Lawrence H Yang
Lawrence H Yang
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Chair and Professor of Social and Behavioral Sciences
Associate Director, Global Center for Implementation Science
Founding Director, Global Mental Health and Stigma Program
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Professional overview
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Dr. Lawrence Yang is Professor and Chair of the Department of Social and Behavioral Sciences; Associate Director of the Global Center for Implementation Science at NYU; and Founding Director of NYU’s Global Mental Health and Stigma Program. He is also PI of a generous donor gift from the Li Ka Shing Foundation to fund an initiative to promote Global Mental Health and Wellness (see link).
Dr. Yang has received extensive interdisciplinary training, including clinical psychology (Boston University), psychiatric epidemiology (Columbia University) and medical anthropology (Harvard University). Dr. Yang has received six national awards in stigma, including the Maltz Prize for Innovative and Promising Schizophrenia Research in 2021 (Brain and Behavior Research Foundation; see link). Dr. Yang has >175 peer-reviewed publications, including in journals such as the JAMA, JAMA Psychiatry, British Journal of Psychiatry, and the American Journal of Public Health. Regarding currently-funded NIH grants, he is PI of three separate R01 grants (below), is multiple PI of a D43 Implementation Science Training Grant in Vietnam, and is co-investigator on 4 R01-level grants. Lawrence is also applying his expertise to address the novel topic of “Migration Stigma”, where he led a think tank and conference sponsored by the prestigious Ernst Strüngmann Forum (June, 2022; see link), which has resulted in a recently-published book by MIT press (Migration Stigma (mit.edu)) and a publication in JAMA (see link).
Brief Research Narrative: If every public health researcher had a calling card, Dr. Lawrence Yang's would be stigma.
What began as a curiosity to think, study and write about his own culture -- Chinese culture and its influences on how stigma is expressed-- drove the GPH Professor to develop a framework for how stigma acts to impede social recovery that could be applied to cultural groups to improve the lives of countless people with mental illness and their families around the world. Dr. Yang also conducts several ongoing research studies on the forefront of global mental health and implementation science.
Building upon dissertation research conducted in Beijing, China, Lawrence initiated his stigma research via an NIMH K-award (2005-2010). Lawrence conducted a study in New York City of how stigma shapes the course of mental illness among Chinese immigrants. Lawrence formulated how culture relates to stigma--i.e. the “What Matters Most” framework—to help implement interventions to improve recovery for stigmatizing conditions. He learned that upholding face (to achieve lineage obligations) was essential, as it is for Asians in many countries. Lawrence then formulated an anti-stigma intervention to help people with mental illness take a powerful step towards regaining face. To inform global programs, Lawrence then applied the ‘what matters most’ approach to HIV stigma in Botswana. Lawrence identified that “womanhood” in Botswana is signified by “having and caring for children” (AJPH, 2021). These cultural imperatives bring pregnant women into contact with free antenatal services, including routine HIV testing, where their HIV status is discovered before their male partners, leading women diagnosed with HIV to be blamed and stigmatized. Lawrence used this framework in a completed NIMH-funded R21 grant to implement an intervention to counter culturally-salient aspects of HIV stigma that impede anti-retroviral treatment. This stigma intervention, by utilizing the perspective that a woman in Botswana who achieves ‘what matters most’ can be protected from HIV stigma, has shown promising results. Lawrence has received a new R01 (R01 TW012402) to expand this intervention for use with women with HIV with serious mental illness in Botswana. He also participated as a Scientific member of the “NIH Office of AIDS Research & NIMH HIV-Related Intersectional Stigma” Working Group (2020).
Lawrence has advanced global mental health research in China as PI of two NIMH-funded R01 studies (R01MH108385; R01 MH127631) with co-PI's, Dr.’s Michael Phillips, William Stone and Matcheri Keshavan, seeking to characterize the cognition of completely untreated psychosis in China. Recently, China has implemented programs to detect untreated psychosis countrywide. Ascertaining participants in rural China, the study has enrolled~ 300 untreated psychosis participants, who are then matched with ~300 treated psychosis participants and an additional ~300 healthy control participants. The study’s first publication shows that cognitive performance may continue to decrease as the duration of untreated psychosis becomes prolonged (JAMA Psychiatry, 2020), thus potentially shifting the scientific thinking about schizophrenia by suggesting possible novel neurodegenerative processes in the natural course of chronic psychosis. A 3-year Supplement also examines the neurobiological markers of untreated psychosis to validate three psychosis subgroups that exhibit neurobiologically distinct differences (or ‘biotypes’). A follow-up longitudinal, 5-year R01 proposal (2021-2026) to capitalize upon this rare cohort has been funded by NIMH.
Relevant to implementation science, Lawrence leads a project to help address the gap in global mental health treatment among those who need but do not receive care for mental disorders, which is disproportionately high in low- and middle-income countries. There has been a call to scale-up mental health services via sharing of mental health care with a broader array of nonspecialists (e.g., community health workers). Yet, knowledge on how to successfully implement task-sharing mental health strategies in real-world settings is lacking. Lawrence is PI of a third NIMH-funded R01 (with co-PI, Dr. Judy Bass; R01 MH122851) to validate a newly-developed measure that enables rapid assessment of modifiable critical factors affecting the implementation of task sharing mental health strategies. This R01 is based upon the “Shared Research Project”, where Dr.’s Yang and Bass examined the barriers and facilitators to scale-up task-sharing interventions in four previous, NIMH-funded global regional networks spanning 4 global hubs (i.e., Latin America; Africa, and India/ Pakistan). This current study will validate this measure within three additional, ongoing NIMH-funded task-sharing mental health programs in South Africa, Chile, and Nepal, thus advancing implementation science globally.
