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AIMS: This study examines: (a) the prevalence rate of type 2 diabetes mellitus (T2DM) in Chinese Americans (CAs); (b) the influence of acculturative status (i.e. generational status and linguistic fluency) on T2DM prevalence; (c) and differences in diabetes management between CAs and Non-Hispanic Whites (NHWs). METHODS: We used 2011-2018 data from the California Health Interview Survey (CHIS) to analyze the prevalence rate and management of diabetes among the CAs. Chi-squares, linear regressions, and logistic regressions were used to analyze the data. RESULTS: After controlling for demographic, socioeconomic, and health behaviors, there were no significant differences in the T2DM prevalence rate between CAs overall or of varying acculturative statuses compared with NHWs. However, there were differences in diabetes management, with first-generation CAs being less likely to exam glucose daily, have medical care plans developed by medical providers, or have confidence in controlling diabetes compared to NHWs. CAs with limited English proficiency (LEP) were less likely to perform self-monitoring of blood glucose or have confidence in managing their diabetes care compared to NHWs. Finally, non-first generation CAs were also more likely to take diabetes medication compared to NHWs. CONCLUSIONS: Although the prevalence rate of T2DM was found to be similar between CAs and NHWs, significant differences were found in diabetes care and management. Specifically, those who were less acculturated (e.g. first generation and those with LEP) were less likely to actively manage and have confidence in managing their T2DM. These results highlight the importance of targeting immigrants with LEP in prevention and intervention efforts.

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The majority of research on accessing and utilizing mental health services has focused on patient barriers to care. Few studies have explored possible provider biases that may impact client access at point of entry. Using the audit method, we conducted an email-based field experiment to investigate the responsiveness of psychotherapy providers to inquiries from simulated patients with different backgrounds (i.e., race, gender, diagnosis, and ability to pay). A total of 725 therapists (176 men, 549 women) practicing in Chicago, Illinois were identified from an online therapist directory and randomized to receive emails requesting therapy appointments. Overall, 21.7% of providers did not return prospective client email inquiries; 32.5% of providers were somewhat responsive in that they returned an email despite not being able to take on the client; and 45.7% were highly responsive in that they returned an email and offered an appointment or the opportunity to discuss the matter further. Male providers were less responsive to African American and Latinx simulated clients and most responsive to White clients, whereas female providers were more likely to respond similarly to all simulated clients. Moreover, regardless of the providers' gender, they were more responsive to simulated patients with depression than to simulated patients with schizophrenia or borderline personality disorder (BPD). Finally, providers were more responsive to those who could pay the full fee than to those who requested a sliding scale. Educating providers on these possible biases is important because it could help reduce biased behaviors and improve access to care for vulnerable populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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Asian Americans (AAs) are a diverse group who come from many different cultures, backgrounds, immigration histories, geographic regions, and experiences. Unfortunately, AAs are commonly stereotyped as a model minority, used as an intermediary minority, and consequently have been marginalized and left out of dialogues of racism and discrimination. Internalized racism (IR), defined as the internalization of bias and oppression toward one's group, is an especially insidious form of divisive racism that remains largely misunderstood and unaddressed in AAs. In addition to devaluing oneself, IR creates division in communities and reinforces systems of oppression. This paper reviews the extant literature on IR among AAs and discusses the importance of addressing this deleterious issue and its consequences on individual, family, and community mental health. Moreover, I discuss and elucidate how stereotypes about AAs (e.g., model minority, perpetual foreigner, gendered stereotypes, and conceptions of beauty) directly promote and reinforce different types of internalized oppression (e.g., intraracial hierarchies, intraethnic othering, gendered emasculation, and hypersexualization, colorism and Western standards of beauty). Clinical and community recommendations are provided through a multilevel preventive intervention framework. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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One of the most persistent health disparities is the underutilization of mental health services by people of color. Neither evidence-based treatments (universal focus) nor culturally adapted treatments (group focus) have reduced these disparities. We propose the personal relevance of psychotherapy (PROP) model, which integrates universal, group, and individual dimensions to determine the personal relevance of interventions. A cultural example of personal relevance among people of East Asian ancestry involves "face" (i.e., one's prestige and position in society), which may moderate treatment outcomes. Pragmatic intervention approaches focused on helping individuals cope with specific external problems, compared to managing a "personal" disease, can effectively "restore" face. Thus, social problem-solving interventions may be more personally relevant to many people of East Asian ancestry than are approaches that are internally focused. In addition, we posit that social neuroscience can offer unique opportunities above and beyond self-report measures when assessing the impact of PROP and the personal relevance of interventions for diverse populations. Our preliminary evidence upon testing this hypothesis indicated that among Asian Americans, exposure to problem-solving therapy content elicited significantly greater neural activity in brain areas associated with personal relevance compared to exposure to cognitive-behavioral therapy content. Identifying personally relevant interventions has the potential to reduce mental health disparities by increasing engagement with mental health services for diverse groups. The increased client engagement produced by personally relevant interventions also has the potential to make mental health services more effective for diverse groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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BACKGROUND: Obesity is a cardiovascular disease risk factor and affects approximately 13.7 million U.S. children and adolescents between the ages 2 and 19 years old in 2015-2016. PURPOSE: To determine the relationship between children's average long-term exposure to maternal depressive symptoms age 1 month to Grade 6 and adolescents' body mass index (BMI) z-score at age 15 mediated by the adolescents' depressive symptom experience. METHODS: A total of 1,364 infants and their families from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were recruited. RESULTS: Mediation analyses revealed a significant relationship between children's average long-term exposure to maternal depressive symptoms from age 1 month to Grade 6 and adolescents' BMI z-score at age 15 (total effect = 0.015, p = .013, 95% confidence interval (CI): 0.0032, 0.027). The adolescents' experience of depressive symptoms significantly mediated this relationship (indirect effect = 0.0021, bias-corrected bootstrapped 95% CI: 0.0004, 0.0044), with this mediated relationship more pronounced in girls. CONCLUSIONS: Findings indicate the possible existence of a mediating role of adolescents' depressive symptoms experience in the pathway from average long-term exposure to maternal depressive symptoms during children's early life to adolescents' elevated BMI.

