rates but typically do not control for potential confounding by sample contextual variations in historical epoch, geographical location, and social demography. An empirical study of race/ethnicity differences in psychological distress is reported as an attempt to control these contexts by using a sample that is homogeneous in age, historical epoch, geography, and social demography (954 youth ages 18-19 living in a single, large urban community). No mean differences in psychological distress were observed among four racial/ethnic groups: Asians, African Americans, Latinos, and non-Hispanic Whites. A second analysis compared 17 different racial/ethnic groups defined in terms of family national origin. No differences in psychological distress were found among these groups. The findings are consistent with the view that race/ethnicity itself is not related to disparities in mental health.     

Alpha-1 Couples: Interpersonal and Intrapersonal Predictors of Spousal Communication and Stress

Couples often discuss genetic test results, and then manage their implications together. This interdependence can lead to common, shared experiences, similar intrapersonal processes to manage shared stressors, or interpersonal influences between spouses, leading to different outcomes. This study sought to reveal the intracouple, intrapersonal, and interpersonal influences of genetic stigma and negative feelings on spousal communication and perceived stress with 50 couples in which one spouse is a member of a genetic disease registry. The results were analyzed with dyadic analysis, including multilevel modeling. The findings showed that registered members and their spouses were not statistically different in their mean levels of perceived genetic stigma, negative feelings about alpha-1 antitrypsin deficiency (AATD), conversations with each other about the AATD test results, and their perceived stress. The findings also showed that their intracouple consistencies were not high, and their intrapersonal and interpersonal influences on communication and stress differed. The social implications of genetic research at the interpersonal level are discussed.     

Examining civic engagement in ethnic minority youth populations: A literature review and concept analysis

Racial reckoning is defined as the subjugation of Black, Indigenous, and people of Color (BIPOC) to racial hierarchies and subordinate groups that influence multiple well-being outcomes throughout the developmental lifespan and across generations. With the two pandemics of racial reckoning and COVID-19 amidst a growing controversial political landscape, topics around civic engagement have been brought to the forefront of community conversation. Discussions surrounding civic engagement must go beyond addressing issues of public concern and examine the vehicle in which civic engagement may be delivered. This is becoming increasingly important as civic engagement is one of the main avenues of social change through individual and collective action, particularly regarding racial reckoning and healthcare disparities highlighted by COVID-19. The paper focuses on civic engagement among ethnic minority youth and young adults. An integrated model of civic engagement was created based off what was learned through this review. This proposed model of civic engagement is meant to be the first step to addressing the gap in civic engagement literature for ethnic minority youth. Weaknesses and future considerations regarding the model will also be discussed, as well as any implications for ethnic minority youth and young adults.     

'No-show': therapist racial/ethnic disparities in client unilateral termination

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.     

Emotional reality: A further contribution to dramatology

This paper is a further contribution to dramatology, introduced in this journal in 2009. It focuses on the two basic modes of communication in any dramatic situation: (1) the nonverbal transfer of feelings and emotions, originating in the preverbal period of the love relationship between mother and child, and (2) the interchange of words and thoughts that develops with the acquisition of language. The early nonverbal mode of communication is the basis for proposing to rename Freud's concept of psychic reality “emotional reality.” On this view, emotional reality is seen as the primary fact of psychological life versus thoughts expressed in words as the derivative fact. Developmentally, emotions and ideas become united in complexes combining the emotional coloration of ideas and the ideational content of emotions. From the perspective of methodology, Freud, his followers, and his critics all conflated theories of disorder and theories of treatment. At the beginning of his journey, Freud was dyadic and interpersonal in formulating a unified theory of disorder and a method of treatment. In later years, he formulated monadic and intrapersonal theories of disorder while remaining interpersonal in his method of treatment, contributing to conflicts among the various psychoanalytic schools.     

Daily hassles and distress among college students in relation to immigrant and minority status

The study separated acculturation-specific daily hassles (outgroup and ingroup) and non-specific hassles (general and family) in their contribution to distress (depression and physical symptoms). In contrast to earlier work, generic measures of acculturation-specific hassles were developed, without reference to the respondent's specific ethnic group. University students indicated their ethnic/ cultural origins, their place of birth, and the place of birth of both parents. On this basis, eighty-three females and thirteen males were assigned to the immigrant, minority status group. Fifty females and seven males were assigned to the immigrant, non-minority group, and forty-two females and eleven males to the nonimmigrant/non-minority status group. The immigrant/minority status group reported more outgroup hassles compared to the immigrant/non-minority group. In hierarchical multiple regression analyses, the contribution of general hassles and family hassles to the prediction of depression and physical symptoms depended on the group's immigrant/minority status. In controlling for psychological adjustment, general hassles continued to predict depression only for the immigrant/minority status group. Various aspects of the results and their implications were considered.     

