UMD Theses and Dissertations
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Item Distress and Deaths of Despair in the U.S. Healthcare Delivery System: Understanding Patterns in Healthcare among Distressed Americans(2024) Spencer, Merianne Rose Tiglao; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The United States has experienced rising mortality rates for the past several decades. Drug poisonings have increased nearly five-fold, suicide rates by nearly 40%, and by nearly 30% percent for alcohol-induced deaths between 1999 and 2021. This collection of drug-, alcohol- and suicide deaths are oftentimes referred to as “deaths of despair”, first coined by economists Anne Case and Angus Deaton who cited health and socioeconomic disparities driving Americans into mental distress, depression, and anxiety. The impact on the mental health of Americans was further exacerbated by the COVID-19 pandemic; this exposed vulnerabilities in the mental healthcare system as well as the various stressors that negatively impacted individuals across the globe. Using nationally representative data, this dissertation delves into the deaths of despair phenomenon using a multidisciplinary health services research lens. Access, utilization, and risk from deaths of despair are examined by using psychological distress (which is treated as a proxy for despair in the first two aims). Using the Kessler-6 scale, a well-accepted and clinically valid tool for non-specific mental distress, this dissertation explores patterns of healthcare spending among those with varying severity levels of psychological distress over a two-decade period; delves into patterns of healthcare utilization among young adults aged 18-30 (a population disproportionately impacted by stressors during the COVID-19 pandemic) by psychological distress; and quantifies the risk of death among those with varying severity levels of psychological distress.Item Essays on Mental Health, Education, and Parental Labor Force Participation(2024) Nesbit, Rachel; Kuersteiner, Guido; Pope, Nolan; Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This dissertation consists of three chapters in empirical microeconomics. The first chapterfocuses on mental health in the criminal justice system. I show that mandated mental health treatment during probation decreases future recidivism and further that paying for these probationers to receive treatment would be a very cost-effective program. The second chapter focuses on the labor supply of same-sex couples. My coauthors and I document the earnings patterns in same-sex couples after the entrance of their first child and contrast them with the earnings patterns in opposite-sex couples. The third chapter evaluates state-level policies to offer a college admissions exam (either the SAT or ACT) free to all high school students. I estimate precise null effects of the policies on future college attendance. The three chapters are described in further detail below. Chapter 1. Mental health disorders are particularly prevalent among those in the criminaljustice system and may be a contributing factor in recidivism. Using North Carolina court cases from 1994 to 2009, this chapter evaluates how mandated mental health treatment as a term of probation impacts the likelihood that individuals return to the criminal justice system. I use random variation in judge assignment to compare those who were required to seek weekly mental health counseling to those who were not. The main findings are that being assigned to seek mental health treatment decreases the likelihood of three-year recidivism by about 12 percentage points, or 36 percent. This effect persists over time, and is similar among various types of individuals on probation. In addition, I show that mental health treatment operates distinctly from drug addiction interventions in a multiple-treatment framework. I provide evidence that mental health treatment’s longer-term effectiveness is strongest among more financially advantaged probationers, consistent with this setting, in which the cost of mandated treatment is shouldered by offenders. Finally, conservative calculations result in a 5:1 benefit-to-cost ratio which suggests that the treatment-induced decrease in future crime would be more than sufficient to offset the costs of treatment. Chapter 2. Existing work has shown that the entry of a child into a household results in alarge and sustained increase in the earnings gap between male and female partners in oppositesex couples. Potential reasons for this include work-life preferences, comparative advantage over earnings, and gender norms. We expand this analysis of the child penalty to examine earnings of individuals in same-sex couples in the U.S. around the time their first child enters the household. Using linked survey and administrative data and event-study methodology, we confirm earlier work finding a child penalty for women in opposite-sex couples. We find this is true even when the female partner is the primary earner pre-parenthood, lending support to the importance of gender norms in opposite-sex couples. By contrast, in both female and male same-sex couples, earnings changes associated with child entry differ by the relative pre-parenthood earnings of the partners: secondary earners see an increase in earnings, while on average the earnings of primary and equal earners remain relatively constant. While this finding seems supportive of a norm related to equality within same-sex couples, transition analysis suggests a more complicated story. Chapter 3. Since 2001, more than half of US states have implemented policies that requireall public high schools to administer either the ACT or SAT to juniors during