William Martinez

Social Competence in Children with Chronic Illness: A Meta-analytic Review

OBJECTIVE To conduct a meta-analysis of social competence in children with a chronic illness. METHODS The meta-analysis included 57 studies comparing levels of social competence in children with chronic illness to those of children without chronic illness. A random effects model was used to calculate overall effect, subgroup, and meta-regression analyses. RESULTS Overall, the meta-analysis calculated 90 unique outcomes, producing a summary standardized mean difference of d = -0.44, 95% confidence interval (95% CI) -0.52 to -0.36 indicating a medium overall effect for decrease social competence. Chronic illness, measure, and informant moderated social competence outcomes. CONCLUSIONS The impact of chronic illness on youth varied by individual child factors (e.g., gender, chronic illness type) and by measurement features such as informant and measure type. The current study demonstrates a need for further research of the assessment of social competence and has implications for the development of social skills programs for children with chronic illness.

Family orientation, language, and anxiety among low-income Latino youth.

There is emerging evidence that Latino youth report higher levels of anxiety symptoms than children from other ethnic groups. Although often implicated, cultural variables have not been systematically evaluated to determine their relationship to anxiety symptoms in Latino youth. The present study examined family orientation values, as measured by family obligation and affiliative obedience, and their relationship to youth anxiety symptoms. The sample consisted of 133 Latino students (grades 5th through 7th) of low-income backgrounds in an urban public school setting. Structural equation models revealed that higher family orientation was associated with separation anxiety/panic (β=.32) and harm avoidance (β=.51). Models employing language proficiency and use mirrored those employing family orientation, suggesting that language fluency captures, in part, family socialization values. The results provide support for the impact of culture in the assessment and specific needs of Latino youth with anxiety problems.

Symptom Variation on the Trauma Symptom Checklist for Children: A Within‐Scale Meta‐Analytic Review

Trauma exposure in youth is widespread, yet symptom expression varies. The present study employs a within-scale meta-analytic framework to explore determinants of differential responses to trauma exposure. The meta-analysis included 74 studies employing samples of youth exposed to traumatic events and who completed the Trauma Symptom Checklist for Children (TSCC). Mean weighted T scores across all TSCC subscales for U.S. samples ranged between 49 and 52. Youth outside the U.S. reported higher posttraumatic stress, anxiety, and depressive symptoms, whereas those exposed to sexual abuse reported the highest posttraumatic stress, anxiety, depressive, and dissociative symptoms. Higher female representation in samples was associated with higher symptoms on all TSCC subscales except anger. In contrast, ethnic minority representation was associated with lower depressive symptoms. Moderator analyses revealed that sexual abuse, increased percentage of females, and older age were all associated with higher posttraumatic symptoms. The present meta-analytic results help elucidate some of the divergent findings on symptom expression in youth exposed to traumatic events.

Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis

OBJECTIVE Despite the high prevalence of mental disorders in Mexico, minimal mental health services are available and there are large gaps in mental health treatment. Community-based primary care settings are often the first contact between patients and the health system and thus could serve as important settings for assessing and treating mental disorders. However, no formal assessment has been undertaken regarding the feasibility of implementing these services in Mexico. Before tools are developed to undertake such an assessment, a more nuanced understanding of the microprocesses affecting mental health service delivery must be acquired. METHODS A qualitative study used semistructured interviews to gather information from 25 staff in 19 community-based primary care clinics in Mexico City. Semistructured interviews were analyzed by using the meaning categorization method. In a second phase of coding, emerging themes were compared with an established typology of barriers to health care access. RESULTS Primary care staff reported a number of significant barriers to implementing mental health services in primary care clinics, an already fragile and underfunded system. Barriers included the following broad thematic categories: service issues, language and cultural issues, care recipient characteristics, and issues with lack of knowledge. CONCLUSIONS Results indicate that the implementation of mental health services in primary care clinics in Mexico will be difficult. However, the information in this study can help inform the integration of mental health into community-based primary care in Mexico through the development of adequate evaluative tools to assess the feasibility and progress of integrating these services.

The relationship between maternal responsivity, socioeconomic status, and resting autonomic nervous system functioning in Mexican American children

Adversity, such as living in poor socioeconomic conditions during early childhood, can become embedded in childrens physiology and deleteriously affect their health later in life. On the other hand, maternal responsivity may have adaptive effects on physiology during early childhood development. The current study tested both the additive and interactive effects of socioeconomic status (SES) and maternal responsivity measured at 1year of age on resting autonomic nervous system (ANS) function and trajectory during the first 5years of life. Participants came from a birth cohort comprised of Mexican-origin families living in California. Childrens resting ANS functioning (respiratory sinus arrhythmia; RSA; pre-ejection period; PEP; and heart rate; HR) was collected at 1, 3.5, and 5years of age (N=336) and modeled across time using Hierarchical Linear Modeling. Consistent with hypotheses, results showed that low SES predicted flatter trajectories of resting HR and PEP over early childhood (i.e., patterns of consistently higher heart rate; shorter PEP), whereas children who experienced positive maternal responsivity had steeper trajectories in RSA and PEP over time (i.e., increasing parasympathetic activation; decreasing sympathetic activation). The interaction between SES and maternal responsivity significantly predicted RSA intercept at age 5, such that among children living in low SES environments, high maternal responsivity mitigated the negative effect of poverty and predicted higher resting RSA at 5years of age. Results are consistent with the early life programming theory that suggests that environmental influences become biologically embedded in the physiology of children living in socially disadvantaged contexts, and identify increased maternal responsivity as a developmental mechanism that could offset the deleterious effects of low SES.

Neighborhood Context, Family Cultural Values, and Latinx Youth Externalizing Problems

Latinx youth living in the United States reside in a myriad of cultural and neighborhood contexts, yet little is known regarding how cultural values influence behavior problems across neighborhood contexts. Using a person–environment fit framework, the present study explored the degree to which youth cultural values were associated with their externalizing problems, and the degree to which this association was shaped by their neighborhood’s socioeconomic status (SES), and Latinx and immigrant concentration. The sample comprised of 998 Latinx youth (Female = 54.2%), ages 10 to 14 years old (Mage = 11.8), from three large United States metropolitan areas. Multilevel modeling methods indicated that increased fit between youth cultural values and neighborhood Latinx and immigrant concentration was associated with fewer externalizing problems, but only in higher SES neighborhoods. The results support the importance of studying social determinants of Latinx youth behavioral health, and provide implications for both neighborhood-level and individual-level prevention and intervention programming.