Rejected by Caregivers but Connected to Others: Resilience Factors and Negative Mental Health Outcomes Among LGBTQ+ Emerging Adults

Objective: Military Sexual Trauma (MST) has been found to be positively associated with mental health outcomes, such as posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, symptoms of anxiety, and insomnia severity (Jenkins et al., 2015; O'Brien & Sher, 2013). Male survivors of MST face unique challenges, including concerns associated with hypermasculinity (e.g., restrictive emotionality [RE]). Men with high RE (difficulty expressing emotions) report more negative mental health outcomes compared to men with low RE (Good et al., 1995). The present study investigated whether RE moderated the relationship between MST and negative mental health outcomes, while controlling for combat exposure (CE) and age to further assess confounding variables. Method: One hundred thirty-four adult male veterans in behavioral health treatment at a large VA medical center in the mid-Atlantic region of the United States were recruited. Participants provided self-reported data on MST and symptoms of PTSD, depression, anxiety, and insomnia, as well as their endorsement of restrictive emotionality. PROCESS v3.3 (Hayes, 2017) regression analytic method was used to test main and interaction effects. Results: MST was a significant predictor of PTSD symptoms and insomnia severity-but not depressive symptoms or symptoms of anxiety. RE also moderated the relationship between MST and PTSD symptoms, depressive symptoms, and insomnia, after controlling for CE and age. Conclusion: These findings suggest that restricting emotions has a negative influence on men's mental health functioning. Therefore, assessing male veterans' experiences of expressing their emotions within the context of masculinity and their military training will likely have implications on trauma processing and treatment outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

To assess the effect of displacement due to Hurricane Sandy on mental health outcomes among residents of the greater New York City (NYC) area. Prospective, cross sectional. NYC area residents, including Queens, Staten Island, and Long Island. In a 4.25 year period (June 2012 to September 2016), a convenience sample of 1,615 adult residents from the greater NYC area completed validated measures of hurricane exposure (including displacement), perceived stress, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms as well as indicators of alcohol, illicit substance, and tobacco use. Perceived stress, depression, anxiety and PTSD symptoms and alcohol, illicit substance, and tobacco use. Multivariable analyses indicated that displaced participants were more likely to have PTSD (adjusted odds ratio [AOR]: 2.21, 95% CI: 1.73-2.82), depression (AOR: 1.37, 95% CI: 1.05-1.79) and anxiety symptoms (AOR: 1.30, 95% CI: 1.01-1.67) and had a 1.16 unit increase in perceived stress score (SE = 0.38) compared to nondisplaced participants. Staying with friends/family versus at a shelter was significantly associated with a 48 percent decreased odds of having PTSD symptoms (AOR: 0.52, 95% CI: 0.31-0.88) and of being a current tobacco user (AOR: 0.52, 95% CI: 0.30-0.92). Displacement is associated with negative mental health outcomes, particularly displacement to shelters. Disaster preparedness efforts should involve increasing mental health resources to those who are displaced and providing support services within the shelter setting.

Caregivers of patients in vegetative state and minimally conscious state play a crucial role in the process of taking care and, as previous studies reported, they can suffer of high burden and negative health outcomes. The aim of this national cross-sectional study was to assess whether physical and mental health of caregivers, considering gender differences, is related to the presence of depressive symptoms, anxiety, age and patient's disease duration. Four-hundred and eighteen caregivers, 294 women and 124 men, completed the State Trait Anxiety Inventory-Y, Beck Depression Inventory, second version and Short Form-12. Hierarchical multiple regression analyses were performed to evaluate to which extent depressive and anxiety symptoms predict physical and mental health. Men reported higher levels of mental health state, whereas physical health was not different across gender. High levels of anxiety symptoms were associated to negative mental health outcomes in both genders, whereas depressive symptoms were found to impact on female's mental and physical health only. A comprehensive and cost-effective screening of anxiety and depressive symptoms may help to identify determinants of health worsening in order to plan, when necessary, caregivers' support. Female caregivers of patients in vegetative state and minimally conscious state have poorer levels of mental health, whereas physical health is similar to men's. Anxiety symptoms are related to negative mental health outcomes in both male and female caregivers, whereas depressive symptoms are found to impact on female mental and physical health only. It is essential to consider and assess depressive and anxiety symptoms as they may contribute to caregivers' health worsening. This knowledge can lead to plan more comprehensive and tailored caregivers' supports and a better care for patients.

