Lawrence H Yang

Lawrence Yang
Lawrence H Yang

Interim Chair and Professor of Social and Behavioral Sciences

Associate Director, Global Center for Implementation Science

Founding Director, Global Mental Health and Stigma Program

Professional overview

Dr. Lawrence Yang is Professor and Interim 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 >145 peer-reviewed publications, including in journals such as 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) and is co-investigator on 4 R01 grants and another R34 grant. 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 will yield a published book by MIT Press (anticipated 2023).

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 recently 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 servicesvia 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.

Education

BA, High Honors and Phi Beta Kappa, Wesleyan University, Middletown, CT
PhD, Boston University, Boston, MA
Clinical Fellowship, Harvard Medical School (Massachusetts Mental Health Center)
Postdoctoral Fellowship, Columbia Mailman School of Public Health (NIMH funded T32 Training Program in Psychiatric Epidemiology)

Honors and awards

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)

Areas of research and study

Cognition and Psychosis
Global Health
Implementation science
Mental Health
Stigma of Health Conditions
“At-Risk” States for Psychosis

Publications

Publications

"It Is Hard to Be a Woman With Schizophrenia": Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma in Young Adults

Amsalem, 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

2022

Journal title

The Journal of clinical psychiatry

Volume

84

Issue

1
Abstract
Abstract
Objective: Women with schizophrenia encounter specific gender-related 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 gender-specific content therein. Methods: We compared the efficacy at post-intervention and 30-day follow-up of 2 brief (~80-second) videos, with and without gender-related 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 gender-related 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 pilot pragmatic trial of a “what matters most”-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana

Yang, L. H., Eschliman, E. L., Mehta, H., Misra, S., Poku, O. B., Entaile, P., Becker, T. D., Melese, T., Brooks, M. J., Eisenberg, M., Stockton, M. A., Choe, K., Tal, D., Li, T., Go, V. F., Link, B. G., Rampa, S., Jackson, V. W., Manyeagae, G. D., Arscott-Mills, T., Goodman, M., Opondo, P. R., Ho-Foster, A. R., & Blank, M. B. (n.d.).

Publication year

2022

Journal title

AIDS Research and Therapy

Volume

19

Issue

1
Abstract
Abstract
We conducted a pilot trial of an intervention targeting intersectional stigma related to being pregnant and living with HIV while promoting capabilities for achieving ‘respected motherhood’ (‘what matters most’) in Botswana. A pragmatic design allocated participants to the intervention (N = 44) group and the treatment-as-usual (N = 15) group. An intent-to-treat, difference-in-difference analysis found the intervention group had significant decreases in HIV stigma (d = − 1.20; 95% CI − 1.99, − 0.39) and depressive symptoms (d = − 1.96; 95% CI − 2.89, − 1.02) from baseline to 4-months postpartum. Some, albeit less pronounced, changes in intersectional stigma were observed, suggesting the importance of structural-level intervention components to reduce intersectional stigma.

A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial

Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks

Le, P. T. D., Eschliman, E. L., Grivel, M. M., Tang, J., Cho, Y. G., Yang, X., Tay, C., Li, T., Bass, J., & Yang, L. H. (n.d.).

