INFLUENCE OF IMMIGRATION STATUS ON THE 10-YEAR TRAJECTORIES OF PSYCHOSOCIAL FUNCTIONING IN INDIVIDUALS WITH TRAUMATIC BRAIN INJURY

The population of racially/ethnically diverse groups within the U.S. is growing at an exponential rate. The U.S. Census Bureau estimated the number of foreign-born individuals in the U.S. to be nearly 40 million or 13% of the total population (Grieco et al., 2012). Racially/ethnically diverse groups in the U.S. have a higher incidence of traumatic brain injury (TBI; Gary et al., 2009). Although racial/ethnic disparities have been documented in numerous outcomes, research has yet to thoroughly explore differences in rehabilitation outcomes for immigrants relative to U.S.-born individuals. The purpose of this study was to compare the functional and mental health outcomes over the first 10 years after TBI for individuals born in the U.S. vs. those who had immigrated to the U.S. For the current analyses, a sample of 12,161 individuals in the TBI Model Systems database with a coding for Country of Birth = US (N=10,662) vs. Other than the US (N=1,507) was used. Findings suggested that immigrants with TBI exhibited higher life satisfaction trajectories than those born in the U.S., even after controlling for demographic and injury-related covariates, but comparable levels of depression and anxiety. Immigrants also exhibited lower motor functional independence trajectories than those born in the U.S., again even after controlling for demographic and injury-related covariates. However, immigrants generally showed a stronger upward quadratic trajectory in motor functional independence with the greatest gains between the 5- and 10-year time points, whereas those born in the U.S. improved more quickly but then plateaued between the 5- and 10-year time points; these differential effects over time dissipated with the addition of demographic and injury-related covariates. Immigrants exhibited lower cognitive functional independence trajectories, as well as greater supervision needs trajectories, than those born in the U.S., even after controlling for demographic and injury-related covariates. These findings support current literature suggesting that racially/ethnically diverse group exhibit lower functional independence on the FIM when compared to White American groups. They may also suggest potential systematic barriers such as healthcare access and language barriers that may influence the frequency, rate, and quality of care received. The results highlight the importance of uncovering cultural distinctions and can aid in facilitating research examining immigration-based disparities following TBI

An Interactive Training Model to Promote Cultural Humility For Early Childhood Professionals

The disability population in the United States has grown, with an estimated 2.6 million households having at least one child with a disability in 2019 (Young, 2019). Racially minoritized children disproportionately represent disability categories with Black and Indigenous children being overdiagnosed with emotional disturbance disabilities (Oswald & Coutinho, 2001). Further, minoritized children often experience greater rates of complex trauma (Horowitz, Weine, & Jekel, 1995) and this exposure significantly impacts minoritized children’s mental health (Flannery, Wester, & Singer, 2004). Included in these social determinants of health are the impacts of racism and racial trauma. Racism has been associated with mental health disparities from birth (Pachter & Coll, 2009). Yet, Black children are more likely to be misdiagnosed compared to their White peers (Mandell, Ittenbach, Levy, & Pinto-Martin, 2007; Szymanski, Sapanski, & Conway, 2011). A hurdle to accurate identification and treatment of trauma/racial trauma for minoritized families is the availability of quality services which is impacted by bias in healthcare and systemic barriers. To effectively address systemic needs, practitioners must adopt a preventative approach early in developmental care and target universal settings by providing psychoeducation. Pre-service trauma-informed training serves as an avenue to educate healthcare providers, paraprofessionals, and policymakers about disparities in healthcare (Beach et al., 2005). Research has demonstrated pre-service training impacts intermediate outcomes such as the knowledge, attitudes, and skills of health professionals, whereas, others question longitudinal effectiveness (Shepherd, 2019). Although opinions on the benefits and limitations of pre-service training in healthcare are mixed, there is consensus that pre-service training centered on cultural responsiveness and humility improves patient-provider communication, increases patient satisfaction, and compliance over time (Shepherd, 2019). To address this concern the University Centers for Excellence in Developmental Disabilities (UCEDD), the Leadership Education in Neurodevelopmental Disabilities program, and the Child Development Clinic at the Children\u27s Hospital of Richmond partnered to develop a pilot training series for 0-6 professionals across the state. This 3-part training series was sponsored by Head Start State Collaboration Office in partnership with the Early Childhood Mental Health Virginia initiative (a jointly funded initiative at the UCEDD). The training was designed for Head Start Health Specialists, Mental Health Specialists, or Education Specialists and designed to provide interactive information on implicit biases, social determinants of health, the intersectionality of racism, and trauma to improve culturally-responsive care and address disparities. The Diversity Informed Tenants for Work with Infants, Children, and Families were incorporated into the training. Preliminary qualitative and quantitative results demonstrate participants’ attributional shifts and a commitment to incorporating culturally responsive efforts in their communities and workplaces. The pilot was expanded to include mental health practitioners across central Virginia. Overall, results demonstrate a successful training model for early childhood practitioners\u27 understanding of diversity, equity, and inclusion, and have aided in developing a system that supports diversity. This underscores the need for interactive training for paraprofessionals that provide psychoeducation that also addresses individual understanding of implicit biases/roles within systems. This training can be utilized with other early childhood professionals to build a culturally responsive system of care for children 0-6