A great deal of research in the military context has focused on deployment-related stressors and their relationship to negative mental health outcomes; however, there is a paucity of research examining how the unique stressors soldiers face while in garrison (i.e., at their home base or installation; e.g., lack of meaningful work) relate to these outcomes. Because many in garrison stressors are either a necessary part of the job (e.g., environmental aspects like dust, sand, insects, or animals) or would require large-scale, systematic changes (e.g., mandatory trainings), it is important to examine modifiable elements that could buffer against negative mental health outcomes in this context, such as unit cohesion. Past research has found that high levels of unit cohesion weaken the relationship between deployment-related stressors and negative mental health outcomes; therefore, the primary hypothesis of this study is that unit cohesion will moderate the relationship between in garrison occupational stressors and mental health outcomes, with greater unit cohesion associated with a weaker relationship between in garrison occupational stressors and mental health outcomes. To examine this hypothesis, the present study analyzed data from 500 active duty soldiers located at an Army installation in the continental United States. As part of a larger study, participants completed self-report measures focusing on in garrison occupational stressors, unit cohesion, and mental health outcomes (i.e., symptoms of PTSD, anxiety, & depression). Unit cohesion was found to only significantly moderate the relationship between work stressors and symptoms of anxiety (as indicated by scores on the GAD-7). Implications, limitations, and future directions are discussed.

Although killing in combat is associated with negative mental health outcomes and hazardous alcohol use, mechanisms that underlie this risk are not well understood. To our knowledge, this present brief report is the first to use mediation analysis to examine associations between killing in combat, distinct facets of rumination (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts), and negative mental health outcomes (i.e., depression, anxiety, PTSD, suicidality) and hazardous alcohol use. Participants were a community sample of 283 military personnel (158 males [60.31%]; mean age = 32.61 [SD = 7.11]) who had deployed in support of recent wars in Iraq or Afghanistan. Participants completed an online self-report survey. Three rumination facets (i.e., problem-focused thoughts, counterfactual thinking, and anticipatory thoughts) uniquely (controlling for effects of other rumination facets) mediated the associations between killing in combat and negative mental health outcomes and hazardous alcohol use. Taken together, killing in combat was associated with higher levels of each rumination facet, which in turn were distinctly associated with more negative symptoms of mental health and more hazardous drinking (problem-focused thoughts were the only facet to mediate all effects). Beyond these significant mediation effects, killing in combat still had a significant direct effect on every outcome. These findings provide preliminary support for associations between killing in combat and negative mental health outcomes and hazardous alcohol use. Furthermore, rumination (particularly problem-focused thoughts) may be an important consideration in the evaluation and care of recent-era combat veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: Studies on mental health rates among primary school children are still limited, particularly related to psychological trauma and its relationship to other mental health challenges. Objective: The objective of this study was to 1) examine the prevalence of PTSD, depression, and anxiety symptoms in primary school children before the Covid-19 pandemic; 2) identify the relationship between PTSD, depression and anxiety symptoms; and 3) investigate potential gender differences in PTSD symptoms. Methods: This is the first cross-sectional study examining the rates of trauma exposure, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in primary school children before the covid-19 pandemic in Malaysia. Two hundred and twenty-one students participated in this study. They were recruited from four primary schools that volunteered to participate in this study. PTSD Checklist for DSM-5 (PCL-5), Child PTSD Symptoms Scale-5 (CPSS-5), The Center for Epidemiologic Studies Depression Scale version (CESD), and the Spence Children's Anxiety Scale (SCAS) were used to survey psychological symptoms. Results: Most of the students, or 54.3% of them, have experienced at least one traumatic event. Of 221 students, 39.4% reported having PTSD symptoms, 38% reported having depressive symptoms, and 19% reported having anxiety symptoms. Female students were more likely to report PTSD symptoms compared to male students. The first regression analysis model indicated that depressive symptoms were the only significant predictors of PTSD. In the second model, religion, family income, anxiety, and PTSD symptoms were significant predictors of depressive symptoms. In the third model, depressive symptoms were the sole significant predictors of anxiety. Conclusion: The study reveals that primary school children experience high levels of trauma, PTSD, depression, and anxiety, especially before the COVID-19 pandemic. During the early phases of the pandemic, these mental health issues have been largely neglected in Malaysia, with limited preventative and therapeutic interventions available. Future research should focus on documenting the prevalence of these issues in relation to the COVID-19 pandemic.

