Publications by authors named "Supriya Misra"

20 Publications

  • Page 1 of 1

Stigma, Structural Vulnerability, and "What Matters Most" Among Women Living With HIV in Botswana, 2017.

Am J Public Health 2021 Jun 10:e1-e9. Epub 2021 Jun 10.

Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the Department of Psychology, University of Botswana, Gaborone, Botswana. Marlene M. Eisenberg and Michael B. Blank are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lyla S. Yang is with the Columbia School of Social Work, Columbia University. Thi Xuan Dai Cao is with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada. Lilo I. Blank is with the College of Arts and Sciences, University of Rochester, Rochester, NY. Timothy D. Becker is with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Bruce G. Link is with the Department of Sociology, University of California Riverside. Patlo Entaile is with the Botswana‒UPenn Partnership, Gaborone. Philip R. Opondo is with the Department of Psychiatry, University of Botswana. Tonya Arscott-Mills is with the Perelman School of Medicine, University of Pennsylvania. Ari R. Ho-Foster is with the Faculty of Medicine, University of Botswana.

To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from "what matters most" in local culture. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners'. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner's status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as "promiscuous" and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies. (. Published online ahead of print June 10, 2021: e1-e9. https://doi.org/10.2105/AJPH.2021.306274).
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http://dx.doi.org/10.2105/AJPH.2021.306274DOI Listing
June 2021

Structural Racism and Immigrant Health in the United States.

Health Educ Behav 2021 Jun;48(3):332-341

New York University, New York, NY, USA.

Immigration has been historically and contemporarily racialized in the United States. Although each immigrant group has unique histories, current patterns, and specific experiences, racialized immigrant groups such as Latino, Asian, and Arab immigrants all experience health inequities that are not solely due to nativity or years of residence but also influenced by conditional citizenship and subjective sense of belonging or othering. Critical race theory and intersectionality provide a critical lens to consider how structural racism might uniquely impact the health of racialized immigrants, and to understand and intervene on the interlocking systems that shape these shared experiences and health consequences. We build on and synthesize the work of prior scholars to advance how society codifies structural disadvantages for racialized immigrants into governmental and institutional policies and how that affects health via three key pathways that emerged from our review of the literature: (1) formal racialization via immigration policy and citizenship status that curtails access to material and health resources and political and civic participation; (2) informal racialization via disproportionate immigration enforcement and criminalization including ongoing threats of detention and deportation; and (3) intersections with economic exploitation and disinvestment such as labor exploitation and neighborhood disinvestment. We hope this serves as a call to action to change the dominant narratives around immigrant health, provides conceptual and methodological recommendations to advance research, and illuminates the essential role of the public health sector to advocate for changes in other sectors including immigration policy, political rights, law enforcement, labor protections, and neighborhood investment, among others.
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http://dx.doi.org/10.1177/10901981211010676DOI Listing
June 2021

Racial Disparities in Cognitive Function among Middle-Aged and Older Adults: The Roles of Cumulative Stress Exposures Across the Life Course.

J Gerontol A Biol Sci Med Sci 2021 Apr 7. Epub 2021 Apr 7.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.

Background: Racial disparities in cognitive function are well documented, but factors driving these disparities remain underexplored. This study aims to quantify the extent to which cumulative stress exposures across the life course explain Black-White disparities in executive function and episodic memory in middle-aged and older adults.

Methods: Data were drawn from the 2004-2006 wave of the Midlife Development in the United States Study (MIDUS 2) and the MIDUS Refresher study (N = 5,947; 5,262 White, 685 Black). Cumulative stress exposures were assessed by 10 domains (i.e., childhood stress, stressful life events in adulthood, financial stress, work psychological stress, work physical stress, work-family conflicts, neighborhood disorder, relationship stress, perceived inequality, perceived discrimination). Cognitive function was assessed using the Brief Test of Adult Cognition by Telephone. Marginal structural models were used to quantify the proportion of the effect of race/ethnicity status on cognitive function mediated through cumulative stress exposures.

