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Addressing Health Disparities in Anxiety and Related Disorders: Current Efforts in the Field to Improve Treatment Access and Effectiveness of Interventions in Diverse Populations

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 January 2020) | Viewed by 24349

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Special Issue Editor

Dr. Anu Asnaani

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Center for the Treatment and Study of Anxiety, University of Pennsylvania, 3535 Market St, 6th floor, Philadelphia, PA 19104, USA
Interests: anxiety disorders; obsessive compulsive disorder; post-traumatic stress disorder; community-based work; health disparities; diversity issues; mechanisms of evidence-based treatments; effectiveness; treatment outcome

Special Issue Information

Dear Colleagues,

As you are each aware, the prevalence and associated distress of anxiety and its related disorders remain of utmost concern to clinicians; researchers; policy makers; and, most of all, to those many individuals who suffer from these symptoms every day. Furthermore, while a number of highly effective treatments have been tested in large randomized clinical trials for anxiety-based disorders, the individuals who have been studied in the context of these trials are not necessarily demographically or clinically representative of the full scope of those who are burdened by anxiety symptoms. In addition, there remain significant disparities in access to evidence-based treatments for anxiety symptoms for a variety of populations, including those seeking care in non-specialty community settings, individuals who are recent immigrants or refugees, at-risk children and adolescents in under-resourced inner-city settings, those living in rural/remote locations, and other groups who may be reticent to seek help for anxiety symptoms because of stigma around mental health treatment.

The healthcare burden and deleterious impact on quality of life for countless individuals struggling with anxiety symptoms across these diverse populations are significant and have been well-documented in the literature. Given this compelling data highlighting the examination of anxiety pathology and differential treatment access in these groups, an increasing number of mental health researchers and providers have been turning their focus to reducing the health disparities in anxiety and its related disorders globally. This Special Issue in the International Journal of Environmental Research and Public Health is dedicated to highlighting the current efforts being made by each of you to address and reduce this disparity in access to care, the examination of effective treatment ingredients, and the assessment of the implementation of treatments and policies relating to anxiety symptoms.

Your contribution in the form of original research or reviews falling under the umbrella of health disparities in anxiety and its related disorders (e.g., post-traumatic disorder, obsessive compulsive disorder) in a variety of populations (particularly those which have been understudied to date) will be considered. Papers that present ongoing implementation efforts or a policy roll-out that is currently underway related to reducing such disparities will also be considered. It is hoped that this Issue will shine a much needed spotlight on what our field is doing to address the current inequalities in the application of effective interventions and the assessment of anxiety symptoms across a broader range of individuals who deserve better care.

Dr. Anu Asnaani
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

anxiety disorders
obsessive compulsive disorder
post-traumatic stress disorder
community samples
health disparities
mechanisms of evidence-based strategies
effectiveness of evidence-based strategies
implementation in diverse settings

Published Papers (5 papers)

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Research

17 pages, 1674 KiB

Open AccessArticle

Association Rule Learning Is an Easy and Efficient Method for Identifying Profiles of Traumas and Stressors that Predict Psychopathology in Disaster Survivors: The Example of Sri Lanka

by Nuwan Jayawickreme, Ehsan Atefi, Eranda Jayawickreme, Jiale Qin and Amir H. Gandomi

Int. J. Environ. Res. Public Health 2020, 17(8), 2850; https://doi.org/10.3390/ijerph17082850 - 21 Apr 2020

Cited by 7 | Viewed by 3110

Abstract

Research indicates that psychopathology in disaster survivors is a function of both experienced trauma and stressful life events. However, such studies are of limited utility to practitioners who are about to go into a new post-disaster setting as (1) most of them do not indicate which specific traumas and stressors are especially likely to lead to psychopathology; and (2) each disaster is characterized by its own unique traumas and stressors, which means that practitioners have to first collect their own data on common traumas, stressors and symptoms of psychopathology prior to planning any interventions. An easy-to-use and easy-to-interpret data analytical method that allows one to identify profiles of trauma and stressors that predict psychopathology would be of great utility to practitioners working in post-disaster contexts. We propose that association rule learning (ARL), a big data mining technique, is such a method. We demonstrate the technique by applying it to data from 337 survivors of the Sri Lankan civil war who completed the Penn/RESIST/Peradeniya War Problems Questionnaire (PRPWPQ), a comprehensive, culturally-valid measure of experienced trauma, stressful life events, anxiety and depression. ARL analysis revealed five profiles of traumas and stressors that predicted the presence of some anxiety, three profiles that predicted the presence of severe anxiety, four profiles that predicted the presence of some depression and five profiles that predicted the presence of severe depression. ARL allows one to identify context-specific associations between specific traumas, stressors and psychological distress, and can be of great utility to practitioners who wish to efficiently analyze data that they have collected, understand the output of that analysis, and use it to provide psychosocial aid to those who most need it in post-disaster settings. Full article

(This article belongs to the Special Issue Addressing Health Disparities in Anxiety and Related Disorders: Current Efforts in the Field to Improve Treatment Access and Effectiveness of Interventions in Diverse Populations)

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15 pages, 1294 KiB

Open AccessArticle

Trauma Education and Stigma Reduction in Global Settings: An Evaluation of the Impact of a One-Day Trauma Psychoeducation Workshop with Community Stakeholders in the Caribbean Nation of Saint Lucia

by Anu Asnaani, Su-Anne R. Charlery White, Ifrah Majeed and Tammi-Marie Phillip

Int. J. Environ. Res. Public Health 2020, 17(7), 2255; https://doi.org/10.3390/ijerph17072255 - 27 Mar 2020

