Association of sociocultural stressors with bipolar disorder onset in Puerto Rican youth growing up as members of a minoritized ethnic group: results from the Boricua Youth Longitudinal Study

BACKGROUND: The development of bipolar disorder is currently explained by a complex interaction of genetic and environmental factors. Less is known regarding the influence of sociocultural factors. This study aims to evaluate the incidence and impact of sociocultural factors on bipolar disorder onset in two comparable samples of youth growing up in different social settings. METHODS: We leveraged data from two urban population-based cohorts representative of Puerto Rican children growing up in either San Juan (Puerto Rico) or the South Bronx (NYC) and followed up for 17 years. Bipolar disorder diagnoses were based on retrospective self-reports on the World Health Organization Composite International Diagnostic Interview. We used a causal inference approach to estimate associations of sociocultural factors with bipolar disorder onset after adjusting for potential confounders. FINDINGS: We found that South Bronx children, who grew up as a minoritized group, had twice the risk of bipolar disorder onset as young adults, with an incidence rate of 2.22 new cases per 1000 person-years compared to 1.08 new cases in San Juan (incidence rate difference, 1.13; 95% CI, 0.09-1.20). After adjusting for potential confounders, South Bronx children had the same lifetime hazard of bipolar disorder onset compared to San Juan children. However, our analysis demonstrated that caregivers' exposure to societal cultural stress partially explained the increased risk of bipolar disorder onset in the South Bronx, in addition to the potential contribution of genetics. INTERPRETATION: Our results provide evidence that societal cultural stress can increase the risk of lifetime bipolar disorder onset in youth growing up as a minoritized group. Addressing stress in minoritized groups might reduce the risk of bipolar disorder onset. FUNDING: The Boricua Youth Study has been supported by the National Institutes of HealthMH56401, MH098374, DA033172, and AA020191. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article

Trends in maternal mental health during the COVID-19 pandemic-evidence from Zambia

The COVID-19 pandemic has increased social and emotional stressors globally, increasing mental health concerns and the risk of psychiatric illness worldwide. To date, relatively little is known about the impact of the pandemic on vulnerable groups such as women and children in low-resourced settings who generally have limited access to mental health care. We explore two rounds of data collected as part of an ongoing trial of early childhood development to assess mental health distress among mothers of children under 5-years-old living in two rural areas of Zambia during the COVID-19 pandemic. We examined the prevalence of mental health distress among a cohort of 1105 mothers using the World Health Organization's Self-Reporting Questionnaire (SRQ-20) before the onset of the COVID-19 pandemic in August 2019 and after the first two infection waves in October-November 2021. Our primary outcome was mental health distress, defined as SRQ-20 score above 7. We analyzed social, economic and family level characteristics as factors modifying to the COVID-19 induced changes in the mental health status. At baseline, 22.5% of women were in mental health distress. The odds of mental health distress among women increased marginally over the first two waves of the pandemic (aOR1.22, CI 0.99-1.49). Women under age 30, with lower educational background, with less than three children, and those living in Eastern Province (compared to Southern Province) of Zambia, were found to be at highest risk of mental health deterioration during the pandemic. Our findings suggest that the prevalence of mental health distress is high in this population and has further worsened during COVID-19 pandemic. Public health interventions targeting mothers' mental health in low resource settings may want to particularly focus on young mothers with limited educational attainment

Predictors Of Positivity Of [F-18]F-Choline PET-CT In Prostate Cancer Recurrence. Preliminary Results

