All Articles

Shervin Assari*

Department of Urban Public Health & Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA

Background: According to the Minorities’ Diminished Returns (MDRs), highly educated African American (AA) and Latino people remain at high risk of tobacco use. One hypothesis suggests that this high risk of tobacco use stems from AA and Latino people remaining unrealistically optimistic, resulting in the risks of tobacco use being discounted. Aims: To better understand the role of cognitive bias as a mechanism behind the high risk of smoking in highly educated minorities, we studied ethnic variation in the association between smoking intensity and perceiving oneself as a smoker among young American adult established current smokers.

Methods: In this cross-sectional study, we used baseline data of 2,475 young adults (18-24 years) who were current established smokers. The data came from the Population Assessment of Tobacco and Health (PATH; 2013) study, a nationally representative survey in the US. The independent variable was smoking intensity. The dependent variable was not perceiving oneself as a smoker (probably due to optimistic cognitive bias and discounting the risk). Age, gender, and education were the covariates. Ethnicity was the moderator. Logistic regressions were used to analyze the data.

Results: From the total number of 2,475 current smokers, 2106 (85.1%) perceived themselves-as a smoker, and 369 (14.9%) smokers perceived themselves as a non-smoker. A high level of smoking intensity was associated with lower odds of not perceiving oneself as a smoker. Two significant interactions were found between Latino and AA ethnicity and smoking intensity, suggesting that the effect of smoking intensity on perceiving oneself as a smoker is weaker in AAs than Whites and Latinos than non-Latinos.

Conclusions:While tobacco use intensity is associated with a lower likelihood of optimistic cognitive bias and not perceiving oneself as a smoker, Latino and AA young adults who smoke many cigarettes a day are more likely than their non-Latino White counterparts with the same smoking risk not to perceive themself as a smoker. This finding suggests a psychological discounting of risk among AA and Latino smokers. Such cognitive bias may help them avoid cognitive dissonance and reduce their own perceived risk of cancer and other fatal conditions from smoking. A cognitive bias may increase the smoking burden of AA and Latino young adults through discounting smoking risk.

Kevin J. Rivera¹, Jenny Y. Zhang², David C. Mohr³, Annie B. Wescott⁴, Aderonke Bamgbose Pederson^2*

¹Department of Psychiatry, Carver College of Medicine, University of Iowa. 200 Hawkins Dr, Iowa City, Iowa, 52242, United States

²Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University. 446 E. Ontario St, #7-200, Chicago, Illinois, 60611, United States

³Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University. 680 N. Lake Shore Dr, Suite 1400, Chicago, Illinois, 60611, United States

⁴Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University. 320 E Superior St, Chicago, Illinois, 60611, United States

Among African Americans, the chronicity and severity of mental illness correlates with worse health outcomes and widens health disparities. Stigma related to mental illness compounds mental health disparities by creating barriers to help-seeking behavior. We examine the current tools designed to reduce mental illness stigma and promote improved mental health outcomes among African Americans. The authors reviewed the current evidence in the literature for such stigma reduction interventions. The review team developed a focused search across four databases: PubMed, Embase, Scopus, and APA PsycINFO. Initial searches identified 120 articles, from which six studies were included as reporting on mental illness stigma reduction interventions among African Americans. We describe these four quantitative and two qualitative studies. There have been various interventions used among African Americans to reduce mental illness stigma, and the level of efficacy and effectiveness is not well studied. Our review demonstrated a need for more robust studies to yield strong evidence on effectiveness among stigma reduction interventions in this target population. The evidence does support tailoring intervention studies to this population. Effectively engaging and partnering with key stakeholders, including schools, community organizations, and faith-based institutions enhances the acceptance and delivery of stigma reduction interventions.

