Mental health disparities experienced by sexual and gender diverse (SGD) young adults are well do... more Mental health disparities experienced by sexual and gender diverse (SGD) young adults are well documented. Yet, few studies have examined mental health disparities between SGD subgroups. Even fewer have investigated disparities that may exist for individuals whose SGD identities are non-monosexual (i.e., diverse sexual orientations besides gay/lesbian) or gender non-binary, who may experience exacerbated marginalization and disparities. The present study examines differences in weight and shape concerns and symptoms of depression, anxiety (general, panic, social and post-traumatic stress), alcohol use disorder, and insomnia among sexually diverse (SD) subgroups (lesbian or gay, bisexual, queer, asexual, pansexual, multiple identities, and questioning), and gender diverse (GD) subgroups (trans man, trans woman, and non-binary) of college students. We hypothesized that non-monosexual students would have a greater mental health symptom burden than their monosexual peers and we explored...
BACKGROUND Background: Suicide attempts and suicide death disproportionately affect sexual and ge... more BACKGROUND Background: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (ages 18-24). However, suicide prevention strategies tailored for emerging adult sexual and gender minorities (EA-SGM) are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing risk for suicide in the general population, but it is unclear how best to support EA-SGM in their use of a Safety Plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide; STARS) builds on content from an existing life-skills mobile application for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM, namely positive affect, discrimination, and social disconnection. The mobile application is delivered to participants randomized to STARS alongside 6 peer mentoring session to support use of the Safety Plan and other life-skills from the application to ultimately reduce suicide risk. OBJECTIVE Objective: We will pilot test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intentions to use the SPI and overcome obstacles to its use. EA-SGM will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. METHODS Methods: Guided by the RE-AIM framework, we will recruit and enroll a racially/ethnically diverse sample of 60 EA-SGM reporting past-month suicidal ideation. Using a Type 1 Effectiveness-Implementation Hybrid Design, participants will be randomized to receive the SP intervention (Control arm) or to receive the SP intervention alongside STARS (Intervention arm). We will follow participants for six months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants’ willingness and adoption of SPI and STARS, and staff’s experiences delivering the program. RESULTS Results: Research activities began in September 2021 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #849500). Study recruitment began on October 14, 2022. CONCLUSIONS Conclusions: This project will be among the first tailored, mobile-based interventions for EA-SGM at risk for suicide. This project is responsive to documented gaps for this population: 1) approaches that address chosen family; 2) focus on a life-course perspective; 3) online approaches; and 4) focus on health equity and provision of additional services relevant to sexual and gender minority youth. CLINICALTRIAL ClinicalTrials.gov NCT05018143 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/48177
Objectives: In a national sample of college students, this study aimed to evaluate whether barrie... more Objectives: In a national sample of college students, this study aimed to evaluate whether barriers to mental health treatment varied by race and ethnicity. Methods: Data were drawn from a large multicampus study conducted across 26 US colleges and universities. The sample (n = 5841) included students who screened positive for at least one mental health disorder and who were not currently receiving psychotherapy. Results: Black and Hispanic/Latine individuals showed a greater willingness to seek treatment than White individuals. However, Black and Hispanic/Latine individuals faced more financial barriers to treatment, whereas Hispanic/Latine individuals also showed a lower perceived importance of mental health. Asian American individuals preferred to handle their issues on their own or with support from family/friends and had lower readiness, willingness, and intentions to seek help than White individuals, with greater financial barriers as well.Conclusions: Disparities in unmet tre...
International Journal of Environmental Research and Public Health
The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and ch... more The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and chronic worry. We previously demonstrated that worry about the pandemic was more strongly associated with subsequent insomnia than the converse during the acute (first 6 months) phase of the pandemic. In this report, we evaluated whether that association held over one year of the pandemic. Participants (n = 3560) completed self-reported surveys of worries about the pandemic, exposure to virus risk factors, and the Insomnia Severity Index on five occasions throughout the course of one year. In cross-sectional analyses, insomnia was more consistently associated with worries about the pandemic than exposure to COVID-19 risk factors. In mixed-effects models, changes in worries predicted changes in insomnia and vice versa. This bidirectional relationship was further confirmed in cross-lagged panel models. Clinically, these findings suggest that during a global disaster, patients who report elev...