Publication year

2022

Journal title

Implementation Science

Volume

17

Issue

1
Abstract
Abstract
Background: Task-sharing is a promising strategy to expand mental healthcare in low-resource settings, especially in low- and middle-income countries (LMICs). Research on how to best implement task-sharing mental health interventions, however, is hampered by an incomplete understanding of the barriers and facilitators to their implementation. This review aims to systematically identify implementation barriers and facilitators in evidence-based task-sharing mental health interventions using an implementation science lens, organizing factors across a novel, integrated implementation science framework. Methods: PubMed, PsychINFO, CINAHL, and Embase were used to identify English-language, peer-reviewed studies using search terms for three categories: “mental health,” “task-sharing,” and “LMIC.” Articles were included if they: focused on mental disorders as the main outcome(s); included a task-sharing intervention using or based on an evidence-based practice; were implemented in an LMIC setting; and included assessment or data-supported analysis of barriers and facilitators. An initial conceptual model and coding framework derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework was developed and iteratively refined to create an integrated conceptual framework, the Barriers and Facilitators in Implementation of Task-Sharing Mental Health Interventions (BeFITS-MH), which specifies 37 constructs across eight domains: (I) client characteristics, (II) provider characteristics, (III) family and community factors, (IV) organizational characteristics, (V) societal factors, (VI) mental health system factors, (VII) intervention characteristics, and (VIII) stigma. Results: Of the 26,935 articles screened (title and abstract), 192 articles underwent full-text review, yielding 37 articles representing 28 unique intervention studies that met the inclusion criteria. The most prevalent facilitators occur in domains that are more amenable to adaptation (i.e., the intervention and provider characteristics domains), while salient barriers occur in domains that are more challenging to modulate or intervene on—these include constructs in the client characteristics as well as the broader societal and structural levels of influence (i.e., the organizational, mental health system domains). Other notable trends include constructs in the family and community domains occurring as barriers and as facilitators roughly equally, and stigma constructs acting exclusively as barriers. Conclusions: Using the BeFITS-MH model we developed based on implementation science frameworks, this systematic review provides a comprehensive identification and organization of barriers and facilitators to evidence-based task-sharing mental health interventions in LMICs. These findings have important implications for ongoing and future implementation of this critically needed intervention strategy, including the promise of leveraging task-sharing intervention characteristics as sites of continued innovation, the importance of but relative lack of engagement with constructs in macro-level domains (e.g., organizational characteristics, stigma), and the need for more delineation of strategies for task-sharing mental health interventions that researchers and implementers can employ to enhance implementation in and across levels.

Comparison of social cognition using an adapted Chinese version of the Reading the Mind in the Eyes Test in drug-naive and regularly medicated individuals with chronic schizophrenia and healthy controls in rural China

Deng, F., Phillips, M. R., Cai, B., Yu, G., Qian, M., Grivel, M. M., Chen, H., Ouyang, X., Xue, F., Zhao, M., Kegeles, L. S., Susser, E. S., Keshavan, M. S., Stone, W. S., & Yang, L. H. (n.d.).

Publication year

2022

Journal title

Psychological Medicine

Volume

52

Issue

15

Page(s)

3655-3667
Abstract
Abstract
Background Social cognition has not previously been assessed in treatment-naive patients with chronic schizophrenia, in patients over 60 years of age, or in patients with less than 5 years of schooling. Methods We revised a commonly used measure of social cognition, the Reading the Mind in the Eyes Test (RMET), by expanding the instructions, using both self-completion and interviewer-completion versions (for illiterate respondents), and classifying each test administration as 'successfully completed' or 'incomplete'. The revised instrument (RMET-CV-R) was administered to 233 treatment-naive patients with chronic schizophrenia (UT), 154 treated controls with chronic schizophrenia (TC), and 259 healthy controls (HC) from rural communities in China. Results In bivariate and multivariate analyses, successful completion rates and RMET-CV-R scores (percent correct judgments about emotion exhibited in 70 presented slides) were highest in HC, intermediate in TC, and lowest in UT (adjusted completion rates, 97.0, 72.4, and 49.9%, respectively; adjusted RMET-CV-R scores, 45.4, 38.5, and 34.6%, respectively; all p < 0.02). Stratified analyses by the method of administration (self-completed v. interviewer-completed) and by education and age ('educated-younger' v. 'undereducated-older') show the same relationship between groups (i.e. NC>TC>UT), though not all differences remain statistically significant. Conclusions We find poorer social cognition in treatment-naive than in treated patients with chronic schizophrenia. The discriminant validity of RMET-CV-R in undereducated, older patients demonstrates the feasibility of administering revised versions of RMET to patients who may otherwise be considered ineligible due to education or age by changing the method of test administration and carefully assessing respondents' ability to complete the task successfully.