Allen Azizian

Department of Criminology, California State University, Fresno, USA

The term evidence-based is increasingly found in treatment manuals and program titles designed for individuals convicted of a sexual offense. However, whether the presented evidence truly qualifies as “evidence-based” is questionable. I will share my experience as the clinical director for a private outpatient agency where we designed a program based on the existing peer-reviewed literature on individuals convicted of Child Sexual Exploitation Material (CSEM) offenses. I will describe the steps that we followed in developing a workgroup to explore and apply the knowledge from research to our clinical practice. We adapted the term evidence-informed to acknowledge that the program relied on existing literature in combination with the experiences and expertise of our clinical team. A fictitious case that reflects an amalgamation of facts is presented to demonstrate the assessment and treatment processes. Implications for organizational consensus to conduct program evaluation and research are discussed.

Aderonke Bamgbose Pederson^1*, Valerie Earnshaw², Crystal T. Clark^1*, Katelyn Zumpf¹, Inger Burnett-Zeigler¹

¹Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, United Sates

²Department of Human Development and Family Sciences, University of Delaware, United Sates

Background: Mental health stigma results in unmet mental health needs. Research describing predictors of stigma remains limited among Black immigrants. We aim to examine stigma associated with mental illness among a group of Black immigrant women.

Methods: We examined data from 22 women from two Black immigrant community centers. We collected surveys on demographics, cultural beliefs, migration status, religiosity and mental health stigma. Simple linear regression was used to model the unadjusted association between each component variable and overall stigma scores. All analyses were conducted using R and assumed a two-sided, 5% level of significance.

Results: A linear relationship was found between author-generated scale, the Stigma and Culture Survey (SCS) and the Depression Self Stigma Scale (DSSS). Among respondents, use of religious resources was associated with less stigma (p-value: 0.04). Whereas spirituality and morality was associated with greater stigma (p-value: 0.003). United States citizenship was associated with less stigma (p-value: 0.0001).

Discussion/Conclusion: Religion and spirituality are critical to understanding mental health stigma among Black immigrants. Studies aimed at assessing and reducing stigma need to critically engage with cultural and religious factors.

Danielle M. Viola*

Tranquil Tides Mental Health & Wellness, LLC, USA

Cell phone and social media usage have become intriguing topics to explore and discuss over recent years. This research aims to review correlations of negative effects in mental and physical health caused by cell phone and social media use in the past two decades. The history of cell phones and their capabilities will be introduced. The need for human connection will be emphasized.  Exploration of the connection between unbalanced use and different aspects of health will be evaluated such as addiction, social influences, brain changes, and multitasking. Lastly, resources and recommendations to find balance and support for anyone being adversely affected by cell phones and social media will be provided. Current literature reveals that there is a negative correlation between increased cell phone and social media use with human connection, mental health, and physical health.

Shervin Assari*^1,2, MD, MPH

¹Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA

²Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA 

Background: In the United States, due to residential segregation, racial minorities and families with low socioeconomic status (SES) tend to live in less safe neighborhoods than their White and high SES counterparts. As such, in the US, race, and SES closely correlate with neighborhood safety. Due to the high chronicity of stress in unsafe neighborhoods, perceived neighborhood safety may be a mechanism through which race and SES are linked to children’s mental health. Simultaneously, race and SES may alter the effects of perceived neighborhood safety on children's mental health. Aim: To explore racial and SES differences in the effects of neighborhood safety on children's internalizing symptoms, we compared racially and SES diverse groups of American children for the effects of parents’ perceived neighborhood safety on children's internalizing symptoms. Methods: This cross-sectional study included 10484 children from the Adolescent Brain Cognitive Development (ABCD) study. Mixed-effects regression was used for data analysis. The predictor variable was parents’ perceived neighborhood safety which was treated as a continuous measure. The primary outcome was children's internalizing symptoms reported by children. Race, parental education, household income, and family structure were moderators. Results: Overall, the parents' high neighborhood safety was associated with lower levels of internalizing symptoms in children. Race and household income showed statistically significant interactions with subjective neighborhood safety on children's internalizing symptoms. Parents’ perceived neighborhood safety showed a stronger inverse association with children's internalizing symptoms for Black than White families. Parents’ perceived neighborhood safety showed a stronger inverse association with children's internalizing symptoms for high-income than low-income families. Parental education or family structure did not show any significant interaction with parents’ perceived neighborhood safety on children’s internalizing symptoms. Conclusion: The degree to which neighborhood safety may be associated with children's internalizing symptoms may depend on race and household income. Some of the effects of race and SES on children’s mental health outcomes may be due to interactions with contextual factors such as neighborhood safety. More research is needed on why and how diverse racial and SES groups differ in the association between perceived neighborhood safety and children’s well-being.

