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Background Barriers to mental health care access among Latinx children contribute to mental health disparities. It is unclear whether traditional spiritual guides in Latinx communities may function more as gateway providers or in some instances as deterrents to mental health treatment. This study assesses whether family involvement in Espiritismo and/or Santeria, two forefront non-Christian spiritual traditions among Latinx families, is associated with mental health care utilization among Puerto Rican children in two contexts. Methods Data are from Waves 1–3 (2000–2004) of the Boricua Youth Study, a population-based longitudinal cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico (PR), and the South Bronx, New York (SBx), 5 to 17 years of age (N = 2491). Results At baseline, 5.02% (n = 58) of the families reported involvement with Espiritismo and/or Santeria in the SBx and 3.64% (n = 52) in PR. Logistic regression models predicting mental health service use found, after adjusting for multiple risk and protective factors, that families involved with Espiritismo and/or Santeria were 2.41 times more likely (p = 0.0034) to use mental health services over the course of 3 years than children with no family involvement in these practices in the SBx. The same association was not found in PR. Conclusions The findings among PR families in the SBx lend support to the gateway provider model in which spiritual guides open doors to mental health treatment. Forming community connections between mental health providers and traditional spiritual groups may be a culturally considerate, fruitful approach to reducing barriers to mental health treatment among Latinx families.

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Objective: To examine the diagnoses, demographics, and prevalence of psychotherapy use among children and adolescents prescribed antipsychotics by psychiatric providers in a community setting. Methods: Medical records from 1127 children aged 0 to 17 years who were prescribed antipsychotics in 2014-2015 at Pine Rest Christian Mental Health Services (PRCMHS) outpatient network were analyzed. Antipsychotics, diagnosis codes, demographics, and number of psychotherapy sessions during this time frame were analyzed using χ2 and logistic regression analyses. Results: During this year, 50.8% of the patients attended psychotherapy, and 35.6% attended 5 or more sessions of psychotherapy. The most prevalent primary diagnosis was bipolar disorder (37.1%), followed by attention-deficit/hyperactivity disorder (19.7%). Females being treated with antipsychotics were significantly more likely to attend psychotherapy than their male peers (55.7% vs. 47.9%, P=0.01). In the fully adjusted models, patients with diagnoses of bipolar disorder or disorders first diagnosed in infancy, childhood, or adolescence were less than half as likely to attend psychotherapy as patients with depressive disorders, with adjusted odds ratios of 0.41 and 0.42, respectively. Conclusions: Approximately half of the child and adolescent patients prescribed antipsychotics in this community sample did not attend psychotherapy, and 39% of the patients did not have a diagnosis of bipolar disorder, psychotic disorder, or autistic disorder.

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Objective: To examine the relationship between maternal childhood trauma and early maternal caregiving behaviors (MCB). Method: Participants included 74 mother-infant dyads (maternal age 20-45 years; ethnicity 64.9% Latina) from a longitudinal pregnancy cohort study. Maternal childhood trauma was assessed during pregnancy with the childhood trauma questionnaire (CTQ). Observed mother-infant interactions at infant age 4 months were coded utilizing modified Ainsworth's MCB rating scales that assessed a range of behaviors (e.g., acceptance, soothing, and delight) which we analyze grouped together and will summarize using the term "maternal sensitivity." Linear regressions tested the associations between maternal childhood trauma and MCB. Primary analyses examined the relationships of MCB with (a) any maternal childhood trauma (moderate or greater exposure to physical abuse, sexual abuse, emotional abuse, physical neglect, and/or emotional neglect) and (b) cumulative childhood trauma. Secondary analyses examined the relationships between each type of childhood trauma and MCB. Results: Exposure to childhood trauma was not associated with MCB (p = .88). Cumulative childhood trauma score was associated with lower scores on MCB (β = −1.88, p , .05). Emotional abuse and emotional neglect were individually associated with lower scores on MCB (β = −1.78, p = .04; β = −1.55, p = .04, respectively). Physical abuse, sexual abuse, and physical neglect were not associated with MCB. Conclusions: Many mothers exposed to childhood trauma may be resilient to negative effects on parenting behaviors, while specific experiences of childhood trauma (emotional abuse, emotional neglect, and cumulative childhood trauma) may predict less sensitive early parenting behaviors. Clinical Impact StatementThe impact of childhood trauma on very early parenting behaviors needs to be better clarified to identify parents who could most benefit from parenting interventions. This small, but methodologically rigorous, study of ethnically diverse mothers and infants provides preliminary results demonstrating that many mothers may be resilient to a limited exposure to trauma. Cumulative childhood trauma, and emotional abuse and neglect, however, predict less sensitive early parenting behaviors.

Objective: To assess depression response and remission rates with electroconvulsive therapy (ECT) in a community clinic and to identify factors predicting success in treatment. Methods: We identified 35 patients by a retrospective chart review with a diagnosis of major depressive disorder or depressive disorder not otherwise specified (according to the Diagnostic and Statistical Manual of Mental Disorders IV-TR) who were treated with an acute series of ECT at the Pine Rest ECT Clinic from March, 2014 to March, 2015. Clinical variables, demographics, depression response rates (based on Patient Health Questionnaire-9; PHQ-9), and anxiety response rates (based on Generalized Anxiety Disorder 7-item) were analyzed. Results: Depression response (defined as ≥ 50% reduction in PHQ-9 score) and remission rates (defined as final PHQ-9 score < 5) were 54.3% and 31.4%, respectively. This was a highly treatment resistant sample, with an average of 5.3 antidepressant failures prior to initiating ECT. Logistic regression analysis found that depression response rates were predicted by an improvement in anxiety symptoms (odds ratio 1.41; 95% confidence interval, 1.11, 1.78). Additionally, patients with initial severe anxiety scores were less likely than other patients to exhibit a response in depression (p = .027). Conclusion: Almost half of this sample of patients with treatment resistant depression did not respond to ECT in this community-based clinic. Patients who experienced a response in anxiety symptoms were more likely to experience a depression response while those with severe anxiety were less likely to respond.

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