Andrea Norcini Pala

Self-compassion and emotional invalidation mediate the effects of parental indifference on psychopathology.

This study investigated whether self-compassion and emotional invalidation (perceiving others as indifferent to ones emotions) may explain the relationship of childhood exposure to adverse parenting and adult psychopathology in psychiatric outpatients (N=326). Path analysis was used to investigate associations between exposure to adverse parenting (abuse and indifference), self-compassion, emotional invalidation, and mental health when controlling for gender and age. Self-compassion was strongly inversely associated with emotional invalidation, suggesting that a schema that others will be unsympathetic or indifferent toward ones emotions may affect self-compassion and vice versa. Both self-compassion and emotional invalidation mediated the relationship between parental indifference and mental health outcomes. These preliminary findings suggest the potential utility of self-compassion and emotional schemas as transdiagnostic treatment targets.

A Cross-Cultural Validation of the Implicit Positive and Negative Affect Test (IPANAT)

Self-report measures of affect come with a number of difficulties that can be circumvented by using indirect measurement procedures. The Implicit Positive and Negative Affect Test (IPANAT) is a recently developed measure of automatic activation of representations of affective states and traits that draws on participants’ ratings of the extent to which nonsense words purportedly originating from an artificial language bear positive or negative meaning. Here we compared psychometric properties of this procedure across 10 countries and provide versions in corresponding languages (Chinese, Dutch, English, French, German, Italian, Polish, Russian, and Spanish). The results suggest good reliability, metric invariance, and construct validity across countries and languages. The IPANAT thus turns out as a useful tool for the indirect assessment of affect in different languages and cultures.

Minority Stress, Depression and HIV-Progression Biomarkers: An Exploratory Study on a Sample of Italian HIV-Positive Gay and Bisexual Men

Gay and bisexual men may experience stress due to their social minority status, which is caused by the manifestations of sexual stigma. Stress, in turn, promotes depression and physical health impairments, two major issues in the context of HIV infection. Thus, the relationships between the manifestations of sexual orientation stigma (enacted sexual stigma, the expectations of discrimination from ones family, and internalized homophobia) with depression and HIV-progression biomarkers (CD4+ cell counts and viral load) have been tested. The participants (N = 120) were gay and bisexual HIV-positive Italian men recruited via the Internet. The results of our analyses confirmed that enacted sexual stigma (e.g., homophobic physical aggression) correlated with depression and viral load. Internalized homophobia was associated with a greater level of depression and lower CD4+ cell counts, whereas the expectations of discrimination indirectly corresponded to lower CD4+ cell counts through internalized homophobia. In conclusion, the manifestations of sexual stigma are linked to poorer mental and physical health in HIV-positive gay and bisexual men. Minority stress, then, is an important concept that needs to be further addressed in the contexts of HIV care.

Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting

Objective: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver’s depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring’s psychopathology in a Brazilian sample. Methods: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children’s symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Results: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. Conclusion: These results substantiate our hypothesis that child psychopathology correlates with caregivers’ psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

Gender, violence and resilience among Ugandan adolescents

Resilience, commonly understood as the ability to maintain adaptive functioning in the face of adversity, has emerged as a salient entry point in the field of positive youth development. This study makes a unique contribution by exploring dimensions of resilience among adolescents in Uganda, examining associations between violence from different perpetrators and resilience, and testing whether sex moderates these relationships. Analyses are based on data from 3706 primary school students. Exploratory factor analysis (EFA) identified five factors underlying the construct of resilience: Emotional Support; Family Connectedness; School Connectedness; Social Assets; and Psychological Assets. We used regression analysis to investigate associations between these dependent variables, background characteristics, and experiences of violence (including exposure to intimate partner violence against female caregivers). Results reflect a complex relationship between violence and resilience, with patterns varying by perpetrator (e.g., teacher, peers, caregivers) and some evidence that the sex of the student moderates these dynamics. Overall, there is a consistently negative relationship between all violence measures and Psychological Assets. In addition, teacher violence is associated with lower resilience across factors and both caregiver violence and exposure to IPV are consistently associated with decreased Family Connectedness. These findings suggest that adolescents experiencing (and exposed to) violence from adults may be particularly vulnerable to internalizing and/or externalizing behaviors and withdrawal from the family. Findings point to preventing violence from teachers complemented with enhancing family relationships as promising avenues for resilience-strengthening interventions, and also emphasize the need to consider gendered strategies to ensure girls and boys benefit equally.

Mental illness sexual stigma: Implications for health and recovery.