Daily hassles and distress among college students in relation to immigrant and minority status

The study separated acculturation-specific daily hassles (outgroup and ingroup) and non-specific hassles (general and family) in their contribution to distress (depression and physical symptoms). In contrast to earlier work, generic measures of acculturation-specific hassles were developed, without reference to the respondent's specific ethnic group. University students indicated their ethnic/ cultural origins, their place of birth, and the place of birth of both parents. On this basis, eighty-three females and thirteen males were assigned to the immigrant, minority status group. Fifty females and seven males were assigned to the immigrant, non-minority group, and forty-two females and eleven males to the nonimmigrant/non-minority status group. The immigrant/minority status group reported more outgroup hassles compared to the immigrant/non-minority group. In hierarchical multiple regression analyses, the contribution of general hassles and family hassles to the prediction of depression and physical symptoms depended on the group's immigrant/minority status. In controlling for psychological adjustment, general hassles continued to predict depression only for the immigrant/minority status group. Various aspects of the results and their implications were considered.     

Relationship Distress as a Mediator of Adverse Childhood Experiences and Health: Implications for Clinical Practice with Economically Vulnerable Racial and Ethnic Minorities

Adverse childhood experiences (ACE) are interpersonal sources of distress negatively correlated with physical and mental health, as well as maladaptive intimate partner conflict strategies in adulthood. Economically vulnerable racial and ethnic minorities report the greatest disparities in exposure to ACE, as well as relationship distress and health. Yet, little is known about the connections between ACE, relationship distress, and health. We therefore tested a theoretical model for the mediating role of relationship distress to explain the ACE‐health connection with a sample (N = 96) predominantly racial/ethnic minorities (87%) with low income. We applied partial least squares structural equation modeling with bootstrapping (N = 500). Relationship distress strengthened the predictive relationship between ACE and health, and accounted for 42% of the variance in health. The results provide preliminary support for relationship distress as a social determinant of health disparities with implications for interdisciplinary health intervention.     

Co-Occurring Youth Profiles of Adverse Childhood Experiences and Protective Factors: Associations with Health,Resilience, and Racial Disparities

It is important to understand racial/ethnic differences in adverse childhood experiences (ACEs), given their relationship to long-term physical and mental health, and the public health cost of the significant disparities that exist. Moreover, in order to inform interventions and promote resilience, it is critical to examine protective factors that mitigate the relationship between adversity and poor health. The current study utilized latent transition analyses (LTA) to examine co-occurring profiles of ACEs and protective factors (from school, family, and community contexts) and links to health outcomes among 30,668 Black (10.4%), Latinx (12.3%), and White youth (77.3%) ages 12–17 (52.5% male) who participated in the 2011–12 National Survey of Children's Health (NSCH). Results suggested that greater adversity was associated with worse health, while more access to protective factors was associated with better health. White youth had consistently lower endorsement of ACEs, greater access to protective factors, and better health compared to their Black and Latinx counterparts. Efforts to improve child health and racial/ethnic disparities in research and practice must consider adversity, protective factors, and the systemic inequities faced by racial/ethnic minority youth in the United States.     

Cultural competence and evidence-based practice in mental health services: a complementary perspective

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed.     

Gathering Diverse Perspectives to Tackle “Wicked Problems”: Racial/Ethnic Disproportionality in Educational Placement

Among students receiving behavioral health and special education services, racial/ethnic minority students are consistently overrepresented in settings separate from general classrooms. Once separated, many young people struggle to improve academically and face significant difficulty upon trying to return to a general education setting. Given the complex, ongoing, and multifaceted nature of this challenge, racial/ethnic disproportionality can be identified as a “wicked problem,” for which solutions are not easily identified. Here, we describe our community-engaged research efforts, eliciting perspectives from relevant partners in an ongoing dialogue, to better integrate diverse stakeholders’ perspectives when attempting to address such disparities. We conducted focus groups and qualitative interviews with members of three stakeholder groups: community-serving organizations, individuals with lived experience of behavioral health conditions, and state-level policymakers, with a shared interest in addressing racial and ethnic disparities. Participant responses illustrated the “wickedness” of this problem and highlighted the need for additional supports for students, families, and school personnel, increased collaboration across relevant systems and agencies, and reduced barriers related to funding. Overall, this methodology bridged differing perspectives to develop, in concert with our partners, a shared language of the problem and a core set of issues to consider when seeking to effect change.     