the school day free of charge, making that aspect of the college application process less costly in both time and money. I evaluate these policies using American Community Surveys (ACS) from 2000 to 2019. I augment ACS data with the Census Master Address File to precisely identify the state in which individuals took the exam. Exploiting variation in policy implementation across state and time, I find across all specifications that increased access to standardized college entrance exams has no effect on subsequent college attendance. It also does not shift students between public and private colleges or between two- and four-year programs. The results of this chapter suggest that, to the extent that these policies were introduced to encourage college-going among marginal students, they did not accomplish their goal. This provides evidence about the kinds of support necessary to influence educational outcomes for students from disadvantaged families.Item Intersectional stigma, self-efficacy, depression, and resilience: a Rasch analysis(2022) Reuben, Jacqueline; Liu, Hongjie; Turpin, Rodman; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Black men who have sex with men (BMSM) are disproportionally affected by negative health outcomes associated with stigma related to both their racial and sexual minority status. Foundational to understanding stigma is the ability to correctly measure this latent construct. The Rasch model is a probabilistic model for analyzing categorical data that was developed to improve the measurement of latent traits. This study, grounded in intersectional minority stress theory, reviewed the application of Rasch analysis in the HIV/AIDS literature (Aim 1) and used the Rasch model to calibrate person measures to assess the interrelationships among internalized stigma, resilience, self-efficacy, and psychologic well-being among BMSM (Aims 2 and 3). Methods: For Aim 1, we conducted a systematic review of the literature following PRISMA guidelines. Aims 2 and 3 used data from a cross-sectional online survey of 151 HIV-negative BMSM in 2020. For Aim 2, we conducted Rasch analysis to assess the psychometric properties of the internalized racism (IR), internalized homophobia (IH), self-efficacy, and resilience scales. For Aim 3, we used linear regression and path analysis of the Rasch-calibrated person measures to examine the mediating and modifying effects of self-efficacy and resilience on the relationship between intersectional stigma and depressive symptoms. Results: For Aim 1, after screening 183 articles, 45 articles were included in the analysis. Strengths and weaknesses of using the Rasch approach were summarized. For Aim 2, the final IR scale had a person reliability and separation of 0.91 and 3.13, respectively, and an item reliability and separation of 0.94 and 4.01, respectively. The final IH scale had a person reliability and separation of 0.88 and 2.72, respectively, and an item reliability and separation of 0.79 and 1.95, respectively. For Aim 3, IR (β=0.296, 95% CI [0.133, 0.458]) and IH (β=0.414, 95% CI [0.204,0.623]) were independently and positively associated with depression in multivariable models controlling for age, income, and relationship status. Resilience and self-efficacy modified the relationship between IH and depression (βIHxRES=-0.034, 95% CI [-0.060, -0.008] and βIHxSE=-.056, 95% CI [-0.113, 0.00], respectively), but there was no evidence of effect modification by resilience or self-efficacy on the association between IR and depression. Public health implications: Our findings suggest that interventions targeting multiply marginalized groups such as BMSM that address co-occurring forms of stigma and foster positive self-evaluation and coping skills may reduce the negative consequences of internalized stigma on mental health outcomes.Item AN INTERSECTIONALITY, MINORITY STRESS, AND LIFE-COURSE THEORY INFORMED LATENT PROFILE ANALYSIS OF STRESS(OR) AND PSYCHOSOCIAL BUFFERING FACTORS AMONG FIRST-GENERATION LATINX IMMIGRANT YOUTH FROM THE NORTHERN TRIANGLE: EFFECTS ON MENTAL HEALTH AND SUICIDALITY(2022) Salerno, John P.; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In alignment with the intersectionality theoretical framework, first-generation Latinx immigrant youth from the Northern Triangle (i.e., El Salvador, Guatemala, and Honduras) may suffer from complex forms of vulnerability as a result of their multiple marginalized social identities and statuses. Indeed, consistent with the life-course perspective, immigrant youth from the Northern Triangle face unique risks for experiencing cumulative external stressors across the life-course in the context of the phases of migration, including pre- to post-migration victimization, and immigration-related family separation (e.g., forced family separation). The minority stress theory adds the potential for experiencing immigrant minority identity/status-related stress, such as discrimination or negative feelings attributed to being an immigrant, specifically during the post-migration context in the U.S., which could exacerbate mental health by adding to cumulative stress. Yet, the post-migration time period may be an important turning point for Latinx immigrant youth from the Northern Triangle, during which psychosocial buffering resources, like school, peer, and family support, and ethnic identity importance may have a strong and distinct impact that could significantly mitigate the cumulative mental health effects of life-course and minority stress(ors). Considering the increasing surge of immigrant youth from the Northern Triangle, which account for the majority of youth being apprehended at the U.S.