Coronavirus Disease (COVID-19) Related Discrimination and Mental Health in Five U.S. Southern Cities

Le, P. T. D., Misra, S., Hagen, D., Wang, S. M., Li, T., Brenneke, S. G., Yang, L. H., & Goldmann, E. (n.d.).

Publication year

2022

Journal title

Stigma and Health
Abstract
Abstract
Evidence is mounting that stigma and discrimination related to coronavirus disease (COVID-19) disproportionately impact racial/ethnic minority groups, and that these experiences can worsen mental health. The present study sought to examine multiple types of COVID-related discrimination and their associations with mental health outcomes among racial/ethnic groups in the U.S. South, a region characterized by high levels of racial polarization and increasingly large numbers of undocumented immigrants.We used the cross-sectional, population-based COVID-19 Southern Cities Study (5/26/20–6/6/20) of n = 1,688 adults in Atlanta-GA, Austin-TX, Dallas-TX, Houston-TX, and New Orleans-LA. Three adapted scales (Everyday Discrimination, Major Discrimination, Heightened Vigilance) assessed self-reported COVID-related discrimination. Mental health outcomes included psychological distress, sleep troubles, physical reactions, and self-rated worsened mental health. Bivariable comparisons and adjusted logistic regression models were conducted. The study found that major discrimination was more common (p < .001) among Hispanic and non-Hispanic Black than non-Hispanic Asian and non-Hispanic White respondents. All racial/ethnic minority groups experienced more everyday discrimination (p = .004) and heightened vigilance due to anticipated discrimination (p < .001) than non-Hispanic White respondents. All discrimination types were associated with all mental health outcomes (Odds Ratio; OR range: 1.63–2.61) except everyday and major discrimination with sleep troubles. Results showing greater COVID-related discrimination for racial/ethnic minority groups confirm that these discrimination experiences are not solely about the infectious disease itself, but also entrenched with persistent racism. Responses to COVID-related discrimination should also consider long-lasting impacts on mental health for racial/ethnic minority groups even after the immediate pandemic ends.

Determinants of never-treated status in rural versus urban contexts for individuals with schizophrenia in a population-based study in China

Yang, L. H., Phillips, M. R., Li, X., Yu, G., Grivel, M. M., Zhang, J., Shi, Q., Ding, Z., Pang, S., & Susser, E. (n.d.).

Publication year

2022

Journal title

BMC psychiatry

Volume

22

Issue

1
Abstract
Abstract
Background: A goal of China’s 2012 National Mental Health Law is to improve access to services and decrease urban versus rural disparities in services. However, pre-reform data is needed for objective evaluation of these reforms’ effectiveness. Accordingly, this study compares the pre-reform utilization of medical services for the treatment of schizophrenia in rural and urban communities in China. Methods: In a large community-based study in four provinces representing 12% of China’s population conducted from 2001 to 2005, we identified 326 individuals with schizophrenia (78 never treated). Comparing those living in urban (n = 86) versus rural (n = 240) contexts, we used adjusted Poisson regression models to assess the relationship of ‘never treated’ status with family-level factors (marital status, family income, and number of co-resident family members) and illness severity factors (age of onset, symptom severity and functional impairment). Results: Despite similar impairments due to symptoms, rural patients were less likely to have received intensive mental health services (i.e., use psychiatric inpatient services), and appeared more likely to be ‘never treated’ or to only have received outpatient care. Among rural patients, only having more than four co-resident family members was independently associated with ‘never-treated’ status (RR = 0.34; 95% CI, 0.12–0.94; p = 0.039). Among urban patients, only older age of onset was independently associated with ‘never-treated’ status (RR = 1.06; 95% CI 1.02–1.10, p = 0.003). Conclusions: Identifying differential drivers of service utilization in urban and rural communities is needed before implementing policies to improve the utilization and equity of services and to define metrics of program success.

