Behavioral & Community Health
Permanent URI for this communityhttp://hdl.handle.net/1903/2271
Prior to January 24, 2011, this unit was named the Department of Public & Community Health.
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Item Exploring Young Bi+ Women's Intersecting Mental Health and Sexual and Reproductive Health Experiences in Context: A Multi-Analytic Method Qualitative Study(2023) Robinson, Jennifer Lynn; Aparicio, Elizabeth M; Butler, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Young bi+ women report worse mental health and sexual and reproductive health (SRH) outcomes compared to gay, lesbian, and straight young adults. They experience intersecting threats to their health and well-being due to their sexuality, gender, and stage of development. There is a lack of research on bi+ women’s unique mental health and SRH experiences, and often bi+ women are overlooked due to bi-erasure and biphobia. Regressive policies related to LGBTQ+ and women’s rights, including increased restrictions to reproductive healthcare after the Dobbs v. Jackson Women’s Health Organization decision overturning abortion protections, further threaten bisexual women’s health. This dissertation used a multi-analytic method qualitative approach to explore the intersecting mental health and SRH experiences of young bisexual women in the current socio-political context. Semi-structured in-depth interviews were conducted over Zoom with 16 young bi+ women from across the U.S. A narrative inquiry approach was used to explore young bi+ women’s mental health experiences and coping strategies. In addition, thematic analysis was used to investigate how young bi+ women describe their mental health as intersecting with their SRH in the current socio-political context. The study yielded rich and nuanced information about challenges these young bi+ women experienced throughout their lives that affected their mental health and SRH. Experiencing trauma had far-reaching negative effects on their mental health. Participants discussed the challenges of forming their identity within the social context, particularly as bi+ women in a society that often invalidates bisexual identities and subjugates women. They also discussed the joys along with difficulties of navigating young adulthood. They further described coping with challenges in a variety of adaptive (e.g., therapy, exercise) and maladaptive (e.g., substance use, self-injury) ways. They discussed relying on social support such as partners, friends, family, therapists, and teachers. Participants desired more support with sexuality-related issues, particularly in early adolescence. These bi+ women described their mental health and SRH as intertwined and discussed how bodily autonomy and agency were essential to their well-being. The socio-political context, including social norms, rhetoric, and federal- and state-level policies, influenced participants’ well-being. The current study shows that young bi+ women face unique threats to their mental health and SRH. Practice implications include improving access to affordable and LGBTQ+-affirming healthcare and developing interventions attuned to the needs of young bi+ women. Policies are needed that uphold the choice and agency of young women in their reproductive health decision-making. Future research should continue to explore the needs and experiences of young bi+ women concerning their mental health and SRH including demographic differences along with potential mechanisms resulting in poorer health.Item Understanding the informal help-seeking process of Korean emerging adults living in the U.S.: Influence of the family context(2022) Yoo, Jee Hun; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Korean Americans are a major Asian subgroup in the U.S., and epidemiological data demonstrate that rates of mental health symptoms are higher among Korean American emerging adults compared to other Asian American counterparts. Seeking and receiving appropriate support are important ways to cope with mental health burden, but there is a dearth of literature on how Asian Americans seek help from friends and family members. Available studies suggest that various sociocultural factors influence the informal help-seeking process among Asian Americans. As family context has a significant impact on children’s sociocultural development, examining such contextual factors can help understand some of the mechanisms and correlates of informal help-seeking. In this dissertation study, I explored the characteristics and associations among family communication patterns, relevant sociocultural factors (i.e., perceived parental support, emotional self-control, relational concerns, face loss concerns), and informal help-seeking intentions using a sample of 201 Korean American emerging adults (ages 18 – 29) drawn from an online survey. In paper 1, factor analysis showed that different help sources can be grouped into three domains (i.e., formal sources, family members, and partner and friends), with intention to seek help being the highest towards partner and friends, followed by family members and formal sources. Characteristics of higher acculturation were positively associated with help-seeking intention towards partner and friends. In paper 2, mediation analyses revealed that participants with parents fostering unrestrained communications perceived receiving more informational support from parents, which in turn was associated with higher intention to seek parental support. Participants with parents emphasizing conformity in beliefs and values perceived receiving less emotional and implicit support from parents, which in turn was associated with lower intention to seek parental support. The negative association between conformity orientation and perceived emotional support was only significant among participants identifying