Journal for person-oriented research, Dec 11, 2022
Background: Given that suicide ideation (SI) fluctuates drastically over short periods of time an... more Background: Given that suicide ideation (SI) fluctuates drastically over short periods of time and is heterogenous across individuals, idiographic suicide research is warranted. In this pilot study, we used intensive ecological momentary assessment (EMA) to examine whether anxiety, depression, and PTSD symptoms on a given day predicted next-day SI on a person-to-person basis. Methods: PLWH (N = 10) with past-month SI completed daily randomly assessed ratings of suicidal urges using the Suicide-Visual Analogue Scale (S-VAS) and daily assessed ratings of anxiety, depression, and PTSD symptoms for 28 days. We used N = 1 Dynamic Structural Equation Modeling to test whether depression, anxiety or PTSD symptoms in the prior day predicted next-day S-VAS for each individual. Results: Across all participants, S-VAS on a given day was not predicted by prior-day anxiety, PTSD symptoms or S-VAS. In one participant, higher depression symptoms predicted lower next-day S-VAS. Conclusions: Daily-level data may be insufficient to predict near-term increases in suicide risk based on anxiety, depression, or PTSD symptoms in PLWH. These findings suggest the importance of finer-grained assessments (e.g., assessing suicide risk and its correlates multiple times per day) to better understand changes in suicide risk over time among PLWH.
Background: The contrast avoidance model (CAM) proposes that persons with generalized anxiety dis... more Background: The contrast avoidance model (CAM) proposes that persons with generalized anxiety disorder (GAD) are sensitive to sharp increases in negative emotion or decreases in positive emotion (i.e., negative emotional contrasts; NEC) and use worry to avoid NEC. Sensitivity to and avoidance of NEC could also be a shared feature of major depressive disorder (MDD) and social anxiety disorder (SAD). Methods: In a large college sample (N = 1,409), we used receiver operating characteristics analysis to examine the accuracy of a measure of emotional contrast avoidance in detecting probable GAD, MDD, and SAD. Results: Participants with probable GAD, MDD, and SAD all reported higher levels of contrast avoidance than participants without the disorder (Cohen's d = 1.32, 1.48 and 1.53, respectively). Area under the curve, a measure of predictive accuracy, was 0.81, 0.87, and 0.83 for predicting probable GAD, MDD, and SAD, respectively. A cutoff score of 48.5 optimized predictive accuracy for probable GAD and SAD, and 50.5 optimized accuracy for probable MDD. Conclusion: A measure of emotional contrast avoidance demonstrated excellent ability to predict probable GAD, MDD, and SAD. Sensitivity to and avoidance of NEC appears to be a transdiagnostic feature of these disorders.
The Autism‐Spectrum Quotient (AQ) is a popular instrument used to assess the degree to which indi... more The Autism‐Spectrum Quotient (AQ) is a popular instrument used to assess the degree to which individuals exhibit features of autism spectrum conditions (ASC). The current study aimed to develop a theory‐driven factor structure of the AQ that would fit as well across samples as the 12 previously proposed factor structures, all of which, except for the original Baron‐Cohen model, had been developed on the basis of exploratory factor analysis (EFA) or principal component analysis. We first proposed a six‐factor solution: (1) social anhedonia; (2) interest in details/patterns; (3) imagination ability; (4) desire for predictability/routine; (5) social cognition; and (6) social discourse convention. We tested the six‐factor structure and made final item selections (27 items) with EFA using data from college students (n = 503). Then, we empirically tested alternative factor structure models in three other independent samples (ns = 503; 1263; 1641) using confirmatory factor analysis. Result...