Kathryn Pitten^*

Territory Business Manager, Boston, Alkermes, USA

Background: There has long been an association between family history and mental illness; however, recently, researchers have focused on the correlation between childhood adverse events and mood disorders, specifically bipolar disorder.
Methods: A literature search of peer reviewed journals published from 2015 to 2020 was conducted using the keywords: childhood adverse events, childhood adversity, childhood trauma, bipolar disorder, mental illness, and mood disorders from the EBSCO database which included, APA PsychArticles, Child Development and Adolescent Studies, Health Source: Nursing/Academic Edition, and MEDLINE.
Results: : The results demonstrate a strong correlation between childhood adverse events and bipolar disorder specifically, sexual abuse in females, maternal separation, economic difficulties and family history of mental illness. Specific childhood adverse events show a correlation with specific types of mental illness. The recollection of abuse is associated with an increased risk of depressive symptoms. Additionally, childhood adverse events are associated with clinical outcomes of bipolar disorder including age of onset, chronicity, psychotic episodes and suicidality.
Conclusion: : The findings suggest that females that experience childhood adverse events may be at a higher risk for developing bipolar disorder and the clinical outcome of bipolar disorder may also be affected by the type and number of childhood adverse events. The results also suggest that schizophrenic spectrum disorders, bipolar disorder and major depressive disorder are associated with different childhood adverse events. Females who have recollections of childhood abuse are at an increased risk for depressive symptoms associated with bipolar disorder. Psychosocial interventions that are geared towards limiting childhood adverse events may reduce the incidence of mental illness, specifically bipolar disorder.

Aman Dule¹*, Gutema Ahmed², Worknesh Tessema², Matiwos Soboka²

 

¹Mettu University, College of health science, Department of psychiatry, Mettu, Ethiopia

²Jimma University, Institute of health science, Faculty of medicine, Department of psychiatry, Jimma, Ethiopia

Purpose: The aim of this study is to assess the quality of sleep and contributing factors in treated patients with schophrenia.

Materials and methods: The sleep quality of 411 subjects in treatment for schizophrenia was assessed. A cross-sectional study design was used to determine mediating factors. A consecutive sampling technique was used for recruitment. The Pittsburgh Sleep Quality Index (PSQI) was used to assess outcome variables, and the positive and negative syndrome scale (PANSS) and the four-item Morisky-Green test (MGT) was used for symptom severity and medication adherence. Logistic regression analysis was used to determine factor association and the adjusted odds ratio (AOR) and a p-value < 0.05 determined statistical significance.

Results: More than half of the patients were poor sleepers. Sleep determinants were: a) urban residence AOR=3.08 [2.57, 8.12], b) family size ≥6 AOR=2.72 [1.38, 5.08], c) current khat use AOR=2.30 [1.22, 4.31], d) low antipsychotics adherence AOR=6.23 [3.61, 10.75], e) positive and negative syndrome scale (PANSS) for positive symptoms greater than mean AOR=2.99 [1.69, 5.30] and PANSS for general symptoms greater than mean AOR=4.22 [2.22, 8.05]. These were all significantly associated with sleep quality on multiple logistic regressions.

Conclusion: There is a high prevalence of poor sleep quality among schizophrenia patients and risk factors are known. It is time to address these factors clinically to ensure better health for this population.