EP-173 Aim/Introduction: To analyze the validity of [18F]F-Choline PET-CT results in prostate cancer recurrence in our daily practice, based on theoretical cut-off points of prostatespecific antigen (PSA), its kinetic, and PSA doubling time (PSADT), to identify predictors of positivity and modify the indication criteria. Materials and Methods: Prior to the validity analysis, a descriptive, prospective analysis of consecutive patients with prostate cancer treated with curative intent by radical prostatectomy (RP) or radiotherapy (RT), who underwent PET-CT scan with recurrence criteria: PSA =1 or PSA 0.4-1 with PSADT Nadir + 2 after RT, was performed. Results: From April to December 2019, 69 patients were included, 40 were treated with RP (58%) and 29 with RT (42%). In 45 patients (65%) PET-CT was able to identify recurrence of the disease (positive PET) and in 24 it was not (negative PET). Of patients treated with RP, 82, 5% (33/40) had PSA>1, and of those, 61% were positive PET. 17, 5% (7/40) had PSA6months (28/69), in 71% if PSADT6 months, in 61% and 92% if PSADT<6 months and in 77% and 100% if PSADT<3 months. Conclusion: Preliminarily and awaiting validation, it seems that PSA>1 after RP or Nadir +2 after RT is an indicator of PET-CT. There seems to be a tendency that shows that PSA<1 after RP is an indicator of PET-CT if PSADT<3 months. PSADT <3 or <6 months could be the best predictor of positivity of PET-CT with [18F]F-Choline in recurrent prostate cancer

Study and comprehension of barriers to mental health in Latino population : social and cultural factors related to access and retention to mental health services /

Introducció: La població llatinoamericana esta permanentment creixent als Estats Units i a Espanya, fet que planteja importants reptes als sistemes de salut pública en ambdós països, des de la limitada accessibilitat als serveis de salut mental i substancies fins a la baixa qualitat i la manca de continuïtat del tractament. La recerca sobre les barreres especifiques de la població llatinoamericana a l'accés i a la retenció als servies de salut mental i de substàncies i el seu rol a la hora de predir l'adherència al tractament es escassa. En aquest projecte de recerca, ens proposem identificar barreres d'accés i retenció i els factors clínics, socials i culturals relacionats a les barreres i als serveis. A més, avaluem com aquests factors i barreres en l'atenció afecten la retenció a un tractament integrador culturalment adaptat per a Llatins amb trastorns de salut mental i substancies. Mètodes: aquest treball de doctorat inclou investigació clínica, amb un estudi d'observació i un d'intervenció i una revisió crítica del tema. Els participants han estat reclutats prospectiva ment a la comunitat en tres ciutats: Boston, Madrid i Barcelona. Després d'examinar els símptomes de salut mental i abús de substàncies, es van recollir dades sobre barreres percebudes, símptomes clínics, coneixements en salut, discriminació i variables sociodemogràfiques. Per el segon estudi, els participants elegibles van ser assignats aleatòriament per rebre el Programa d'Intervenció Integral per a Problemes Duals i Acció precoç (IIDEA), una intervenció de psicoteràpia culturalment sensible basada en la teràpia cognitiva-conductual (CBT), la psicoeducació i el "mindfulness" i es va avaluar l'adhesió a aquesta intervenció. El primer article publicat es un estudi observacional que descriu les barreres a la retenció als serveis de salut mental i substancia en la població llatina i compara diferencies entre els dos països. El segon estudi presenta l'avaluació de la relació entre les barreres percebudes prèviament a rebre el tractament i l'adherència a la intervenció al programa IIDEA. Finalment, es presenta una revisió crítica de la literatura que valora l'accés i la retenció a l'atenció dels immigrants que complementa el projecte de recerca. Resultats: les barreres que reflecteixen l'autosuficiència "Voler solucionar el problema un mateix", la desconfiança en els serveis de salut mental i de substancies, "Pensant que el tractament no funcionarà" i "No estar segur d'on anar o qui ha de veure" van ser els les barreres més freqüentment registrades per als immigrants llatins. Es van trobar diferències en les barreres segons el lloc d'estudi. També es van trobar dues barreres específiques associades a l'ús de serveis de salut mental i de substancies. Pel que fa a la retenció a la intervenció de l'IIDEA, els Llatins que van que presentaven més de tres barreres van mostrar una major finalització del programa en comparació amb els que en presentaven menys, una diferència que va ser significativa. La barrera que reflectia una falta de confiança en els serveis de salut mental i substancies va resultar significativament associada a una major retenció i fins i tot a la finalització del programa. La Educació i la discriminació percebuda van resultar esser predictors per completar el programa IIDEA. La revisió critica de la literatura presenta algunes solucions i alternatives per millorar l'accés i la retenció als serveis de salut mental i de substàncies per a la població immigrant. Conclusions: Aquesta tesi destaca la importància d'avaluar les barreres en l'atenció sanitària en la població immigrant. Es