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Education
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BA, High Honors and Phi Beta Kappa, Wesleyan University, Middletown, CTPhD, Boston University, Boston, MAClinical Fellowship, Harvard Medical School (Massachusetts Mental Health Center)Postdoctoral Fellowship, Columbia Mailman School of Public Health (NIMH funded T32 Training Program in Psychiatric Epidemiology)
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Honors and awards
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Maltz Prize for Innovative and Promising Schizophrenia Research -- Brain and Behavior Research Foundation (2021)NIH Fellow-Training Institute for Dissemination & Implementation Research in Health (TIDIRH) (2019)Fellow (Elected), American Psychopathological Association (2018)Award for Emerging Leadership, Americal Psychological Association (2012)Award for Advancing Minority Mental Health, American Psychiatric Foundation (2012)Young Investigator Award, NARSAD/ Brain and Behavior Foundation (2010)Emerging Leader Award for Significant Contributions to the Advancement of Ethnic Minority Psychology, American Psychological Association (2010)Calderone Award for Junior Faculty, Columbia University School of Public Health (2009)REACH for the R01 Award, Columbia University Irving Institute for Clinical and Translational Research (2009)Early Career Research Award, American Psychological Association (2008)Early Career Award, Asian American Psychological Association (2008)Dalmas A. Taylor Outstanding Student Dissertation Award, American Psychological Association (Division of Clinical Psychology- Ethnic Minority Focus) (2002)Outstanding Dissertation Award, American Psychological Association (Division of International Psychology) (2002)
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Areas of research and study
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Cognition and PsychosisGlobal HealthImplementation scienceMental HealthStigma of Health Conditions“At-Risk” States for Psychosis
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Publications
Publications
A "what Matters Most" approach to investigating intersectional stigma toward HIV and cancer in Hanoi, Vietnam
AbstractEschliman, E. L., Hoang, D., Khoshnam, N., Ye, V., Kokaze, H., Ji, Y., Zhong, Y., Morumganti, A., Xi, W., Huang, S., Choe, K., Poku, O. B., Alvarez, G., Nguyen, T., Nguyen, N. T., Shelley, D., & Yang, L. H. (n.d.).Publication year
2024Journal title
Journal of the National Cancer Institute - MonographsVolume
2024Issue
63Page(s)
11-19AbstractBackground: Vietnam is experiencing a growing burden of cancer, including among people living with HIV. Stigma acts as a sociocultural barrier to the prevention and treatment of both conditions. This study investigates how cultural notions of "respected personhood"(or "what matters most") influence manifestations of HIV-related stigma and cancer stigma in Hanoi, Vietnam. Methods: Thirty in-depth interviews were conducted with people living with HIV in Hanoi, Vietnam. Transcripts were thematically coded via a directed content analysis using the What Matters Most conceptual framework. Coding was done individually and discussed in pairs, and any discrepancies were reconciled in full-Team meetings. Results: Analyses elucidated that having chu tín-a value reflecting social involvement, conscientiousness, and trustworthiness-and being successful (eg, in career, academics, or one's personal life) are characteristics of respected people in this local cultural context. Living with HIV and having cancer were seen as stigmatized and interfering with these values and capabilities. Intersectional stigma toward having both conditions was seen to interplay with these values in some ways that had distinctions compared with stigma toward either condition alone. Participants also articulated how cultural values like chu tín are broadly protective against stigmatization and how getting treatment and maintaining employment can help individuals resist stigmatization's most acute impacts. Conclusions: HIV-related and cancer stigma each interfere with important cultural values and capabilities in Vietnam. Understanding these cultural manifestations of these stigmas separately and intersectionally can allow for greater ability to measure and respond to these stigmas through culturally tailored intervention.A case study of the development of a valid and pragmatic implementation science measure: the Barriers and Facilitators in Implementation of Task-Sharing Mental Health interventions (BeFITS-MH) measure
AbstractYang, L. H., Bass, J. K., Le, P. T. D., Singh, R., Gurung, D., Velasco, P. R., Grivel, M. M., Susser, E., Cleland, C. M., Alvarado, R., Kohrt, B. A., & Bhana, A. (n.d.).Publication year
2024Journal title
BMC health services researchVolume
24Issue
1AbstractBackground: Few implementation science (IS) measures have been evaluated for validity, reliability and utility – the latter referring to whether a measure captures meaningful aspects of implementation contexts. We present a real-world case study of rigorous measure development in IS that assesses Barriers and Facilitators in Implementation of Task-Sharing in Mental Health services (BeFITS-MH), with the objective of offering lessons-learned and a framework to enhance measurement utility. Methods: We summarize conceptual and empirical work that informed the development of the BeFITS-MH measure, including a description of the Delphi process, detailed translation and local adaptation procedures, and concurrent pilot testing. As validity and reliability are key aspects of measure development, we also report on our process of assessing the measure’s construct validity and utility for the implementation outcomes of acceptability, appropriateness, and feasibility. Results: Continuous stakeholder involvement and concurrent pilot testing resulted in several adaptations of the BeFITS-MH measure’s structure, scaling, and format to enhance contextual relevance and utility. Adaptations of broad terms such as “program,” “provider type,” and “type of service” were necessary due to the heterogeneous nature of interventions, type of task-sharing providers employed, and clients served across the three global sites. Item selection benefited from the iterative process, enabling identification of relevance of key aspects of identified barriers and facilitators, and what aspects were common across sites. Program implementers’ conceptions of utility regarding the measure’s acceptability, appropriateness, and feasibility clustered across several common categories. Conclusions: This case study provides a rigorous, multi-step process for developing a pragmatic IS measure. The process and lessons learned will aid in the teaching, practice and research of IS measurement development. The importance of including experiences and knowledge from different types of stakeholders in different global settings was reinforced and resulted in a more globally useful measure while allowing for locally-relevant adaptation. To increase the relevance of the measure it is important to target actionable domains that predict markers of utility (e.g., successful uptake) per program implementers’ preferences. With this case study, we provide a detailed roadmap for others seeking to develop and validate IS measures that maximize local utility and impact.A Feasibility and Pilot Trial of the Brief Educational Guide for Individuals in Need (BEGIN): Psychoeducation for Individuals at Risk for Psychosis