Results: After adjusting for age, sex, and sample, on average, Black participants had lower levels of executive function (difference: -0.83 standard deviation units, 95% CI -0.91, -0.75) and episodic memory (difference: -0.53 standard deviation units, 95% CI -0.60, -0.45) scores than White participants. Cumulative stress exposures accounted for 8.4% of the disparity in executive function and 13.2% of the disparity in episodic memory.

Conclusions: Cumulative stress exposures across the life course explained modest proportions of Black-White disparities in cognitive function in this large cross-sectional study.
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http://dx.doi.org/10.1093/gerona/glab099DOI Listing
April 2021

Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions.

Am J Community Psychol 2021 Apr 3. Epub 2021 Apr 3.

New York University School of Global Public Health, New York, NY, USA.

Stigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self-stigma than White American groups. In within-group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family's sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self-stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.
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http://dx.doi.org/10.1002/ajcp.12516DOI Listing
April 2021

Identifying "What Matters Most" to Men in Botswana to Promote Resistance to HIV-Related Stigma.

Qual Health Res 2021 Mar 25:10497323211001361. Epub 2021 Mar 25.

Columbia University, New York, New York, USA.

Despite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups ( = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the "what matters most" (WMM) and "structural vulnerability" frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.
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http://dx.doi.org/10.1177/10497323211001361DOI Listing
March 2021

Perceived major experiences of discrimination, ethnic group, and risk of psychosis in a six-country case-control study.

Psychol Med 2021 Mar 2:1-9. Epub 2021 Mar 2.

Department of Psychiatry, University of Cambridge, CambridgeCB2 0SZ, UK.

Background: Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority.

Methods: We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case-control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups.

Results: Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91-1.59) for any discrimination and 1.79 (95% CI 1.19-1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12-2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65-3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%).

Conclusions: Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.
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http://dx.doi.org/10.1017/S0033291721000453DOI Listing
March 2021

Neighborhood social cohesion and disease prevention in Asian immigrant populations.

Prev Med 2020 12 22;141:106298. Epub 2020 Oct 22.

Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, USA. Electronic address:

In the United States (US), chronic disease risk factors are highly prevalent among Asian immigrant communities, who also exhibit low health screening rates. Perceived neighborhood social cohesion (NSC) has been associated with preventive healthcare use in the general US population, although it remains unexplored among Asian Americans (AAs). The aim of this study is to evaluate the association between NSC and preventive screening for hypertension, high cholesterol, diabetes, and depression among East, South and Southeast Asian American (EAA, SAA, SEAA) communities in New York City (NYC) using cross-sectional, locally collected data from 2013 to 2016. NSC was assessed using a 4-question scale to create an additive score between 4 and 16 and was analyzed both as a continuous and categorial variable (High, Medium, and Low tertiles). Recent screening was defined as a check-up within the last year for each of the included health conditions. A one-unit increase in NSC score was associated with increased odds of recent screening for high cholesterol in EAAs (AOR = 1.09, 95%CI:1.00-1.20); for high cholesterol, diabetes, and depression in SAAs (AOR = 1.08, 95%CI:1.00-1.20; AOR = 1.07, 95%CI:1.00-1.15; AOR = 1.15, 95%CI:1.06-1.25); and with high cholesterol among SEAAs (AOR = 1.12, 95%CI:1.00-1.25). Overall, NSC was an important facilitator for preventive screening behaviors for specific conditions in different groups, though was consistently associated with screening for high cholesterol in our sample. Enhancing NSC through family and community-based programming may be one strategy to encourage screening for preventive behaviors, though more research is needed to elucidate a precise mechanism.
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http://dx.doi.org/10.1016/j.ypmed.2020.106298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581417PMC
December 2020

'Mothers moving towards empowerment' intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial.

Trials 2020 Oct 7;21(1):832. Epub 2020 Oct 7.

New York University, New York, NY, United States.

Background: With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children's lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the "What Matters Most" stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the "Mothers Moving towards Empowerment" (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period.

Methods: This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status).

Discussion: Our trial will evaluate MME, a culturally based HIV stigma reduction intervention using the "What Matters Most" framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana.