necessària una millor adaptació dels serveis de salut mental i substancies a la població immigrant per tal de superar barreres com l'autosuficiència i la desconfiança i així millorar l'accés i la retenció en l'atenció als serveis de salut mental i substancies.Background: Growing Latino population in U.S. and Spain poses important challenges for public health systems in both countries, from limited accessibility of behavioral health services to low quality and lack of continuity of care. There is a paucity of research that identifies the specific barriers and their role on predicting adherence to mental health and substance abuse treatment within Latino populations and investigates whether these variables change depending on the host country. In this research project, we aim to identify barriers to access and retention and the clinical, social and cultural factors related to them. Moreover, we assess how these factors and barriers in care influence treatment retention of a culturally adapted integrative therapy for Latinos with behavioral disorders. Methods: This research work included a clinical research body, with an observational and an interventional component and a critical review on the topic. Participants were recruited prospectively in the community in three sites; Boston, Madrid and Barcelona. After being screened for mental health and substance abuse symptoms, data on perceived barriers, clinical symptoms, health literacy, discrimination and socio-demographic variables was collected. Eligible participants were randomized for receiving the Integrative Intervention for Dual Problems and Early Action program (IIDEA), a cultural sensitive psychotherapy intervention based on Cognitive Behavioral Therapy (CBT), psychoeducation and mindfulness. Adherence to this intervention was assessed. The observational study that described barriers to retention to treatment among Latinos was first published. A second study assessing the relationship between previously reported barriers to care and adherence to the IIDEA intervention was written and submitted for publication. Finally, a critical review of the literature assessing access and retention to care among Latino immigrants complemented the research project. Results: Barriers that reflect self-reliance "Wanting to handle the problem on one's own", mistrust on behavioral health care systems, "Thinking that treatment would not work", and "Being unsure of where to go or who to see" were the most frequently reported barriers for Latino immigrants. Differences in reported barriers were found across sites. Two specific barriers were also found to be associated with use of behavioral services. Regarding retention to the IIDEA intervention, Latinos who reported at least one barrier at baseline presented a higher retention to the program compared to those participants who did not report any barrier. Participants that reported more than three barriers showed greater completion of the program compared to those who reported less than three barriers, a difference that was also significant. Mistrust in the behavioral services reported barrier was significantly associated with greater retention in the program. Education and perceived discrimination were found to be predictors for completing the IIDEA program. Conclusions: This thesis points out the importance of assessing barriers in health care. Efforts to improve behavioral health services must be tailored to immigrants 'context, with attention to overcoming attitudes of self-reliance, cultural mistrust and outreach to improve access to and retention in care among Latino immigrants

Recent advances on social determinants of mental health: looking fast forward

The fields of psychiatry and mental health are increasingly recognizing the importance of social determinants of health (SDOH) and their impact on mental health outcomes. In this overview, the authors discuss the recent research, from the past 5 years, on advances made in SDOH work. SDOH frameworks and theories have expanded to include more social conditions, from traumas associated with immigration to psychosocial and community strengths, that impact mental health and well-being. Research has consistently shown the pervasive deleterious impacts of inequitable social conditions (e.g., food insecurity, housing instability) on minoritized populations' physical and mental health. Social systems of oppression (e.g., racism, minoritization) have also been shown to confer higher risk for psychiatric and mental disorders. The COVID-19 pandemic illuminated the inequitable impact of the social determinants of health outcomes. More efforts have been made in recent years to intervene on the social determinants through interventions at the individual, community, and policy levels, which have shown promise in improving mental health outcomes in marginalized populations. However, major gaps remain. Attention should be paid to developing guiding frameworks that incorporate equity and antiracism when designing SDOH interventions and improving methodological approaches for evaluating these interventions. In addition, structural-level and policy-level SDOH efforts are critical for making long-lasting and impactful advances toward mental health equity