eSToRY Center Research

PI: Margaret Weiss, MD, PhD & Eleanor Richards, PhD

Adolescence is often when mental illness begins to emerge. Failure to detect early subthreshold symptoms of incipient disorders is a major impediment to prevention and diagnosis. Risk factors for REL-minority youth can be heightened due to their greater likelihood of experiencing discrimination and socioeconomic barriers and their subsequent impacts on access and engagement in treatment and overall wellness. This project aims to implement and test tools necessary to prevent transitions to mental illness among at-risk youth, particularly at-risk racial/ethnic and language (REL)-minority youth. The overall aim of this project is to prevent and remediate a surge in youth mental illness and to reduce persistent treatment disparities. First, we use a remote adaptive testing technology, “K-CAT+”, to provide rapid community-based screening. Second, we will evaluate the effectiveness of a targeted, online health promotion intervention, COPE2THRIVE (C2T), to build resilience in a REL-diverse sample of school-aged youth. Third, we will assess whether this approach mitigates increased risk faced by racial/ethnic and language (REL)-minority youth.

PI: Nicholas Carson, MD, FRCPC & Philip Wang MD, DrPH

Identifying effective suicide prevention strategies for racial/ethnic and language (REL)-diverse populations of youth at high risk of suicide has enormous public health importance. Suicide rates for persons aged 10-24 have increased by more than 50% over the last decade in nearly every state and for nearly every racial/ethnic minority group, with particularly concerning increases in suicide attempts among black youth. Little is known about the long-term effects of community-based treatment in urban safety net healthcare systems with REL-diverse youth populations. In this project, we aim to utilize a unique clinical-sociocontextual dataset of over 15,000 youth patients at high risk for suicide to conduct comparative effectiveness research (CER) to identify effective treatments for suicide prevention and how these differ across REL-diverse groups. We will assess long-term treatment outcomes through present-day follow-up computerized adaptive testing with a sub-sample of patients to analyze current-day suicidal outcomes, psychopathology, and measure social determinants and quality of care.

PI: Benjamin Cook, PhD, MPH & Michael Flores, PhD, MPH

Accumulating evidence links childhood psychological trauma to increased likelihood and severity of mental illness and poor outcomes. By age sixteen, 60% of children have experienced an adverse childhood event and 30% have experienced more than one event, with disproportionately higher rates of adverse childhood events in economically disadvantaged, racial/ethnic/language (REL)-minority communities. In this study, we use a clinical-sociocontextual dataset of more than 600,000 patients, linked to insurance claims, criminal justice, and individual- and community-level social determinants of health data, to better understand the trajectories from psychological trauma to mental illness, predictors of negative and positive trajectories, and how mental health treatment mitigates negative trajectories for REL-minority populations.

PI: Caryn Rogers, Ph.D.

Despite years of directed policy reform, great disparities persist in mental health treatment access for Black youth in the United States. These disparities may be particularly salient for Black youth with Sickle Cell Disease (SCD), especially adolescents/young adults (AYA) transitioning from pediatric to adult care. Currently over 95% of children with SCD will survive into adulthood (life expectancy is still only 42 years of age) as a result of early diagnosis and treatment improvement. However, this improvement in morbidity and mortality has created a new at-risk population: AYA with SCD transitioning from pediatric to adult care. This transition is high-risk and life-threatening for AYA with SCD. AYA with SCD experience the highest per capita expenditures of any pediatric chronic illness and face difficulties related to siloed treatment and extensive barriers to transition. Adolescence is a vulnerable and pivotal time, marked by rapid physiological, social, and psychological change. At this age, AYA often lose steady support from their caregivers and providers as they transition to adult care, but may lack disease knowledge, self-efficacy and self-advocacy skills to maintain their health care and health outcomes, and are more likely to experience a discontinuity of care and to rely on emergency departments (ED) instead of a designated health provider, with serious health implications.This study will assess correlates of mental health care engagement for adolescents/young adults with sickle cell disease transitioning from pediatric to adult care and identify and contextualize barriers and facilitators to mental health care engagement for these individuals transiting from pediatric to adult care.

PI: Franchesca (Franckie) Castro-Ramirez

Black and racial ethnic linguistic (REL-) minority youth have the highest rates of violence exposure yet remain under- diagnosed and treated for psychological problems related to trauma and suicidal thoughts and behaviors (STBs). Meanwhile, they are also overdiagnosed with disruptive behavior disorders, which perpetuates criminal stereotypes such as the Superpredator myth and lead to more frequent incarceration.Instead of access to sources of healing and rehabilitation Black/REL-minority youth are exposed and re-exposed to cycles of violence. While suicide prediction models are accurate for White populations, they show poor sensitivity for minoritized groups. Focus on minoritized youth and their unique risk factors may help mitigate racial bias in health-care algorithms and identify needs for social services that reduce barriers to accessing treatment. Youth decision making is another understudied mechanism that can help explain behavior responses to violence and optimize treatment engagement. This study aims to (1) use health-care algorithms to test the link between (a) neighborhood disadvantage and self-and other-directed violence and (b) direct victimization and self-and other-directed violence above and beyond the neighborhood, and (2) examine the role of choice behavior in self-and other-directed violence using behavioral tasks and qualitative interviews.