Trial Registration: ClinicalTrials.gov NCT03698981 . Registered on October 8, 2018.
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http://dx.doi.org/10.1186/s13063-020-04676-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542742PMC
October 2020

Determinants of Depression Risk among Three Asian American Subgroups in New York City.

Ethn Dis 2020 24;30(4):553-562. Epub 2020 Sep 24.

Department of Population Health, NYU Grossman School of Medicine, New York, NY.

Objective: Although the fastest growing minority group, Asian Americans receive little attention in mental health research. Moreover, aggregated data mask further diversity within Asian Americans. This study aimed to examine depression risk by detailed Asian American subgroup, and further assess determinants within and between three Asian ethnic subgroups.

Methods: Needs assessment surveys were collected in 16 Asian American subgroups (six Southeast Asian, six South Asian, and four East Asian) in New York City from 2013-2016 using community-based sampling strategies. A final sample of N=1,532 completed the PHQ-2. Bivariate comparisons and multivariable logistic models explored differences in depression risk by subgroup.

Results: Southeast Asians had the greatest depression risk (19%), followed by South Asians (11%) and East Asians (9%). Among Southeast Asians, depression risk was associated with lacking health insurance (OR=.2, 95% CI: 0-.6), not having a provider who speaks the same language (OR=3.2, 95% CI: 1.3-8.0), and lower neighborhood social cohesion (OR= .94, 95% CI: .71-.99). Among South Asians, depression risk was associated with greater English proficiency (OR=3.9, 95% CI: 1.6-9.2); and among East Asians, depression risk was associated with ≤ high school education (OR=4.2, 95% CI: 1.2-14.3). Additionally, among Southeast Asians and South Asians, the highest depression risk was associated with high levels of discrimination (Southeast Asian: OR=9.9, 95% CI: 1.8-56.2; South Asian: OR=7.3, 95% CI: 3.3-16.2).

Conclusions: Depression risk and determinants differed by Asian American ethnic subgroup. Identifying factors associated with depression risk among these groups is key to targeting limited public health resources for these underserved communities.
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http://dx.doi.org/10.18865/ed.30.4.553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518536PMC
April 2021

Preventing type 2 diabetes among South Asian Americans through community-based lifestyle interventions: A systematic review.

Prev Med Rep 2020 Dec 21;20:101182. Epub 2020 Aug 21.

Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States.

Ethnic South Asian Americans (SAAs) have the highest relative risk of type 2 diabetes mellitus (T2DM) in the United States (US). Culturally tailored lifestyle interventions have the potential to promote South Asian diabetes prevention; however, the extent of their use and evaluation in US settings remains limited. This systematic review characterizes and evaluates outcomes of community-based lifestyle interventions targeted towards T2DM indicators among South Asians living in the US. A PRISMA-informed search of Pubmed, Embase, Cochrane, Web of Science, and clinical trial registry databases using key words pertaining to South Asians migrants and diabetes indicators (glucose and insulin outcomes) was conducted of community-based lifestyle interventions published up until October, 31 2019. Of the eight studies included in the final synthesis, four interventions focused on cultural and linguistic adaptations of past chronic disease prevention curricula using group-based modalities to deliver the intervention. Hemoglobin A1c (A1c) was the most common outcome indicator measured across the interventions. Three of the five studies observed improvements in indicators post-intervention. Based on these findings, this review recommends 1) greater exploration of community-based lifestyle interventions with high quality diabetes indicators (such as fasting blood glucose) in ethnic SAA communities, 2) expanding beyond traditional modalities of group-based lifestyle interventions and exploring the use of technology and interventions integrated with passive, active, and individualized components, and 3) development of research on diabetes prevention among second generation SAAs.
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http://dx.doi.org/10.1016/j.pmedr.2020.101182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441043PMC
December 2020

Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging "What Matters Most" to Resist Stigma.

AIDS Behav 2021 Feb;25(2):459-474

Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Perceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify "full personhood" could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to "what matters most" (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both [Formula: see text]). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r = .39, p = .005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r = .32, p = .026) and social support number (r = .29, p = .047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.
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http://dx.doi.org/10.1007/s10461-020-03012-yDOI Listing
February 2021

Psychological impact of anti-Asian stigma due to the COVID-19 pandemic: A call for research, practice, and policy responses.

