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Introduction
Skills and Expertise
Publications
Publications (103)
Suicide is the 10th most frequent cause of death in the US with 47,511 deaths in 2019, of which 23,941 were firearm suicides. Certain subgroups within the general population are at increased risk for firearm suicide, including law enforcement, active-duty military, veterans, persons with post-traumatic stress disorder, sexual minorities, and young...
Peer support groups have become widely utilized among those in recovery from problematic substance use. Yet, these peer-based programs vary and research examining their effectiveness has yielded mixed results. Relatively less is known about the impacts of arts-based peer recovery programs. Some research suggests that theatre may offer a powerful to...
Guardrails along roadsides can alleviate the severity of crashes if they function as intended. When guardrails are damaged or not maintained they can contribute to injury and death. There has been an exponential number of lawsuits pertaining to fatalities sustained from guardrails. Research on guardrail maintenance and performance is needed to impr...
Suicide is a leading cause of mortality and firearm suicide accounts for the majority of fatalities. Firearm owners are a diverse population and firearm-specific suicide prevention programs should be tailored to distinct at-risk firearm-owning groups. This study set out to identify groups of firearm owners with differential suicide risk having uniq...
Involvement of community health workers (CHWs) within task-sharing to bridge the mental health treatment gap has been proven to be efficacious in randomized controlled trials. The impact of mental health programs based on task-sharing paradigm greatly depends on the performance of CHWs which, in-turn, is influenced by their readiness for change. Ho...
As the United States (U.S.) continues to prioritize federal immigration enforcement, subnational localities increasingly enact their own immigration policies. Cities limiting cooperation with federal immigration enforcement are commonly referred to as sanctuary cities, which aim to improve immigrant safety and wellbeing. Yet, little is known about...
Background
Health literacy (HL) has been defined as the ability of individuals to access, understand, and utilise basic health information. HL is crucial to patient engagement in treatment through supporting patient autonomy, informed consent and collaborative care. In people with physical disorders, poor HL is associated with poor health outcomes,...
The present study examined revictimization, defined as sexual or physical assault in adulthood that followed a history of childhood maltreatment. We aimed to identify factors associated with revictimization over time in a group of U.S. military veterans deployed following the September 11, 2001, terrorist attacks (9/11). As revictimization is assoc...
Purpose
Immigrant mental health is closely linked to the context of reception in the receiving society, including discrimination; past research has examined this relationship only cross-sectionally. This longitudinal study examines the relationships between discrimination and mental health among Somali immigrants living in North America from 2013 t...
Social support is closely linked to health, but little is known about United States (U.S.) veterans' social support over time and factors that may influence their support trajectories. This study investigates social support over time for U.S. men and women Post-9/11 veterans in relation to trauma history and gender. A secondary analysis of longitud...
Literacy is an important predictor of health care utilization and outcomes. We examine literacy among people seeking care in a state funded mental health clinic (Site 1) and a safety-net hospital clinic (Site 2). Limited literacy was defined as literacy at or below the 8th grade level. At Site 1, 53% of participants had limited reading literacy and...
Improbable Players (IP) has been creating applied theatre for substance use disorder prevention since 1984, training more than 200 sober actor/teaching artists to perform plays and facilitate workshops addressing addiction, alcoholism, and the opioid crisis. The company operates, for its actors, as a long-term arts- integrated peer recovery support...
Background
A large body of research highlights the lasting impact of pre-resettlement violence on the mental health of refugees after resettlement. However, there is limited research on violence exposure after resettlement and its association with mental health. We examine the association of pre- and post-resettlement violence with post-resettlemen...
There is increasing documentation that refugees face experiences of interpersonal or structural discrimination in health care and employment. This study examines how Somali refugees understand various forms of discrimination in employment and health care related to their health, utilization of, and engagement with the health care system in the Unit...
Subjective social status (SSS) has largely been ignored within psychotherapy literature. We investigated the association between similarities in client-clinician perceptions of SSS, similarities in their report of the quality of working alliance, and resultant anxiety symptoms.
Participants represented a primarily low-income, culturally diverse sa...
Objective:
This study sought to examine perceived barriers to and facilitators of the adoption, implementation, and sustainability of community-based mental health peer support services for criminal justice-involved individuals, also known as "forensic peer support" (FPS).
Methods:
Qualitative interviews were conducted with stakeholders (N=14) a...
Objectives:
Understanding how immigrant young adults engage with civic society over time is critical to understanding and fostering healthy development and healthy democracies. The present study examines how civic engagement and antisocial attitudes/behavior of Somali young adult immigrants (ages 18-30, N = 498) in four North American regions co-oc...
In this study, we examined the relationships among discrimination and mental health for Somali young adults, a group at risk for an unfavorable context of reception, and the way in which individual- and community-level factors explain these associations. The present study drew upon data collected during the first wave of the Somali Youth Longitudin...