AbstractHerrera, S. N., Sarac, C., Vaidya, S. A., Shuster, S., Lyallpuri, R., Dobbs, M. F., Gorman, J., Phili, A., Mcgowan, A., Portner, S., Mikelic, M., Jespersen, R., Deluca, J. S., Lim, K. Y., Yang, L. H., Wyka, K., Landa, Y., & Corcoran, C. M. (n.d.).Publication year
2024Journal title
Psychological ServicesAbstractIndividuals at clinical high risk for psychosis (CHR) report a strong desire for psychoeducation, and clinical guidelines recommend psychoeducation in early psychosis care. Although several CHR psychoeducation models have been developed, additional research is needed to establish the effectiveness of these models. The goal of this study was to conduct a pilot trial of the Brief Educational Guide for Individuals in Need (BEGIN). BEGIN is a brief structured psychoeducation intervention designed to educate CHR individuals on symptoms and treatment options. We conducted a feasibility and pilot study of 25 CHR individuals (60% female, Mage = 20.6, 64% non-White, 52% Hispanic/Latino) identified via the Structured Interview for Psychosis Risk Syndromes. Qualitative interviews were administered to learn about their experience and analyzed using iterative thematic analysis. Participants (n = 12) completed pre- and post-BEGIN self-report measures to assess factors that influence treatment engagement, including CHR knowledge and motivation for therapy. Data were analyzed using Hedges’ g effect sizes and paired samples t tests. The intervention completion rate (83%) and therapeutic alliance were high. Qualitative themes and quantitative measures converged on similar results showing how CHR individuals were impacted by receiving psychoeducation via BEGIN, including increased CHR knowledge (g = 1.37), competence to monitor symptoms (g = 0.53), hope (g = 0.87), and motivation for therapy (g = 0.46). This study demonstrated the feasibility, acceptability, and potential benefits of the BEGIN CHR psychoeducation model, including enhancing motivation for treatment. The flexible but standardized format can facilitate BEGIN’s implementation and dissemination.A pilot study investigating the effect of the BEGIN psychoeducation intervention for people at clinical high risk for psychosis on emotional and stigma-related experiences
AbstractMikelic, M., Jusdanis, A., Bergson, Z., DeLuca, J. S., Sarac, C., Dobbs, M. F., Shuster, S., Vaidya, S., Wyka, K., Yang, L. H., Landa, Y., Corcoran, C. M., & Herrera, S. N. (n.d.).Publication year
2024Journal title
Early Intervention in PsychiatryVolume
18Issue
12Page(s)
1055-1061AbstractAim: There is concern that the provision of the clinical high risk for psychosis (CHR) label is stigmatizing. Prior research suggests people have nuanced reactions to feedback involving the CHR label, including a positive experience receiving feedback and improvement in negative emotions (e.g., shame), while also exhibiting concerns about self-perception and perceptions from others related to the label. The current pilot study aimed to evaluate whether individuals at CHR showed changes in emotional and stigma-related experiences following a CHR psychoeducation intervention, BEGIN: Brief Educational Guide for Individuals in Need. Method: Participants at CHR (N = 26) identified via the Structured Interview for Psychosis-Risk Syndromes completed the Mental Health Attitudes Interview measuring symptom-related and CHR label-related stigma at pre- and post-intervention. Results: Stigma did not increase and participants had greater positive emotions (e.g., feeling hopeful and relieved), post-BEGIN. Conclusion: This study suggests that standardized CHR psychoeducation does not increase stigma in individuals at CHR.Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): A systematic review and meta-regression
AbstractDeng, F., Bueber, M. A., Cao, Y., Tang, J., Bai, X., Cho, Y., Lee, J., Lin, Z., Yang, Q., Keshavan, M. S., Stone, W. S., Qian, M., Yang, L. H., & Phillips, M. R. (n.d.).Publication year
2024Journal title
Psychological MedicineVolume
54Issue
5Page(s)
847-873AbstractThe reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.Evaluation of Two Videos that Apply Evidence-Based Strategies to Increase Self-Efficacy and Reduce Opioid-Related Stigma Among Medical Students
AbstractEschliman, E. L., Choe, K., Fei, Y. C., Kang, C., Koetje, J., Harocopos, A., Harris, M. N., DeWalt, J., Christopher, S. A., Jackson, V. W., & Yang, L. H. (n.d.).Publication year
2024Journal title
Academic PsychiatryVolume
48Issue
2Page(s)
123-134AbstractObjective: This study evaluated the video-based application of evidence-based stigma reduction strategies to increase medical students’ screening-diagnostic self-efficacy for opioid use disorder (OUD) and reduce stigma toward opioid use. Methods: Formative qualitative research informed development of two videos for medical students. One uses an education strategy by including education regarding non-stigmatizing language use and OUD screening and diagnosis (Video A); the other uses an interpersonal contact strategy by presenting narratives regarding opioid use from three people who have a history of opioid use and three physicians (Video B). Both videos were administered to all respondents, with video order randomized. Effects on outcomes were evaluated using a pre-/post-test design with a 1-month follow-up. Participants also provided feedback on video content and design. Results: Medical students (N = 103) watched the videos and completed the pre-/post-test, with 99% (N = 102) completing follow-up 1 month after viewing both videos. Self-efficacy increased directly following viewing Video A, and this increase was sustained at 1-month follow-up. Stigma toward opioid use decreased directly following viewing Video B, and this decrease was sustained at 1-month follow-up for participants who watched Video B first. Statistically significant improvements were observed in most secondary outcomes (e.g., harm reduction acceptability) directly following watching each video and most were sustained at 1-month follow-up. Feedback about the videos suggested the delivery of evidence-based strategies in each video was appropriate. Conclusions: Video-based applications of these evidence-based strategies were found acceptable by medical students and have potential to elicit sustained improvement in their screening-diagnostic self-efficacy and opioid-related stigma.How Shared Dietary Behaviors Within Asian American Families Are Influenced by Emotional Interaction Qualities: A Nationwide Cross-sectional Analysis
AbstractAli, S. H., Meltzer, G., DiClemente, R. J., Islam, N. S., Yi, S. S., Yang, L. H., & Misra, S. (n.d.).Publication year
2024Journal title