Psychol Trauma 2020 Jul 11;12(5):461-464. Epub 2020 Jun 11.

Department of Social and Behavioral Sciences, School of Global Public Health, New York University.

The COVID-19 pandemic is linked to a rise in stigma and discrimination against Chinese and other Asians, which is likely to have a negative impact on mental health, especially when combined with additional outbreak-related stressors. We discuss the need to consider the potential harms of these anti-Asian sentiments during both the height of the pandemic and longer-term recovery through (a) research-examining how it affects mental health and recovery; (b) practice-implementing evidence-based stigma reduction initiatives; and (c) policy-coordinating federal response to anti-Asian racism including investment in mental health services and community-based efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0000821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958926PMC
July 2020

How Early Life Adversities Influence Later Life Family Interactions for Individuals with Schizophrenia in Outpatient Treatment: A Qualitative Analysis.

Community Ment Health J 2020 08 9;56(6):1188-1200. Epub 2020 May 9.

Boston Medical Center, Boston, USA.

Many individuals diagnosed with schizophrenia state that family relationships are a primary facilitator of their recovery. However, they also report higher rates of early life adversities, typically in their family environments. We used modified Grounded Theory on 20 semi-structured, in-depth interviews with adults (half ethnic minorities, half women) diagnosed with schizophrenia or schizoaffective disorder and receiving treatment at an urban psychiatric outpatient clinic to investigate how early life adversities influence later life family interactions. Approximately half of participants did not mention early life adversities and described positive family interactions and perceived supportive involvement in their illness. The other half of participants experienced abusive and/or unstable childhood homes that many explicitly linked to limited family interactions and perceived absence of support for their illness. These findings suggest that limited familial interactions following early life adversities may reflect resilient boundary setting, and indicate the value of considering these adversities before incorporating families in care.
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http://dx.doi.org/10.1007/s10597-020-00627-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295262PMC
August 2020

Botswana's HIV response: Policies, context, and future directions.

J Community Psychol 2020 04 17;48(3):1066-1070. Epub 2020 Jan 17.

Social and Behavioral Sciences, New York University College of Global Public Health, New York, New York.

This brief report describes key periods in the history of the national public health response to the human immunodeficiency virus (HIV) epidemic in Botswana. It reveals the context leading to the development of HIV policies presently in place and current challenges that remain. The report concludes with opportunities for future directions, initiatives, and policy changes to reduce the high rates of HIV.
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http://dx.doi.org/10.1002/jcop.22316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103557PMC
April 2020

'Global mental health': systematic review of the term and its implicit priorities.

BJPsych Open 2019 May 31;5(3):e47. Epub 2019 May 31.

Professor, Department of Epidemiology, Harvard T.H. Chan School of Public Health, USA.

Background: The term 'global mental health' came to the fore in 2007, when the Lancet published a series by that name.

Aims: To review all peer-reviewed articles using the term 'global mental health' and determine the implicit priorities of scientific literature that self-identifies with this term.

Method: We conducted a systematic review to quantify all peer-reviewed articles using the English term 'global mental health' in their text published between 1 January 2007 and 31 December 2016, including by geographic regions and by mental health conditions.

Results: A total of 467 articles met criteria. Use of the term 'global mental health' increased from 12 articles in 2007 to 114 articles in 2016. For the 111 empirical studies (23.8% of articles), the majority (78.4%) took place in low- and middle-income countries (LMICs), with the most in Sub-Saharan Africa (28.4%) and South Asia (25.5%) and none from Central Asia. The most commonly studied mental health conditions were depression (29.7%), psychoses (12.6%) and conditions specifically related to stress (12.6%), with fewer studies on epilepsy (2.7%), self-harm and suicide (1.8%) and dementia (0.9%). The majority of studies lacked contextual information, including specific region(s) within countries where studies took place (20.7% missing), specific language(s) in which studies were conducted (36.9% missing), and details on ethnic identities such as ethnicity, caste and/or tribe (79.6% missing) and on socioeconomic status (85.4% missing).