-Mexico border, as well as grave concerns about their experiences of vulnerability and mental health, it is of utmost importance to utilize intersectionality, minority stress, and life-course theories to identify and understand the psychosocial risk and protective factors that can mitigate or exacerbate their mental health during post-migration in the U.S. To this end, in collaboration with a community-partner and a high school in Hyattsville, Maryland, primary surveys assessing external life-course stressors across the phases of migration (i.e., pre- to post-migration victimization, and family separation), post-migration immigrant-related minority stress (i.e., immigrant-related discrimination and negative immigrant stress-related feelings), and post-migration psychosocial buffering factors (i.e., family, peer, and school support, and ethnic identity importance) among first-generation Latinx immigrant youth from the Northern Triangle were administered (N = 172). In Paper 1, the aim was to identify potential intersections of minority stress (post-migration immigrant minority stress) and psychosocial buffering resources (family, peer, and school support, and ethnic identity importance), and their associations with external stressors (pre- to post-migration victimization and immigration-related family separation). Latent profile analysis was conducted to identify and describe latent profiles that varied at the intersections of post-migration immigrant minority stress and psychosocial buffering factors, and their associations with pre- to post- migration victimization, and family separation stressors. In Paper 2, the aim was to understand whether latent profiles characterized by the intersections of immigrant minority stress and psychosocial buffering factors, and external stressors (pre- to post-migration victimization and immigration-related family separation) jointly predicted mental health outcomes. ANOVA models were conducted to examine the associations of latent profile membership, pre- to post-migration victimization, and family separation with mental health outcomes (i.e., PTSD, depression, anxiety, and emotional problem symptoms) when all were included in the model as independent predictors. In Paper 3, the aim was to understand whether latent profile membership and external stressors jointly predicted suicidality. Logistic regression models were conducted to examine the associations of latent profile membership, pre- to post-migration victimization, and family separation with suicidality (i.e., suicidal ideation) when all were included in the model as independent predictors. Paper 1 findings revealed a three latent-profile model characterized by post-migration 1) moderate immigrant minority stress and low psychosocial buffering factors (moderate stress/low buffer), 2) moderate immigrant minority stress and moderate psychosocial buffering factors (moderate stress/moderate buffer), and 3) low immigrant minority stress and high psychosocial buffering factors (low stress/high buffer). Post-migration victimization was significantly associated with latent profile membership, such that those in the low stress/high buffer profile group (11%) were least likely to experience post-migration victimization compared to the moderate stress/moderate buffer (most likely; 49%) and moderate stress/low buffer (33%) profile groups (p < .001). Overall prevalence of in-transit victimization (7.70%) was too low for valid statistical assessment. Pre-migration victimization and family separation were not significantly associated with latent profile membership. Paper 2 factorial ANOVA analyses demonstrated that latent profile membership post-migration victimization, and family separation were statistically significant predictors of mental health outcomes (PTSD, depression, anxiety, and emotional problem symptoms) when all were included in the models. Bonferroni-corrected factorial ANOVA test findings revealed that youth in the low stress/high buffer profile group were significantly less likely to experience PTSD (p < .001, p = .003), depression (p < .001, p < .001), anxiety (p < .001, p < .001), and emotional problem symptoms (p = .002, p = .041) compared to youth in both the moderate stress/moderate buffer and moderate stress/low buffer profile groups (respectively). The moderate stress/low buffer profile group did not differ significantly from the moderate stress/moderate buffer profile group in-terms of any mental health outcome. Post-migration victimization was independently and positively associated with PTSD (p = .010), anxiety (p < .001), and emotional problem (p = .042) symptoms (but not depression symptoms), and forced family separation was independently and positively associated with PTSD (p = .026), anxiety (p = .017), and depression symptoms (p = .009; but not emotional problem symptoms) in factorial ANOVA. Pre-migration victimization was not a significant predictor of any mental health outcomes, and in-transit victimization prevalence was too low for valid statistical assessment of its association with mental health outcomes. Paper 3 multivariable logistic regression analyses demonstrated that latent profile membership was the only statistically significant predictor of suicidality. The low stress/high buffer profile group was significantly less likely to experience suicidality compared to both the moderate stress/moderate buffer (87.8% decrease in the odds; OR = 0.122; p < .001) and moderate stress/low buffer (95.6% decrease in the odds; OR = 0.044; p < .001) profile groups in multivariable logistic regression. The moderate stress/low buffer profile group did not differ significantly from the moderate stress/moderate buffer profile group in-terms of suicidality. Post-migration