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated w... more Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with significant cognitive impairment and increased risk for mental health comorbidities. This study aimed to identify specific associations between cognitive impairment, self-reported disruptions in memory, and psychiatric symptoms including depression, anxiety, posttraumatic stress disorder (PTSD), and perceived sleep concerns. Methods Data collected from all consecutive patients with Post-Acute Sequelae of SARS-CoV-2 infection (PASC) who presented to a dedicated Post-COVID Clinic were used to evaluate whether certain psychiatric symptoms were more strongly associated with cognitive impairment and self-reported memory disturbances. Results Univariate and multivariable analyses revealed that depression symptom severity was significantly associated with the severity of cognitive impairment among patients with PASC. This association was driven primarily by lower performance on verbal fluency, attention, and delayed recall tasks among patients with higher depression symptoms severity. Perceived sleep concerns were an important predictor of self-reported memory disturbances. Conversely, neither PTSD symptom severity nor anxiety symptom severity were significant predictors of cognitive impairment or self-reported memory disturbances. Conclusions These findings have important clinical implications for justifying the need for screening patients with PASC for both depression and cognitive impairment.
SummaryThe coronavirus disease 2019 (COVID‐19) pandemic resulted in significant increases in inso... more SummaryThe coronavirus disease 2019 (COVID‐19) pandemic resulted in significant increases in insomnia, with up to 60% of people reporting increased insomnia. However, it is unclear whether exposure to risk factors for the virus or worries about COVID‐19 are more strongly associated with insomnia. Using a three‐part survey over the course of the first 6 months of the pandemic, we evaluated associations between COVID‐19 exposures, COVID‐19 worries, and insomnia. We hypothesised that COVID‐19‐related worries and exposure to risk of COVID‐19 would predict increases in insomnia. Participants (N = 3,560) completed a survey at three time‐points indicating their exposures to COVID‐19 risk factors, COVID‐19‐related worries, and insomnia. COVID‐19 worry variables were consistently associated with greater insomnia severity, whereas COVID‐19 exposure variables were not. COVID‐19 worries decreased significantly over time, and there were significant interactions between change in COVID‐19 worries...
Mental health disparities experienced by sexual and gender diverse (SGD) young adults are well do... more Mental health disparities experienced by sexual and gender diverse (SGD) young adults are well documented. Yet, few studies have examined mental health disparities between SGD subgroups. Even fewer have investigated disparities that may exist for individuals whose SGD identities are non-monosexual (i.e., diverse sexual orientations besides gay/lesbian) or gender non-binary, who may experience exacerbated marginalization and disparities. The present study examines differences in weight and shape concerns and symptoms of depression, anxiety (general, panic, social and post-traumatic stress), alcohol use disorder, and insomnia among sexually diverse (SD) subgroups (lesbian or gay, bisexual, queer, asexual, pansexual, multiple identities, and questioning), and gender diverse (GD) subgroups (trans man, trans woman, and non-binary) of college students. We hypothesized that non-monosexual students would have a greater mental health symptom burden than their monosexual peers and we explored...