Conclusions: Research identifying itself as 'global mental health' has focused predominantly on depression in LMICs and lacked contextual and sociodemographic data that limit interpretation and application of findings.

Declaration Of Interest: None.
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http://dx.doi.org/10.1192/bjo.2019.39DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582218PMC
May 2019

Early Parental Death and Risk of Psychosis in Offspring: A Six-Country Case-Control Study.

J Clin Med 2019 Jul 23;8(7). Epub 2019 Jul 23.

Department of Psychosis Studies, Institute of Psychiatry, King's College London, London SE5 8AF, UK.

Evidence for early parental death as a risk factor for psychosis in offspring is inconclusive. We analyzed data from a six-country, case-control study to examine the associations of early parental death, type of death (maternal, paternal, both), and child's age at death with psychosis, both overall and by ethnic group. In fully adjusted multivariable mixed-effects logistic regression models, experiencing early parental death was associated with 1.54-fold greater odds of psychosis (95% confidence interval (CI): 1.23, 1.92). Experiencing maternal death had 2.27-fold greater odds (95% CI: 1.18, 4.37), paternal death had 1.14-fold greater odds (95% CI: 0.79, 1.64), and both deaths had 4.42-fold greater odds (95% CI: 2.57, 7.60) of psychosis compared with no early parental death. Experiencing parental death between 11 and 16 years of age had 2.03-fold greater odds of psychosis than experiencing it before five years of age (95% CI: 1.02, 4.04). In stratified analyses, experiencing the death of both parents had 9.22-fold greater odds of psychosis among minority ethnic groups (95% CI: 2.02-28.02) and no elevated odds among the ethnic majority (odds ratio (OR): 0.96; 95% CI: 0.10-8.97), which could be due in part to the higher prevalence of early parental death among minority ethnic groups but should be interpreted cautiously given the wide confidence intervals.
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http://dx.doi.org/10.3390/jcm8071081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679091PMC
July 2019

Childhood Assets and Cardiometabolic Health in Adolescence.

Pediatrics 2019 03 4;143(3). Epub 2019 Feb 4.

Departments of Social and Behavioral Sciences and.

Background: Research shows that the development of cardiometabolic disease can begin early in life with risk factors accumulating over time, but less is known about protective pathways to positive health. In this study, we use prospective data to test whether childhood assets predict a greater likelihood of being in optimal cardiometabolic health by age 17.

Methods: Data are from 3074 participants in the Avon Longitudinal Study of Parents and Children (mean age = 17.8). Four childhood assets were prospectively assessed via cognitive tests and parent report when children were between ages 8 and 10: strong executive functioning skills, prosocial behaviors, and low levels of internalizing and externalizing problems. Cardiometabolic health was assessed at ages 9 and 17 by using a composite dysregulation score derived from multiple biological parameters, including cholesterol, blood pressure, C-reactive protein, insulin resistance, and BMI. Associations between assets and optimal health at age 17 (ie, a dysregulation score of ≤1) were evaluated with Poisson regression models with robust error variances.

Results: After controlling for covariates (including sociodemographics, correlates of cardiometabolic health, and dysregulation scores at age 9), participants with multiple assets were 1.08 to 1.27 times more likely to be in optimal cardiometabolic health at age 17 compared with those with 0 or 1 asset. Each additional asset conferred a 6% greater likelihood of optimal health over time (relative risk = 1.06 [95% confidence interval: 1.01 to 1.11]).

Conclusions: Childhood assets predicted cardiometabolic health with seemingly cumulative impacts. Identifying early assets may provide novel targets for prevention and elucidate pathways to positive adult health.
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http://dx.doi.org/10.1542/peds.2018-2004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398368PMC
March 2019

Childhood Maltreatment and Health Impact: The Examples of Cardiovascular Disease and Type 2 Diabetes Mellitus in Adults.

Clin Psychol (New York) 2017 Jun 10;24(2):125-139. Epub 2017 Apr 10.

