The present commentary offers a timely exploration of the racial trauma experienced by Asian, Black, and Latinx communities as it relates to COVID-19. Instances of individual, cultural, and structural racism and implications for mental health are discussed. Evidence-based strategies are identified for mental health professionals in order to support healing and mitigate the risk of further racial traumas.
Highlights
This study focused on implementation processes, and facilitators and barriers to ACEs screenings.
There was high feasibility and acceptability of ACEs screenings at infants’ pediatric visits.
Almost half of families at well‐child pediatric visits indicated positive for ACEs.
A majority of families with ACEs accepted prevention services in the pediatric setting.
Wellness navigators provided a cultural bridge and service access in integrated behavioral health.
High rates of exposure to violence and other adversities among Latino/a youth contributes to health disparities. The current paper addresses the ways in which community-based participatory research (CBPR) and human centered design (HCD) can help to engage communities in dialogue and action. We present a project exemplifying how community forums, with researchers, practitioners, and key stakeholders, including youth and parents, integrated HCD strategies with a CBPR approach. Given the potential for power inequities between these groups, CBPR+HCD acted as a catalyst for reciprocal dialogue and generated potential opportunity areas for health promotion and change. Future directions are described.
A growing body of research suggests that personality characteristics relate to physical health; however, this relation ship has primarily been tested in cross-sectional studies that have not followed the participants into old age. The present study utilizes data from a 70-year longitudinal study to prospectively examine the relationship between the adaptive defense mechanisms in midlife and objectively assessed physical health in late life. In addition to examining the direct effect, we test whether social support mediates this relation ship. The sample consisted of 90 men who were followed for over seven decades beginning in late adolescence. Health ratings from medical records were made at three time points (ages 70, 75, and 80). Defense mechanisms were coded from narratives by trained independent raters (Vaillant, Bond, & Vaillant, 1986). Independent raters assessed social supports between ages 50 and 70. More adaptive defenses in midlife were associated with better physical health at all three time points in late life. These relationships were partially mediated by social support. Findings are consistent with the theory that defense maturity is important for building social relationships, which in turn contribute to better late-life physical health. Psychological interventions aimed at improving these domains may be beneficial for physical health.
It is important to understand racial/ethnic differences in adverse childhood experiences (ACEs), given their relationship to long‐term physical and mental health, and the public health cost of the significant disparities that exist. Moreover, in order to inform interventions and promote resilience, it is critical to examine protective factors that mitigate the relationship between adversity and poor health. The current study utilized latent transition analyses (LTA) to examine co‐occurring profiles of ACEs and protective factors (from school, family, and community contexts) and links to health outcomes among 30,668 Black (10.4%), Latinx (12.3%), and White youth (77.3%) ages 12–17 (52.5% male) who participated in the 2011–12 National Survey of Children's Health (NSCH). Results suggested that greater adversity was associated with worse health, while more access to protective factors was associated with better health. White youth had consistently lower endorsement of ACEs, greater access to protective factors, and better health compared to their Black and Latinx counterparts. Efforts to improve child health and racial/ethnic disparities in research and practice must consider adversity, protective factors, and the systemic inequities faced by racial/ethnic minority youth in the United States.
Widespread implementation of adverse childhood experiences (ACEs) screening is occurring in the United States in response to policies and practice recommendations. However, limited research has established how these screening efforts impact the health care system and ultimately health outcomes. This article examines the current knowledge base on screening in medical settings. A scoping review of articles reporting on ACEs screening and prevalence in the United States was conducted. Of the 1,643 unique studies across two decades, 12 articles meeting criteria included nine on routine screening in medical settings and three on population-based surveys. A Monte Carlo simulation model was designed to synthesize evidence, identify key areas of uncertainty, and explore service system implications. Results indicated significant heterogeneity in the proportion of respondents who reported ACEs, with 6% to 64% of patients reporting 1ϩ ACEs and .01% to 40.7% reporting 4ϩ ACEs. Gaps in the literature were identified regarding cut-scores for referrals and referral completion rates. Three scenarios, modeled based on these data and past research on behavioral health screenings in pediatric primary care, demonstrated how ACEs screening may differentially impact behavioral health care systems. Priorities for future research were highlighted to refine estimates of the likely impact of ACEs screening on health care delivery.
Public Significance StatementSignificant efforts are being made to screen for and respond to ACEs within primary care settings to help mitigate the individual and public health impact of ACEs. A scoping review and simulation modeling demonstrated the potential impacts of ACEs screening on the supply and demand for behavioral health care services.
Erikson’s (1950) model of
adult psychosocial development outlines the significance of successful
involvement within one’s relationships, work, and community for healthy
aging. He theorized that the consequences of not meeting developmental
challenges included stagnation and emotional despair. Drawing on this model, the
present study uses prospective longitudinal data to examine how the quality of
assessed Eriksonian psychosocial development in midlife relates to late-life
cognitive and emotional functioning. In particular we were interested to see
whether late-life depression mediated the relationship between Eriksonian
development and specific domains of cognitive functioning (i.e., executive
functioning and memory).
Participants were 159 men from the over 75 year longitudinal Study of
Adult Development. The sample was comprised of men from both higher and lower
socio-economic strata. Eriksonian psychosocial development was coded from
men’s narrative responses to interviews between the ages of
30–47 (Vaillant and Milofsky,
1980). In late life (ages 75–85) men completed a performance
- based neuropsychological assessment measuring global cognitive status,
executive functioning, and memory. In addition depressive symptomatology was
assessed using the Geriatric Depression Scale.
Our results indicated that higher midlife Eriksonian psychosocial
development was associated with stronger global cognitive functioning and
executive functioning, and lower levels of depression three to four decades
later. There was no significant association between Eriksonian development and
late-life memory. Late-life depression mediated the relationship between
Eriksonian development and both global cognition and executive functioning. All
of these results controlled for highest level of education and adolescent
intelligence.
Findings have important implications for understanding the lasting
benefits of psychosocial engagement in mid-adulthood for late-life cognitive and
emotional health. In addition, it may be that less successful psychosocial
development increases levels of depression making individuals more vulnerable to
specific areas of cognitive decline.
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