BackgroundViolence against women (VAW) is a major public health and human rights concern with profound mental health consequences. However, the association between specific VAW forms and mental health, particularly among left-behind women in rural China, remains unclear.ObjectiveThis study aimed to identify the associations of VAW with depression, anxiety, and comorbid symptoms and to explore the potential roles of resilience and social support.MethodsThe cross-sectional survey was conducted in Y City, Henan Province, China, in July 2023. A multistage stratified random sampling method was used to recruit left-behind women, resulting in a final sample of 1503 participants. Data on participants and their VAW were collected through a face-to-face questionnaire survey. The forms of VAW assessed were nonpartner violence (NPV) and intimate partner violence (IPV; including remote IPV). Depressive symptoms were evaluated using the 10-item Center for Epidemiological Studies Depression Scale, while anxiety symptoms were assessed with the Generalized Anxiety Disorder-7. The comorbid symptoms of depression and anxiety (CDA) were ascertained as the simultaneous presence of depressive and anxiety symptoms. A multivariable logistic regression model was used to estimate the odds ratio and 95% CIs. A 4-way decomposition analysis was conducted to test the mediation roles and interactions of resilience and social support between VAW and mental health outcomes. Population attributable fractions and pathway-specific population attributable fractions were calculated to estimate the burden of mental health outcomes attributable to VAW.ResultsLifetime VAW (adjusted odds ratio [aOR] 1.84, 95% CI 1.32‐2.54) was associated with an increased risk of CDA. Women who were exposed to lifetime IPV (aOR 1.84, 95% CI 1.32‐2.56), remote IPV (aOR 2.79, 95% CI 1.60‐4.74), and NPV (aOR 2.63, 95% CI 1.58‐4.26) had an increased likelihood of reporting CDA. Similar associations could also be found for depressive symptoms and anxiety symptoms. In the 4-way decomposition analysis for VAW and CDA, mediation effects of low resilience and social support were statistically significant (P<.05), whereas none of the interactions reached significance (P>.05). The pure mediation proportion was 28.2% for the low resilience and 18.6% for the social support between VAW and CDA. A total of 20.8% of CDA cases, 15.1% of depressive symptoms cases, and 22.7% of anxiety symptoms cases were attributable to VAW. Among these, low resilience accounted for 7.2% and low social support accounted for 4.7% of CDA cases as mediators.ConclusionsLifetime VAW, including IPV (and remote IPV) and NPV, shows significant associations with CDA and depressive and anxiety symptoms among rural left-behind women in China. The associations are partly mediated by low resilience and social support. Targeted strategies, including efforts to reduce violence against rural left-behind women, enhance their resilience and strengthen their social support networks, are urgently needed.

P03-508 - The influence of social support, conflict, and stressful life events on PTSD, depression, and anxiety symptom severity in U.S. army female veterans

