Familism, a cultural value that emphasizes warm, close, supportive family relationships and that family be prioritized over self, has been associated with psychological health. The goal of this work was to fill a gap in the literature on how familism contributes to psychological health. Drawing from conceptual links between familism and close relationship processes, we hypothesized that familism contributes to better psychological health by facilitating closeness and social support. A university sample of U.S. women and men of Latino (n = 173), European (n = 257), and Asian (n = 642) cultural backgrounds completed measures of familism, closeness to family members, general perceived social support, and psychological health as indexed by perceived stress, general mental health, and depressive symptoms. Structural equation multiple-group modeling analyses found direct effects of familism on closeness to family members and perceived social support and an indirect effect of familism on better psychological health via greater closeness to family members and greater perceived social support. These effects did not differ by cultural background. Consistent with previous research, however, Latinos reported the highest levels of familism of the three cultural groups, and women reported higher familism and support as well as poorer psychological health than men. Discussion is focused on the implications of these findings for understanding the association of familism with psychological health and the relevance of the familism construct for diverse U.S. groups.

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This article outlines the development and usability–feasibility testing of an automated text-messaging adjunct to cognitive– behavioral therapy (CBT) for depression in a public sector clinic serving low-income patients. The text-messaging adjunct is aimed at increasing homework adherence, improving self-awareness, and helping track patient progress. Daily text messages were sent to patients, inquiring about their mood. Additional daily messages corresponded to themes of a manualized group CBT intervention. These included (1) thought tracking (both positive and negative), (2) tracking of pleasant activities, (3) tracking of positive and negative contacts, and (4) tracking of physical well-being. We tested the adjunct in 2 CBT groups (1 English & 1 Spanish) consisting of 12 patients total during and after treatment. Participants responded at a rate of 65% to text messages, and they reported overall positive experiences. We propose that text messaging has the potential to improve mental health care broadly, and among low-income populations specifically, with cost-effective means.

BackgroundCognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy.ObjectivesThe aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients.MethodsPatients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week’s content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills.ResultsIntent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=−2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=−1.65, P=.10). Both patients assigned to the text messaging adjunct (B=−.29, 95% CI −0.38 to −0.19, z=−5.80, P<.001) and patients assigned to the control conditions (B=−.20, 95% CI −0.32 to −0.07, z=−3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction.ConclusionsThis study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment.

Psychological assessment and intervention are extending from the clinic into daily life. Multiple forces are at play: Advances in mobile technology, constrained clinical care, and consumer demand for contextualized, nonstigmatizing, and low-cost alternatives are beginning to change the face of psychological assessment and interventions. Mobile, social, and wearable technologies are now enabling individuals to measure themselves and to integrate myriad forms of help and entertainment. The massive data sets generated by self-tracking of mood and passive sensing of voice, activity, and physiology may eventually reorganize taxonomies of mental health concerns. Compelling mobile therapies will also emerge, involving contextually appropriate, entertaining, and dynamic feedback to provide help in the context of daily life. The efficacy of such applications will be tested through citizen science as well as clinical trials. This article reviews technical advances that can be applied to enhance assessment and intervention and dramatically increase access to psychotherapy. It is recommended that, in addition to exploring clinically oriented products, practitioners should support patients’ use of direct-to-consumer applications in ways that align with therapeutic objectives.

Ecological momentary interventions (EMIs) are becoming more popular and more powerful resources for the treatment and prevention of depression and anxiety due to advances in technological capacity and analytic sophistication. Previous work has demonstrated that EMIs can be effective at reducing symptoms of depression and anxiety as well as related outcomes of stress and at increasing positive psychological functioning. In this review, we highlight the differences between EMIs and other forms of treatment due to the nature of EMIs to be deeply integrated into the fabric of people's day-to-day lives. EMIs require unique considerations in their design, deployment, and evaluation. Furthermore, given that EMIs have been advanced by changes in technologies and that the use of behavioral intervention technologies for mental health has been increasing, we discuss how technologies and analytics might usher in a new era of EMIs. Future EMIs might reduce user burden and increase intervention personalization and sophistication by leveraging digital sensors and advances in natural language processing and machine learning. Thus, although current EMIs are effective, the EMIs of the future might be more engaging, responsive, and adaptable to different people and different contexts.

The authors developed and tested a 35-min psychoeducational program with the goal of increasing Spanish-speaking persons’ literacy of psychosis. The program uses popular cultural icons derived from music, art, and videos, as well as a mnemonic device—La CLAve (The Clue)—to increase (a) knowledge of psychosis, (b) efficacy beliefs that one can identify psychosis in others, (c) attributions to mental illness, and (d) professional help-seeking. Assessments were conducted before and after administering the program to both community residents (n = 57) and family caregivers of persons with schizophrenia (n = 38). For community residents, the authors observed increases across the 4 domains of symptom knowledge, efficacy beliefs, illness attributions, and recommended help-seeking. For caregivers, increases were observed in symptom knowledge and efficacy beliefs. La CLAve is a conceptually informed psychoeducational tool with a developing empirical base aimed at helping Spanish-speaking Latinos with serious mental illness obtain care in a timely manner.