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Racism and race-related stress can negatively impact the mental health status of ethnic minorities. In recent years, college campuses have held demonstrations to promote awareness regarding racism and to call for resources to help improve campus climate and to address the needs of students of color. This study answers this call by developing and evaluating the benefits of a peer-led compassionate meditation program to help students of color heal from race-related stress. To date, no studies have examined whether compassionate meditation (a specific type of meditation) can be used as a therapeutic tool to address racial stress. This article discusses the formative process for developing and pilot-testing the effects of this culturally responsive 8-session compassionate meditation program with Asian American college students. Despite a small sample size, results were promising. and participants evidenced decreases in general distress, as well as depression, anxiety, and PTSD symptoms. Moreover, by the end of the program, fewer students were clinically depressed. The results of this study provide some initial evidence that brief, culturally responsive compassionate meditation interventions may be a promising and cost-effective method for addressing the impact of racism and race-related stress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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Eager to build an integrated community-based mental health system, in 2004 China started the '686 Programme', whose purpose was to integrate hospital and community services for patients with serious mental illness. In 2015, the National Mental Health Working Plan (2015-2020) proposed an ambitious strategy for implementing this project. The goal of this review is to assess potential opportunities for and barriers to successful implementation of a community-based mental health system that integrates hospital and community mental health services into the general healthcare system. We examine 7066 sources in both English and Chinese: the academic peer-reviewed literature, the grey literature on mental health policies, and documents from government and policymaking agencies. Although China has proposed a number of innovative programmes to address its mental health burden, several of these proposals have yet to be fully activated, particularly those that focus on integrated care. Integrating mental health services into China's general healthcare system holds great promise for increased access to and quality improvement in mental health services, as well as decreased stigma and more effective management of physical and mental health comorbidities. This article examines the challenges to integrating mental health services into China's general healthcare system, especially in the primary care sphere, including: accurately estimating mental health needs, integrating mental and physical healthcare, increasing workforce development and training, resolving interprofessional issues, financing and funding, developing an affordable and sustainable mental health system, and delivering care to specific subpopulations to meet the needs of China's diverse populace. As China's political commitment to expanding its mental health system is rapidly evolving, we offer suggestions for future directions in addressing China's mental health needs.