OBJECTIVE The majority of people in psychiatric care worldwide are sexually active, and studies have revealed sharply elevated rates of HIV infection in that group compared with the general population. Recovery-oriented treatment does not routinely address sexuality. We examined the relationship between gender, severe mental illness diagnosis, and stigma experiences related to sexuality among people in psychiatric outpatient care. METHOD Sexually active adults attending 8 public outpatient psychiatric clinics in Rio de Janeiro (N = 641) were interviewed for psychiatric diagnosis and stigma experiences. Stigma mechanisms well-established in the literature but not previously examined in relation to sexuality were measured with the Mental Illness Sex Stigma Questionnaire, a 27-item interview about stigma in sexual situations and activities. RESULTS Experiences of stigma were reported by a majority of participants for 48% of questionnaire items. Most people reported supportive attitudes toward their sexuality from providers and family members. Those with severe mental illness diagnoses showed greater stigma on individual discrimination and structural stigma mechanisms than did those with nonsevere mental illness diagnoses, whereas there was no difference on the social psychological processes (internalized stigma) mechanism. Regardless of diagnosis or gender, a majority of participants devalued themselves as sexual partners. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Adults in psychiatric outpatient care frequently reported stigma experiences related to aspects of their sexual lives. From the perspectives of both HIV prevention and recovery from mental illness, examinations of the consequences of stigma in the sexual lives of people in psychiatric care and improving their measurement would have wide applicability. (PsycINFO Database Record

Discriminant analysis of caregivers' psychiatric symptoms according to offspring psychopathology

Associations between parent or caregiver depression and adverse child outcomes are well established. We previously examined correlations of symptoms of common mental disorders in caregivers with offspring psychopathology in a Brazilian sample. Sixty-eight primary caregivers of 110 children (age 6-15 years) were enrolled. Caregivers were assessed using the Self-Reporting Questionnaire (SRQ-20), which measures symptoms of common mental disorders. We used the Strengths and Difficulties Questionnaire (SDQ) to measure children’s symptoms. In our previous results, higher SRQ-20 scores in caregivers correlated significantly with offspring psychiatric symptoms (beta = 0.20; p = 0.04). We further investigated this result by conducting a discriminant analysis. A multinomial logistic regression with Bayesian estimation (Mplus, 7.4) was carried out to identify the symptoms assessed with the SRQ-20, discriminating three groups of children: 1) asymptomatic (SDQ o 14, impact supplement score = 0); 2) symptomatic without impact (SDQ X 14, impact supplement score = 0); and 3) symptomatic with impact (SDQ X 14, impact supplement score X 1). The results (Table 1) showed that caregivers of symptomatic children without impact reported lower depressed mood, lower somatic (anxiety) and somatic (gastrointestinal) symptoms, more weight loss, and lower insight compared to caregivers of asymptomatic children. Caregivers of symptomatic children with impact reported lower depressed mood, lower retardation, more agitation, lower somatic (gastrointestinal) symptoms, more weight loss, and less insight than caregivers of asymptomatic children. Comparison between the two groups of caregivers of symptomatic children showed that the group with impact reported higher levels of early insomnia, lower retardation, lower agitation, higher anxiety (psychological and somatic), more somatic symptoms, and less insight. These results possibly demonstrate a trend toward symptomatology interaction between caregivers and their offspring. Weissman et al. studied the differential effects of a depressed mother’s treatment on her child, and found that children whose mothers were on escitalopram showed significantly greater improvement in symptoms and functioning as compared to children whose mothers were on bupropion or a combination of both. The authors also observed that maternal baseline negative affectivity (which captures high levels of stress, irritability, and anxiety) appeared to moderate the effect of maternal treatment on children. Possibly, these mothers are better treated with escitalopram, which enhances serotoninergic neurotransmission, as compared to bupropion, which enhances dopaminergic transmission. In another study, Morgan et al. evaluated how maternal neural response to child affect is related to depression by using an fMRI task. They found that comorbid anxiety, chronicity of depression, and poor mother-child relationship emerged as predictors of altered maternal neural response to child affect. Few studies have sought to elucidate the mechanisms of parental-offspring psychopathology.

Examining the Unique Characteristics of a Non-Probability Sample of Undocumented Female Sex Workers with Dependent Children: The Case of Haitians in the Dominican Republic

Haitians in the Dominican Republic (DR) are increasingly marginalized due to recent legislation that stripped Haitian-Dominicans of their citizenship and increased Haitian migrants’ deportation risk. Haitian female sex workers (FSWs) are particularly vulnerable, though little is known about them. This study will help public health efforts targeted at sex workers to better reach Haitian FSWs and address their needs by identifying a profile of characteristics unique to this group compared to Dominican FSWs. Data were collected in 2014 among Haitian and Dominican FSWs in Puerto Plata, DR. Surveys assessed respondents’ demographics, health consciousness, depression, and stigma. Adjusted logistic regressions showed that Haitian FSWs were disadvantaged: they had significantly lower rates of education, more children, and less permanent income. Furthermore, Haitian FSWs were more likely to work independently and for fewer hours. Interestingly, Haitian FSWs internalized less stigma than Dominicans. Though we can only speculate, this could be due to migration for sex work, or the lack of formal employment for Haitians. Initiatives to alleviate poverty, create formal jobs, and overturn discriminatory legislation may have the most impact for Haitian FSWs.