BACKGROUND Background: Suicide attempts and suicide death disproportionately affect sexual and ge... more BACKGROUND Background: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (ages 18-24). However, suicide prevention strategies tailored for emerging adult sexual and gender minorities (EA-SGM) are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing risk for suicide in the general population, but it is unclear how best to support EA-SGM in their use of a Safety Plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide; STARS) builds on content from an existing life-skills mobile application for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM, namely positive affect, discrimination, and social disconnection. The mobile application is delivered to participants randomized to STARS alongside 6 peer mentoring session to support use of the Safety Plan and other life-skills from the application to ultimately reduce suicide risk. OBJECTIVE Objective: We will pilot test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intentions to use the SPI and overcome obstacles to its use. EA-SGM will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. METHODS Methods: Guided by the RE-AIM framework, we will recruit and enroll a racially/ethnically diverse sample of 60 EA-SGM reporting past-month suicidal ideation. Using a Type 1 Effectiveness-Implementation Hybrid Design, participants will be randomized to receive the SP intervention (Control arm) or to receive the SP intervention alongside STARS (Intervention arm). We will follow participants for six months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants’ willingness and adoption of SPI and STARS, and staff’s experiences delivering the program. RESULTS Results: Research activities began in September 2021 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #849500). Study recruitment began on October 14, 2022. CONCLUSIONS Conclusions: This project will be among the first tailored, mobile-based interventions for EA-SGM at risk for suicide. This project is responsive to documented gaps for this population: 1) approaches that address chosen family; 2) focus on a life-course perspective; 3) online approaches; and 4) focus on health equity and provision of additional services relevant to sexual and gender minority youth. CLINICALTRIAL ClinicalTrials.gov NCT05018143 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/48177
Objectives: In a national sample of college students, this study aimed to evaluate whether barrie... more Objectives: In a national sample of college students, this study aimed to evaluate whether barriers to mental health treatment varied by race and ethnicity. Methods: Data were drawn from a large multicampus study conducted across 26 US colleges and universities. The sample (n = 5841) included students who screened positive for at least one mental health disorder and who were not currently receiving psychotherapy. Results: Black and Hispanic/Latine individuals showed a greater willingness to seek treatment than White individuals. However, Black and Hispanic/Latine individuals faced more financial barriers to treatment, whereas Hispanic/Latine individuals also showed a lower perceived importance of mental health. Asian American individuals preferred to handle their issues on their own or with support from family/friends and had lower readiness, willingness, and intentions to seek help than White individuals, with greater financial barriers as well.Conclusions: Disparities in unmet tre...
International Journal of Environmental Research and Public Health
The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and ch... more The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and chronic worry. We previously demonstrated that worry about the pandemic was more strongly associated with subsequent insomnia than the converse during the acute (first 6 months) phase of the pandemic. In this report, we evaluated whether that association held over one year of the pandemic. Participants (n = 3560) completed self-reported surveys of worries about the pandemic, exposure to virus risk factors, and the Insomnia Severity Index on five occasions throughout the course of one year. In cross-sectional analyses, insomnia was more consistently associated with worries about the pandemic than exposure to COVID-19 risk factors. In mixed-effects models, changes in worries predicted changes in insomnia and vice versa. This bidirectional relationship was further confirmed in cross-lagged panel models. Clinically, these findings suggest that during a global disaster, patients who report elev...
Journal for person-oriented research, Dec 11, 2022
Background: Given that suicide ideation (SI) fluctuates drastically over short periods of time an... more Background: Given that suicide ideation (SI) fluctuates drastically over short periods of time and is heterogenous across individuals, idiographic suicide research is warranted. In this pilot study, we used intensive ecological momentary assessment (EMA) to examine whether anxiety, depression, and PTSD symptoms on a given day predicted next-day SI on a person-to-person basis. Methods: PLWH (N = 10) with past-month SI completed daily randomly assessed ratings of suicidal urges using the Suicide-Visual Analogue Scale (S-VAS) and daily assessed ratings of anxiety, depression, and PTSD symptoms for 28 days. We used N = 1 Dynamic Structural Equation Modeling to test whether depression, anxiety or PTSD symptoms in the prior day predicted next-day S-VAS for each individual. Results: Across all participants, S-VAS on a given day was not predicted by prior-day anxiety, PTSD symptoms or S-VAS. In one participant, higher depression symptoms predicted lower next-day S-VAS. Conclusions: Daily-level data may be insufficient to predict near-term increases in suicide risk based on anxiety, depression, or PTSD symptoms in PLWH. These findings suggest the importance of finer-grained assessments (e.g., assessing suicide risk and its correlates multiple times per day) to better understand changes in suicide risk over time among PLWH.
