Stress trajectories, health behaviors, and the mental health of black and white young adults

This paper uses data from the National Longitudinal Study of Adolescent Health to examine the mental health of non-Hispanic black and white young adults in the US. We use latent growth curve modeling to characterize the typical stress trajectories experienced by black and white young adults spanning the bulk of their lives. We identify the following four stress trajectories: 1) relatively stress free; 2) stress peak at age 15 and a subsequent decline; 3) stress peak at age 17 and a subsequent decline; and 4) a moderately high chronic stress. Results indicate that black adolescents have significantly higher risk of being in all three of the stressful classes compared to white adolescents. Stress exposure is strongly associated with depression and the race differences in stress profiles account for a modest amount of the observed race differences in mental health. We do not observe any race differences in behavioral responses to stressors; black youth are no more likely than white youth to engage in poor health behaviors (e.g., smoking, drinking, or obesity) in response to stress. We provide tentative support for the notion that poor health behaviors partially reduce the association between stress and depression for blacks but not whites. These findings contribute to unresolved issues regarding mental and physical health disparities among blacks and whites.     

Examining the Effects of an Adolescent Pregnancy Prevention Program by Risk Profiles: A More Nuanced Approach to Program Evaluation

PurposeThe objective of the study was to examine whether latent class analysis (LCA) could (1) identify distinct subgroups of youth characterized by multiple risk and protective factors for early sexual initiation and (2) allow for a more nuanced assessment of the effects of a middle school program to prevent teen pregnancy/HIV/sexually transmitted infection.MethodsLCA was applied to data from the baseline (seventh grade) sample of 1,693 sexually inexperienced students participating in a randomized controlled trial of It's Your Game…Keep It Real in Harris County, Texas. Multilevel analysis was applied within subgroups defined by the latent classes to assess for potential differential program effects.ResultsLCA identified 3 distinct profiles of youth: family disruption, other language household, and frequent religious attendance. Multilevel analyses found differential effects of the program across these profiles with a significant and substantial reduction (30%) in initiation of vaginal sex by ninth grade for students in the family disruption profile only.ConclusionsApplication of LCA may hold promise for conducting more nuanced evaluations and refinements of behavior change interventions for youth.     

Use of the public mental health system by children in foster care: Client characteristics and service use patterns

This study examined client crossover from the social services (DSS) to the mental health (SDMHS) system in San Diego County. Public mental health service use was examined in 1,352 subjects participating in a longitudinal study of children in foster care. Overall, 17.4% (n=235) of the children in DSS were also served in SDMHS. Children in DSS who also received services from SDMHS (multiple-system youth) were compared with children only served in DSS (single-system youth). Multiple-system youth were significantly older and had different removal and placement histories than single-system youth. Within multiple-system youth, analyses compared demographic and diagnostic data of subgroups defined by the number of episodes and/or the levels of mental health care received. These analyses revealed that a small group of multiple-system youth (16.6%) were the most severely disturbed and received the most services. Methodological issues related to tracking clients across service sectors are discussed.     

Patterns of Reasons for Taiwanese Adults’ Health Information–Seeking Efforts: A Latent Class Analysis Approach

The aims of this study were to use latent class analysis (LCA) to identify subgroups of adults in Taiwan based on their reasons for seeking health information and to explore predictors of subgroup membership. A questionnaire survey of 752 adults from 25 communities in Taiwan was conducted. LCA was used to identify distinct classes of participants; latent class regression was performed to identify factors predicting latent class membership. Three classes emerged through LCA. The Health-Improving Group (50.40%) reported high probabilities of reasons relevant to improving their or someone else’s health but low probabilities of reasons relevant to patient–provider interaction. The Active Group (32.98%) showed high probabilities of almost all of the reasons for seeking health information. The Passive Group (16.62%) showed low probabilities across all of the reasons. Compared to the Health-Improving Group, the Active Group was significantly more likely to have higher education and perceive higher information-seeking self-efficacy. The individuals in the Passive Group were significantly more likely to be male, be younger, have lower health literacy, and have fewer years of education than those in the Health-Improving Group. This LCA approach can provide important information on how communication strategies should be applied to different population subgroups.     