Cited by 2 | Viewed by 3868

Abstract

The independent island nation of Saint Lucia and surrounding Caribbean countries have fairly well-documented high reported rates of trauma, but limited training infrastructure for trauma-related mental health support and treatment services. This study addresses this disparity between high trauma exposure and sparse trauma-related resources by studying how a one-day training workshop impacted self-rated knowledge about trauma and stigma towards trauma survivors. The training was provided by a licensed clinical psychologist in partnership with a local women’s rights group. Participants (n = 41) included school counselors, nurses, psychiatric providers, health educators, and advocates on the island. Participants completed pre- and post-workshop measures examining the variables of interest. The one-day workshop provided training on trauma types, post-trauma reactions, options for treatment, and hands-on training for trauma crisis-management and short-term interventions. Following the workshop, participants reported increased knowledge of trauma, more accurate perceptions of its prevalence, better understanding of evidence-based treatments, and lower trauma survivor-related stigma. This is the first trauma-focused workshop tested in St. Lucia, where the need for such training is considerable given few treatment options for trauma survivors in this area. Work is underway to provide more expansive services for trauma across the Caribbean region, given these preliminary promising findings. Full article

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10 pages, 303 KiB

Open AccessArticle

Traumatic Experiences and Mental Health Risk for Refugees

by Victoria A. Schlaudt, Rahel Bosson, Monnica T. Williams, Benjamin German, Lisa M. Hooper, Virginia Frazier, Ruth Carrico and Julio Ramirez

Int. J. Environ. Res. Public Health 2020, 17(6), 1943; https://doi.org/10.3390/ijerph17061943 - 16 Mar 2020

Cited by 25 | Viewed by 4399

Abstract

Refugees who settle in Western countries exhibit a high rate of mental health issues, which are often related to experiences throughout the pre-displacement, displacement, and post-displacement processes. Early detection of mental health symptoms could increase positive outcomes in this vulnerable population. The rates and predictors of positive screenings for mental health symptoms were examined among a large sample of refugees, individuals with special immigrant visas, and parolees/entrants (N = 8149) from diverse nationalities. Logistic regression analyses were used to determine if demographic factors and witnessing/experiencing violence predicted positive screenings. On a smaller subset of the sample, we calculated referral acceptance rate by country of origin. Refugees from Syria, Iraq, and Afghanistan were most likely to exhibit a positive screening for mental health symptoms. Refugees from Sudan, Iraq, and Syria reported the highest rate of experiencing violence, whereas those from Iraq, Sudan, and the Democratic Republic of Congo reported the highest rate of witnessing violence. Both witnessing and experiencing violence predicted positive Refugee Health Screener-15 (RHS-15) scores. Further, higher age and female gender predicted positive RHS-15 scores, though neither demographic variable was correlated with accepting a referral for mental health services. The findings from this study can help to identify characteristics that may be associated with risk for mental health symptoms among a refugee population. Full article

10 pages, 328 KiB

Open AccessArticle

Impact of Status-Based Rejection Sensitivity on Depression and Anxiety Symptoms in Gay Men

by Joseph Slimowicz, Jedidiah Siev and Paula M. Brochu

Int. J. Environ. Res. Public Health 2020, 17(5), 1546; https://doi.org/10.3390/ijerph17051546 - 28 Feb 2020

Cited by 13 | Viewed by 4419

Abstract

Status-based rejection sensitivity refers to the anxious expectation and tendency to perceive rejection in ambiguous social scenarios based on one’s minority identification. This study evaluates the implications of sensitivity to rejection based on sexual orientation identity on negative mental health outcomes. Current minority stress models include rejection sensitivity as a factor that may contribute to adverse negative psychosocial outcomes in LGBT persons. This study evaluates the role of rejection sensitivity alongside demographically relevant predictors such as age, race, education, and level of sexuality disclosure in predicting the presence of significant depression and anxiety scores among a sample of gay men. Results indicate that rejection sensitivity, sexuality openness, and anxiety were significant predictors of depression symptoms, whereas age and depression were significant predictors of anxiety symptoms. This study supports the role of rejection sensitivity as a contributor to negative mental health outcomes among gay men, particularly as it pertains to internalizing mental health disorders. Full article

15 pages, 454 KiB

Open AccessArticle

Barriers to Mental Health Help-Seeking Amongst Refugee Men

by Yulisha Byrow, Rosanna Pajak, Tadgh McMahon, Amitabh Rajouria and Angela Nickerson

Int. J. Environ. Res. Public Health 2019, 16(15), 2634; https://doi.org/10.3390/ijerph16152634 - 24 Jul 2019

Cited by 40 | Viewed by 7991

Abstract

Rates of help-seeking for mental health problems are low amongst refugee communities, despite the high prevalence of PTSD reported amongst these individuals. Research suggests that the key barriers to seeking help for psychological problems include structural barriers (e.g., unstable housing), cultural barriers (e.g., mental health stigma), and barriers specific to refugees and asylum seekers (e.g., visa status). This study examined the effect of structural, cultural and refugee specific barriers on the relationship between PTSD symptom severity and intentions to seek help from professional, social, and community sources. Data was collected from 103 male refugees and asylum seekers with an Arabic-, Farsi-, or Tamil-speaking background. Participants completed measures indexing demographics, trauma exposure, PTSD symptoms, mental health stigma, and help-seeking intentions. Path analyses indicated that PTSD severity was associated with lower help-seeking intentions indirectly via mental health stigma (self-stigma for seeking help and self-stigma for PTSD) and visa security. PTSD severity was also associated with greater help-seeking intentions from community members indirectly via structural barriers. These findings are important to consider when identifying key barriers to mental health help-seeking and developing interventions designed to increase help-seeking for psychological problems, within this group. Full article

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Addressing Health Disparities in Anxiety and Related Disorders: Current Efforts in the Field to Improve Treatment Access and Effectiveness of Interventions in Diverse Populations

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