Development of the Brief Educational Guide for Individuals in Need (BEGIN): A psychoeducation intervention for individuals at risk for psychosis

Herrera, S. N., Lyallpuri, R., Sarac, C., Dobbs, M. F., Nnaji, O., Jespersen, R., DeLuca, J. S., Wyka, K. E., Yang, L. H., Corcoran, C. M., & Landa, Y. (n.d.).

Publication year

2022

Journal title

Early Intervention in Psychiatry

Volume

16

Issue

9

Page(s)

1002-1010
Abstract
Abstract
Aim: Identification of individuals with psychosis risk (PR) through screening and specialized assessment is becoming more widespread in an effort to promote early intervention and improve recovery outcomes. PR individuals report interest in psychoeducation, though such interventions are currently lacking. Our goal was to develop a structured PR psychoeducation intervention grounded in theory and stakeholder feedback. Methods: By following a step-by-step intervention development model, we identified relevant conceptual frameworks, developed the content and format, and obtained stakeholder feedback. This process resulted in a 5-session PR psychoeducation intervention, Brief Educational Guide for Individuals in Need (BEGIN), with content conveyed visually via a slideshow presentation. PR individuals (n = 5) and parents of PR individuals (n = 5) reviewed BEGIN's content and format, and provided feedback through semi-structured qualitative interviews. Major themes were identified through iterative thematic analysis. Results: PR individuals and parents had a positive impression of BEGIN's materials and step-by-step format and psychoeducation about the PR condition. They indicated that the intervention was likely to encourage agency. PR participants emphasized the importance of a patient's decision regarding whether their family member(s) should participate in BEGIN. Parents reported that BEGIN is an important first step in treatment and offers a safe therapeutic environment. Feedback was then utilized to modify the intervention. Conclusions: BEGIN is desired by consumers and may lay the foundation for future engagement with treatment by facilitating agency. A feasibility trial is underway and future studies are needed to measure outcomes (e.g., treatment engagement) and evaluate BEGIN as an evidence-based PR psychoeducation model.

Effectiveness of enhancing contact model on reducing stigma of mental illness among family caregivers of persons with schizophrenia in rural China: A cluster randomized controlled trial

Ran, M. S., Wang, Y. Z., Lu, P. Y., Weng, X., Zhang, T. M., Deng, S. Y., Li, M., Luo, W., Wong, I. Y. L., Yang, L. H., Thornicroft, G., & Lu, L. (n.d.).

Publication year

2022

Journal title

The Lancet Regional Health - Western Pacific

Volume

22
Abstract
Abstract
Background: Contact-based intervention has been documented and proved effective on reducing stigma of mental illness in high-income countries, but it is still unclear about the effectiveness of the contact-based intervention among family caregivers of persons with schizophrenia (FCPWS) in low- and middle-income countries including rural China. Methods: We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin district of Chengdu city in Southwest China. The FCPWS in these townships were randomly allocated to the Enhancing Contact Model (ECM), Psychoeducational Family Intervention (PFI), or Treatment as Usual (TAU) group. FCPWS in three groups were provided specific interventions and follow-ups. By using a mixed-effect model, our goal was to examine the differences in affiliate self-stigma scale (ASSS) scores among three groups with the data collected at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up timepoints, respectively. This trial is registered with ChiCTR, number ChiCTR2000039133. Findings: In April 2019, 253 FCPWS from 8 townships were randomly assigned to receive either ECM (cluster=3, n=90), PFI (cluster=2, n=81), or TAU (cluster=3, n=82). Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower ASSS scores at 9-month follow-up (estimated parameter [EP]= -5.51, 95% CI -10.27 to -0.74, p=0.02). There were no statistically significantly different ASSS scores at 9-month follow up between ECM and PFI groups. Compared with participants in the PFI group, younger (<60 years old), with higher monthly income and other caregiver (e.g., parent, sibling, child) participants in the ECM group had statistically significantly lower ASSS scores in the 3-month follow-up (EP = -5.66, 95% CI -10.13 to -1.19, p<0.01; EP = -7.82, 95% CI -11.87 to -3.78, p<0.001; EP = -6.79, 95% CI -10.69 to -2.90, p<0.001, respectively). Interpretation: This first trial in rural China shows that ECM intervention, a new anti-stigma intervention model, is a promising method for reducing affiliate stigma among FCPWS. The ECM intervention is more effective and stable than the PFI on reducing affiliate stigma among FCPWS. Further research needs to explore whether a long-term intervention could produce a more positive anti-stigma outcome trajectory. Funding: General Research Fund, University Grants Committee, Hong Kong SAR (GRF, Grant No. 17605618, 2018-2021, PI: Dr. M.S. Ran).