Racial differences in the mental health needs and service utilization of youth in the juvenile justice system

Mental health placement rates by the juvenile justice system differ by race. However, it is unknown whether mental health needs differ by race. This study attempted to investigate potential differences in mental health needs and service utilization among Caucasian, African American, and Hispanic juvenile justice involved youth. A stratified random sample of 473 youth petitioned, adjudicated, and incarcerated from 1995–1996 was examined using a standard chart review protocol and the Childhood Severity of Psychiatric Illness measure for mental health needs. Significant and unique mental health needs were demonstrated for all racial groups. African American youth demonstrated the greatest level of needs. Minority status indicated significantly lower rates of mental health service utilization. Minority youth in the juvenile justice system are most at risk for underserved mental health needs. Based on the current data, it can be inferred that the first contact with the state's child and adolescent serving system, which includes the juvenile justice and mental health sectors, appears to be through the juvenile justice sector for many minority youth with delinquency problems.     

A sample of homeless and runaway youth in New Jersey and their health status

In this study of homeless and runaway young people served by youth shelters in New Jersey mental health problems were predominant. They include anxiety, depression, suicide attempts, drug and alcohol abuse. The sample exhibited high levels of general behavioral problems and school and/or peer problems. One quarter of the sample had had trouble with the law. About two thirds of the sample were homeless rather than runaway. For a similar proportion of the sample this was a repeat experience and/or had lasted a week or more. Only one third were able to be reunited with their families after being served. The prognosis for these youth is poor without specific programs to protect them and their physical and mental health.     

Perceived Gender Transition Progress,Gender Congruence,and Mental Health Symptoms Among Transgender Adolescents

PurposeTransgender adolescents (TGAs) have high risk for experiencing mental health problems, but little is known about how aspects of gender identity relate to their mental health symptoms. Evidence from child and adult samples of transgender individuals indicates making progress in gender transition milestones and higher levels of congruence between gender identity and gender expression are related to fewer mental health problems. We examined associations between perceived transition progress, gender congruence, and mental health symptoms in a diverse, nationwide sample of TGAs.MethodsTGAs (n = 1,943) participated in a cross-sectional online survey. Perceived gender transition progress, gender congruence, and depressive and anxiety symptoms were assessed. Path analysis was conducted to examine whether transition progress was related to mental health symptoms via higher levels of gender congruence.ResultsMost TGAs had undertaken at least one social transition step (98%), but only 11% had taken medical transition steps. Higher gender congruence was associated with lower mental health symptoms. Greater transition progress was associated with higher gender congruence, and perceived transition progress evidenced negative indirect associations with mental health symptoms. TGAs identifying with binary identities (transmasculine and transfeminine youth) reported lower levels of transition progress and gender congruence compared to other subgroups of TGAs.DiscussionHigher levels of perceived transition progress and gender congruence are related to lower mental health symptoms among TGAs. Mental health interventions tailored to the unique developmental needs of TGAs are needed given high risk for mental health problems within this population, and interventions addressing transition progress and gender congruence should be examined.     

That’s Not My Problem: Convergence and Divergence Between Self- and Other-Identified Problems Among Homeless Adolescents

Mental health symptoms, victimization experiences, and rates of substance use among homeless youth were assessed using typical clinical intake questions and standard questionnaires. Youth were also asked what they regarded as their primary problems. Results indicated that issues likely to concern health professionals, such as past victimization, high rates of substance use, and psychological symptoms, are often not regarded as problems by homeless youth. Also, based on responses to a coping interview, homeless youth indicated that they rarely sought help from mental health professionals, and tended to cope with problems in a variety of other ways. Despite obstacles to the provision of services, many youth indicated a willingness to talk to a counselor about self-identified problems and there were some points of convergence between self- and other-identified problems. This study was supported by a Grant from the American Academy of Pediatrics.     

Ethnic and gender disparities in needed adolescent mental health care

Psychological problems are overlooked and undertreated in adolescents, especially in low-income and ethnically-diverse youth. School-based health centers are one way to increase health care utilization, and may be particularly important for accessing hard-to-reach populations. The present study examines adolescents' psychological health and their experiences with receiving needed mental health care. Participants included 1,695 African-American (31%), Hispanic (38%), and White (31%) high-school students in southeast Texas. All students were from the same high school and all had access to a school-based mental health clinic. Twenty six percent of the sample had symptoms indicative of major depression, and 18% had scores consistent with subthreshold depression. Across all ethnicities, the prevalence of depressive symptoms was highest among females. Depressed White students were more likely than depressed minority youth to report having received a prior diagnosis of depression and to have been treated for depression. Thus, ethnic disparities in obtaining needed mental health care may persist even in settings where access to equivalent care is readily available.     