Is Helping Really Helping? Health-Related Quality of Life after TBI Predicting Caregiver Depression Longitudinally in Latin America

Objective: Studies have shown that functional and psychosocial sequelae of traumatic brain injury (TBI) predict emotional well-being of caregivers (Harris, 2000). Previous research examining the mental health of caregivers and the health-related quality of life (HRQoL) of people with TBI have primarily been in the US (Sander, 2012). Very little research has been conducted to uncover the unique relationships between HRQoL of people with TBI and caregiver mental health longitudinally, or in low-middle income Latin American countries. The aim of this study was to evaluate how HRQoL after TBI predict caregiver depression longitudinally in two countries and three data collection sites in Latin America. Design: Multi-site, multinational longitudinal study. Setting: Three hospitals in Neiva and Cali, Colombia, and Mexico City, Mexico (before hospital discharge), as well as in the homes of individuals with TBI and caregivers in these regions (before discharge, at 2 and 4 months after discharge). Participants: A sample of 109 TBI caregiver-patient dyads (n = 218) was included in the study. Main Outcome Measure(s): Caregiver depression (Patient Health Questionnaire-9) and HRQoL in the person with TBI (Short Form-36). Results: Three multiple regressions were conducted to examine which aspects of patient HRQoL at baseline predicted caregiver depression at baseline, 2 months, and 4 months post-discharge. Eight aspects of patient HRQoL were simultaneously entered into each model as predictors: physical functioning, role limitations (physical and emotional), vitality, mental health, social functioning, pain, and general health. At baseline, the overall model significantly predicted caregiver depression, F(8, 105) = 2.62, p = .012, R 2 = .18. Patient mental health was the only significant unique predictor of caregiver depression at baseline, p = .021, β = -.34. The overall model predicting 2-month caregiver depression was significant, F(8, 101) = 3.21, p = .003, R 2 = .22. Only mental health, p = .016, β = -.36, was a significant unique predictor. The overall model predicting 4-month caregiver depression was significant, F(8, 98) = 2.70, p = .010, R 2 = .19, and no factors uniquely predicted caregiver depression, all ps\u3e.05. Conclusions: Results suggest that TBI patient HRQoL can predict caregiver depression among Latin American caregivers before and during the first 4 months after hospital discharge. Across all three time points (baseline, 2 months, and 4 months), caregiver depression was significantly predicted by patient HRQoL. At baseline, patient mental health was the only domain that uniquely predicted caregiver depression. At 2 months, only physical role limitations uniquely predicted caregiver depression, and no unique predictors were detected at 4 months. These findings suggest that within the cultural framework in Latin America, there is a strong relationship between functional and psychological impairments after TBI and depression outcomes in Latin American caregivers. The results highlight the importance of uncovering these relational distinctions and may infer early detection of mental health needs and psychological intervention considerations for Latin American caregivers.https://scholarscompass.vcu.edu/gradposters/1052/thumbnail.jp