as American or bi-cultural. In paper 3, bivariate analyses showed that conversation orientation was positively associated with informal help-seeking intention, while conformity orientation, emotional self-control, relational concerns, and face loss concerns were negatively associated. Mediation analyses indicated that participants with parents stressing conformity in beliefs and values were more likely to endorse suppression of emotional expression and be concerned with potential loss of face from help-seeking, which in turn were associated with lower intention to seek help from family and friends. Findings from this dissertation study point to the utility of examining family contextual factors to better understand the informal help-seeking process among Korean American emerging adults. More studies on Asian Americans’ informal help-seeking are needed to find more culturally appropriate ways to address the mental health needs of this population.Item YO SOY PAZ (I AM PEACE): PILOT STUDY OF A TRAUMA-INFORMED, COMMUNITY AND MINDFULNESS-BASED PROGRAM FOR LATINO IMMIGRANTS IN MARYLAND.(2022) Munoz, Juliana; Green, Kerry M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: One in three Latinos in the US is an immigrant. Immigrants face particular stressors that are heightened by previous traumatic experiences before, during, and after migration. Latino populations report the highest level of stress of all racial/ethnic groups in the US and the second-highest prevalence of mental health illness. Mindfulness-Based Interventions (MBIs) have shown to be successful at reducing stress and strengthening mental health in diverse populations, yet little is known about the effects of these interventions on this particular population.Methods: The pilot study tested the Yo Soy Paz (I am Peace) online synchronous program, an evidence and trauma-informed mindfulness-based intervention that was adapted for immigrant Latina mothers and the community staff members that work with them in a community setting. The eight session pilot intervention was delivered to three cohorts for a total of 41 participants, including staff and parents of youth receiving services at a local community-based organization that serves Latino immigrants. The study used the Consolidated Framework for Implementation Research (CFIR) to examine the feasibility, acceptability, appropriateness, and fidelity of the Yo Soy Paz online program. The study also examined the initial effects of the program on stress, mindfulness, mind-body connection, and subjective well-being. Qualitative and quantitative data were collected through self-reported pre-post questionnaire, fidelity checklists, and focus groups with parents and staff. Results: Acceptability, feasibility, fidelity and appropriateness scored high on the quantitative measures. Inner compatibility with the organization’s mission and vision, clients’ needs and the organization’s receptivity to implement the intervention scored in the medium range. Mothers’ and promotoras’ self-reported mean scores for subjective wellbeing and perceived physical and mental health increased significantly from baseline- to post-test. No significant changes were observed in surveys completed by the staff, even though focus group participants reported meaningful improvement. Discussion: Overall the pilot feasibility study was well received and relevant for the organization and the population they serve. MBIs for Latino immigrants and the staff that works with them have the potential to improve well-being and overall mental and physical health. The study’s findings provide guidance to others in implementing online mindfulness practices with Latino immigrants and the staff that works with them.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 EXPLORING THE EFFECTS OF ADVERSE CHILDHOOD EXPERIENCES AND SOCIAL INTEGRATION ON ADOLESCENT SUICIDAL IDEATION: A SECONDARY ANALYSIS OF THE NATIONAL COMORBIDITY SURVEY REPLICATION ADOLESCENT SUPPLEMENT (NCS-A)(2018) Washington, Kathleen Elaine; Desmond, Sharon M; Hancock, Gregory R; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Exposure to adverse childhood experiences is common among youth. Numerous studies have identified cumulative exposures to adversity during childhood as a serious public health issue. Studies have found a significant dose-response association between cumulative adversities and risk for negative behavioral and mental health outcomes in adults, and developmental delays and internalizing and externalizing disorders in children. Efforts to expand existing knowledge about childhood adversities and the factors that are protective has been a focus of recent efforts. In this dissertation, two studies were conducted to assess the relationship of adverse childhood experiences and social integration on risk for adolescent suicidal ideation. Study 1 focused on assessing the predictability of a 20-item childhood adversity assessment versus a 9-item assessment for risk of suicidal ideation. Results from this study found that additional items in the expanded assessment were predictive of suicidal ideation and increasing exposures significantly increased risk for suicidal ideation. However, the 20-item assessment was only slightly more predictive of suicidal ideation compared to the 9-item assessment. Study 2 examined the protective effect of family, school, religious/spiritual, peer and teacher integration as a protective factor of the relationship of cumulative childhood adversity and adolescent suicidal ideation. Results indicate family, school and religious/spiritual integration reduce risk for suicidal ideation for adolescents reporting 1-3 adversities. Only family integration significantly reduced risk for suicidal ideation for youth reporting 4-6 adversities. None of the five social integration factors reduced suicidal ideation risk for youth