Family and racial factors associated with suicide and emotional distress among latino students

Background:  Latino youth experience disproportionate rates of mental health problems including suicide and depression. Better understanding of underlying risk and protective factors on the part of school-based health professionals, teachers, and health care providers in their lives is warranted. The aims of this secondary analysis of 2004 Minnesota Student Survey data were to (1) describe the mental health status of a statewide sample of Latino 9th- and 12th-grade students; (2) explore relationships of family protective factors (communication, caring, and connection) with suicidal ideation, suicidal attempts, and emotional distress; and (3) highlight similarities and differences in family protective factors among subgroups of Latino students.
Methods:  Parallel analyses were completed for Latino-only and Latino-mixed students. Bivariate logistic regression models were used to examine associations between each family variable and each study outcome.
Results:  Nearly 1 in 5 Latino high school students have had suicidal thoughts in the past year; past year suicide attempts ranged from 6% to 18.5% across grade and gender subgroups. Most concerning are ninth-grade Latino girls, a group in which 30-40% reported suicidal thoughts and 14-19% reported attempting suicide in the past year.
Conclusions:  An important study finding is the high rate of suicidal ideation, suicide attempts, and emotional distress among students who self-identified as being of mixed ethnicity. Study findings can be used to inform mental health promotion initiatives and culturally tailor interventions with Latino students.     

Assessment of Self-Reported Emotional and Behavioral Difficulties Among Pre-University College Students in Bangalore,India

Background:The understanding of youth mental health needs and development of service delivery models is a national public health challenge.Objectives:The rates and predictors of emotional and behavioral problems among 1087 youth were assessed in a pre-university college in Bangalore, India. Variations in rates of disturbance, identified by using different cut-off points, were also examined.Results:Results indicated that 10.1% of adolescents had total difficulty levels in the abnormal range, with 9% at risk for emotional symptoms, 13% for conduct problems, 12.6% for hyperactivity/inattention and 9.4% for peer problems. Select gender differences were present. Cut-off scores derived from the sample yielded lower estimates of disturbance than the published cut-offs. Regression analysis identified predictors of total difficulty levels.Conclusions:Implications for assessment of youth mental health and planning targeted services in educational institutions are discussed.     

Overall health and healthcare utilization among latino american women in the United States

Abstract Purpose: The purpose of this study was to examine the chronic conditions, behavioral-mental health and service utilization of Latino American women in the first epidemiologic survey in the United States. Methods: Using a national sample (n=1427) from the National Latino and Asian American Study, we assessed and compared the prevalence of overall health and service use in three major subgroups, Cuban, Mexican, and Puerto Rican, and in other Latino American women. Service use included general medical, mental health, and subspecialists. Results: In physical health, Puerto Rican American women reported the highest rate of asthma, whereas Mexican American women reported the highest rate of diabetes. Cuban American women reported the highest rate of hypertension and heart diseases. Body mass index (BMI) indicated that overweight (BMI 25-29.9?kg/m(2)) and obesity (BMI≥30?kg/m(2)) were prevalent in all three subgroups: two thirds of Mexicans and Puerto Ricans, respectively, and >50% of Cuban Americans. Of the sample, 11.6% rated their mental health status as fair or poor, and 10.8% reported at least one major depressive disorder (MDD) in the past 12 months. Puerto Rican American women had the highest rates on depression, substance abuse, and seeking mental health service, and Cuban American women saw specialists most frequently. Conclusions: Patterns of overall health issues varied among Latino American subgroup women, yet they have low rates of healthcare use. It is critical to further examine factors associated with the sex-specific health issues and with their health services underuse.     

