Lindsay A. Bornheimer

Mental Health Service Use Types Among Asian Americans with a Psychiatric Disorder: Considerations of Culture and Need

Despite levels of need that are comparable with other groups, relatively few Asian Americans receive mental health care. While studies have described the tendency for Asian Americans to delay care until mental health symptoms are severe, relatively little research has examined how the severity of symptoms impact mental health service use. This study uses publicly available data from the National Latino and Asian American Study (NLAAS) and focuses solely on Asian American respondents with a psychiatric disorder (n = 230). Unexpectedly, few Asian Americans with a psychiatric disorder received care in a medical setting. The perception of mental health needs increased the likelihood of using mental health specialist care. Social and systemic barriers together hinder mental health service use. Implications for addressing Asian American mental health service use within a changing health care environment are discussed.

Moderating effects of positive symptoms of psychosis in suicidal ideation among adults diagnosed with schizophrenia

BACKGROUND Suicide is among the leading causes of death for adults diagnosed with schizophrenia, with risk estimates being over eight folds greater than the general population. While the majority of research to date focuses on the role of symptoms of depression in suicide risk, there is a lack of consensus and understanding of the relationship between positive symptoms of psychosis and both suicidal ideation and attempt. The current study examined pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), hopelessness, and suicidal ideation among a population of adults diagnosed with schizophrenia. METHODS Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n=1460) at baseline. Suicidal ideation, hopelessness, and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). Data were analyzed with Structural Equation Modeling (SEM) using Mplus 7. RESULTS Symptoms of depression, positive symptoms of psychosis, and hopelessness independently predicted suicidal ideation. Hopelessness significantly mediated the relationship between symptoms of depression and suicidal ideation. Lastly, positive symptoms of psychosis were found to moderate the relationship between symptoms of depression and suicidal ideation. CONCLUSIONS The current study provides evidence for the role that positive symptoms of psychosis (specifically hallucinations and delusions) play in suicidal ideation, pointing towards the implication that beyond symptoms of depression, positive symptoms must be evaluated for and treated.

Symptoms of Depression, Positive Symptoms of Psychosis, and Suicidal Ideation Among Adults Diagnosed With Schizophrenia Within the Clinical Antipsychotic Trials of Intervention Effectiveness

Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms of depression are consistently supported factors involved in suicidal ideation, findings on the role of positive symptoms of psychosis have been mixed with limited understandings of risk. Accordingly, this study aimed to identify the pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), and suicidal ideation. Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1,460). Suicidal ideation and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). The data were analyzed using Structural Equation Modeling (SEM). As symptoms of depression and positive symptoms of psychosis independently increased, on average there were associated increases in suicidal ideation. The present study provides support for the relationship between positive symptoms of psychosis, specifically hallucinations and delusions, and suicidal ideation. Future prospective longitudinal study designs are needed to further increase understandings of the roles that hallucinations, delusions, and additional symptoms of schizophrenia play in both suicidal ideation and attempt to ultimately inform evidence-based interventions aiming to reduce suicidal death.

Suicide among individuals with schizophrenia: A risk factor model

ABSTRACT Suicide is the tenth leading cause of death in the United States and is the leading cause of death among individuals with schizophrenia. In order to prevent premature suicidal death and improve the quality of life among individuals with schizophrenia, conceptual models are needed to understand the mechanisms of suicide risk. This article reviews the theoretical perspectives of schizophrenia, suicide, and the intersection of schizophrenia and suicide to develop a conceptual basis for future prevention and intervention efforts by health and mental health practitioners and researchers. A better explanation and understanding of risk factors for suicide has the potential to play a larger role in treatment and recovery of schizophrenia, and prevent premature suicidal death. As a result of the absence to date of theoretically driven and empirically testable models of suicidal behaviors tailored for individuals with schizophrenia, the current article proposes a model of suicide risk specific to individuals with schizophrenia to increase understanding of risk and to inform prevention efforts.

The intersection of extreme poverty and familial mental health in the United States

ABSTRACT Approximately 22% of children in the United States live in poverty, with high rates of caregiver depression and child disruptive behavior disorders (DBD). The current study aims to explore the relationships between living in extreme poverty and both child and parent mental health. Data are comprised of findings from the first effectiveness study of the 4Rs and 2Ss intervention, in addition to preliminary data from an implementation study currently underway (n = 484). Families with an annual income of less than

A model of integrated health care in a poverty-impacted community in New York City: Importance of early detection and addressing potential barriers to intervention implementation

9,999 reported significantly greater child DBD scores and prevalence of clinically significant levels of caregiver depressive symptoms compared to income levels over

Provider Attitudes, Organizational Readiness for Change, and Uptake of Research Supported Treatment:

10,000. Findings support the recommendation for parental mental health to be attended to within the context of child mental health services.

Barriers to Service Utilization and Child Mental Health Treatment Attendance Among Poverty-Affected Families

ABSTRACT Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention.

Multiple Family Group Service Delivery Model for Children With Disruptive Behavior Disorders: Impact on Caregiver Stress and Depressive Symptoms

Purpose: As implementation and evaluation of research supported treatment (RST) expands across diverse mental health settings, it is essential to understand the facilitators and inhibitors of uptake. The current study examined the relationships between organizational readiness for change, attitudes toward RST, and use of RST among a sample primarily of social workers. Methods: Participants included 158 providers from public child mental health outpatient clinics in the New York metropolitan area. Data were analyzed using structural equation modeling. Results: Use of RST was greater among providers who were younger and had fewer years of professional experience. Both organizational need for change and climate directly and indirectly related to use of RST through attitudes toward RST (partial mediator). Discussion: The organizational context is an important factor that relates to attitudes toward and use of RST in practice. Future research is needed to continue examining factors of RST uptake and sustainability.

An examination of the relationship between maternal depression and barriers to child mental health services

OBJECTIVE The majority of children who initially engage in mental health treatment in the United States drop out prematurely, a problem further exacerbated among children living in poverty. This study examined the relationships between sociodemographic characteristics, barriers to treatment use, and session attendance. METHODS Data were obtained from participants (N=225) in the 4R2S field trial. Barriers were measured using the Kazdin Barriers to Treatment Participation Scale. RESULTS Barriers endorsed by families attending less treatment primarily aligned with practical rather than perceptual obstacles. Critical events linked to lower attendance included moving too far away from the clinic, a job change, and a childs moving out of the home. CONCLUSIONS Child mental health programs serving low-income families may consider structural modifications to allow for greater family support as well as flexibility in treatment delivery by leveraging technology. Future research is needed to evaluate barriers to treatment and alternate modalities in relation to service utilization.