International Journal of Behavioral MedicineAbstractBackground: Asian American (AA) young adults face a looming diet-related non-communicable disease crisis. Interactions with family members are pivotal in the lives of AA young adults and form the basis of family-based interventions; however, little is known on the role of these interactions in shared family food behaviors. Through an analysis of 2021 nationwide survey data of 18–35-year-old AAs, this study examines how the quality of family member interactions associates with changes in shared food purchasing, preparation, and consumption. Method: Interaction quality was assessed through 41 emotions experienced while interacting with family, and was categorized as positive (e.g., “I look forward to it”), negative (e.g., “I feel annoyed”), and appreciation-related (e.g., “I feel respected”) interactions. Participants were also asked how frequently they ate meals, ate out, grocery shopped, and cooked with their family. Results: Among the 535 AAs surveyed (47.6% East Asian, 21.4% South Asian, 22.6% Southeast Asian), 842 unique family interactions were analyzed; 43.5% of interactions were with mothers, followed by siblings (27.1%), and fathers (18.5%). Participants most frequently ate meals with their family (at least daily for 33.5% of participants), followed by cooking (at least daily for 11.3%). In adjusted analyses, an increase in shared food behaviors was particularly associated with positive interactions, although most strongly with cooking together and least strongly with eating meals together; significant differences between ethnic subgroups were not observed. Conclusion: Findings revealed the importance of family interaction quality when leveraging family relationships to develop more tailored, impactful AA young adult dietary interventions.Impacts of the Affordable Care Act Medicaid Expansion on Mental Health Treatment Among Low-income Adults Across Racial/Ethnic Subgroups, 2010–2017
AbstractLieff, S. A., Mijanovich, T., Yang, L., & Silver, D. (n.d.).Publication year
2024Journal title
Journal of Behavioral Health Services and ResearchVolume
51Issue
1Page(s)
57-73AbstractThis study examines whether the Affordable Care Act (ACA) Medicaid expansion (ME) was associated with changes in racial/ethnic disparities in insurance coverage, utilization, and quality of mental health care among low-income adults with probable mental illness using the National Survey on Drug Use and Health with state identifiers. This study employed difference-in-difference models to compare ME states to non-expansion states before (2010–2013) and after (2014–2017) expansion and triple difference models to examine these changes across non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic/Latino racial/ethnic subgroups. Insurance coverage increased significantly for all racial/ethnic groups in expansion states relative to non-expansion states (DD: 9.69; 95% CI: 5.17, 14.21). The proportion low-income adults that received treatment but still had unmet need decreased (DD: −3.06; 95% CI: −5.92, −0.21) and the proportion with unmet need and no mental health treatment increased (DD: 2.38; 95% CI: 0.03, 4.73). ME was not associated with reduced disparities.Interdisciplinary perspectives on 'what matters most' in the cultural shaping of health-related stigma in Indonesia
AbstractSantosa, A., Sopamena, Y., Visser, M., Dadun, D., Damayanti, R., Yang, L., Zweekhorst, M., & Peters, R. (n.d.).Publication year
2024Journal title
BMJ Global HealthVolume
9Issue
9AbstractHealth-related stigma plays a significant role in the burden of various health conditions such as neglected tropical diseases and mental illnesses, and undermines successful health outcomes. Stigmatised individuals can face lifelong socioeconomic consequences because of their condition. It is broadly recognised that culturally salient factors interact with the way stigma is expressed in different local contexts. This study aimed to capture cultural capabilities that shape health-related stigma in Indonesia, using the 'what matters most' (WMM) stigma framework. In this qualitative research, 15 in-depth interviews with experts in the field of Indonesian culture and health studies were conducted, followed by a group discussion. Data were collected between April and September 2021, and analysed using thematic content analysis. The analysis shows that cultural values such as communal participation in local networks and the 'shame culture' shapes experiences of stigma in Indonesia. Moreover, the participants explained that achieving full standing in the Indonesian context meant contributing to the collective interest and maintaining the family reputation. Personhood is also related to socially defined gender roles. For example, community participation was often influenced by patriarchal values, which lead to differences in access to life opportunities, while recognition in the family was often connected to complying with gender roles. This study contributes to research on the cultural shaping of health-related stigma involving the WMM framework in the Indonesian context. Future research should focus on the perspectives of those who are affected by stigmatised conditions and on integrating these insights in the assessment and reduction of health-related stigma.Parsing stigma’s relationship with the psychosocial functioning of youth identified as at clinical high risk for psychosis: evaluating whether symptom stigma or labelling stigma is stronger
AbstractYang, L. H., Grivel, M. M., Blasco, D., Girgis, R. R., Huang, D., Woodberry, K. A., Corcoran, C. M., McFarlane, W. R., & Link, B. G. (n.d.).Publication year
2024Journal title
British Journal of PsychiatryAbstractBackground The clinical high risk for psychosis (CHR-p) syndrome enables early identification of individuals at risk of schizophrenia and related disorders. We differentiate between the stigma associated with the at-risk identification itself (‘labelling-related’ stigma) versus stigma attributed to experiencing mental health symptoms (‘symptom-related’ stigma) and examine their relationships with key psychosocial variables. Aims We compare labelling- and symptom-related stigma in rates of endorsement and associations with self-esteem, social support loss and quality of life. Method We assessed stigma domains of shame-related emotions, secrecy and experienced discrimination for both types of stigma. Individuals at CHR-p were recruited across three sites (N = 150); primary analyses included those who endorsed awareness of psychosis risk (n = 113). Paired-sample t-tests examined differences in labelling- versus symptom-related stigma; regressions examined associations with psychosocial variables, controlling for covariates, including CHR-p symptoms. Results Respondents reported greater symptom-related shame, but more labelling-related secrecy. Of the nine significant associations between stigma and psychosocial variables, eight were attributable to symptom-related stigma, even after adjusting for CHR-p symptoms. Conclusions Stigma attributed to symptoms had a stronger negative association with psychosocial variables than did labelling-related stigma among individuals recently identified as CHR-p. That secrecy related to the CHR-p designation was greater than its symptom-related counterpart suggests that labelling-related stigma may still be problematic for some CHR-p participants. To optimise this pivotal early intervention effort, interventions should address the holistic ‘stigmatising experience’ of having symptoms, namely any harmful reactions received as well as participants’ socially influenced concerns about what their experiences mean, in addition to the symptoms themselves.Perceptions of stigma in youth at clinical high risk for psychosis and depressive symptomatology
