Zornitsa Kalibatseva

Open Trial of Vinyasa Yoga for Persistently Depressed Individuals: Evidence of Feasibility and Acceptability.

The aim of this study was to assess the acceptability and feasibility of Vinyasa yoga as an adjunctive treatment for depressed patients who were not responding adequately to antidepressant medication. The authors also planned to ask participants for qualitative feedback on their experience of the class and to assess change over time in depression and in possible mediating variables. The authors recruited 11 participants in 1 month for an 8-week open trial of yoga classes. They found that 10 participants completed follow-up assessments, 9 of 10 were positive about their experience, and all provided feedback about what was and was not helpful about yoga, as well as barriers to class attendance. Over the 2-month period, participants exhibited significant decreases in depression symptoms and significant increases in an aspect of mindfulness and in behavior activation. This pilot study provided support for continuing to investigate Vinyasa yoga as an adjunct treatment for depression. The next step required is a rigorous randomized clinical trial.

Disentangling immigrant status in mental health: Psychological protective and risk factors among latino and asian american immigrants

This study aimed to disentangle the psychological mechanisms underlying immigrant status by testing a model of psychological protective and risk factors to predict the mental health prevalence rates among Latino and Asian American immigrants based on secondary analysis of the National Latino and Asian American Study. The first research question examined differences on the set of protective and risk factors between immigrants and their U.S.-born counterparts and found that immigrants reported higher levels of ethnic identity, family cohesion, native language proficiency, and limited English proficiency than their U.S.-born counterparts. The second research question examined the effect of the protective and risk factors on prevalence rates of depressive, anxiety, and substance-related disorders and found that social networking served as a protective factor. Discrimination, acculturative stress, and family conflict were risk factors on the mental health for both ethnic groups. Clinical implications and directions for future research are provided.

A critical review of culturally sensitive treatments for depression: Recommendations for intervention and research

Recent meta-analyses and reviews have showed that culturally adapted mental health interventions are more effective for racial and ethnic minorities than traditional unadapted psychotherapy. Despite the advances in providing culturally sensitive mental health services, disparities among racial and ethnic minorities still exist. As a body of literature on culturally sensitive treatments accumulates, there is a need to examine what makes a treatment for specific presenting problems culturally sensitive. This article presents a critical review of existing culturally sensitive treatments for depression because it is one of the most common and debilitating mental disorders. In particular, we examined what treatment modalities were used, what types of adaptations were implemented, and what populations were targeted. The conceptual framework this review uses to categorize existing culturally sensitive treatments includes a top-down, a bottom-up, or an integrative approach. The review reveals that the majority of culturally sensitive treatments for depression employed an evidence-based bottom-up approach, which involved general and practical adaptations, such as translating materials or infusing specific cultural values. Most studies used cognitive-behavioral strategies and included Latinos and African Americans. Recommendations and future directions in interventions and research are discussed to decrease mental health care disparities among ethnic minorities.

Measuring Homework Completion in Behavioral Activation

The aim of this study was to develop and validate an observer-based coding system for the characterization and completion of homework assignments during Behavioral Activation (BA). Existing measures of homework completion are generally unsophisticated, and there is no current measure of homework completion designed to capture the particularities of BA. The tested scale sought to capture the type of assignment, realm of functioning targeted, extent of completion, and assignment difficulty. Homework assignments were drawn from 12 (mean age = 48, 83% female) clients in two trials of a 10-session BA manual targeting treatment-resistant depression in primary care. The two coders demonstrated acceptable or better reliability on most codes, and unreliable codes were dropped from the proposed scale. In addition, correlations between homework completion and outcome were strong, providing some support for construct validity. Ultimately, this line of research aims to develop a user-friendly, reliable measure of BA homework completion that can be completed by a therapist during session.

Psychometric Properties of the Persian Version of the Short Beck Depression Inventory with Iranian Psychiatric Outpatients

The short form of the Beck Depression Inventory (BDI-13) is useful for the screening and assessment of depression in clinical and research settings. The aim of the present study was to investigate the psychometric properties of the Persian (Farsi) version of BDI-13 in an Iranian clinical sample. The sample consisted of 52 Iranian psychiatric outpatients who received services at psychiatric and psychological clinics at the School of Behavioral Sciences & Mental Health-Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS) in Tehran, Iran. The study examined the reliability, construct validity, and factor structure of the instrument. The instrument indicated good reliability with Cronbachs alpha of .85 and strong construct validity based on moderate to strong positive correlations with other measures of mental health issues. Using a Principal Component Analysis and Varimax Rotation with Kaiser Normalization, three factors were identified and labeled Affective (F1), Somatic/Vegetative (F2), and Cognitive/Loss of Functioning (F3). The current factor structure suggests that depression is a multidimensional construct in an Iranian clinical sample. This study provides further evidence that the Persian version of the BDI-13 is a psychometrically sound instrument that can be used for clinical and research purposes in Iran.

Stigma, mental health, and counseling service use: A person-centered approach to mental health stigma profiles.

The current study examined reports of stigma toward mental health services, depressive symptoms, flourishing, and mental health service use among a sample of 8,285 college students across the United States who completed the Healthy Minds Study. The study aimed to: (a) identify profiles of public and personal stigma against mental health service utilization, and (b) examine the demographic predictors of stigma group membership and mental health service utilization. Latent profile analyses revealed 3 distinct groups based on public and self-stigma (i.e., “High Self, High Public Stigma,” “Average Self, High Public Stigma,” and “Low Self, Low Public Stigma”). Subsequent analyses examined demographic characteristics and mental health across the 3 groups. Results indicated significant differences in age, gender, race/ethnicity, mental health, and mental health service use across the 3 groups. Results further showed that students with high perceived need for mental health services, identifying as male or Asian, and belonging to the “High Self, High Public Stigma” group had lower likelihood of seeking mental health services in the past year. Implications for future research and clinical practice are discussed.

Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients

INTRODUCTION The Patient Health Questionnaire-9 (PHQ-9) is a brief screening and diagnostic tool for depression. It has been used in research and clinical practice in primary care and other clinical and non-clinical settings. The PHQ-9 has not had its validity examined in psychiatric and psychological settings in Iran. METHODS A cross-sectional study was conducted to investigate the validation of the Farsi version of the PHQ-9. A convenience sample of 130 Iranian volunteer psychiatric outpatients was selected from psychiatric and psychological clinics. They completed the PHQ-9, the Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5), and the short form of the Beck Depression Inventory-13 (BDI-13). Data were analyzed by descriptive statistics, Cronbachs α, Pearson correlation coefficient, principal component analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS Mean score of the PHQ-9 was 12.83 (standard deviation = 6.25), indicating moderately severe depression in the sample. Cronbachs α coefficient for PHQ-9 was 0.88, and one-week test-retest reliability 0.79. The PHQ-9 correlated 0.64 with PHQ-15, -0.35 with WHO-5, and 0.70 with BDI-13, indicating good construct and criterion-related validity. The results of the factor analysis of PHQ-9 items identified and confirmatory factor analysis confirmed a single factor labeled general depression. CONCLUSIONS The PHQ-9 appears to have a unidimensional structure, adequate validity and reliability, and can be useful in epidemiological/research settings. Based on previous literature and on the present findings, the PHQ-9 may have applicability to other contexts in the studied population, but this needs to be confirmed by other studies.

Cultural Factors, Depressive and Somatic Symptoms Among Chinese American and European American College Students:

This study seeks to fill a gap in the existing empirical literature about the relationship between somatic and depressive symptoms and their associations with cultural factors among Chinese American and European American college students. In particular, the study examined how three culturally relevant psychological constructs, self-construal, loss of face, and emotion regulation, associate with depressive and somatic symptoms among Chinese American and European American college students and if they can explain possible group differences in depressive symptoms. The sample consisted of 204 Chinese American and 315 European American college students who completed an online survey. Based on multiple regression analyses, European American students reported higher levels of somatic symptoms on the Patient Health Questionnaire–15 (PHQ-15) than Chinese Americans. There was no initial group difference in depressive symptoms based on Center for Epidemiologic Studies–Depression Scale (CES-D) scores. Correlations between depressive and somatic symptoms, independent and interdependent self-construal, and cognitive reappraisal and independent self-construal were stronger for European Americans than Chinese Americans. Somatic symptoms, loss of face, and expressive suppression were positively associated with depressive symptoms, whereas independent self-construal and cognitive reappraisal were negatively associated with depressive symptoms for both groups. When controlling for gender and somatic symptoms, being Chinese American and male was significantly and positively associated with depressive symptoms measured with the CES-D. These ethnic and gender differences in depressive symptoms were explained by independent self-construal, loss of face, cognitive reappraisal, and expressive suppression. Clinical implications include the incorporation of specific culturally relevant constructs and avoidance of race-, ethnicity-, and gender-based stereotypes to reduce health disparities in depression treatment.

Loss of face, intergenerational family conflict, and depression among Asian American and European American college students

Asian-American college students have reported higher scores of depression than European-American college students. This study examined the mediating effects of loss of face and intergenerational family conflict between race/ethnicity and depression and hypothesized that these variables would explain previously observed depression differences. The sample consisted of 488 undergraduate students: 209 self-identified as Asian American and 279 as European American. Participants filled out paper-and-pencil questionnaires. As predicted, the study found that Asian Americans reported higher scores on depression, loss of face, and intergenerational family conflict than European Americans. Loss of face explained more variance in depression among Asian Americans than European Americans. However, intergenerational family conflict explained equal levels of variance in depression for both groups. A structural equation model revealed that the relationship between race/ethnicity and depression was fully mediated by loss of face and intergenerational family conflict. In conclusion, using the disentangling approach, differences in depression scores between Asian-American and European-American college students can be explained by differences in culturally relevant constructs, such as loss of face and intergenerational family conflict.

Assessing Depression and Suicidality in Asian-Americans

This chapter provides a review of the most commonly used measures of depression and suicidality among Asian-Americans. The goal of the chapter is to inform clinicians about the psychometric properties of instruments assessing depression and suicidality among Asian-Americans. We examine the reliability, validity, and utility of the Center for Epidemiological Studies—Depression, Beck Depression Inventory, Geriatric Depression Scale, Hamilton Rating Scale of Depression, Patient Health Questionnaire-9, and Zung Self-Rating Depression Scale. Given the dearth of literature on suicidality measures, the chapter briefly reviews a few instruments that have been used in Asian samples. Most of the measures demonstrated adequate psychometric properties and could be used in their original form or with minor alterations (e.g., remove positively worded items). However, all of the measures need to be used with caution with Asian-American clients and complemented with culturally sensitive diagnostic interviews. More research is needed to establish the measurement equivalence (internal validity) and specificity and sensitivity (external validity) of the available depression and suicide measures for Asian-Americans.