Sarah Araji¹, Ashley Griffin², Laura Dixon^3,4, Shauna-Kay Spencer¹, Charlotte Peavie¹, Kedra Wallace^1,5*

 

¹Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, 39216, USA

²Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216 USA

³Department of Psychology, University of Mississippi, Oxford, MS 38677 USA

⁴Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, 39216 USA

⁵Department of Neurobiology & Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, 39216 USA

Anxiety during pregnancy is associated with adverse outcomes in mothers and infants. Unfortunately, as anxiety is often synonymously mentioned with depression, the studies focusing solely on anxiety during pregnancy are not as robust as those in the field of depression are. In this work, we provide an overview of what is currently known about general anxiety during pregnancy, pregnancy-related anxiety and the potential impacts anxiety could have on post-partum care. An overview of potential risk factors, post-partum maternal outcomes, infant outcome along with pharmacological and non-pharmacological treatments are covered with a specific focus on high-risk pregnancies. Although anxiety during pregnancy is normative; anxiety can become problematic and negatively impact upon behavior, resulting in potential harm to the mother, as well as her developing fetus or child (ren) at home. The clinical diagnosis for anxiety and conditions associated with anxiety often require lengths of time that are not applicable for the pregnant patient, which has led to diagnosis and terms such as pregnancy-related anxiety. Importantly, increasing awareness about the increased potential risk to mothers who may be affected by anxiety during pregnancy or the post-partum period has the potential to improve maternal mental health screening and access to care.

Divya K. Madhusudhan¹, Kore N. Glied¹, Eugene Nguyen¹, Jennifer Rose¹, Dena M. Bravata^1,2*

 

¹Crossover Health, San Clemente, CA

²Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA

Introduction: Anxiety disorders which include generalized anxiety disorder, panic disorder (PD), post-traumatic stress disorder, and obsessive-compulsive disorder are common psychiatric condition associated with significant social, occupational, physical, and economic costs. Interventions that target the respiratory dysregulation associated with anxiety disorders have demonstrated considerable therapeutic benefit. However, no such intervention has been evaluated in among PD patients receiving care in an employer-sponsored health center.

Objective: To evaluate the use of a novel, capnometry-assisted breathing therapy on clinical outcomes, engagement, and satisfaction for patients with PD receiving care in an employer-sponsored health center.

Methods: Prospective analysis of participants using the program between 1/1/2018 and 06/30/2020.

Results: Twenty-two participants enrolled. Their average weekly usage remained high throughout the 4-week treatment protocol of 17 minutes twice a day for 28 days (11.6 sessions (SD 3.1) in week one and 10.4 sessions (SD 4.0) in week four). Their average Panic Disorder Severity Scale score decreased from 13.3 (SD ± 3.6) to 5.6 (SD ± 1.8), indicating that panic severity decreased from “moderately ill” to “slightly ill.” Use of the program was associated with clinically and statistically significant improvements in respiratory markers: average respiratory rate decreased from 14.9 (SD 3.6) to 11.9 (SD 4.7) breaths per minute (p<0.001) and end-tidal pCO2 increased from 37.2 mmHg (SD 4.2) to 39.1 mmHg (SD 3.6) (p<0.001). Engagement was associated with decline in utilizations of behavioral health services at employer-sponsored primary care center clinic after the intervention.

Conclusion: The clinical improvements observed in this pilot suggest that capnometry-assisted breathing therapy is a valuable tool for patients suffering from panic-associated symptoms.

Tiffany Field^1,2*, Shantay Mines², Samantha Poling², Miguel Diego¹, Debra Bendell², Connie Veazey²

¹University of Miami/Miller School of Medicine, USA

²Fielding Graduate University, USA

The effects of age (young versus old) and living status (alone versus with others) during the COVID-19 lockdown were assessed via a Survey Monkey questionnaire on 260 individuals (18-82 years). Both age and living status and their interaction effects were explored via ANOVAs on scales for health, media use, mood states including anxiety and depression, posttraumatic stress symptoms, fatigue and sleep disturbances. ANOVAs were conducted via a median split on age as well as on a group comparison of young (20-40 years) versus old (60-80 years) individuals. The results of these two types of data analyses were consistent on most variables, suggesting that the young versus the old experienced more stress, anxiety, depression, and PTSD symptoms as well as greater fatigue and sleep disturbances. And, they reported fewer health activities. Significant effects were also noted for the alone versus living with others’ groups including less engagement in exercise and work at home by the alone individuals as well as more stress, depression, fatigue, and PTSD symptoms. A significant age by living condition interaction effect suggested that the young living alone had the highest depression scores. The experiences that were common to the young, the living alone, and the young living alone were being lonely, depressed and fatigued. These results highlight the importance of prevention/intervention for the young, the alone and the young alone during lockdowns like COVID-19.