AbstractAlliende, L. M., Strauss, G. P., Yang, L. H., & Mittal, V. A. (n.d.).Publication year
2024Journal title
Schizophrenia ResearchVolume
269Page(s)
79-85AbstractIt is unclear what types of stigma youth at clinical high risk for psychosis (CHR) experience, and the relationship between them and symptomatology. 94 CHR youth, and a control group of 45 youth with no psychosis spectrum symptoms (NP) were rated for perceived devaluation (i.e. negative views from others) and internalized mental health stigma (i.e. the extent to which they would agree with said views) as well as positive and mood symptomatology. CHR youth reported stigma more frequently than the NP group (χ2(1) = 53.55, p < .001) and at higher levels (perceived devaluation: t (137) = 8.54, p < .001; internalized stigma: t (137) = 7.48, p < .001). Surprisingly, in the CHR group, positive symptoms held no significant relationship to stigma measures. However, ratings of perceived devaluation stigma were associated with depressive symptomatology (β = 0.27, t = 2.68, p = .0087) and depression scores were conversely associated with perceived devaluation stigma (β = 0.30, t = 2.05, p = .043). These findings speak to the relationship between depressive symptomatology and perceived devaluation stigma in CHR youth. Perceived devaluation stigma showed greater clinical significance and could have different mechanisms than internalized stigma in CHR youth. It is also noteworthy that while positive symptoms play a central role in defining the CHR syndrome, they seem less relevant to the experience of stigma than mood symptoms. These findings highlight the importance of interventions aimed at ameliorating youth's exposure to negative views about mental health as those managing depressive symptomatology.Randomized Controlled Trial of a Brief Video Intervention to Reduce Self-Stigma of Mental Illness
AbstractAmsalem, D., Jankowski, S. E., Yanos, P., Yang, L. H., Markowitz, J. C., Rogers, R. T., Stroup, T. S., Dixon, L. B., & Pope, L. G. (n.d.).Publication year
2024Journal title
Journal of Clinical PsychiatryVolume
85Issue
1AbstractObjective: Self-stigma, a phenomenon wherein individuals internalize self-directed negative stereotypes about mental illness, is associated with negative outcomes related to recovery. This randomized controlled study assessed the efficacy of a brief social contact–based video intervention in reducing self-stigma in a large sample of individuals ages 18–35 endorsing an ongoing mental health condition. We hypothesized that the brief video would reduce self-stigma. Methods: In January and February 2023, we recruited and assigned 1,214 participants to a brief video-based intervention depicting a young individual living with mental illness sharing his personal story or to a non-intervention control. In the 2-minute video, informed by focus groups, a young individual described struggles with mental illness symptoms; this was balanced with descriptions of living a meaningful and productive life. Self-stigma assessments (Stereotype Endorsement, Alienation, Stigma Resistance, Perceived Devaluation Discrimination, Secrecy, and Recovery Assessment Scale) were conducted pre- and post-intervention and at 30-day follow-up. Results: A 2×3 group-by-time analysis of variance showed that mean self-stigma scores decreased in the intervention arm relative to control across 5 of 6 self-stigma domains: Stereotype Endorsement (P=.006), Alienation (P<.001), Stigma Resistance (P=.004), Secrecy (P<.001), and Recovery Assessment Scale (P<.001). Cohen d effect sizes ranged from 0.22 to 0.46 for baseline to post-intervention changes. Baseline and 30-day follow-up assessments did not significantly differ. Conclusions: A 2-minute social contact–based video intervention effectively yielded an immediate but not a lasting decrease in self-stigma among young individuals with ongoing mental health conditions. This is the first study to examine the effect of a video intervention on self-stigma. Future trials of self-stigma treatment interventions should explore whether combining existing interventions with brief videos enhances intervention effects.Stigma assessment and reduction in communities: Guide to engage with culture using ‘what matters most’
Visser, M. J., Sutiawan, R., Sopamena, Y., Innoeze, U., Nwefoh, E., Subedi, M., Yang, L. H., Zweekhorst, M. B., Dadun, ., & Peters, R. M. (n.d.).Publication year
2024Journal title
Leprosy ReviewVolume
95Issue
3The use and operationalization of “structural stigma” in health-related research: A scoping review
AbstractEschliman, E. L., Kisanga, E. P., Huang, L. J., Poku, O. B., Genberg, B. L., German, D., Murray, S. M., Yang, L. H., & Kaufman, M. R. (n.d.).Publication year
2024Journal title
BMC public healthVolume
24Issue
1AbstractBackground: Research that investigates the negative health effects of stigma beyond the individual and interpersonal levels is increasingly using the concept of “structural stigma.” This scoping review investigates how the concept of “structural stigma” has been used and operationalized in health-related literature to date in order to characterize its usage and inform future operationalizations. Methods: A systematic search and screening process identified peer-reviewed, English-language research articles that used the term “structural stigma” available prior to January 1, 2024 in five databases (i.e., PubMed, PsycINFO, Embase, Web of Science, CINAHL). Results: Of the 298 articles identified, over half (53%) were published from 2021 onward. Articles most commonly were set in the United States (n = 163, 55%), investigated stigma toward sexual minority people (n = 163, 55%), and cited the introduction of a special issue of Social Science & Medicine as their source of the concept (n = 84, 28%). Most articles (64%) used at least one additional conceptual framework, most commonly minority stress theory (n = 107, 36%). Quantitative operationalizations (n = 102) engaged most in the conceptual domain of laws and government-level policies, while qualitative operationalizations (n = 68) engaged most with institutional (i.e., non-government-level) policies, practices, and procedures. Conclusions: As the use of “structural stigma” is increasing, operationalizations can better leverage the concept’s breadth and account for individuals’ intersectional lived experiences. This will necessitate bridging across methodologies and bodies of research on related negative social processes.Use of the Chinese version of the MATRICS Consensus Cognitive Battery to assess cognitive functioning in individuals with high risk for psychosis, first-episode schizophrenia and chronic schizophrenia: a systematic review and meta-analysis