reporting 7 or more adversities. Further, peer and teacher integration were not found to be a protective influence across any of the adverse childhood experiences risk groups. Future public health research must focus on identifying those childhood experiences that may increase risk for poor behavioral and mental health outcomes. Current priorities should also focus on youth who have experienced higher levels of adversity so that more appropriate prevention and intervention programs and policies can be developed. Finally, given the impact of childhood adversities on health and wellbeing over the life-course, more efforts are needed to reduce or eliminate childhood adversities.Item Graduate school burnout and attrition: Examining associations with substance use, mental health problems, and academic support(2018) Allen, Hannah Katherine; Arria, Amelia; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)There is a well-established connection between health and academic achievement among high school and undergraduate students. Despite the high prevalence of substance use and mental health problems during young adulthood, few studies have examined these relationships among graduate students. Two distinct but interrelated studies were conducted to examine substance use and mental health problems as potential contributors to graduate student burnout and attrition, both individually and in conjunction with academic support factors including advisor satisfaction, departmental support, and program climate. The selection of these variables was determined by an overarching socio-ecological framework, whereby academic success is driven by multiple spheres of influence. The first study utilized secondary data to understand the associations between patterns in alcohol consumption, marijuana use, and mental health during the undergraduate college years and graduate degree completion. The lack of association found between behavioral health during college and graduate degree completion might be due to a decrease in mental health and substance use problems during the post-college years, as well as a possible selection effect where those with mental health and substance use problems are less likely to enroll in graduate school. The second study involved primary data collection to examine the correlates of substance use, mental health problems, and academic support among a sample of graduate students, as well as evaluate the associations between these variables and three dimensions of burnout (exhaustion, cynicism, and inefficacy). Findings showed graduate student subgroups that might be at increased risk for behavioral health problems, particularly professional doctoral students and students enrolled in programs in the humanities and social sciences. High-risk alcohol use, stress, and depression symptoms were all associated with increased levels of burnout, but high levels of departmental and advisor support appeared to buffer this effect. This research is a first step in extending knowledge on the relationship between potentially modifiable health-related risk factors and graduate student burnout and attrition. This line of research has implications for graduate students, faculty, and administrators who are committed to improving student success and well-being.Item Exploring Predictors of Military Spouses’ Comfort Seeking Military-Provided Counseling Services(2017) Brown, Christye Yvonne; Beck, Kenneth; Zanjani, Faika; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Over 1.2 million (approximately half) of the service members deployed in support of the Global War on Terror were married at the time of their last deployment (Department of Defense, 2013). Data from the study of military and veteran families suggests that both stress and the process of coping with or overcoming exposure to adversity or stress resonate across the family system (Meredith L. S., et al., 2011), and that the impact of war and its consequences are experienced by partners and families in addition to service members (Lester, Blair, Saltzman, & Klosinski, 2013). The purpose of this study was to determine predictors of spouses' comfort in seeking military-provided counseling services when service members are deployed, by examining spousal coping behaviors, mental health status, and social support and demographics (rank and gender), as reported from the 2012 Active Duty Spouses Survey (ADSS). Analyzing survey data from 10,574 participants, we determined that 82.5% of the participants had spouses who were deployed for more than 30 consecutive days, and 64.3% of the participants felt comfortable using military-provided services for counseling. Statistically significant predictors of comfort-seeking, military-provided counseling services included positive coping behaviors, mental health status, social support, and the rank of the spouse’s partner. Spouses of officers were less likely to feel comfortable using military-provided services for counseling compared to spouses of enlisted service members. The level of psychological stress experienced by the spouses correlated with all predictors of comfort seeking, military-provided services for counseling. The results were consistent with previous studies on the predictors and outcomes of psychological stress among military spouses, and supported the Transactional Model of Stress and Coping. The results have practical significance because they will help planners tailor programs to optimize the uptake of counseling services for military spouses who are in need. We recommend that future research incorporate measures of the service members’ extended deployments in combat zones to determine if extended combat-related deployment predicts spouses’ comfort seeking military-provided services for counseling. Qualitative research may also be useful to provide more insight into why some military