Haiyan XING¹*, Wei YU^2#

¹Department of Nursing, School of Medicine, Shaoxing University, Zhejiang Province, China

²Institute of Epidemiology, Shaoxing Keqiao District Center for Disease Control and Prevention, Zhejiang Province, China

The purpose of this study is to examine the change of Health-related quality of life (HRQOL) and rearing behavior among migrant children as well as their correlations in the city of Shaoxing, China. By cluster sampling, 149 migrant children had completed the questionnaires in 2014 and 2015. Spearman’s correlation was performed to clarify the relationship between change of HRQOL and rearing behavior in migrant children. Multiple linear stepwise regression analytical methods were used to identify the variables that were associated with change of HRQOL. The results showed that total score, physical health, psychosocial health, emotional functional and social functional of HRQOL among migrant children had increased and overprotection of parents was declined. There were negative correlation between change of quality of life (total score) and change of parents rejection or mother overprotection. There were also negative correlation between change of psychosocial health and change of parents rejection and overprotection. The change of quality of life was mostly reflected by change of mother rejection. These data show that HRQOL and negative rearing behavior among migrant children had improved. The change of quality of life was most affected by the negative rearing behavior of parents, especially mothers.

Stefanie R. Pilkay¹*, Terri Combs-Orme², Frances Tylavsky³, Nicole Bush⁴, Alicia K. Smith⁵

¹Falk College, School of Social Work, Syracuse University, Syracuse, New York

²College of Social Work, University of Tennessee, Knoxville, Tennessee

³Department of Preventive Medicine, University of Tennesse Health and Science Center, e, Memphis, Tennessee

⁴Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California

⁵Department of Gynecology and Obstetrics, Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia

Summary: The prenatal environment can influence gene expression involved in the development, possibly contributing to generational patterns of psychological health. Moreover, sex-specific developmental differences in-utero may result in gene expression differences associated with the prenatal environment. However, it is not clear if maternal overall psychological symptoms will associate with newborn’s gene expression, or if such patterns are consistent between sexes. This study explored the relationships between maternal psychological health (PsyH) and newborn’s gene expression patterns. We assessed PsyH with the Brief Symptom Inventory and newborn gene expression in umbilical cord blood. We conducted combined and sex-stratified analyses of genes expressed in umbilical cord blood.

Findings: PsyH associated with differential expression of 157 genes in males. The 157 differentially expressed genes are more likely to function in metabolic processes. There were no significant differences in gene expression in females.

Application: The sex-specific nature of these findings suggests males may be more vulnerable than females to mothers’ psychological functioning during pregnancy. It is possible that the male-specific results are due in part to female newborns developing under different neuroendocrine conditions. Future research examining prenatal exposures should consider sex differences.

Ruchita Agrawal^1,2*

¹Seven Counties Services, Louisville KY, USA (Formerly, Centerstone)

²Department of Psychiatry, University of Louisville, Louisville KY, USA

Benzodiazepines have been commonly prescribed for the treatment of anxiety and insomnia in the last few decades. There has been a rising concern regarding safety of benzodiazepines due to overdose related deaths, addictions, and cognitive side effects. COVID- 19 pandemic is expected to cause a mental health crisis. Several studies have shown an increase in anxiety and insomnia. This could mean that prescriptions of benzodiazepine could increase due to increase in anxiety and insomnia. We caution health care providers to use best practices and treat patients with psychotherapy as the first line of treatment and not pharmacotherapy. Prescription Drug Monitoring programs (PDMPs) were started due to this concern of overdose deaths, diversion related to opioids and benzodiazepines. PDMPs are mandatory in most states in the United States of America now.We recommend all health care providers to look at their benzodiazepine prescribing practice, monitor PDMP data and make policies to implement changes in order to avoid the next crisis of benzodiazepines after opioids.