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OBJECTIVE: No randomized controlled trials (RCTs) for adults have compared the effectiveness of a well-specified psychotherapy and a culturally adapted version of the same treatment. This study evaluated the effectiveness of cognitive-behavioral therapy (CBT) and culturally adapted CBT (CA-CBT) in treating depressed Chinese-American adults. METHODS: This RCT treated 50 Chinese Americans who met criteria for major depression and sought treatment at community mental health clinics. Screening of participants began in September 2008, and the last assessment was conducted in March 2011. Participants were stratified by whether they were already taking antidepressants when they first came to the clinic and randomly assigned to 12 sessions of CBT or CA-CBT. The study did not influence regular prescription practices. The primary outcomes were dropout rates and Hamilton Depression Rating Scale scores at baseline, session 4, session 8, and session 12. RESULTS: Participants in CA-CBT demonstrated a greater overall decrease in depressive symptoms compared with participants in CBT, but the groups had similarly high depression rates at week 12. Differences in dropout rates for the two groups approached, but did not meet, statistical significance (7%, CA-CBT; 26%, CBT). CONCLUSIONS: Chinese Americans entered this study with very severe depression. Participants in both CBT and CA-CBT demonstrated significant decreases in depressive symptoms, but the majority did not reach remission. Results suggest that these short-term treatments were not sufficient to address such severe depression and that more intensive and longer treatments may be needed. Results also indicate that cultural adaptations may confer additional treatment benefits.

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The acculturative family distancing (AFD) rating questionnaire measures the distancing that occurs between immigrant parents and their children, which is caused by breakdowns in communication and cultural value differences. The items included in the AFD questionnaire are indicators for more proximal and problem-focused aspects of the acculturation gap. In this study, a psychometric analysis is performed on the data gathered with the AFD instrument. One hundred twenty-three Chinese American families (112 mothers, 85 fathers, and 120 children for a total of 317) completed the questionnaire. In addition, the specifications for an extended 2-tier item factor analysis model within a Bayesian multidimensional item response theory framework are provided to psychometrically analyze the AFD data. Results suggest that the original 2 dimensions of Communication Difficulties and Cultural Values Incongruency can be further refined into 4 clinically relevant dimensions (i.e., Verbal Communication Difficulties, Nonverbal Communication Difficulties, General Cultural Values Incongruency, and Family Values Incongruency). Moreover, reducing the number of items can improve AFD estimates and reduce assessment burden.

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This study examined the relationship between therapist characteristics, therapeutic orientations, person-level and agency-level practices with cultural competency among 221 Los Angeles County community mental health clinicians. Results from an online survey indicated that compared to White therapists, ethnic minority therapists were more personally involved in communities of color, more likely to use a cultural framework in clinical practice, and perceived their agencies to be more culturally sensitive. Ethnic minority therapists also reported greater multicultural (MC) awareness and better MC counseling relationships with their clients than White therapists. Personal involvement in communities of color accounted for ethnic differences in MC awareness and MC counseling relationships. Compared to therapists with a strictly non-behavioral (psychodynamic or humanistic) orientation, therapists with an eclectic (or integrative) therapy orientation reported having a higher level of community knowledge. Therapists with an eclectic orientation reported greater MC awareness than therapists with a non-behavioral orientation, while both eclectic and behavioral (cognitive behavioral or behavior modification) therapists recounted better MC counseling relationships with their clients than therapists with a non-behavioral orientation. Community knowledge mediated eclectic vs. non-behavioral therapeutic orientation differences in MC awareness. Agency resources/linkages and outreach both moderated the relationship between therapeutic orientation and MC skills. Results suggest that if therapists become more personally involved with diverse populations, they will feel more culturally aware and feel like they have a better relationship with ethnic minority clients.