For academic researchers and interested individuals who would like to learn more about internalized racism and health, we suggest reviewing the papers listed in the Author Recommends section. For educators of introductory level undergraduates, we recommend the resources in the Online Materials section. For educators of upper-level undergraduates and graduate students, we recommend the resources in the Sample Syllabus section. Gale, M. M., Pieterse, A. L., Lee, D. L., Huynh, K., Powell, S., & Kirkinis, K. (2020). A meta-analysis of the relationship between internalized racial oppression and health-related outcomes. The Counseling Psychologist, 48(4), 498–525. https://doi.org/10.1177/001445w. In this meta-analysis, the authors reviewed 29 studies (32 effect sizes) on the relationships between internalized racism and negative physical and mental health outcome. They found that internalized racism is associated with negative physical and mental health outcomes. Williams, D. R., & Mohammed, S. A. (2013). Racism and health I: Pathways and scientific evidence. American Behavioral Scientist, 57(8), 1152–1173. https://doi.org/10.1177/0002764213487340. This paper outlines the multiple pathways by which racism can affect health. The model emphasizes the importance of distinguishing basic causes from surface or intervening causes. Hwang, W. C. (2021). Demystifying and addressing internalized racism and oppression among Asian Americans. American Psychologist, 76(4), 596–610. https://doi.org/10.1037/amp0000798. In this paper, the author reviews the literature on internalized racism among Asian Americans. They also discuss the importance of addressing the individual, family, and community mental health consequences of internalized racism. Last, they discuss preventive interventions to reduce internalized racism among Asian Americans. Graham, J. R., West, L. M., Martinez, J., & Roemer, L. (2016). The mediating role of internalized racism in the relationship between racist experiences and anxiety symptoms in a Black American sample. Cultural Diversity and Ethnic Minority Psychology, 22(3), 369–376. https://doi.org/10.1037/cdp0000073. Using cross-sectional data, the study explored the potential mediating role of internalized racism in the relationship between racist experiences and anxiety symptomology in a Black American sample. They found that internalized racism mediated the relationship between past-year frequency of racist events and anxious arousal as well as past-year frequency of racist events and stress symptoms. Thus, internalized racism mediates between inter-personal stigma and health. James, D. (2021). Self-and group-focused internalized racism, anxiety, and depression symptoms among African American adults: A core self-evaluation mediated pathway. Group Processes & Intergroup Relations, 24(8), 1335–1354. https://doi.org/10.1177/1368430220942849. Using cross-sectional data, this paper shows that internalized racism is indirectly associated with greater anxiety and depression symptoms via the affective (self-esteem, emotional stability), but not the motivational (locus of control, self-efficacy), components of core self-evaluations. That is, internalized racism is leads to adverse health via a self-evaluation- mediated pathway. Smith, L. L. (2022). Speaking the Unspoken: Understanding Internalized Racial Oppression from the Perspective of Black Women Psychotherapists. Smith College Studies in Social Work, 92(1), 48–72. https://doi.org/10.1080/00377317.2022.2026855. This article explored how Black women psychotherapists understand internalized racism and whether this understanding influences psychotherapy with Black women clients. The author uses information from qualitative interviews to begin a discussion about the ways in which mental health providers can assess and target internalized racism. Steele, J. M. (2020). A Cognitive Behavioral Therapy (CBT) approach to internalized racism among African Americans. International Journal for the Advancement of Counseling, 42(3), 217–233. https://doi.org/10.1007/s10447-020-09402-0. This article presents a CBT approach to understanding and treating internalized racism among African American clients. Racism and health https://www.cdc.gov/minorityhealth/racism-disparities/index.html. What is internalized racism? https://www.youtube.com/watch?v=RBrW129hKmg. Host Farah Nasser chats with University of Toronto professor Girish Daswani, as well as writer and communications professional, Gelek Badheytsang about internalized racism, how some people of color can develop self-hate for their own community, and how to unlearn it. https://www.racialequitytools.org/resources/fundamentals/core-concepts/internalized-racism. Healing from internalized racism https://www.youtube.com/watch?v=LUl8tc7QlIo. Dr. Janeé M. Steele, faculty at Walden University, and a licensed professional counselor and certified CBT therapist, discuss how to heal from internalized racism. https://www.pbs.org/video/a-true-story-of-internalized-racism-ykccak/. A True Story of Internalized Racism: Jo talks about her opinions and experiences with internalized racism, the way we process racism, and how to be better than our mistakes. Jones, C. P. (2000). Levels of racism: a theoretic framework and a gardener's tale. American Journal of Public Health, 90(8), 1212–1215. https://doi.org/10.2105/ajph.90.8.1212. Williams, D. R., Lawrence, J. A., & Davis, B. A. (2019). Racism and health: evidence and needed research. Annual Review of Public Health, 40, 105–125. https://doi.org/10.1146/annurev-publhealth-040218-043750. David, E. J. R., Schroeder, T. M., & Fernandez, J. (2019). Internalized racism: A systematic review of the psychological literature on racism's most insidious consequence. Journal of Social Issues, 75(4), 1057–1086. https://doi.org/10.1111/josi.12350. Huber, L. P., Johnson, R. N., & Kohli, R. (2006). Naming racism: A conceptual look at internalized racism in US schools. Chicano-Latino Law Review, 26, 183–206. https://doi.org/10.5070/C7261021172. Bailey, T.-K. M., Chung, Y. B., Williams, W. S., Singh, A. A., & Terrell, H. K. (2011). Development and validation of the Internalized Racial Oppression Scale for Black individuals. Journal of Counseling Psychology, 58(4), 481–493. https://doi.org/10.1037/a0023585. David, E. J. R., & Okazaki, S. (2006). The Colonial Mentality Scale for Filipino Americans: Scale construction and psychological implications. Journal of Counseling Psychology, 53(2), 241–252. https://doi.org/10.1037/0022-0167.53.2.241. James, D. (2021). Self-and group-focused internalized racism, anxiety, and depression symptoms among African American adults: A core self-evaluation mediated pathway. Group Processes & Intergroup Relations, 24(8), 1335–1354. https://doi.org/10.1177/1368430220942849. Trieu, M. M. (2019). Understanding the use of “twinkie,” “banana,” and “FOB”: Identifying the origin, role, and consequences of internalized racism within Asian America. Sociology Compass, 13(5), e12679. https://doi.org/10.1111/soc4.12679. Thomas, A. J., Witherspoon, K. M., & Speight, S. L. (2004). Toward the development of the stereotypic roles for Black women scale. Journal of Black Psychology, 30(3), 426–442. https://doi.org/10.1177/0095798404266061. Velez, B. L., Polihronakis, C. J., Watson, L. B., & Cox Jr, R. (2019). Heterosexism, racism, and the mental health of sexual minority people of color. The Counseling Psychologist, 47(1), 129–159. https://doi.org/10.1177/0011000019828309. None. The author has no conflicts of interest to disclose. Drexler James is an assistant professor of psychology at the University of Minnesota, Twin Cities. He received his Ph.D. in social/personality psychology from the University of Illinois at Chicago. Drexler's research examines how different dimensions of oppression become embodied at multiple levels to affect the health of racial and sexual minorities. His research uses and advances theories of social stigma to investigate the antecedents and consequences of internalized oppression, the mechanisms through which it may contribute to racial and sexual minority health inequities, and the factors that may exacerbate or mitigate its effects on health. His research makes significant theoretical contributions, advances our understanding of self-stigma, internalized racism, internalized homophobia, and health inequities, and has practical implications for improving the lives of marginalized communities.