We apply the theory of collateral consequences and a social stress process framework to school discipline to examine whether exclusionary school discipline policies are associated with the mental health and wellbeing of adolescents who have never been suspended or expelled and whether this association varies across race/ethnicity. Data are from 8,8...
Sexual violence is a prevalent crime but vastly underreported and with serious long-term health consequences for survivors. Disclosure of sexual violence represents a social experience that may offer support towards healing or further traumatization depending on the response received. Although current research suggests that process of disclosure it...
Objective:
The aim of this study was to understand the relationship between mental health stigma and wellbeing in a sample of commercial construction workers.
Methods:
A sequential quantitative to qualitative mixed methods study was conducted. First, 264 workers were surveyed and logistic regression examined the associations between mental healt...
Violence prevention efforts must take into consideration the potentially stigmatizing labels associated with violence, and how youth perceive different types of violence in their communities. Somali communities and individuals in North America have at times been labeled as at-risk for violence, with two notable examples being gang violence and ideo...
Objective:
Understanding factors that promote and hinder the recovery process for people living with serious mental illness remains of critical importance. We examine factors, including limited literacy, associated with mental health recovery among public mental health service users.
Method:
This study uses data from a mixed-methods, service-use...
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Experiences of perceived stigma and discrimination are associated with a range of negative health outcomes. Individuals with substance use disorders and co-occurring mental health problems experience significant public stigma and discrimination associated with multiple aspects of identity. Less is known as to how these experiences of stigma and dis...
Public mental health service users frequently manage multiple health conditions, and are often prescribed multiple medications. While medications are useful tools in treating diagnosed mental illnesses, they bring management challenges and also can carry complex meanings for the individuals taking them. This study utilized a qualitative methodologi...
Abstract: Increasingly strict immigration and economic policies create barriers to safety, security, and wellbeing for immigrants in the US. The relationship between immigration and economic barriers are well documented. However, little research has addressed how economic security and access to services in the US are key factors in constructing imm...
Objective:
Despite calls for increased peer support services for individuals involved with the criminal justice system, little is known about the training, employment, and characteristics of forensic peer specialists (FPSs). Pennsylvania developed the nation's first FPS program and remains at the forefront of the field. This paper responds to thre...
Assessed the prevalence of suicide risk factors and behaviors among firearms owners from a nationally representative random sample recruited via online consumer panel. Compared suicide risk factors among firearm owners to national population estimates.
Almost half of adolescents aged 11 to 14 have dated and between 10% and 30% report experiencing Teen Dating Violence (TDV). However, there are no evidence-based TDV prevention interventions designed for afterschool, community-based settings with middle-school youth, in high-risk neighborhoods. Start Strong Boston (SSB) is a model that fills all thr...
While evidence has shown that professional mental health services are highly effective with treatment and symptom management, not all who need those services utilize them. Furthermore, there is evidence that certain racial, ethnic, cultural, and religious groups are less likely to seek or access mental health care. The Arab Muslim minority living i...
Background
Health literacy (HL) has been defined as the degree to which individuals possess the capacity to obtain, process, understand and utilise basic health information. For people with schizophrenia, important aspects of their HL include the ability to understand information about their illness and treatment, taking medications correctly, and...
Importance
Few randomized clinical trials have been conducted with ethnic/racial minorities to improve shared decision making (SDM) and quality of care.
Objective
To test the effectiveness of patient and clinician interventions to improve SDM and quality of care among an ethnically/racially diverse sample.
Design, Setting, and Participants
This c...
Understanding the relationships between immigrants and refugees and the police is a critical research task with implications for both community–police partnerships and the effectiveness of law enforcement efforts. This study contributes to such an understanding by examining perceptions of police and police interactions among Somali immigrants and r...
The disadvantaged social position of public mental health service users reflects synergistic relationships among tangible disadvantage and stigma and its consequences. Limited literacy, an important factor in social disadvantage and an additional source of stigma, is virtually absent from the discussion. Employing a mixed-methods, service user–info...
PurposeTo understand how people using community public mental health services conceptualize community and their place within it within the post-deinstitutionalization era.
Methodology/approachTwo hundred ninety-four service users completed structured interviews in two urban, outpatient, public, and community mental health facilities in the Northeas...
This study assesses individual- and area-level predictors of racial/ethnic disparities in mental health care episodes for adults with psychiatric illness. Multilevel regression models are estimated using data from the Medical Expenditure Panel Surveys linked to area-level data sets. Compared with Whites, Blacks and Latinos live in neighborhoods wit...
Poster exploring the role of multiple stigmas among public mental health service users.