Spanish Translation and Psychometric Validation of a Measure of Acculturative Stress among Latinx Immigrants in the USA

BACKGROUND: In the U.S., the Latinx community is growing at a faster rate than any other racial and ethnic minority group. Members of this community have been found to experience a number of acculturative stressors after immigrating including xenophobia, racism, and discrimination. Although several scales have been created in recent years to measure acculturative stress in Spanish-speaking immigrants, they are long, do not have nuanced subscales, or have not been validated in an extremely diverse sample of Latinx immigrants. OBJECTIVE: The purpose of the current study was to translate and psychometrically validate the Riverside Acculturative Stress Inventory (RASI) in a diverse sample of Spanish-speaking immigrants. METHODS: A sample of 202 Latinx immigrants in the U.S. completed the RASI as well as measures of depression and anxiety. RESULTS: An initial confirmatory factor analysis suggested at the overall subscale factor structure was not an ideal fit for the data. Exploratory factor analysis suggested the retention of four subscales, each with three items, forming a 12-item Spanish RASI short form. As indices of convergent validity, the RASI total score was positively associated with depression and anxiety. CONCLUSIONS: Findings from the study contribute to the literature a brief and valid assessment of acculturative stress in Spanish-speaking immigrants. The RASI Spanish short form holds promise to stimulate research on the unique adversities experienced by Latinx immigrants.https://scholarscompass.vcu.edu/uresposters/1418/thumbnail.jp

Is Helping Really Helping? Health-Related Quality of Life after TBI Predicting Caregiver Depression Symptom Trajectories in Latin America

Previous research connecting health-related quality of life (HRQoL) in people with traumatic brain injury (TBI) and caregiver mental health has primarily been conducted cross-sectionally in the U.S. and Western Europe. This study, therefore, examined how HRQoL in individuals immediately after their TBI predicts longitudinal caregiver depression symptom trajectories in Latin America. A sample of 109 patients with an acute TBI and 109 caregivers (total n = 218) was recruited from three hospitals in Mexico City, Mexico, and in Cali and Neiva, Colombia. TBI patients reported their HRQoL while they were still in hospital, and caregivers reported their depression symptoms at the same time and at 2 and 4 months later. Hierarchal linear models (HLM) found that caregiver depression symptom scores decreased over time, and lower patient mental health and pain-related quality of life at baseline (higher pain) predicted higher overall caregiver depression symptom trajectories across the three time points. These findings suggest that in Latin America, there is an identifiable relationship between psychological and pain-related symptoms after TBI and caregiver depression symptom outcomes. The results highlight the importance of early detection of caregiver mental health needs based in part upon patient HRQoL and a culturally informed approach to rehabilitation services for Latin American TBI caregivers

Spanish Translation and Psychometric Validation of a Measure of Acculturative Stress among Latinx Immigrants in the USA

Background: In the United States, the Latinx community is growing at a faster rate than any other racial or ethnic minority group. Members of this community have been found to experience a number of acculturative stressors after immigrating, including xenophobia, racism, and discrimination. Although several scales have been created in recent years to measure acculturative stress in Spanish-speaking immigrants, they are long, do not have nuanced subscales, or have not been validated in an extremely diverse sample of Latinx immigrants. Objective: The purpose of the current study was to translate and psychometrically validate the Riverside Acculturative Stress Inventory (RASI) in a diverse sample of Spanish-speaking immigrants. Methods: A sample of 202 Latinx immigrants in the United States completed the RASI as well as measures of depression and anxiety. Results: An initial confirmatory factor analysis suggested that the overall subscale factor structure was not an ideal fit for the data. An exploratory factor analysis suggested the retention of four subscales, each with three items, forming a 12-item Spanish RASI short form. As indices of convergent validity, the RASI total score was positively associated with depression and anxiety. Conclusions: The findings from the study contribute to the literature a brief and valid assessment of acculturative stress in Spanish-speaking immigrants. The RASI Spanish short form holds promise to stimulate research on the unique adversities experienced by Latinx immigrants

U.S. vs. Foreign Nativity and 10-Year Trajectories of Mental Health after Traumatic Brain Injury: A Model Systems Study