‘Youth-friendly’ characteristics of professionals in mental health settings

Abstract

Adolescents have a unique developmental vulnerability to suicide, with youth presenting as the second most vulnerable group to suicide across the lifespan. Youth have been recognized as underserved mental health service recipients, with only one in six of those in need receiving care. Calls for innovative mental health services to better serve youth have been articulated for over a decade and the adolescent health and mental health communities have responded. However, to date there has been little empirical discussion of the caregiver characteristics that would increase the likelihood of youth feeling comfortable discussing their mental health concerns. Objectives of this study were twofold: (1) to ask a large sample of Canadian youth [n?=?11 171: 5146 males, 6001 females (n?=?24 participants did not indicate their sex )] to identify characteristics of mental health professionals they would define as ‘youth-friendly’, and (2) to test which youth-friendly characteristics are deemed important to youth based on their circumstances, including those experiencing recent suicidality. Gender differences are also tested and explored. The absence of youth-friendly mental health service provision is proposed to be a modifiable barrier to help seeking in at-risk youth.     

Association between mental and physical health problems in high-risk adolescents: a longitudinal study

PURPOSE: This longitudinal study examined the relationship between mental and physical health problems in a sample of high-risk youth served in the public sector. METHODS: Participants included youth aged 9-18 years at baseline, randomly sampled from one of five public service sectors in San Diego County, California, and youths may have been active to more than one sector. Diagnoses for mood, anxiety, and disruptive disorders based on structured diagnostic interviews were determined at baseline and data regarding health-related problems were collected 2 years post-baseline. RESULTS: Mood and disruptive behavior disorders were related to cumulative health problem incidence, as well as aggregate measures of health problems and severe health problems. In addition mood disorder diagnosis was associated with higher rates of infectious diseases, respiratory problems, and weight problems. Disruptive disorder diagnosis was related to higher rates of risk behavior-related health problems. CONCLUSIONS: The present work extends the research on the relationship between mental and physical health problems to adolescents served in the public sector, who are at especially high risk for behavioral and emotional problems. Potential mechanisms by which mental health problems may impact health problems are discussed. We suggest the development of effective interagency cooperation between medical and mental health systems to improve the care of youth with comorbid mental and physical disorders.     

Psychopathology as a Predictor of Medical Service Utilization for Youth in Residential Treatment

Rising health care costs have led to an emphasis on identifying factors that contribute to medical service utilization. Previous research has suggested an association between youth psychopathology and service utilization; however, prospective studies among high-risk populations are needed. The current study examined youth psychopathology as a predictor of subsequent medical service utilization among a large sample (N?=?536) of youth entering residential treatment. Youth psychopathology and medical status were assessed at intake, and medical service utilization was tracked across the duration of the residential placement. Results indicated that higher levels of psychopathology predicted greater youth medical service utilization, even after controlling for the presence of a diagnosed medical condition. Internalizing problems was a significant independent predictor of utilization, but externalizing problems was not. These findings highlight the association between mental health and medical service utilization and suggest that effective behavioral health services may be helpful in reducing costly medical service needs.     

Educational inequalities in the co-occurrence of mental health and substance use problems,and its adult socio-economic consequences: a longitudinal study of young adults in a community sample

Objectives

To examine the relationship between the co-occurrence of mental health and substance use problems and socio-economic status (SES).

Study design

A prospective longitudinal study of 808 males and females followed to age 30.

Methods

Survey data were used to derive latent classes (profiles) of mental health (depression, anxiety) and substance use (alcohol, nicotine, and marijuana [cannabis]) problems at age 27. Analyses examined the associations of these profiles with earlier educational attainment (high school diploma) and indicators of SES at age 30.

Results

Latent Class Analysis produced four profiles: a low disorder symptoms group, a licit substance use disorder symptoms group (alcohol and nicotine), a mental health disorder symptoms group, and a comorbid group. Earning a high school diploma by age 21 decreased the odds of belonging to the comorbid group or the licit substance use disorder symptoms group when compared to the low disorder symptoms group. These disorder profiles also were found to adversely impact subsequent adult SES. The adverse impact was more evident in income maintenance and wealth accumulation by age 30 than market or non-market labour force participation.

Conclusions

Earning a high school diploma lessens the risk of co-occurring mental health and substance use problems which contribute to economic instability in young adulthood. Findings underscore the importance of public health programmes to reduce the incidence of mental health and substance use problems and their associated high costs to individuals and to society.     