Investigating the Physical and Mental Health Nexus: a Network Analysis of Depression, Cardiometabolic Health, Bone Mass, and Perceived Health Status Among Filipino Domestic Workers

Neurodegenerative model of schizophrenia: Growing evidence to support a revisit

Stone, W. S., Phillips, M. R., Yang, L. H., Kegeles, L. S., Susser, E. S., & Lieberman, J. A. (n.d.).

Publication year

2022

Journal title

Schizophrenia Research

Volume

243

Page(s)

154-162
Abstract
Abstract
Multidimensional progressive declines in the absence of standard biomarkers for neurodegeneration are observed commonly in the development of schizophrenia, and are accepted as consistent with neurodevelopmental etiological hypotheses to explain the origins of the disorder. Far less accepted is the possibility that neurodegenerative processes are involved as well, or even that key dimensions of function, such as cognition and aspects of biological integrity, such as white matter function, decline in chronic schizophrenia beyond levels associated with normal aging. We propose that recent research germane to these issues warrants a current look at the question of neurodegeneration. We propose the view that a neurodegenerative hypothesis provides a better explanation of some features of chronic schizophrenia, including accelerated aging, than is provided by neurodevelopmental hypotheses. Moreover, we suggest that neurodevelopmental influences in early life, including those that may extend to later life, do not preclude the development of neurodegenerative processes in later life, including some declines in cognitive and biological integrity. We evaluate these views by integrating recent findings in representative domains such as cognition and white and gray matter integrity with results from studies on accelerated aging, together with functional implications of neurodegeneration for our understanding of chronic schizophrenia.

OnTrack Chile for people with early psychosis: a study protocol for a Hybrid Type 1 trial

Mascayano, F., Bello, I., Andrews, H., Arancibia, D., Arratia, T., Burrone, M. S., Conover, S., Fader, K., Jorquera, M. J., Gomez, M., Malverde, S., Martínez-Alés, G., Ramírez, J., Reginatto, G., Restrepo-Henao, A., Rosencheck, R. A., Schilling, S., Smith, T. E., Soto-Brandt, G., Tapia, E., Tapia, T., Velasco, P., Wall, M. M., Yang, L. H., Cabassa, L. J., Susser, E., Dixon, L., & Alvarado, R. (n.d.).

Publication year

2022

Journal title

Trials

Volume

23

Issue

1
Abstract
Abstract
Background: Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. Methods: The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. Discussion: Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. Trial registration: www.ClinicalTrials.govNCT04247711. Registered 30 January 2020. Trial status: The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).

Reducing public stigma toward individuals with psychosis across race and gender: A randomized controlled trial of young adults

Amsalem, D., Valeri, L., Jankowski, S. E., Yang, L. H., Bello, I., Nossel, I., Malinovsky, I., Smith, S., Ngo, H., Lieff, S. A., Pagdon, S., Lipp, A., Markowitz, J. C., Neria, Y., & Dixon, L. B. (n.d.).