Background: Previous research has found racial and ethnic disparities in life satisfaction, depression, and anxiety after traumatic brain injury (TBI). However, limited studies have examined differences in these variables between U.S.- and foreign-born individuals with TBI. The purpose of this study was to examine whether differences exist in mental health outcomes between U.S.- and foreign-born individuals with TBI at 1, 2, 5, and 10 years after injury, as well as examine whether demographic and injury-related characteristics account for these differences. Method: Participants were 8289 individuals with TBI who identified as U.S.-born and 944 who identified as born outside the U.S. in the TBI Model Systems study. Participants completed measures of mental health outcomes at 1, 2, 5, and 10 years after injury. Results: Foreign-born individuals with TBI had comparable levels of depression and anxiety trajectories to U.S.-born individuals, yet higher life satisfaction trajectories, even after controlling for demographic and injury-related variables. Conclusion: Rehabilitation professionals should consider in their clinical work the mechanisms that likely influence mental health outcomes among foreign-born individuals, including family-based values that increase resilience, as well as the possible under-reporting of mental health symptoms along the lines of cultural norms

Suicidal Ideation After Acute Traumatic Brain Injury:A Longitudinal Actor-Partner Interdependence Model of Patients and Caregivers in Latin America

Traumatic brain injury (TBI) is associated with depression, anxiety, and even suicidality in individuals with TBI and in caregivers. Moreover, emotional functioning in individuals with TBI is linked with caregiver functioning. However, no known studies to date have examined linkages in suicidal ideation in individuals with TBI and family caregivers. This is especially important in Latin America, where TBI rates are high, and where cultural norms influence family caregiving. This study examined associations among self-reported suicidal ideation in individuals with TBI and their primary caregivers over time in Mexico and Colombia. Research Method/Design: A total of 109 individuals and their primary caregivers completed measures during hospitalization for TBI and at 2 and 4-months posthospitalization. The primary outcome was Item 9 from the Spanish version of the Patient Health Questionnaire-9, assessing for thoughts of death or suicide in the previous 2 weeks. Results: Patients and caregivers reported high levels of suicidal ideation (18.3%–22.4% and 12.4%–15.7%, respectively) at each time point, and suicidal ideation at one time point strongly predicted ideation at the next. When patients endorsed suicidal ideation in the hospital, their caregivers tended to endorse suicidal ideation 2 months later. Although unaccounted for variables could be driving these relationships, they may also provide possible evidence of causal preponderance between patient and caregiver suicidal ideation post-TBI. Conclusions/Implications: Clinicians and rehabilitation specialists can use these findings to inform suicide risk assessment by expanding these practices to caregivers of patients who endorsed suicidal ideation. Interventions after TBI should incorporate caregivers given this study showed significant interdependence of suicidality between patients and caregiver

Relationship Satisfaction and Depression After Traumatic Brain Injury An Actor-Partner Interdependence Model of Patients and Caregivers in Mexico and Colombia

#nofulltext#Objective Traumatic brain injury represents a major public health concern, particularly in low- and middle-income countries like in Latin America. Family members are often caregivers for individuals with traumatic brain injury, which can result in significant stress. Research is needed to examine depression and quality of the caregiving relationship in these dyads. This study examined relationship quality and depression longitudinally after traumatic brain injury within the caregiving relationship. Design Dyads (N= 109) composed of individuals with traumatic brain injury and their caregivers were recruited from three hospitals in Mexico and Colombia. They self-reported depression and relationship satisfaction during hospitalization and at 2 and 4 mos after hospitalization. Results A 2-lag Actor Partner Interdependence Model demonstrated that patients and caregivers reporting high relationship satisfaction at baseline experienced lower depression 2 mos later, which then predicted higher caregiver relationship satisfaction at 4 mos. Moreover, patients with high relationship satisfaction at baseline had caregivers with lower depression at 2 mos, which was then associated with patients' higher satisfaction at 4 mos. Conclusions Within individuals with traumatic brain injury and caregivers, depression and relationship satisfaction seem to be inversely related. Furthermore, patients' and caregivers' depression and relationship satisfaction impact each other over time, demonstrating interdependence within the caregiving relationshi