An index to examine the sexual HIV risk of psychiatric service users based on sexual partners

cases described herein, we suggest that rapid infusion of S-(+)-ketamine may offer less tolerability compared to the racemic formulation. However, the infusion rate used to treat these patients may explain, at least in part, the poor tolerability observed. Therefore, we maintain that ketamine administration should only be performed in the inpatient setting, with supporting services and monitoring available, using a slow infusion over at least 40 minutes.

Validation of the Minority Stress Scale among Italian gay and bisexual men.

The experience of sexual orientation stigma (e.g., homophobic discrimination and physical aggression) generates minority stress, a chronic form of psychosocial stress. Minority stress has been shown to have a negative effect on gay and bisexual men’s (GBM’s) mental and physical health, increasing the rates of depression, suicidal ideation, and HIV risk behaviors. In conservative religious settings, such as Italy, sexual orientation stigma can be more frequently and/or more intensively experienced. However, minority stress among Italian GBM remains understudied. The aim of this study was to explore the dimensionality, internal reliability, and convergent validity of the Minority Stress Scale (MSS), a comprehensive instrument designed to assess the manifestations of sexual orientation stigma. The MSS consists of 50 items assessing (a) Structural Stigma, (b) Enacted Stigma, (c) Expectations of Discrimination, (d) Sexual Orientation Concealment, (e) Internalized Homophobia Toward Others, (f) Internalized Homophobia toward Oneself, and (g) Stigma Awareness. We recruited an online sample of 451 Italian GBM to take the MSS. We tested convergent validity using the Perceived Stress Questionnaire. Through exploratory factor analysis, we extracted the 7 theoretical factors and an additional 3-item factor assessing Expectations of Discrimination From Family Members. The MSS factors showed good internal reliability (ordinal &agr; > .81) and good convergent validity. Our scale can be suitable for applications in research settings, psychosocial interventions, and, potentially, in clinical practice. Future studies will be conducted to further investigate the properties of the MSS, exploring the association with additional health-related measures (e.g., depressive symptoms and anxiety). L’esperienza dello stigma sessuale (ad esempio, discriminazione e aggressioni fisiche) genera stress da minoranza (minority stress), una forma di stress psicosociale cronico. Lo stress da minoranza ha un effetto negativo sulla salute mentale e fisica dei gay e uomini bisessuali (GUB) ed è una delle cause degli elevati tassi di depressione, ideazioni suicidarie e comportamenti sessuali a rischio di HIV. In ambienti religiosi e conservativi come l’Italia, l’esperienza dello stigma sessuale può essere più frequente e intenso. Nonostante ciò, lo stress da minoranza fra i GUB italiani rimane poco investigato. Lo scopo di questo studio era di esaminare la dimensionalità, l’attendibilità interna, e la validità convergente del Minority Stress Scale (MSS), uno strumento Italiano in grado di misurare le manifestazioni dello stigma sessuale. L’MSS è composto da 50 item che misurano (a) lo Stigma Strutturale, (b) lo Stigma Manifesto, (c) le Aspettative di Essere Discriminato, (d) l’Occultamento dell’Orientamento Sessuale, (e) l’Omofobia Interiorizzata Diretta Verso gli Altri, (f) l’Omofobia Interiorizzata Diretta Verso Se Stessi, e (g) la Consapevolezza dello Stigma. Abbiamo reclutato un campione di 451 GUB Italiani online che hanno compilato l’MSS. La validità convergente è stata valutata utilizzando il Perceived Stress Questionnaire. Attraverso l’analisi fattoriale esplorativa, abbiamo estratto sette fattori teorici e un fattore aggiuntivo composto da 3-item “Aspettative di Discriminazione dai propri Familiari.” I fattori del MSS hanno dimostrato una buona attendibilità interna (ordinal &agr; > .81) e una buona validità convergente. La nostra scala può essere utilizzata nell’ambito della ricerca, interventi psicosociali e, potenzialmente, nella pratica clinica. Ulteriori studi verranno condotti per valutare le proprietà psicometriche dell’MSS come l’associazione con altri fattori legati alla salute (ad esempio, sintomi depressivi e ansia).