Shervin Assari^1,2*, Golnoush Akhlaghipour³, Mohammed Saqib⁴, Shanika Boyce⁵, Mohsen Bazargan¹

¹Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

²Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

³Department of Neurology, UCLA, Los Angeles, CA, USA

⁴Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA

⁵Department of Pediatrics, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

Background: Considerable research has suggested that race and age are two major determinants of brain development, including but not limited to development of the prefrontal cortex (PFC). Minorities’ Diminished Returns (MDRs), however, suggests that race (as a proxy of racism) may interact with various determinants of human and brain development. Minimal knowledge, however, exists on whether age and race also interact on shaping PFC response to threat among American children.

Purpose: Using data from a task-based functional brain imaging study and considering race as a sociological rather than a biological construct, we investigated combined effects of race and age on prefrontal cortical (PFC) response to threat. We explored racial heterogeneities in the association between age and PFC response to threat by comparing Black and White children.

Methods: This study used the task-based functional Magnetic Resonance Imaging (fMRI) data from the Adolescents Brain Cognitive Development (ABCD) study, a national, landmark, multi-center brain imaging investigation of 9-10 years old children in the US. The primary outcomes were mean beta weights of n-back runs measuring PFC response to threating versus neutral face contrast in the following regions of interest (ROIs): left hemisphere-lateral orbito-frontal, left hemisphere -superior-frontal, right hemisphere -caudal middle frontal, and right hemisphere -superior frontal cortex. The independent variable was age. Covariates were sex, ethnicity, family socioeconomic status, and neighborhood socioeconomic status. Race was the focal moderator. To analyze the data, we used linear regression models without and with interactions and SES as covariates.

Results: We included 5,066 9-10 years old children. Age and race did not show direct effects on PFC response to threatening relative to neutral faces. While ethnicity, sex, and socioeconomic status were controlled, age and race showed a systematic interaction on PFC response to threatening relative to neutral faces.

Conclusions: For American children, race and age do not have direct effects but multiplicative effects on PFC response to threat. The results may be reflective of social inequalities in how Black and White children are socialized and developed. The results are important given the role of the PFC in regulating the limbic system response to threat. Coordinated work of the limbic system and PFC is a core element of children’s behavioral and emotional development. Future research is needed on how social stratification and racism shape emotion processing and regulation of American children in response to threat.

Per Eisele*

Associate professor, Department of Psychology, Mid Sweden University, Sweden

Background: The mental health continuum was created for the purpose of measuring mental health with several different wellbeing items.

Aims: The aim of the present study was to investigate the mental health continuum together with a new struggle continuum scale. With languishing and flourishing at the ends of a vertical scale and surrendering and struggling at the ends of a horizontal scale a quadratic model is suggested. Four factors can be distinguished at the corners of the square, depressed, anxious, content and joyful.

Methods: The sample (N=294) consisted of 174 women with a mean age of 40.48 and 124 men with a mean age of 37.27 year. The mental health continuum scale was used together with a new scale measuring struggling, the tendency to give up easily or keep on fighting.

Results: The model was tested on a normal population and was confirmed. Result of chi-square, correlation and t-test analyses show that the two scales could detect depressed, anxious, content and joyful participants.

Conclusions: The result has implications for the choice between mindfulness and activity-based interventions. Discussion about the result are provided.

Dena M. Bravata^1,2*, Divya K. Madhusudhan², Michael Boroff², Kevin O. Cokley³

¹Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA

²Crossover Health, San Clemente, CA

³University of Texas at Austin, Austin, TX

K Gilrain*, P Fizur, R Allen, E Campbell, P Watson, S Jordan, E Kupersmith, A Rostain

Division of Behavioral Medicine, Cooper University Hospital, USA

Background: Promoting resilience in healthcare workers is a well-studied area that has taken on new significance in the context of the COVID-19 pandemic. Extant literature suggests a need to expand resiliency efforts, with a recommended focus on multimodal approaches.