victimization was no longer a statistically significant predictor of suicidality in the multivariable logistic regression model. Pre-migration victimization and family separation were not significant predictors of suicidality, and in-transit victimization prevalence was too low for valid statistical assessment of its association with suicidality. Considering the results of all three studies in Papers 1-3, latent profiles, characterized by the intersections of immigrant minority stress and psychosocial buffering resources, were a significant independent predictor of all mental health outcomes and suicidality. Yet, external stressors, particularly post-migration victimization (PTSD, anxiety, and emotional problem symptoms) and immigration-related family separation (PTSD, anxiety, and depression symptoms) were also significant independent predictors of mental health outcomes, suggesting that these factors also explain post-migration mental health outcomes to some degree above and beyond latent profile membership. In totality, findings strongly suggest that further exploration of post-migration immigrant minority stress and psychosocial buffering resources is urgently warranted to identify ways of overcoming the effects of externalized immigrant-related stressors and reducing mental health burden among first-generation Latinx immigrant youth from the Northern Triangle, a highly vulnerable population. Consistent with minority stress and intersectionality theories, protective associations with mental health were present when post-migration immigrant minority stress was low and psychosocial buffering was high, but these protective associations were lost when immigrant minority stress increased to moderate level and when psychosocial buffering decreased to moderate or low level. From another viewpoint, there were risk associations with mental health when post-migration immigrant minority stress was moderate and psychosocial buffering was low or moderate, but these risk associations were reversed toward being protective when immigrant minority stress lowered to low level and when psychosocial buffering increased to high level. That post-migration victimization and forced family separation remained positive predictors of mental health outcomes in multivariable analyses highlights that these external life-course stressors exacerbated mental health above and beyond the associations of post-migration immigrant minority stress and psychosocial buffering latent profile membership alone. Findings provide valuable information for policy and intervention development and reform in the U.S. that focuses on factors that can be intervened on during the post-migration phase in the U.S. (as opposed to less intervenable factors that occurred during pre and in-transit migration) to positively impact mental health and wellbeing among first-generation Latinx immigrant youth from the Northern Triangle. When immigrant youth experience low immigrant minority stress, strong peer and family support networks, as well as supportive schools and feeling that their foreign, cultural, and ethnic identities are celebrated and welcomed, this could have a significant protective effect toward their mental health and suicidality. However, if youth are facing low levels of these psychosocial buffering experiences and moderate (or potentially high) levels of immigrant minority stress, they may experience negative effects that hinder their mental health and suicidality. Additionally, post-migration victimization and forced family separation are particularly impactful predictors of mental health above and beyond the effects of latent profile group membership alone, which indicate the urgent need for mental health services and support resources that address these stressful and traumatic life-course experiences among first-generation Latinx immigrant youth from the Northern Triangle. Findings elucidate post-migration immigrant minority stress and psychosocial buffering pathways for future development and evaluation to improve Northern Triangle immigrant youths’ mental health and suicidality.Item LGBTQ Community Belonging and Involvement as Predictors of Sexual Minorities' Well-Being(2021) Burrows, Michael; Mohr, Jonathan J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Sexual minorities (SM; i.e., lesbian, gay, bisexual, queer, and asexual+) experience high rates of discrimination and stigma, which account for mental health disparities based on sexual orientation (Cochran, 2001; Meyer, 2003). A growing body of research suggests that LGBTQ community may be a source of resilience. This thesis examines two ways that SM can interact with and experience LGBTQ community: LGBTQ community belonging (a subjective sense of belonging or being a part of LGBTQ community; Frost & Meyer, 2012; Puckett et al., 2015) and community involvement (engagement in LGBTQ nightlife, social clubs, politics, and community sports; Foster-Gimbel et al., 2020).Across two time points over an approximately 6.5 week period, 171 SM completed surveys assessing LGBTQ community belonging and community involvement, psychological well-being (depression, anxiety, loneliness, positive affect, and satisfaction with life), perceived social support, and internalized stigma. Analyses focused on (a) relations between community variables (belonging and involvement) and well-being over time, and (b) the potential mediating roles of social support and internalized stigma in these relations. Most hypothesized relations between community variables and future well-being did not emerge. However, results supported associations between community involvement and future satisfaction with life, even after controlling for LGBTQ community