spouses feel comfortable using military-provided services for counseling while others do not.Item THE ASSOCIATION BETWEEN NEGATIVE CONFLICT BEHAVIOR AND SUBCLINICAL LEVELS OF PSYCHOPATHOLOGY SYMPTOMS IN CLINIC COUPLES: AN ACTOR-PARTNER INTERDEPENDENCE MODEL APPROACH EXAMINING MEDIATION BY PERCEIVED CRITICISM AND MODERATION BY POSITIVE COMMUNICATION(2015) White, Anna; Epstein, Norman B; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Past research on family members as psychosocial stressors leading to increased symptom distress has been mostly limited to psychiatric populations and has been problem-focused. The current study used behavioral observations and partner reports to examine the relationship between positive and negative partner behavior and individual symptom distress, mediated by perceived criticism, in 96 clinical couples. Results of structural equation modeling showed that male negative behavior had a positive relationship with female symptom severity mediated by perceived criticism. Female negative behavior had a negative relationship with male symptom severity, not mediated by perceived criticism. Warmth displayed no significant relationship with perceived criticism or symptom severity for either gender. Recommendations for future research include examining the role of power in the relationship between negative partner behavior and symptom severity and assessing the ratio between positive and negative behaviors rather than as separate variables. Replication of these results is warranted.Item PREDICTORS OF RESILIENCE AMONG COMMISSIONED OFFICERS IN THE UNITED STATES PUBLIC HEALTH SERVICE(2012) Peat, Raquel Antonia; Desmond, Sharon M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this cross-sectional study was to examine the predictors of resilience and mental health among United States Public Health Service (USPHS) commissioned officers who have deployed. The study employed the Transactional Model of Stress and Coping (Antonovsky and Kats, 1967; Cohen, 1984; Lazarus and Cohen, 1977) to aid in evaluation of the above factors. Relatively few research studies have examined the concept of resilience, and to date, no study has systematically examined risk, social support, mental health and resilience in USPHS commissioned officers. A pilot study (N = 11) was conducted to determine acceptability of the survey items and assess time needed to complete the questionnaire. The final 94-item on-line survey was completed over a two month time period by a convenience sample of 534 USPHS commissioned officers. Univariate analyses demonstrated that when entered individually, team support, post-deployment social support and mental health (protective factors) and the covariates, gender and relationship status were significantly (p<0.05) associated with resilience, while predeployment affectivity (risk factor) was not. When all risk and protective factors were entered into the multivariate logistic regression model, team support, post-deployment social support, mental health, gender and being divorced as compared to being separated, widowed or living with a partner were found to be significantly associated with resilience (p<0.05). Also, both team support and resilience were negatively associated with mental illness measured using depression, anxiety and post-traumatic stress disorder subscales (p<0.05). Those USPHS commissioned officers who reported mental illness were less likely to be resilient. This study provides new data that may help improve our understanding of the resilience and mental health of USPHS commissioned officers, before and after deployment. Findings can be used to inform education and training programs for USPHS commissioned officers (e.g. coping skills training techniques) to help increase their ability to thrive despite adversity before and after deployment.Item Self-Efficacy and Stigma in Seeking Mental Health Services in the U.S. Army(2012) Koeppl, Patrick Thomas; Gold, Robert S.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Among the highest personal costs, and perhaps the most pervasive and potentially disabling consequences of engaging the U.S. military in combat operations, is the threat to the psychological health of the servicemen and women and the associated impacts on their families. Negative stigma associated with seeking mental health services undermines servicemen and women's access to such services and to seeking the care they require, either for themselves or their families. While negative stigma is well documented in servicemen and women and their families, little has been done to understand the role self-efficacy plays in relation to servicemen and women seeking such services. This study assessed and evaluated aspects of stigma associated with seeking mental health services among members of the U.S. Army, and explored the role self-efficacy plays in predicting the seeking of those services. It also sought to explore and understand the factors which predict servicemen and women's willingness to seek mental health services for themselves and their children in an environment where stigmatization of those who seek such services is high. This study included an analysis of data from a 53-item email survey administered to active-duty Army servicemen and women in 2007. Stigma was found to be the primary barrier to servicemen and women's willingness to seek care for themselves or for a child, and self-efficacy was found to moderate the relationship between stigma and willingness to seek mental health services. The results of this study will provide information pertinent to developing strategies and interventions for the U.S. Army to assist their servicemen and women (and their families) in overcoming negative stigma associated with seeking mental health services and for improving the access to and use of mental health services offered by the Army.