AbstractCai, B., Zhu, Y., Liu, D., Li, Y., Bueber, M., Yang, X., Luo, G., Su, Y., Grivel, M. M., Yang, L. H., Qian, M., Stone, W. S., & Phillips, M. R. (n.d.).Publication year
2024Journal title
The Lancet Regional Health - Western PacificVolume
45AbstractMore than one hundred studies have used the mainland Chinese version of the MATRICS Consensus Cognitive Battery (MCCB) to assess cognition in schizophrenia, but the results of these studies, the quality of the reports, and the strength of the evidence provided in the reports have not been systematically assessed. We identified 114 studies from English-language and Chinese-language databases that used the Chinese MCCB to assess cognition in combined samples of 7394 healthy controls (HC), 392 individuals with clinical high risk for psychosis (CHR-P), 4922 with first-episode schizophrenia (FES), 1549 with chronic schizophrenia (CS), and 2925 with schizophrenia of unspecified duration. The mean difference (MD) of the composite MCCB T-score (−13.72) and T-scores of each of the seven cognitive domains assessed by MCCB (−14.27 to −7.92) were significantly lower in individuals with schizophrenia than in controls. Meta-analysis identified significantly greater cognitive impairment in FES and CS than in CHR-P in six of the seven domains and significantly greater impairment in CS than FES in the reasoning and problem-solving domain (i.e., executive functioning). The only significant covariate of overall cognitive functioning in individuals with schizophrenia was a negative association with the severity of psychotic symptoms. These results confirm the construct validity of the mainland Chinese version of MCCB. However, there were significant limitations in the strength of the evidence provided about CHR-P (small pooled sample sizes) and the social cognition domain (inconsistency of results across studies), and the quality of many reports (particularly those published in Chinese) was rated ‘poor’ due to failure to report sample size calculations, matching procedures or methods of handling missing data. Moreover, almost all studies were cross-sectional studies limited to persons under 60 with at least nine years of education, so longitudinal studies of under-educated, older individuals with schizophrenia are needed.“It’s Tough to Be a Black Man with Schizophrenia”: Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma
AbstractAmsalem, D., Jankowski, S. E., Pagdon, S., Smith, S., Yang, L. H., Valeri, L., Markowitz, J. C., Lewis-Fernández, R., & Dixon, L. B. (n.d.).Publication year
2024Journal title
Schizophrenia bulletinVolume
50Issue
3Page(s)
695-704AbstractBackground and Hypothesis: Racial discrimination and public stigma toward Black individuals living with schizophrenia create disparities in treatment-seeking and engagement. Brief, social-contact-based video interventions efficaciously reduce stigma. It remains unclear whether including racial identity experiences in video narrative yields greater stigma reduction. We hypothesized that we would replicate findings showing sustained stigma reduction in video-intervention groups vs control and that Black participants would show greater stigma reduction and emotional engagement than non-Black participants only for a racial-insights video presenting a Black protagonist. Study Design: Recruiting using a crowdsourcing platform, we randomized 1351 participants ages 18–30 to (a) brief video-based intervention, (b) racial-insights-focused brief video, or (c) non-intervention control, with baseline, post-intervention, and 30-day follow-up assessments. In 2-minute videos, a young Black protagonist described symptoms, personal struggles, and recovery from schizophrenia, with or without mentioning race-related experiences. Study Results: A 3 × 3 ANOVA showed a significant group-by-time interaction for total scores of each of five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery (all P < .001). Linear mixed modeling showed a greater reduction in stigma from baseline to post-intervention among Black than non-Black participants in the racial insights video group for the social distance and social restriction domains. Conclusions: This randomized controlled trial replicated and expanded previous findings, showing the anti-stigma effects of a brief video tailored to race-related experiences. This underscores the importance of personalized, culturally relevant narratives, especially for marginalized groups who, more attuned to prejudice and discrimination, may particularly value identification and solidarity. Future studies should explore mediators/moderators to improve intervention efficacy."It Is Hard to Be a Woman With Schizophrenia": Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma in Young Adults
AbstractAmsalem, D., Jankowski, S. E., Pagdon, S., Valeri, L., Smith, S., Yang, L. H., Markowitz, J. C., Lewis-Fernández, R., & Dixon, L. B. (n.d.).Publication year
2023Journal title
Journal of Clinical PsychiatryVolume
84Issue
1AbstractObjective: Women with schizophrenia encounter specific genderrelated stressors that may affect their recovery process. They are more susceptible to victimization and tend to experience more shame and stigma about their illness. Confronting stigma early in the illness could enhance treatment seeking. No studies have examined the efficacy of stigma-reducing interventions focused on public stigma toward women living with schizophrenia or have tested the effect of genderspecific content therein. Methods: We compared the efficacy at post-intervention and 30-day follow-up of 2 brief (∼80-second) videos, with and without genderrelated content, and a non-intervention control, in 1,181 young adults, between September and November 2021. The videos feature an empowered young woman living with schizophrenia who describes struggling with her psychotic illness to attain recovery and hope. Results: A 3 × 3 group-by-time analysis of variance showed decreased mean stigma scores over time in the two intervention arms relative to controls across all 5 public stigma domains: social distance (F = 17.1, P < .001), stereotyping (F = 25.0, P < .001), separateness (F = 8.3, P < .001), social restriction (F = 16.6, P < .001), and perceived recovery (F = 7.8, P < .001). Linear mixed modeling showed a greater intervention effect for women in the gender-related video group in social distance, stereotyping, and separateness. Conclusions: Greater stigma reduction among women in the genderrelated video group underscores the importance of tailoring the narrative to specific experiences related to socio-demographic characteristics, especially among members of marginalized groups. This attenuation may result in greater identification and solidarity with the presenter. Future studies should explore other socially oppressed groups, including Black, Latinx, Asian, and LGBTQ+ communities.A conceptual framework for how structural changes in emerging acute substance use service models can reduce stigma of medications for opioid use disorder