Psychiatric emergency services (PES) remain a critical and under-examined component of the community mental health system. We describe how a unique community-academic partnership came together to examine repeat use of PES through the design and conduct of a qualitative study using a CBPR approach. The goals of the project were to: (1) develop a mod...
We present a model for the development and conduct of a community-based participatory research project with transition age youth (TAY) mental health service users. Community-based participatory research frameworks can facilitate equitable partnerships and meaningful inclusion but have not been fully drawn upon in mental health research. The model i...
Refugee studies have examined both resilience and adverse outcomes, but no research has examined how different outcomes co-occur or are distinct, and the social-contextual factors that give rise to these diverse outcomes. The current study begins to address this gap by using latent profile analysis to examine the ways in which delinquency, gang inv...
Objective: To examine violence perpetration among Somali young adults and the potential for community belonging and neighborhood cohesion to serve as protective influences. Method: Somalis (N = 374) living in 4 North America cities completed verbally administered standardized instruments assessing trauma, neighborhood cohesion, Somali belongingness...
Emergency medical technicians and paramedics form the backbone of the United States' Emergency Medical Service (EMS) system. Despite the frequent involvement of EMS with people with mental health and substance abuse problems, the nature and content of this work, as well as how EMS providers think about this work, have not been fully explored. Using...
Three-quarters of people with an alcohol use disorder in the USA never receive treatment. Our understandings of who receives care are informed by sociological perspectives, theories and models, each of which discuss the role of lay people's understanding of illness. However, comparatively little work has been done to unpack the cognitive processes...
Refugee adolescents often immigrate to a new society because of experiences of persecution and trauma, which can have profound effects on their mental health. Once they immigrate, many refugees experience stressors related to resettlement and acculturation in the new society. The current study examined relationships among acculturation styles and h...
The relationship between literacy and health has been well documented: research shows that people with limited literacy skills have worse health outcomes for numerous chronic conditions. However, little is known about how literacy relates to mental health, including access to treatment and recovery. A pilot study was conducted with mental health se...
The authors recently began a research study, funded by the National Institute of Mental Health, aimed at increasing the understanding of the ways in which limited literacy affects the lives of people with serious mental illness. In preparing for the study, the authors reviewed many health literacy screens and assessments for their appropriateness i...
Young adults with mental illness, also known as transition age youth (TAY), struggle with economic, social and housing instability, and are at increased risk for poor health outcomes as they transition from adolescence to adulthood. A community-based participatory research (CBPR) collaborative made up of mental health service users, family members...
Objectives:
Self-rated health (SRH) is an important indicator of overall health, predicting morbidity and mortality. This paper investigates what individuals incorporate into their self-assessments of health and how acculturation plays a part in this assessment. The relationship of acculturation to SRH and whether it moderates the association betw...
A high level of health literacy is essential for successful management of disorders such as schizophrenia and depression, yet there has been little research into the role that health literacy plays in the lives of people with mental illness. Many people who live with serious mental illness interact with a number of clinicians, for both acute and ch...
Background: Patients with substance abuse problems are over-represented among those seeking care in emergency settings, including psychiatric emergency rooms (PERs). Patients with dual recovery needs often present complex treatment concerns in such settings. Despite the high percentage of people seeking care in PERs with substance abuse problems, l...
CONTEXT Extensive observational evidence indicates that youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. OBJECTIVE To use experimental evidence to assess whether gender and family health problems modify the mental health effects of moving from high- to low-poverty neighborhoods. DE...
Although sexual victimization has been associated with suicidal behaviors, its association with completed suicide has not been examined. We investigated this association among Danish women using longitudinal data and a conservative definition of victimization. This population-based case-control study included 476 suicide cases and 12,010 matched co...
The impact of maternal depression on women and their families has been well documented. Given the prevalence and impact of this problem, one important strategy is to strengthen and expand our public health approaches.
Although principles of social epidemiology are increasingly used in the field of maternal and child health, few public health effort...
To determine the impact of a 16 week high-intensity progressive resistance exercise training (PRT) program on the mental health of older Puerto Rican adults with type 2 diabetes.
Fifty-eight Puerto Rican adults were randomly assigned to supervised PRT (n = 29) or a control group (n = 29). A secondary analyses were conducted, and 2 mental health out...
Reviews the book Homelessness, Housing, and Mental Illness by Russell K. Schutt and Stephen Goldfinger (2011). The book provides in-depth examination of the complexity of the lives of people with mental illness, substance abuse and housing instability, as well as the complexity of the social problem of people without stable and safe housing. The bo...
Background:
The risk of suicide is increased among people with inflammatory bowel disease (IBD); however, most of the evidence regarding this association comes from studies of all-cause mortality, with small numbers of people who have committed suicide, or from clinical case reports. The current study examined the association between the two forms...