Harvard T. H. Chan School of Public Health, Massachusetts General Hospital.

Child maltreatment is associated with increased risk for an array of mental and physical health problems. We reviewed studies examining associations of child maltreatment, assessed either alone or in combination with other adversities, with cardiovascular disease (CVD) and Type 2 Diabetes. PubMed was searched for relevant studies until December, 2015. Forty publications met inclusion criteria. Consistent positive associations were noted across a range of childhood adversities. Child maltreatment was associated with CVD (myocardial infarction, stroke, ischemic heart disease, coronary heart disease) in 91.7% of studies, with diabetes in 88.2% of studies, and with blood pressure/hypertension in 61.5% of studies. Inclusion of mental disorders tended to attenuate associations. Sex-related differences were under-examined. Implications for future research and intervention efforts are discussed.
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http://dx.doi.org/10.1111/cpsp.12191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578408PMC
June 2017

Functional overlap of top-down emotion regulation and generation: an fMRI study identifying common neural substrates between cognitive reappraisal and cognitively generated emotions.

Cogn Affect Behav Neurosci 2014 Sep;14(3):923-38

Department of Psychology, University of Denver, 2155 S. Race St, Frontier Hall, Denver, CO, 80209, USA.

One factor that influences the success of emotion regulation is the manner in which the regulated emotion was generated. Recent research has suggested that reappraisal, a top-down emotion regulation strategy, is more effective in decreasing self-reported negative affect when emotions were generated from the top-down, versus the bottom-up. On the basis of a process overlap framework, we hypothesized that the neural regions active during reappraisal would overlap more with emotions that were generated from the top-down, rather than from the bottom-up. In addition, we hypothesized that increased neural overlap between reappraisal and the history effects of top-down emotion generation would be associated with increased reappraisal success. The results of several analyses suggested that reappraisal and emotions that were generated from the top-down share a core network of prefrontal, temporal, and cingulate regions. This overlap is specific; no such overlap was observed between reappraisal and emotions that were generated in a bottom-up fashion. This network consists of regions previously implicated in linguistic processing, cognitive control, and self-relevant appraisals, which are processes thought to be crucial to both reappraisal and top-down emotion generation. Furthermore, individuals with high reappraisal success demonstrated greater neural overlap between reappraisal and the history of top-down emotion generation than did those with low reappraisal success. The overlap of these key regions, reflecting overlapping processes, provides an initial insight into the mechanism by which generation history may facilitate emotion regulation.
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http://dx.doi.org/10.3758/s13415-013-0240-0DOI Listing
September 2014

Bottom-up and top-down emotion generation: implications for emotion regulation.

Soc Cogn Affect Neurosci 2012 Mar 4;7(3):253-62. Epub 2011 Feb 4.

Department of Psychology, The University of Denver, Denver, CO 80209, USA.

Emotion regulation plays a crucial role in adaptive functioning and mounting evidence suggests that some emotion regulation strategies are often more effective than others. However, little attention has been paid to the different ways emotions can be generated: from the 'bottom-up' (in response to inherently emotional perceptual properties of the stimulus) or 'top-down' (in response to cognitive evaluations). Based on a process priming principle, we hypothesized that mode of emotion generation would interact with subsequent emotion regulation. Specifically, we predicted that top-down emotions would be more successfully regulated by a top-down regulation strategy than bottom-up emotions. To test this hypothesis, we induced bottom-up and top-down emotions, and asked participants to decrease the negative impact of these emotions using cognitive reappraisal. We observed the predicted interaction between generation and regulation in two measures of emotional responding. As measured by self-reported affect, cognitive reappraisal was more successful on top-down generated emotions than bottom-up generated emotions. Neurally, reappraisal of bottom-up generated emotions resulted in a paradoxical increase of amygdala activity. This interaction between mode of emotion generation and subsequent regulation should be taken into account when comparing of the efficacy of different types of emotion regulation, as well as when reappraisal is used to treat different types of clinical disorders.
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http://dx.doi.org/10.1093/scan/nsq103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304475PMC
March 2012
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