Purpose: The present account describes the unique challenges faced by one urban, northeastern academic medical center during the COVID-19 crisis in promoting resiliency in their healthcare workers at all levels, with the related aim of examining feasibility and acceptability of doing so.

Methods: A review of existing procedures targeting wellness and resiliency at this hospital was completed. A literature review was conducted with regard to promoting resiliency and preventing burnout, with emphasis placed on case studies from other institutions during the pandemic. Post-intervention surveys were conducted to assess feasibility and acceptability.

Results: A multi-component approach was created based on a review of the literature and all available information. The current report focuses on the first five weeks of that effort, the results of which suggest sufficient feasibility and high acceptability among those surveyed. Common themes raised in support sessions are also identified and discussed.

Conclusions: The challenges raised by COVID-19 are significant, with a high probability of impact on the wellbeing of health care workers. Targeting resiliency now may be a key factor in preventing pathological responses later. The current approach appears feasible and acceptable with regard to targeting key resiliency areas. Future studies should focus on the longer term outcomes of these efforts.

Donald F. Graves¹*, Gayle S. Morse^1,4, Kathleen Kerr², David O. Carpenter^3,4

¹Psychology Department, Russell Sage College, Troy, NY, USA

²Department of Family and Community Medicine, University of Toronto, Toronto, Canada

³School of Public Health, University at Albany, Albany, NY, USA

⁴Institute for Health & the Environment, University at Albany, Albany, NY, USA

Gulf War Illess (GWI) is a serious health concern for 30% of veterans who were deployed during the first Gulf War. Symptoms include reduced physical, psychological, and neuropsychological wellness and function. Research indicates that these symptoms can be linked to environmental toxins that veterans were exposed to during their time in theater. Some data suggest that continued internal exposure may be maintaining the illness, thus a detoxification procedure could be of assistance to those experiencing GWI. Reviewed here is a novel detoxification procedure applied as a treatment for GWI and the positive outcomes associated with this procedure. Presented here is a brief logic for the detoxification method, a simple summary of the method, and the encouraging outcomes of the method. Awareness of this and similar detoxification methods’ impacts on GWI symptoms should highlight the need for more research on this and related topics.

Tudor M. Baetu*

Department of Philosophy and Arts, University of Quebec at Trois-Rivieres, Canada

The philosophical thesis of pain eliminativism can be understood in several ways. As a claim about the inadequacy and replacement of folk explanatory pain constructs and concepts, it is congruent with scientific findings. Eliminativism is controversial in as much as it demands a more or less radical recharacterization of the phenomenon of pain in order to ensure compatibility with physicalism and an identity model of reductive explanation. In this respect, eliminativism is at odds with experimental and explanatory paradigms at work in biomedical research. The latter is concerned with reproducible phenomena, controlled experiments generating evidence for causation and causal-mechanistic explanations. Since nothing here supports conclusive inferences about the identity or non-identity of pain, or aspects of it, with biological activity, it is not clear what, if anything at all needs to be eliminated.

Shervin Assari¹*, Sharon Cobb², Mohammed Saqib³, Mohsen Bazargan^1,4

¹Departments of Family Medicine, Charles R Drew University of Medicine and Science

²School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States

³University of Michigan School of Public Health, Ann Arbor, MI, United States

⁴Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States

Background: A large body of empirical evidence on Minorities’ Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities.

Aim: The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days.

Methods: This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data.

Results: Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome.

Conclusion: In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.

Morgan James Grant*, Hala El-Agha, Thuy-Tien Ho, Shobal D. Johnson

Texas Woman’s University, Texas, United States

Thirteen Reasons Why (13RY) is a Netflix series that tells the story of a high school girl named Hannah Baker, who died from suicide due to a series of painful events of betrayal, sexual assault, bullying from classmates, and lack of support from friends, family, and school staff. She prepared and left behind a box with a suicide note and 13 audiotapes to give insight into her suicide. In Thirteen Reasons Why: The impact of suicide portrayal on adolescents’ mental health, Rosa et al. investigated “the influence of media portrayals of suicide on adolescent’s mood" by providing a descriptive, qualitative perspective of mental health, suicidality, and the prevalence of suicidal behavior or ideation, along with emotional processes most affected by the sensationalism and normalization of suicide. This commentary discusses the impact of suicide portrayal on adolescents and highlights the backlash that occurred in response to how 13RY depicted suicide by expanding on the study’s limitations, highlighting controversial issues, and making recommendations for future research by revealing the omission of certain key facts.