Mental Health Disparities,Treatment Engagement,and Attrition Among Racial/Ethnic Minorities with Severe Mental Illness: A Review

Mounting evidence indicates that there are mental health disparities in the United States that disadvantage racial/ethnic minorities in medical and mental health settings. Less is known, however, about how these findings apply to a particularly vulnerable population, individuals with severe mental illness (SMI). The aim of this paper is to (1) provide a critical review of the literature on racial/ethnic disparities in mental health care among individuals with SMI; (2) identify factors which may contribute to the observed disparities; and (3) generate recommendations on how best to address these disparities. Specifically, this article provides an in-depth review of sociocultural factors that may contribute to differences in treatment engagement and rates of attrition from treatment among racial/ethnic minorities with SMI who present at medical and mental health facilities. This review is followed by a discussion of specific strategies that may promote engagement in mental health services and therefore reduce racial/ethnic disparities in SMI.     

An essentialism perspective on intercultural processes

Essentialist theories are the beliefs that there are immutable essences underlying observed differences between social groups (e.g. racial group, cultural group). This paper reviews the intergroup dynamics and intrapersonal processes associated with essentialism. It also explores the interplay between the two. By explicating the intricate relationship between these psychological processes, the current paper aims to advance our understanding of intergroup relations and identify their implications for the study of multiculturalism. We posit that although the commonly observed negative intergroup outcomes, such as prejudices and biases, can be the byproducts of basic cognitive processes associated with essentialist theories, the social power dynamics in a given society also play important roles in shaping the relationships between essentialism and intergroup outcomes. We then discuss the implications of this understanding to our increasingly multicultural world.     

Racial/Ethnic Identity and Subjective Physical and Mental Health of Latino Americans: An Asset Within?

Social Identity Theory indicates that ethnic identity could benefit minority members in a society because of its promotion of a sense of belonging, or of its buffering of the damage of discrimination. Despite growing investigation about Latinos’ overall health, few studies have simultaneously examined the influence of multiple cultural strength factors, especially racial/ethnic identity, social support, and religious attendance, on these outcomes. Using the National Latino and Asian American Study, we examine the potential predictive value of these cultural strength factors on Latinos’ Self-Rated Mental and Physical Health (SRMH and SRPH). Two separate two-step regression models revealed significant positive effects of racial/ethnic identity on both mental and physical health of Latinos, above and beyond the effect of known demographic and acculturation factors, such as discrimination. Religious attendance had a positive effect on SRMH but not on SRPH. The deteriorating roles of discrimination, in mental health only, and that of Length in the US in both outcomes, however, was primarily not altered by entry of these cultural strength factors. The independent direct effect of racial/ethnic identity among Latinos nationwide may suggest that this cultural strength is an internalized protective asset. Longitudinal data is needed to explore its underlying mechanism and long-term impact.     

Testing a model of minority identity achievement, identity affirmation, and psychological well-being among ethnic minority and sexual minority individuals

How is social identity related to psychological well-being among minority individuals? Drawing on developmental models of identity formation (e.g., Erikson, 1968) and on Social Identity Theory (Tajfel & Turner, 1979), we tested a conceptual model examining links between two key aspects of social identity and psychological well-being. We proposed that the association between identity achievement (exploring and understanding the meaning of one's identity) and psychological well-being is mediated by identity affirmation (developing positive feelings and a sense of belonging to one's social group). Across three studies, including ethnic minority high school students (Study 1), ethnic minority college students (Study 2) and lesbian and gay male adults (Study 3), we found strong support for the model. Results suggest that the process of exploring and understanding one's minority identity can serve as an important basis for developing positive feelings toward and an enhanced sense of attachment to the group, which can in turn confer psychological benefits for minority individuals. Implications and directions for future research are discussed.