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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Subject: search.filters.subject.mental health

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    Experiences of child welfare social workers in addressing substance use among maltreated young mothers to prevent child maltreatment
    (Wiley, 2023-02-24) Doig, Amara Channell; Jasczynski, Michelle; Phillips, Danielle R.; Robinson, Jennifer L.; Aden, Faduma; Huq, Maisha; Lee, Kaitlyn; Jones, Gary; Bernardi, Chloe; Aparicio, Elizabeth M.
    Substance use during the perinatal period and while parenting can pose a significant risk to children's safety and well-being. Mothers who have experienced child maltreatment are more likely to use substances than mothers without a history of maltreatment. This study explores how child welfare social workers experience supporting young, maltreated mothers struggling with substance use to prevent the intergenerational transmission of child maltreatment. Semi-structured in-depth interviews were conducted with four social workers working with young mothers with a history of maltreatment and substance use. Interpretative Phenomenological Analysis revealed two themes: (1) grappling with system challenges and (2) supporting strategies for disrupting intergenerational transmission of child maltreatment. The results highlight the need for systemic changes around support for social workers who work with young mothers who use substances and have a history of maltreatment, and substance use treatment and mental health programs themselves. Mothers need access to prenatal programs that are trauma-informed, non-judgemental and that support participants' basic needs and parenting skills.
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    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.
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    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.