belonging. Results also suggested that specific types of community involvement related in unique ways to facets of well-being in the future. Results did not support any of the hypothesized mediated relationships.Item MENTAL HEALTH IN UNIVERSITY STUDENTS IN BANGLADESH: AN EXAMINATION OF CURRENT PRACTICES, SERVICE USE, AND AN EXPLORATION OF THE ACCEPTABILITY OF MHEALTH FOR MENTAL HEALTH AND MINDFULNESS(2021) Sifat, Munjireen Sara; Green, Kerry M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The prevalence of mental health problems, such as depression and suicide, is high in Bangladesh. The incidence of mental health problems in Bangladesh is highest in young adulthood and often occurs in university students. Mobile health apps are effective in Bangladesh for chronic health problems, though there is no current literature on the use of mHealth for mental health promotion in Bangladesh, nor in the university student population in Bangladesh. The study utilizes a multi-method design informed by Self-Determination Theory and the Technology Acceptance Model to explore motivational factors for mental health practices, such as coping techniques, and use of professional services, such as therapy. The quantitative component includes regression analysis of an online survey delivered to students currently enrolled in universities in Bangladesh to determine current attitudes and practices of mental health services (n=350) and the possibility of using mHealth for mental health (n=311). The qualitative component involves thematic analysis of semi-structured interviews with randomly selected students (n=12) who complete the quantitative portion of the study, regarding their opinion of mHealth for mental health app content. Results show that subjective perception of needing mental health support was the strongest predictor of clinical service utilization. Additionally, the perception of viewing mental health positively was associated with actual use of clinical services, but the association became insignificant after adjusting for the perceived need. One's social influences predicted perceived need for mental health support; and knowledge about mental health predicted positive views of clinical mental health care. Intent to use general mHealth is driven by social influence, ease of use, and perceived utility. According to this study, mobile health services are acceptable to this population and can be helpful for students with barriers to accessing traditional mental health services. The qualitative interviews revealed that students felt that guided mindfulness exercises relieved stress, and the potential of having easy access to such exercises on an app on their phone overcame barriers they had previously encountered. These findings suggest that an app with mindfulness exercises may be worth developing and testing in Bangladesh in order to promote student mental health.Item Family Support, Rejection, and Connectedness: Family Context and SGM Youth Mental Health and Substance Use(2021) Tomlinson, Katherine; Fish, Jessica N; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Adolescence is an acutely significant period of development, and sexual and gender minority youth (SGMY) experience unique stressors which contribute to elevated rates of substance use, mood disorders, suicidal ideation and attempts, and other health outcomes when compared with their heterosexual, cisgender peers. Family is often the context in which SGMY navigate these stressors and manage their health. Family rejection and support have each been linked to health outcomes among SGMY, including depression and substance use. More globally, family connectedness is beneficial to adolescent’s health but is an understudied construct within SGMY research. Limited research has examined how these family processes converge to influence SGMY health. In an effort to capture nuance in family process and SGMY health, this study examined the relationship between experiences of family support, rejection, and connection among SGMY and their depressive symptoms and substance use. Findings have implications for research and practice with families.Item Mental Health Advocates as Cultural Intermediaries: A Sociocultural Perspective of Advocacy and Legitimacy(2021) Aghazadeh, Sarah Abigail; Aldoory, Linda; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study sought to understand how advocacy as a public relations activity can give voice to marginalized publics and how/if mental health advocates perceive their advocacy work as influencing culture as it relates to mental health. This study incorporated the theoretical frameworks of fully functioning society theory (FFST) and the circuit of culture. Additionally, this study investigated the concepts of advocacy, legitimacy, cultural intermediation and discourses as they entangle with and within FFST and the circuit of culture. The juxtaposition of these theories helped to uncover both culturally situated best practices of advocacy and interrogate the frames that underpin the rhetorical ideals of a fully functioning society. This study employed qualitative, in-depth interviews with 38 mental health advocates who communicated a variety of perspectives about mental health and illness. Some themes that emerged include: advocacy as both education and empowerment, legitimacy as authority that can derive from both lived and learned experience, the multiple subcultures within the field of mental health advocacy, and the variety of mental health discourses. Furthermore, two overlapping, but distinct missions of advocacy exist including 1) general mental health for all of society and 2) advocacy for people who have experienced significant challenges to daily life