AbstractBecker, T. D., Eschliman, E. L., Thakrar, A. P., & Yang, L. H. (n.d.).Publication year
2023Journal title
Frontiers in PsychiatryVolume
14AbstractStigma toward people taking medication for opioid use disorder (MOUD) is prevalent, harmful to the health and well-being of this population, and impedes MOUD treatment resource provision, help-seeking, and engagement in care. In recent years, clinicians have implemented new models of MOUD-based treatment in parts of the United States that integrate buprenorphine initiation into emergency departments and other acute general medical settings, with post-discharge linkage to office-based treatment. These service models increase access to MOUD and they have potential to mitigate stigma toward opioid use and MOUD. However, the empirical literature connecting these emerging service delivery models to stigma outcomes remains underdeveloped. This paper aims to bridge the stigma and health service literatures via a conceptual model delineating how elements of emerging MOUD service models can reduce stigma and increase behavior in pursuit of life goals. Specifically, we outline how new approaches to three key processes can counter structural, public, and self-stigma for this population: (1) community outreach with peer-to-peer influence, (2) clinical evaluation and induction of MOUD in acute care settings, and (3) transition to outpatient maintenance care and early recovery. Emerging service models that target these three processes can, in turn, foster patient empowerment and pursuit of life goals. There is great potential to increase the well-being of people who use opioids by reducing stigma against MOUD via these structural changes.Association of antiseizure medication adherence with illness perceptions in adults with epilepsy
AbstractChoi, H., Wetmore, J. B., Camarillo, I. A., Misiewicz, S., Siegel, K., Chung, W. K., Leu, C. S., Phelan, J. C., Yang, L. H., & Ottman, R. (n.d.).Publication year
2023Journal title
Epilepsy and BehaviorVolume
145AbstractObjective: We assessed the relationship of epilepsy illness perceptions to antiseizure medication (ASM) adherence. Methods: Surveys were completed by 644 adult patients with epilepsy of unknown cause. We used the Morisky Medication Adherence Scale-8 (MMAS-8) to define “high” adherence (score = 8) and “low-medium” adherence (score < 8). We evaluated epilepsy illness perceptions using seven items from the Brief Illness Perception Questionnaire (BIPQ), each scored from 0-10, measuring participants’ views of the overall effect of epilepsy on their lives, how long it would last, how much control they had over their epilepsy, the effectiveness of their treatment, level of concern about epilepsy, level of understanding of epilepsy, and emotional impact of epilepsy. We investigated the association of each BIPQ item with medication adherence using logistic regression models that controlled for potential confounders (age, race/ethnicity, income, and time since the last seizure). Results: One hundred forty-nine patients (23%) gave responses indicating high adherence. In the adjusted models, for each 1-unit increase in participants’ BIPQ item scores, the odds of high adherence increased by 17% for understanding of their epilepsy (OR = 1.17, 95% CI 1.07–1.27, p < 0.001), decreased by 11% for overall life impact of epilepsy (OR = 0.89, 95% CI 0.82–0.97, p = 0.01) and decreased by 6% for emotional impact of epilepsy (OR = 0.94, 95% CI 0.86–0.99, p = 0.03). No other illness perception was associated with high adherence. Depression, anxiety, and stigma mediated the inverse relationships of high adherence to the overall life impact of epilepsy and the emotional impact of epilepsy. These measures did not mediate the relationship of high adherence to the perceived understanding of epilepsy. Conclusion: These results indicate that a greater perceived understanding of epilepsy is independently associated with high ASM adherence. Programs aimed at improving patients’ understanding of their epilepsy may help improve medication adherence.COVID-19 stigmatization after the development of effective vaccines: Vaccination behavior, attitudes, and news sources
AbstractDes Jarlais, D. C., Lieff, S., Grivel, M., Meltzer, G., Choi, J., Weng, C. A., Feelemyer, J. P., Chang, V. W., & Yang, L. (n.d.).Publication year
2023Journal title
PloS oneVolume
18Issue
4AbstractObjective To compare COVID-19 stigmatization at two pandemic time points (1) August 2020—during lockdowns and prior to vaccine rollout, and (2) May 2021—during vaccine rollout, when approximately half of U.S. adults were vaccinated. Methods Comparison of COVID19-related stigmatization and associated factors in two national internet surveys conducted in August 2020 (N = 517) and May 2021 (N = 812). Factors associated with endorsing stigmatization were identified using regression analysis. The main outcomes included endorsement of stigmatization and behavioral restrictions towards persons with COVID-19 and towards persons of Chinese descent. A previously developed “stigmatizing attitudes and behavioral restrictions” scale was adapted to measure the intersection of negative attitudes toward COVID-19 disease and negative attitudes toward persons of Chinese descent. Results COVID-19 related stigmatization declined significantly from August 2020 to May 2021. Many factors were associated with stigmatizing in both surveys: full time employment, Black race, Hispanic ethnicity, worry about contracting COVID-19, probable depression, and Fox News and social media as sources of information (all positively associated), and self-assessed knowledge about COVID-19, contact with Chinese individuals, and publicly funded news as sources (all negatively associated). Positive attitudes toward vaccination were associated with stigmatization. Conclusions COVID-19 related stigmatization reduced substantially over these two points in the pandemic, with many continuities in the factors associated with stigmatizing. Despite the reduction in stigmatizing, however, some stigmatizing attitudes for both COVID-19 and Chinese individuals remained.Editorial: Global mental health among marginalized communities in pandemic emergencies
Navario, P. S., Upadhaya, N., Hall, B. J., & Yang, L. H. (n.d.).Publication year
2023Journal title
Frontiers in Public HealthVolume
11Effectiveness of enhancing contact model on reducing family caregiving burden and improving psychological wellbeing among caregivers of persons with schizophrenia in rural China
AbstractWang, Y. Z., Weng, X., Zhang, T. M., Li, M., Luo, W., Wong, Y. L. I., Yang, L. H., Thornicroft, G., Lu, L., & Ran, M. S. (n.d.).Publication year
2023Journal title
Psychological MedicineVolume
53Issue
12Page(s)