Background: The contrast avoidance model (CAM) proposes that persons with generalized anxiety dis... more Background: The contrast avoidance model (CAM) proposes that persons with generalized anxiety disorder (GAD) are sensitive to sharp increases in negative emotion or decreases in positive emotion (i.e., negative emotional contrasts; NEC) and use worry to avoid NEC. Sensitivity to and avoidance of NEC could also be a shared feature of major depressive disorder (MDD) and social anxiety disorder (SAD). Methods: In a large college sample (N = 1,409), we used receiver operating characteristics analysis to examine the accuracy of a measure of emotional contrast avoidance in detecting probable GAD, MDD, and SAD. Results: Participants with probable GAD, MDD, and SAD all reported higher levels of contrast avoidance than participants without the disorder (Cohen's d = 1.32, 1.48 and 1.53, respectively). Area under the curve, a measure of predictive accuracy, was 0.81, 0.87, and 0.83 for predicting probable GAD, MDD, and SAD, respectively. A cutoff score of 48.5 optimized predictive accuracy for probable GAD and SAD, and 50.5 optimized accuracy for probable MDD. Conclusion: A measure of emotional contrast avoidance demonstrated excellent ability to predict probable GAD, MDD, and SAD. Sensitivity to and avoidance of NEC appears to be a transdiagnostic feature of these disorders.
The Autism‐Spectrum Quotient (AQ) is a popular instrument used to assess the degree to which indi... more The Autism‐Spectrum Quotient (AQ) is a popular instrument used to assess the degree to which individuals exhibit features of autism spectrum conditions (ASC). The current study aimed to develop a theory‐driven factor structure of the AQ that would fit as well across samples as the 12 previously proposed factor structures, all of which, except for the original Baron‐Cohen model, had been developed on the basis of exploratory factor analysis (EFA) or principal component analysis. We first proposed a six‐factor solution: (1) social anhedonia; (2) interest in details/patterns; (3) imagination ability; (4) desire for predictability/routine; (5) social cognition; and (6) social discourse convention. We tested the six‐factor structure and made final item selections (27 items) with EFA using data from college students (n = 503). Then, we empirically tested alternative factor structure models in three other independent samples (ns = 503; 1263; 1641) using confirmatory factor analysis. Result...
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated w... more Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with significant cognitive impairment and increased risk for mental health comorbidities. This study aimed to identify specific associations between cognitive impairment, self-reported disruptions in memory, and psychiatric symptoms including depression, anxiety, posttraumatic stress disorder (PTSD), and perceived sleep concerns. Methods Data collected from all consecutive patients with Post-Acute Sequelae of SARS-CoV-2 infection (PASC) who presented to a dedicated Post-COVID Clinic were used to evaluate whether certain psychiatric symptoms were more strongly associated with cognitive impairment and self-reported memory disturbances. Results Univariate and multivariable analyses revealed that depression symptom severity was significantly associated with the severity of cognitive impairment among patients with PASC. This association was driven primarily by lower performance on verbal fluency, attention, and delayed recall tasks among patients with higher depression symptoms severity. Perceived sleep concerns were an important predictor of self-reported memory disturbances. Conversely, neither PTSD symptom severity nor anxiety symptom severity were significant predictors of cognitive impairment or self-reported memory disturbances. Conclusions These findings have important clinical implications for justifying the need for screening patients with PASC for both depression and cognitive impairment.
SummaryThe coronavirus disease 2019 (COVID‐19) pandemic resulted in significant increases in inso... more SummaryThe coronavirus disease 2019 (COVID‐19) pandemic resulted in significant increases in insomnia, with up to 60% of people reporting increased insomnia. However, it is unclear whether exposure to risk factors for the virus or worries about COVID‐19 are more strongly associated with insomnia. Using a three‐part survey over the course of the first 6 months of the pandemic, we evaluated associations between COVID‐19 exposures, COVID‐19 worries, and insomnia. We hypothesised that COVID‐19‐related worries and exposure to risk of COVID‐19 would predict increases in insomnia. Participants (N = 3,560) completed a survey at three time‐points indicating their exposures to COVID‐19 risk factors, COVID‐19‐related worries, and insomnia. COVID‐19 worry variables were consistently associated with greater insomnia severity, whereas COVID‐19 exposure variables were not. COVID‐19 worries decreased significantly over time, and there were significant interactions between change in COVID‐19 worries...
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