PurposeUnderstanding the individual and joint associations of positive and negative mental health with screen-time and physical activity (PA) among adolescents is essential to develop enhanced guidance for prevention strategies and appropriate interventions.MethodsParticipants (n=879, n = 463 female, mean age 14.71 (SD = 1.51) years) from second-level schools in Ireland completed a battery of well-validated questionnaires assessing hours of daily screen-time use (TV, computer, and phone), PA levels (PACE+) (low (0–2 day/week), moderate (3–4 day/week), or high (5+day/week), and mental health outcomes (anxiety (STAI-Y2) and depressive symptoms (QIDS) and positive mental health (MHC-SF)). Multiple linear regressions examined associations between screen-time, PA and mental health and one-way ANOVA’s examined differences in mental health outcomes between screen-time mode and use categories (none (0 hours), low (0.5-1.5 hours), moderate (2-4.5 hours), and high (5+ hours)). Cohen’s d effect size and 95% confidence intervals quantified the magnitude of the difference.ResultsHigher computer (β=0.112, p≤0.001) and phone use (β=0.138, p≤0.001) were associated with higher depressive symptoms. Higher TV use (β=-0.111, p≤0.002) and PA levels (β=-0.123, p≤0.001) were associated with lower anxiety symptoms. Higher phone use (β=0.113, p≤0.002) and PA levels (β=0.116, p≤0.001) were associated with higher positive mental health. The magnitude of differences in depressive and anxiety symptoms across screen-time use categories were largely small-to-moderate (d = 0.02 to 0.67) and in positive mental health, ranged from small to large (d = 0.03 to 0.88). The sample was then stratified by PA level to assess the potential moderating influence of PA on the screen-time-mental health association, with mixed results.ConclusionsResults are among the first findings regarding the relationship between screen-time mode and PA levels with mental health, particularly positive mental health among adolescents in Ireland. Associations of screen-time and PA with mental health outcomes varied according to PA level and screen-time mode. The variation in these findings suggest the need to investigate the context of screen-time use and the screen-time activity engaged with. These results suggest that not all screen-time is detrimental and some, in moderation, may be beneficial for mental health. Future research should investigate longitudinal associations between screen-time, PA, and mental health.Support/Funding SourceN/A

Burnout is a mental health problem that appears to be increasingly common among athletes. Importantly, burnout may also simultaneously increase the risk for other health consequences. In order to examine this idea further, in the present study we provide the first systematic review and meta-analysis of the association between athlete burnout and mental and physical health outcomes. A literature search returned 54 studies (N = 13,976 athletes) examining various negative (e.g. depression, anxiety, insomnia; 27 studies) and positive (e.g. satisfaction, vitality, quality of life; 19 studies) mental health outcomes and physical health outcomes (e.g. biomarkers, somatic symptoms, physiological indices; 18 studies). A systematic review of this literature showed that athlete burnout was associated with both increases in negative mental health outcomes and decreases in positive mental health outcomes. However, evidence for an association between athlete burnout and physical health outcomes was mixed. This broad pattern of findings was supported by a meta-analysis. Our review suggests that burnout may indeed have many negative implications for athletes’ health. The findings also identify a need for further research in this area, especially in relation to burnout and its longitudinal association with biomarkers and physiological indices.