5756-5766AbstractBackground. It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS). Methods. We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively. Results. Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 (p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 (p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 (p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 (p = 0.0160 and 0.0486, respectively). Conclusions. This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM’s effectiveness in various population.Four very basic ways to think about policy in implementation science
AbstractPurtle, J., Moucheraud, C., Yang, L. H., & Shelley, D. (n.d.).Publication year
2023Journal title
Implementation Science CommunicationsVolume
4Issue
1AbstractBackground: Policy is receiving increasing attention in the field of implementation science. However, there remains a lack of clear, concise guidance about how policy can be conceptualized in implementation science research. Building on Curran’s article “Implementation science made too simple”—which defines “the thing” as the intervention, practice, or innovation in need of implementation support—we offer a typology of four very basic ways to conceptualize policy in implementation science research. We provide examples of studies that have conceptualized policy in these different ways and connect aspects of the typology to established frameworks in the field. The typology simplifies and refines related typologies in the field. Four very basic ways to think about policy in implementation science research. 1) Policy as something to adopt: an evidence-supported policy proposal is conceptualized as “the thing” and the goal of research is to understand how policymaking processes can be modified to increase adoption, and thus reach, of the evidence-supported policy. Policy-focused dissemination research is well-suited to achieve this goal. 2) Policy as something to implement: a policy, evidence-supported or not, is conceptualized as “the thing” and the goal of research is to generate knowledge about how policy rollout (or policy de-implementation) can be optimized to maximize benefits for population health and health equity. Policy-focused implementation research is well-suited to achieve this goal. 3) Policy as context to understand: an evidence-supported intervention is “the thing” and policies are conceptualized as a fixed determinant of implementation outcomes. The goal of research is to understand the mechanisms through which policies affect implementation of the evidence-supported intervention. 4) Policy as strategy to use: an evidence-supported intervention is “the thing” and policy is conceptualized as a strategy to affect implementation outcomes. The goal of research is to understand, and ideally test, how policy strategies affect implementation outcomes related to the evidence-supported intervention. Conclusion: Policy can be conceptualized in multiple, non-mutually exclusive ways in implementation science. Clear conceptualizations of these distinctions are important to advancing the field of policy-focused implementation science and promoting the integration of policy into the field more broadly.Impact of COVID-19 pandemic on chronic pain and opioid use in marginalized populations: A scoping review
AbstractChoe, K., Zinn, E., Lu, K., Hoang, D., & Yang, L. H. (n.d.).Publication year
2023Journal title
Frontiers in Public HealthVolume
11AbstractIntroduction: The COVID-19 pandemic has had a variable effect on vulnerable populations, including patients with chronic pain who rely on opioid treatment or have comorbid opioid use disorder. Limited access to care due to isolation measures may lead to increased pain severity, worse mental health symptoms, and adverse opioid-related outcomes. This scoping review aimed to understand the impact of the COVID-19 pandemic on the dual epidemics of chronic pain and opioids in marginalized communities worldwide. Methods: Searches of primary databases including PubMed, Web of Science, Scopus, and PsycINFO were performed in March 2022, restricting the publication date to December 1, 2019. The search yielded 685 articles. After title and abstract screening, 526 records were screened by title and abstract, 87 through full-text review, of which 25 articles were included in the final analysis. Results: Our findings illuminate the differential distribution of pain burden across marginalized groups and how it serves to heighten existing disparities. Service disruptions due to social distancing orders and infrastructural limitations prevented patients from receiving the care they needed, resulting in adverse psychological and physical health outcomes. Efforts to adapt to COVID-19 circumstances included modifications to opioid prescribing regulations and workflows and expanded telemedicine services. Conclusion: Results have implications for the prevention and management of chronic pain and opioid use disorder, such as challenges in adopting telemedicine in low-resource settings and opportunities to strengthen public health and social care systems with a multidisciplinary and multidimensional approach.Investigating the Physical and Mental Health Nexus: a Network Analysis of Depression, Cardiometabolic Health, Bone Mass, and Perceived Health Status Among Filipino Domestic Workers
AbstractGarabiles, M. R., Shen, Z. Z., Yang, L., Chu, Q., Hannam, K., & Hall, B. J. (n.d.).Publication year
2023Journal title
International Journal of Behavioral MedicineVolume
30Issue
2Page(s)
234-249AbstractBackground: Migrant domestic workers are vulnerable to physical and mental health problems given the many challenges they experience while working abroad. Using network analysis, this study examined the structure of depression, cardiometabolic health indicators (BMI, waist-hip ratio (WHR), blood pressure, and heart rate), bone mass, and perceived health status in this population. The network model allowed for an examination of central symptoms or symptoms with the most direct connections with other symptoms; bridge symptoms, or symptoms that link two or more communities; and edges, or relationships among symptoms. Method: Cross-sectional data were gathered from 1375 Filipino domestic workers in Macao (SAR), China. Data from a subsample of 510 participants who met a cutoff indicating depression were analyzed. Anthropometric measurements and surveys were used to collect data, which was analyzed using R statistical software. Results: Results showed four community clusters: three communities consisted of at least two depression symptoms each and the fourth community included physical health indicators. Strong edges were formed between BMI-bone mass, psychomotor-concentration, BMI-WHR, and sad mood-anhedonia. The node with the highest expected influence was BMI. There were three bridges: worthlessness, psychomotor difficulties, and concentration difficulties. Conclusion: The link between depression, cardiometabolic indicators, bone mass, and poor perceived health reinforces the need to address multimorbidity within migrant populations. Health promotion interventions that address mental and physical health may improve the health of this population.