PI: Victoria Hasler, Ph.D.

The 1st hospitalization for psychosis (FEP) may be the first major life disruption and crucial turning point in the lives of many patients. Although recommendations for outpatient treatment are made for each patient at discharge, these plans are not always followed. While early and intense multidisciplinary care following a FEP has the potential to lead to a full recovery, the year after a 1st hospitalization is also when patients are at the highest risk for suicide. Outcomes after hospitalization for FEP vary considerably among individuals, and lack of engagement in discharge plans may explain why outcomes are worse for some patients. Research shows that barriers to post-hospitalization mental health care are likely greater for racial/ethnic minority patients than their White counterparts. This study will utilize systematic electronic health record chart review and semi-structured qualitative interviews to identify specific barriers to participating in treatment faced by racial/ethnic minority groups after hospitalization for 1st episode of psychosis (FEP) and will lay the groundwork for further inquiry into what interventions can be designed to facilitate their engagement in appropriate treatment after hospitalization. Integrated findings will be used to develop a novel intervention targeted at the barriers identified.

PI: Meredith Gansner, MD

Treatment of adolescent substance use is challenging due to the diverse social and environmental factors that impact a youth’s use of drugs and alcohol. A growing body of research suggests that digital media use has become one such influential factor; certain online activities appear to increase the likelihood of substance use. Thus, it is important that mental health professionals understand which digital activities have been linked to substance use in order to incorporate discussion of those activities into anticipatory guidance with patients. Not only do racial and ethnic minority youth encounter different digital content than their non-minority peers, even when the same content is encountered (e.g. news coverage surrounding a hate crime), the psychological impact of the content may not be the same. This study will compare differences in frequency of exposure to digital drug-related content between racial/ethnic minority and majority youth and explore associations between these digital exposures and substance use severity in both subgroups to identify themes and patterns in relationships between substance and digital media use in racial and ethnic minority youth and to provide a more granular understanding of temporal associations between digital media exposures and substance use in minority youth through the use of longitudinal sampling.

PI: Xenia Johnson Bhembe, MD

Racism in Black, Indigenous, and People of Color (BIPOC) adults is associated with depression and serious psychological distress. Research shows that racism impacts health behaviors of Black youth, over and above the impacts of poverty or violence. However, most research focuses on youth 15-18 years old, in school or juvenile justice setting. Little is known about the effects of racism experienced by Black youth and their parents on mental health treatment decisions for youth. A parent's experience of racism may lead to delays in engaging in mental health services after referral, yet, to our knowledge, no studies exist examining the relationship between a parent’s racist experience and the mental health decisions they make for their child. Data from the 2017-2018 CHA EHR show Black children referred to mental health care were less likely to receive any subsequent treatment (86.9%) than white children (92.6%). This 12-month mixed-methods study will therefore explore the correlation between completed referrals, race, and racism for Black patients at CHA. The study will examine whether gaps have worsened since the COVID-19 pandemic.

PI: Jeffrey Lam, MD

Innovative approaches are needed to address the growing mental health crisis, particularly among adolescents and young adults. The mental healthcare system has traditionally focused on symptom alleviation, but growing evidence suggests positive psychological well-being (PPWB) enhancement may prevent mental illness. Moreover, assessing PPWB may improve therapeutic alliance by developing increased alignment with patient-cited goals. Currently, little is known about measuring PPWB in patients with mental illness, especially those from racial and ethnic minority backgrounds. The proposed project will be among the first to characterize PPWB within a diverse sample of young adults with mental illness, which would be a first step in mitigating PPWB disparities in this underserved population. This project would build upon existing measurement-based care research at Cambridge Health Alliance (CHA), offering a novel approach to measuring outcomes. Establishing the cultural fit, utility, and relevance of administering PPWB scales in a diverse safety-net outpatient psychiatric clinic is foundational to future studies to implement routine measurement of PPWB at CHA, offer community-based PPWB screening and intervention, and study epidemiology of PPWB in populations with mental illness.

PI: Logan Beyer

Exposure to social risks profoundly impacts pediatric mental health. Historic and ongoing structural racism places Racial/Ethnic/Linguistic (REL) minority youth at a heightened risk of such toxic exposures, threatening their wellbeing. While interventions based in both clinical and community settings recognize this link and aim to mitigate harms, there are still significant barriers to effective programming. At the clinic level, social risk screening is hampered by logistical and implementation challenges. At the community level, data limitations make the process of identifying specific locations with the greatest unmet needs a significant challenge. This study will identify novel methods that utilize existing pediatric electronic medical records to improve the identification of both individuals and geographies with elevated social risks. The significance of this research lies in its approach to re-envision how pediatricians might identify and address social risks. Expanding the screening utility of area-based measures, especially for REL-minority, is a novel approach to risk assessment in pediatric settings. Furthermore, the project utilizes geospatial hotspot analysis, an environmental epidemiology method typically used to map pollutant exposures, to identify concentrated social adversities and elucidate their relationship to health care utilization for child mental health crises, offering insights into where targeted interventions may have the greatest benefits. These novel approaches align with the mission of the eSToRY Center, emphasizing proactive, targeted interventions to bridge health equity gaps.