This study sets out to gauge the relationship between developmental assets of adolescents and their negative mental health outcomes. Sample size comprised of 346 respondents of disadvantaged (at-risk) youth from suburban areas of Kuala Lumpur by using purposive and snowball sampling techniques. Two instruments were used; General Health Questionnaire (GHQ-12) by Goldberg and Williams © (1988) to measure negative mental health outcomes (depression/anxiety and social dysfunctions) and a shorter version of Developmental Assets (© Search Institute) to measure developmental assets. Correlation and multiple regression were employed to test the hypotheses through SPSS (V.22.0). Results depict none of the internal assets had significant correlation with negative mental health outcomes, and external assets; particularly, the hope and expectations of family members have significant negative correlation with depression, anxiety and social dysfunction. While, positive peer influence and neighbourhood religiosity had significant negative correlation with overall negative mental health outcomes. On the other hand, hope and expectations of parents toward their adolescents can predict the severity of negative mental health outcomes. Conclusively, findings exhibit positive influence of peers and neighbourhood religiosity are inversely proportional to negative mental health outcomes. The implications of this study would suggest good and timely parental monitoring of the adolescents is a significant contributor in positive youth development. DOI: 10.5901/mjss.2015.v6n5s1p452

BackgroundChildren orphaned by parental AIDS or those of parents with HIV infection demonstrate many negative mental health outcomes. Different types of psychosocial interventions have been conducted to improve the psychological well-being of these children. The efficacy of these psychosocial interventions has been reviewed and synthesized recently (Skeena et al., Vulnerable Child Youth Stud 12:91-116, 2017), but not quantified.MethodThis study therefore adopted meta-analytic approach to quantify the efficacy of the existing psychosocial interventions on depressive and anxiety symptoms in children affected by parental HIV/AIDS. Eight intervention studies—four randomized controlled trials (RCT) and four pre–post intervention trials—were included.ResultIn general, psychosocial interventions could effectively reduce anxiety or depressive symptoms in children of parents with HIV/AIDS. The overall intervention effect size (Cohen’s d) was 1.298 and 1.100 for depressive and anxiety symptoms, respectively. Publication bias and exploratory moderating effects of study design (RCT vs. pre–post intervention trials), study location, and intervention levels were also analyzed.ConclusionFuture studies reporting the detailed outcome data, which could be used for research integration, are warranted. Further research should also focus on the implementation of evidence-based interventions sensitive to the target population in a developmentally appropriate manner.

Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18–34) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW; 24.9%), (2) cisgender sexual minority men (SMM; 63.8%), and (3) gender minority individuals (GMI; 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily; and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.

In September 2017, Category 4 Hurricane Maria devastated Puerto Rico (PR). This cross-sectional study evaluated the long-term mental health outcomes among women who were pregnant during or became pregnant shortly after (i.e., within 3 months) hurricane exposure. The HELiOS Study cohort recruited 187 mother-child dyads. Mothers reported prenatal hurricane-related experiences (threat, injury, property loss) and completed assessments of posttraumatic stress disorder (PTSD), perceived stress, and depressive symptoms. Maternal probable depression (19.5%), probable PTSD (21.4%), and moderate-to-severe stress (66.1%) were prevalent 12-54 months postpartum. Linear regression models showed that property damage/loss predicted depressive, B=0.290, p=.007, and PTSD symptoms, B=0.893, p=.001, and injury predicted higher depressive, B=0.546, p=.039, and PTSD symptoms, B=1.979, p=.003. Prehurricane depression also predicted higher depressive, B=1.927, p=.035, and PTSD symptoms, B=4.628, p=.046, whereas total trauma count was associated with PTSD symptoms, B=1.905, p=.003, and perceived stress, B=0.803, p=.007. Mothers interviewed closer to the hurricane were more likely to report PTSD symptoms, B=5.001, p=.021. Married, B=-10.706, p=.038, and cohabitating women, B=-10.948, p=.035, reported lower perceived stress. Hurricane-related experiences during pregnancy can have negative long-term effects on maternal mental health. Single mothers and pregnant women with a history of trauma exposure and/or depression may have a heightened risk of adverse postdisaster mental health outcomes.