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OBJECTIVE: We evaluated potential explanations for advantaged mental health status among immigrant Asian American women compared to U.S.-born Asian American women. METHOD: In a nationally representative sample of 1,030 women (185 U.S.-born, 368 early-life immigrants [arrived before 25 years of age], 477 late-life immigrants), we examined the hypothesis that increased exposure to social risk factors mediate nativity-based differences in lifetime prevalence of depression and anxiety disorders. Indicators of social class were also examined as protective factors enjoyed by U.S.-born women that may suppress observed nativity-based disparities. We also examined whether there were group differences in reactivity to stress in predicting disorder. RESULTS: U.S.-born women were twice as likely as late-life immigrants to report lifetime history of depression (odds ratio [OR] = 2.03, 95% CI [1.35, 4.54]) and anxiety (OR = 2.12, 95% CI [1.34, 5.19]). Nativity differences in perceived discrimination, family conflict, and cultural conflict explained disparities in rates of disorder. There was no support for the contention that immigrant women were more psychologically hardy or resilient to social stress. CONCLUSION: Findings suggest that the gap in mental health status between U.S.- and foreign-born Asian American women would indeed be magnified if differences in social status were accounted for, but also that ready explanations for the so-called immigrant paradox are found in differential levels of reported stress exposure.

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OBJECTIVE: Anxiety may interfere with school-age children's independent behaviour and hence, their daily living skills (DLS). Nonetheless, this has not been tested in previous studies of children with clinical anxiety. METHOD: This study compared two groups of age-, gender-, and ethnicity-matched children with and without anxiety disorders (N = 60), testing the association of anxiety disorders with a lack of independence in DLS. RESULTS: Anxiety disorders are significantly associated with less mastery of DLS. Age moderated this effect for children with anxiety disorders; older children were more negatively impacted by anxiety disorders than younger children. CONCLUSIONS: Anxiety disorders may negatively impact children's independence in DLS. As children transition from mid- to late childhood - a period normally marked by increasing independence - this effect may grow in magnitude.

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Psychotherapy is a Western method of treating mental illness. Culturally adapting psychotherapy to better meet the needs of ethnic minorities is an important endeavor. Hall et al. (2011) did an excellent job of reviewing the intersection and divergence between Asian culture and mindfulness and acceptance-based therapies. They also point out that some therapies can be naturally syntonic with Asian American cultural values and belief systems. This is especially important given cultural differences between the East and West. Below, I provide an overview of the complexities involved in adapting treatments for diverse clients. I also discuss the importance of deconstructing stereotypes and understanding the complex interplay between clinical and cultural issues. Individualization of treatment for diverse clients can be achieved through culturally formed practice.

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OBJECTIVE: Knowledge of acculturative processes and their impact on immigrant families remains quite limited. Acculturative family distancing (AFD) is the distancing that occurs between immigrant parents and their children and is caused by breakdowns in communication and cultural value differences. It is a more proximal and problem-focused formulation of the acculturation gap and is hypothesized to increase depression via family conflict. METHOD: Data were collected from 105 Chinese American high school students and their mothers. Rasch modeling was used to refine the AFD measure, and structural equation modeling was used to determine the effects of AFD on youth and maternal depression. RESULTS: Findings indicate that greater AFD was associated with higher depressive symptoms and risk for clinical depression. Family conflict partially mediated this relation for youths, whereas for mothers, AFD directly increased risk for depression. Greater mother-child heritage enculturation discrepancies were associated with greater mother and child AFD. Mainstream acculturation discrepancies and language gaps between mothers and youths were not significantly associated with any of the primary outcome variables. CONCLUSIONS: Results highlight the need for better understanding of how AFD and other acculturation-gap phenomena affect immigrant mental health. They also underscore the need for prevention and intervention programs that target communication difficulties and intergenerational cultural value differences.

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This pilot study tested the effect of cognitive behavioral therapy (CBT) on parent-reported autism symptoms. Nineteen children with autism spectrum disorders and an anxiety disorder (7-11 years old) were randomly assigned to 16 sessions of CBT or a waitlist condition. The CBT program emphasized in vivo exposure supported by parent training and school consultation to promote social communication and emotion regulation skills. Parents completed a standardized autism symptom checklist at baseline and posttreatment/postwaitlist and 3-month follow-up assessments. CBT outperformed the waitlist condition at posttreatment/postwaitlist on total parent-reported autism symptoms (Cohen's d effect size = .77). Treatment gains were maintained at 3-month follow-up. Further investigation of this intervention modality with larger samples and broader outcome measures appears to be indicated.