and/or harm (e.g., prejudice, discrimination) because of a psychiatric diagnosis. This dissertation extended FFST and the circuit of culture to present a culturally embedded conceptual model of advocacy and theoretical propositions to help guide future theory building. The theoretical propositions outline how advocacy is a vehicle for voice to change status quos, how dysfunction and marginality are parallel within FFST, and how legitimation and cultural intermediation align in the context of culturally situated responsible advocacy. The findings also contributed to the existing theories by applying those theories to a specific context of mental health advocacy, which illuminated the importance of questioning normalized values within FFST and approaching intermediation with reflectiveness. This research considers the consequences of advocacy for people with lived experiences and situates advocacy within social justice contexts to inch closer towards the ideals of FFST.Item Measuring and Assessing the Health Implications of Perceived Islamophobia Discrimination among South Asian Muslim Americans(2020) Ahmed, Naheed; Quinn, Sandra C.; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)South Asian Americans have high prevalence rates of Type II diabetes (15.9%) and hypertension (25%). Existing research on this topic has primarily focused on risk factors for these conditions, such as genetics, diet, and physical activity, but a gap remains in our knowledge of stress, specifically exposure to discrimination, as a contributing factor to these health outcomes. This cross-sectional, mixed methods study involved the development and assessment of a novel scale for measuring perceived Anti-Muslim discrimination, and examined associations among discrimination, depressive symptoms, and health risk behaviors (diet, physical activity, tobacco use, alcohol consumption) for Type II diabetes and hypertension. In-depth qualitative interviews (N=40) were conducted with Muslim Americans on how they define Islamophobia, how Muslims are treated and perceived in the U.S., and experiences with Islamophobia. Findings from qualitative interviews, expert reviews (N=5), and cognitive interviews (N=9) informed the development and validation of the 19-item Societal Anti-Muslim Discrimination Index (SAMDI) and the 9-item Interpersonal Anti-Muslim Discrimination Index (IAMDI). Quantitative data (N=347) were collected from Muslim Americans using an online survey. Correlation tests and principal component analysis were used to assess the SAMDI and IAMDI scales (N=347), and structural equation modeling was used to examine relations among discrimination and health using a sub-sample of South Asian Muslim American participants (n=173). Qualitative findings indicate that Islamophobia and xenophobia are significant sources of long-term stress. Participants recounted physical assaults in public locations, persistent questioning regarding their country of origin, and verbal harassment in the form of derogatory terms and comments. Vicarious exposure to Islamophobia was mentioned in relation to observations of other Muslims being harassed and hearing about bias incidents from relatives, friends, and media reports. Quantitative results indicate one-component models and modest to high reliability of the IAMDI (.77) and SAMDI (.88) scales. SAMDI was associated with an increase in depressive symptoms (.19, p<.05), as was IAMDI (.20, p<.05). Neither scale was associated with dietary patterns, tobacco use, or alcohol consumption. Study results demonstrate the link between Islamophobia and depressive symptoms, and provide a unique tool for measuring Anti-Muslim discrimination, which will aid researchers in studying the health implications of Islamophobia.Item Stress, Mental Health, and Self-Care among Refugee Teachers in Malaysia(2020) Gosnell, Nicole; O'Neal, Colleen; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The mental health of post-conflict refugee teachers is understudied, yet critically important given the current refugee crisis which has displaced more than 70 million people (UNHCR, 2019). Teachers in hidden refugee schools are often refugees themselves, have little teacher education, and are faced with overwhelming classroom demands and other unique stressors. This study utilizes a mixed method design to examine stress, mental health (i.e., depression, and anxiety), and self-care among teachers in hidden refugee schools in Kuala Lumpur, Malaysia. Quantitative data are archival, collected in Malaysia in 2013. Quantitative study participants included 97 primarily Burmese refugee teachers and 26 non-refugee teachers living in Malaysia. Quantitative measures included (a) Depression, Anxiety, and Stress Scales (DASS); (b) a self-care strategies questionnaire, and (c) a demographic questionnaire. Quantitative results suggest that refugee teachers have significantly higher rates of mental health and stress, but lower rates of self-care as compared to their non-refugee peer teachers. In addition, higher rates of self-care are associated with lower rates of mental health symptoms and stress rates; the association is moderated by age. Qualitative data were collected in June 2018 via individual interviews with eleven Burmese refugee teachers working in Malaysia. Qualitative results shed light on the unique definitions and experiences of stress, mental health, and self-care among refugee teachers in the context of macrolevel factors. Overall, this dissertation found that macrolevel factors unique to being a refugee impact refugees’ rates, experiences, and definitions of microlevel mental health symptoms, stress, and self-care.
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