Jeffrey S. Nevid*, Alexander J. Gordon, Andrew S. Miele, Luke H. Keating

St. John’s University, New York

Efforts to understand personality features of people who use psychoactive substances have a long history, dating back to early psychoanalytic conceptualizations. Advancements in the field have focused on applying multidimensional personality inventories to better understand personality differences between substance users and non-users, and between different substance use types, with respect to both psychopathological traits and broad dimensional factors. A brief review of this evidence highlights personality features of persons with alcohol and other substance use problems and between users of different types of substances, especially alcohol and opioid substance use disorder patients. A better understanding of personality profiles of substance use disorder groups may be useful in tailoring treatment approaches based on profile characteristics.

Dinesh K Arya*

Yarralumla, Australia

To manage COVID-19 pandemic, most nations have been proactive in introducing wide-ranging measures to prevent its spread, as well as to support the economy. During this pandemic, almost the entire population has been impacted by quarantine and social isolation-related restrictions. It is this aspect that makes this pandemic different from other recent disasters.

It is essential that appropriate mental health support is targeted to support people with suspected and confirmed COVID-19 infections, as well as for the health professionals caring for this cohort. During the pandemic it is also essential that access to appropriate mental health support for those experiencing mental disorders is increased, and that appropriate psychosocial support is available for those experiencing financial hardship resulting from quarantine and social isolation-related restrictions so that they can sustain themselves.

Jeremias L. Convocar*, Vicente D. Billones, Nelly L. Supiter

West Visayas State University, La Paz, Iloilo City, Philippines

Introduction: Previous studies provide insight into the association between incarceration and mental health of prison inmates, but fail to look into the influence Geopathic Stress (GS) and spirituality on perceived stress. This study aimed to determine the levels and relationships that exist among male inmates Perceived Stress, GS and Spirituality.

Method: The study design is a descriptive-correlational study that was conducted among 144 conveniently and purposively selected male inmates of certain city Rehabilitation Center in the Philippines, during the third quarter of fiscal Year 2019. The data gathering for the study utilized the adopted Perceived Stress Scale⁵³, the Religiosity/Spirituality Scale⁵⁴ and the researcher⁵⁵ GS instrument. Some of the items in the instruments were slightly modified with corresponding vernacular language translations in order to fit with prison inmates’ context. The percentage analysis, mean, standard deviation, Mann-Whitney U test, and Kruskall Wallis H test with probability level set at 0.05 alpha.

Results: Generally, the male inmates had fair level of perceived stress and moderate level of spirituality regardless of their age, educational attainment, length of incarceration and status of case. Those who stayed longer (over 3 years) in prison experience most stress than those who stayed shorter. GS induces ones’ level of stress. A negative association between inmates perceived stress and spirituality and a positive association between GS and perceived stress. GS has always been ignored because most of the people are unaware of its occurrence in certain areas and its harmful effects on human health.

Conclusions: Although prison life is generally stressful, if inmates get involved in any religious-spiritual activities like bible study and worship service, vocational trainings, sports, exercises and other stress reduction activities may increase feelings of physical and mental well-being. Perceived long stay in prison induced the boredom of imprisonment and desire for liberty and longing to be with their family all adds to the stress of incarceration. On the other hand, if the inmates unluckily stayed over by sleeping for a long period of time within geopathically stressed area, they will be most likely to experience chronic stress that might develop various health problems. Spirituality is an internal resource that helps male inmates to cope well with stress. When one is connected with his spirituality, there is such a huge reservoir of support and help that one’s worries in life seem inconsequential. The results of this study may challenge health professionals in the correctional system to look into and consider GS and spirituality in managing inmates' stress and mental health.