Acute stress reaction is a diagnosis given immediately following the experience of an exceptional mental or physical stressor. To the best of our knowledge, no study has examined the association between acute stress reaction diagnosis and suicide. The current study examined this association in a population-based sample. In addition, we examined com...
Studies have suggested that discontinuation of treatment in depressed patients is associated with their perceptions about their treatment. We surveyed 403 adults treated for major depressive disorder with a selective serotonin reuptake inhibitor (SSRI) 3 months after onset of treatment to assess their interactions with clinicians, reasons they stop...
Little is known about the nature and content of Emergency Medical Services (EMS) work, a system that is responsible for approximately 16 million transports to American Emergency Departments each year (Warden 2007). Importantly we have found no studies examining the role of EMS in mental health care. In fact, in a 2007 IOM Report Emergency Medical S...
This mixed-method study examines the utility of the Gateway Provider Model (GPM) in understanding service utilization and pathways to help for Somali refugee adolescents. Somali adolescents living in the Northeastern United States, and their caregivers, were interviewed. Results revealed low rates of use of mental health services. However other sou...
This study examines the role of social identity (acculturation and gender) in moderating the association between discrimination and Somali adolescent refugees' mental health. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135). Perceived discrimination, trauma history, posttraumatic stress disorder...
Racism and discrimination can have significant implications for health, through complex biopsychosocial interactions. Latino groups, and particularly Puerto Ricans, are an understudied population in the United States in terms of the prevalence of discrimination and its relevance to health. Participants in our study were 45- to 75-year-old (N = 1122...
Adjustment disorder is a diagnosis given following a significant psychosocial stressor from which an individual has difficulty recovering. The individual's reaction to this event must exceed what would be observed among similar people experiencing the same stressor. Adjustment disorder is associated with suicidal ideation and suicide attempt. Howev...
Mental health problems in adolescents have been recognized as a significant medical concern. They have been associated with risk-taking behaviors during adolescence.
To determine the prevalence of elevated scores for psychological distress among adolescent girls aged 15 to 21 years who present to a pediatric emergency department (PED) for general m...
Staff in the psychiatric emergency room (PER) have demanding jobs requiring a complex balance between the needs and safety of the individual and the community, systemic resources, and job responsibilities while providing timely, effective care. Little research exists concerning day-to-day work activities of PER staff, their interaction, and their p...
Most research regarding posttraumatic stress disorder (PTSD) and suicide has focused on suicidal ideation or attempts; no
known study of the association between PTSD and completed suicide in a population-based sample has been reported. This study
examined the association between PTSD and completed suicide in a population-based sample. Data were obt...
Background: Psychiatric emergency services (PES) remain a critical and under-examined area of the mental health services system. What little is known about the use of these services virtually ignores the experiences and perspectives of the people who use them. In order to provide critical psychiatric emergency care that best meets the needs of PES...
While both limited literacy and mental disorders are prevalent problems, little is known about the relationship between the two, though they both cause considerable distress, stigmatization, diminished quality of life, and impaired functioning. Capabilities suggests that literacy is a central component of well being, providing people with access to...
Service users working in academic and other institutional settings can be a major asset to both the team and the research itself, with the potential to improve research relevance quality, and dissemination. However, without proper preparation and planning, there is great potential for the project to be derailed by tension existing between and among...
Despite national efforts, the number of people who are chronically homeless in our cities remains high. People with serious mental illness and substance abuse problems continue to represent the majority of those experiencing long-term homelessness. Traditional shelters have difficulty engaging and addressing the needs of this group; however, there...
Service users working in academic and other institutional settings can be a major asset to both the team and the research itself, with the potential to improve research relevance quality, and dissemination. However, without proper preparation and planning, there is great potential for the project to be derailed by tension existing between and among...
IntroductionFraming ParticipationConclusion
References
The association between severe headaches and suicidal thoughts or behaviors is generally attributed to underlying depression, but it is plausible that severe headaches can lead to suicidal thoughts/behaviors, independent of the effects of psychiatric conditions. This association has been observed in only 1 previous study. Our multivariate analysis...
This paper describes the development and implementation of the Boston Medical Center (BMC) Advanced Clinical Capacity for Engagement, Safety, and Services Project. In October 2002, the BMC Division of Psychiatry became the first such entity to open a Safe Haven shelter for people who are chronically homeless, struggling with severe mental illness,...
Community-based participatory research has been described as a partnership approach to research, in which community members and researchers are equitably involved in all phases of the research process, and where all partners contribute their expertise and share in decision making and ownership. As such, ethical issues often arise, particularly with...
Little is known about the relationship between mental illness and literacy despite both being prevalent problems. We examine whether literacy varies by psychiatric diagnoses. Interviews and chart reviews (N = 100) were conducted in a behavioral health outpatient clinic. The relationships among sociodemographics, rapid estimate of adult literacy in...