Publication year

2022

Journal title

Schizophrenia Research

Volume

243

Page(s)

195-202
Abstract
Abstract
Background: Social contact-based interventions effectively reduce stigma toward psychosis. We recently demonstrated the efficacy of a 90-second video intervention in reducing stigma. The current randomized controlled study presents four briefer videos differing in presenter's gender/race, with baseline, postintervention, and 30-day follow-up assessments. The study replicates previous findings and examine whether concordance of presenter's and viewer's race/gender enhanced the anti-stigma effect. Methods: Using a crowdsourcing platform, we recruited 1993 participants ages 18–35 years to one of four brief video-based interventions (Black/White female, Black/White male presenters) or a nonintervention control condition. In the videos, a young presenter with psychosis humanized their illness through an evocative description of living a meaningful and productive life. Results: Group-by-time ANOVA showed a significant group-by-time interaction for the total score of all five stigma domains: social distance, stereotyping, separateness, social restriction, and perceived recovery. One-way ANOVA showed greater reductions in video intervention groups than control at post-intervention and 30-day follow-up, but no differences between video groups. Matching race/gender did not further reduce stigma. Conclusions: This randomized controlled study replicated and extended previous research findings, by showing stigma reduction across videos that differ in the presenter's gender and race, thus enhancing generalizability. The videos described the experience of psychosis and reduced stigma, suggesting their potential utility on social media platforms to increase the likelihood of seeking services and ultimately may improve access to care among young individuals with psychosis. Future research should address intersectional stigma experiences by focusing on race/gender and culturally tailoring the narrative.

Reproduction and genetic causal attribution of epilepsy

Stigma and coping experiences in Latinx individuals at clinical high-risk for psychosis

Ruiz, B., Ceccolini, C. J., Shah, B. B., Crump, F., Girgis, R. R., Brucato, G., Yang, L. H., & Corcoran, C. M. (n.d.).

Publication year

2022

Journal title

Early Intervention in Psychiatry

Volume

16

Issue

1

Page(s)

34-41
Abstract
Abstract
Aim: The experiences of culturally diverse individuals at clinical high-risk for psychosis (CHR) is not well studied. Exploratory research needs to examine whether differences exist between racial/ethnic groups within the CHR population. Understanding experiences of Latinx patients is of importance, as the Latinx population represents the most rapidly growing paediatric population in the United States and they face significant barriers to mental health treatment. Because Latinx persons experience high rates of mental illness-based stigma and discrimination in their communities, they may face additional stigma-based barriers to CHR treatment. Method: Twenty-six participants (15 Latinx, 11 non-Latinx white/NLW) who met CHR criteria based on the Structured Interview for Psychosis-Risk Syndromes (SIPS) were interviewed regarding stigma associated with CHR identification and symptoms. Using a consensus-based open-coding thematic analysis approach, data were analysed for stigma, discrimination, and coping responses. Results: Instances of internalization of stereotypes appeared to be more salient to NLW participants than Latinx participants, and Latinx participants reported seemingly more anticipated rejection from stereotypes than NLW participants. Experiences of discrimination also appeared to be more salient to Latinx participants than NLW participants. Moreover, Latinx participants reported evidently greater instances of discrimination across anticipated, individual, and structural discrimination. Finally, while covering strategies appeared to be more salient to NLW's, Latinx clients more often described using secrecy as well as a greater range of coping responses, including empowerment. Conclusion: While the experience of anticipated rejection appeared to be more salient to Latinx CHR participants and they seemingly report more secrecy than NLW, they also engaged in empowerment-related coping strategies. Future research should continue to explore the roles of cultural values in influencing coping strategies among CHR individuals.

The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health

Friedman, S. R., Williams, L. D., Guarino, H., Mateu-Gelabert, P., Krawczyk, N., Hamilton, L., Walters, S. M., Ezell, J. M., Khan, M., Di Iorio, J., Yang, L. H., & Earnshaw, V. A. (n.d.).