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There is considerable evidence indicating that Asian American college students have less favorable attitudes toward and are less likely to use mental health services than other ethnic groups in the United States. Because a person's attitudes are often strongly associated with their voluntary behaviors, understanding what influences help-seeking attitudes may help shed light on why Asian American college students refrain from seeking mental health treatment. Andersen's Sociobehavioral Model is commonly used as a guide to understand help-seeking in the mainstream population. A modified version of this model that includes culture-related variables (i.e., level of acculturation and stigma tolerance) was used to guide this study. Results indicated that stigma tolerance predicted help-seeking attitudes above and beyond traditional variables associated with help-seeking. These findings suggest that reducing societal stigma and increasing individual tolerance to stigma should be a focus for prevention and intervention programs on college campuses.

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How do we culturally adapt psychotherapy for ethnic minorities? Although there has been growing interest in doing so, few therapy adaptation frameworks have been developed. The majority of these frameworks take a top-down theoretical approach to adapting psychotherapy. The purpose of this paper is to introduce a community-based developmental approach to modifying psychotherapy for ethnic minorities. The Formative Method for Adapting Psychotherapy (FMAP) is a bottom-up approach that involves collaborating with consumers to generate and support ideas for therapy adaptation. It involves 5-phases that target developing, testing, and reformulating therapy modifications. These phases include: (a) generating knowledge and collaborating with stakeholders (b) integrating generated information with theory and empirical and clinical knowledge, (c) reviewing the initial culturally adapted clinical intervention with stakeholders and revising the culturally adapted intervention, (d) testing the culturally adapted intervention, and (e) finalizing the culturally adapted intervention. Application of the FMAP is illustrated using examples from a study adapting psychotherapy for Chinese Americans, but can also be readily applied to modify therapy for other ethnic groups.

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OBJECTIVE: Our knowledge of how acculturative processes affect families remains quite limited. This article tests whether acculturative family distancing (AFD), a more proximal and problem-oriented measure of the acculturation gap, influences the mental health status of Asian American and Latino college students. AFD occurs along two dimensions: communication difficulties and cultural value incongruence. METHODS: Data were collected from 186 Asian American (n=107) and Latino (n=79) undergraduates, who provided self-reports on psychological problems, depressive symptoms, and family conflict. A new self-report measure of AFD evidencing good psychometric properties was used to test hypothesized relations among these variables in structural equation models (SEM). RESULTS: For both Asian American and Latinos, results indicated that higher levels of AFD were associated with higher psychological distress and greater risk for clinical depression, and that family conflict mediated this relation. CONCLUSION: AFD processes were associated with the mental health of students and the functioning of their families. These findings highlight potential foci to address in prevention and intervention programs, such as improving communication and teaching families how to negotiate cultural value differences.

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The authors examined the impact of perceived racial discrimination on various mental health outcomes for Asian American and Latino college students within an emic and etic framework. Results indicate that Asian American and Latino college students experienced similar exposure and reactions to various kinds of discrimination. However, Latino students were more likely than Asian American students to have been accused of doing something wrong, such as cheating and breaking the law, and more likely to appraise these experiences as stressful. Asian Americans evidenced higher risk for trait anxiety. Regardless of ethnicity, perceived racial discrimination was associated with several negative mental health outcomes, including higher psychological distress, suicidal ideation, state anxiety, trait anxiety, and depression. Findings highlight the need to address discrimination across multiple social and professional settings and to understand the broad array of mental health outcomes.

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This study examines the impact of level of acculturation and acculturative stress on the mental health of Asian American college students. Hierarchical regression analyses were used to clarify the relation between level of acculturation, acculturative stress, and mental health outcomes (psychological distress and clinical depression). Being less identified with mainstream United States culture was associated with higher psychological distress and clinical depression, but lost significance when acculturative stress was introduced into the model. Retention or relinquishing of identification with one's heritage culture was not associated with mental health outcomes. Although understanding level of acculturation can help us identify those at risk, findings suggest that acculturative stress is a more proximal risk factor and increases risk for mental health problems independently of global perceptions of stress.

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