Sociodemographic and substance use characteristics associated with typologies and composition of social support networks among youth experiencing homelessness in Los Angeles,USA

Youth experiencing homelessness are a vulnerable population with increased behavioural health risks. Social networks are a consistent correlate of youths’ substance use behaviours. However, less is known about the reciprocal relationships among these constructs. This study classified youth experiencing homelessness according to their social support network type (e.g. instrumental, emotional, service) and composition (e.g. family, peers, service staff) and linked their membership in these social network classes to sociodemographic and substance use characteristics. Four waves of cross‐sectional data were collected between October 2011 and June 2013 from youth experiencing homelessness, ages 14–29, at three drop‐in centres in Los Angeles, CA (N = 1,046). This study employed latent class analysis to identify subgroups of youth experiencing homelessness according to the type and composition of their social support networks. Multinomial logistic regression analyses were then conducted to identify the sociodemographic and substance use characteristics associated with social support network class membership. Five latent classes of youths’ social support networks were identified: (a) high staff emotional and service support; (b) high home‐based peer and family emotional, service and instrumental support; (c) moderate street‐ and home‐based peer emotional support; (d) low or no support and (e) high home‐based peer and family emotional and instrumental support. Multinomial logistic regression models indicated that race/ethnicity, gender, sexual orientation, literal homelessness, former foster care experience, depression, heroin and marijuana use were significant correlates of social support network class membership. Results indicate distinct classes of social support networks among youth experiencing homelessness, with certain sociodemographic and substance use characteristics implicated in youths’ social networks.     

Runaway Youth Utilizing Crisis Shelter Services: Predictors of Presenting Problems

The evidence is clear that the problems of runaway youth are immense, varied, and persistent. Services must be designed to address these problems and the factors associated with them. This study investigated a sample (n=156) of runaway youths admitted to basic shelter services and evaluated the individual and family factors associated with various problem domains, including: family relationships, abuse, mental health, substance use, and educational difficulties. Findings demonstrated that family-oriented issues were the predominant predictors of youth problems. Results point to the need for developing and evaluating new approaches in solving problems of runaway youth that incorporate strengthening family relationships.     

Evaluating a low‐intensity cognitive behavioural program for young people in regional Australia

NewAccess is a low‐intensity cognitive behavioural program which was recently trialled for the first time in Australia for clients aged under 18. Given that accessing support earlier tends to result in better outcomes for people with mild‐to‐moderate mental health issues, having NewAccess available for young people has the potential to reduce the likelihood of mild‐to‐moderate mental health concerns developing into more serious, or chronic mental illness over time for some clients, while also freeing up resources for those with more severe support needs. This mixed methods approach presents the findings of an independent evaluation of the program delivered out of two regional headspace centres in 2017‐2019. From an initial sample of 165 young participants aged between 12 and 25, 109 completed the program. Of those who completed the program 60 were under the age of 18. The standardised assessment and outcome measures indicated a very good response to the program, with the majority showing significant improvements in their depression, anxiety and psychological distress scores. The overall ‘reliable improvement’ and ‘recovery rates’ were 64.2% and 72.3% respectively. Overall, the results indicated this program was an acceptable and efficacious intervention for young people in rural settings, when delivered in a ‘youth‐friendly’ service environment.     

Acculturation and Depressive Symptoms in Korean Immigrant Women

Depression is one of the most prevalent health problems for immigrants in the United States (U.S.) and it has been associated with the process of acculturation. A cross-sectional study was conducted to identify subgroups of Korean immigrant women based on their Korean as well as American acculturation levels using cluster analysis and to determine whether these subgroups differ on depressive symptoms in 200 Korean immigrant women aged 20–64. Cluster analysis identified four as the most appropriate number of subgroups: they were designated as Korean cluster (45%), Marginalized cluster (26%), American cluster (22%), and Bicultural cluster (7%). Korean cluster had high scores on Korean acculturation and low American acculturation, Marginalized had low for both, American had high scores on American acculturation, low for Korean acculturation, and Bicultural had high scores for both. Women in the Marginalized subgroup reported significantly higher depression scores than women in the American and Korean clusters. It is important to identify immigrants who do not relate to either their heritage culture or the new host culture and address their mental health risk issues. This paper is based on the first author's dissertation research at the University of Illinois at Chicago. A part of this paper was presented at the Annual Conference of Western Institute of Nursing, Portland, Oregon, April 2007. We thank Prof. Kathryn Lee for comments on earlier draft of this paper.