Publication year

2022

Journal title

Journal of Community Psychology

Volume

50

Issue

1

Page(s)

385-408
Abstract
Abstract
Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the “stigma system” as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.

The Tōhoku Theater Project in Postdisaster Japan: An Exemplar for Addressing Community Mental Health in the Context of Disaster

Pike, K. M., Rebello, T. J., Hanasaki, S., Narita-Ohtaki, R., Kaufman, P., Akiyama, T., Doerries, B., Yang, L. H., Suzuki, N., Magill, E. B., & Yasumura, S. (n.d.).

Publication year

2022

Journal title

Hospital and Community Psychiatry

Volume

73

Issue

6

Page(s)

712-715
Abstract
Abstract
The Tōhoku Theater Project was completed 2 years after the natural and nuclear disasters in Tōhoku, Japan, on March 11, 2011. It employed the dramatic arts to support the healing process, promote resilience, and increase dialogue and understanding about mental health among individuals who were directly affected by the disasters. The four performances fostered important discussions regarding the psychological impact of the Tōhoku disasters. Participants (N=143) found the theater performance effective at facilitating discussion, increasing empathy, and enhancing mental health knowledge, coping, and resilience. The performances provided critical information about access to services; many participants reported that they had not known where to seek help for mental health prior to their involvement with the Tōhoku Theater Project. Lessons learned may inform community-based strategies that promote mental health and healing in the wake of the COVID-19 pandemic and other public health disasters.

Understanding Users’ Perspectives of Psychosocial Mechanisms Underpinning Peer Support Work in Chile

Le, P. T. D., Agrest, M., Mascayano, F., Dev, S., Kankan, T., Dishy, G., Tapia-Muñoz, T., Tapia, E., Toso-Salman, J., Pratt, C., Alves-Nishioka, S., Schilling, S., Jorquera, M. J., Castro-Valdez, J., Geffner, N., Price, L. S. N., Conover, S., Valencia, E., Yang, L. H., Alvarado, R., & Susser, E. S. (n.d.).

Publication year

2022

Journal title

Community mental health journal

Volume

58

Issue

1

Page(s)

111-120
Abstract
Abstract
This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users’ perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system’s incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.

Behavioral correlates of COVID-19 worry: Stigma, knowledge, and news source

Meltzer, G. Y., Chang, V. W., Lieff, S. A., Grivel, M. M., Yang, L. H., & Des Jarlais, D. C. (n.d.).

Publication year

2021

Journal title

International journal of environmental research and public health

Volume

18

Issue

21
Abstract
Abstract
Non-adherence to COVID-19 guidelines may be attributable to low levels of worry. This study assessed whether endorsing COVID-19-stigmatizing restrictions, COVID-19 knowledge, and preferred news source were associated with being ‘very worried’ versus ‘not at all’ or ‘somewhat’ worried about contracting COVID-19. Survey data were collected in July–August 2020 from N = 547 New York State (NYS) and N = 504 national Amazon MTurk workers. Respondents who endorsed COVID-19 stigmatizing restrictions (NYS OR 1.96; 95% CI 1.31, 2.92; national OR 1.80; 95% CI 1.06, 3.08) and consumed commercial news (NYS OR 1.89; 95% CI 1.21, 2.96; national OR 1.93; 95% CI 1.24, 3.00) were more likely to be very worried. National respondents who consumed The New York Times (OR 1.52; 95% CI 1.00, 2.29) were more likely to be very worried, while those with little knowledge (OR 0.24; 95% CI 0.13, 0.43) were less likely to be very worried. NYS (OR 2.66; 95% CI 1.77, 4.00) and national (OR 3.17; 95% CI 1.95, 5.16) respondents with probable depression were also more likely to be very worried. These characteristics can help identify those requiring intervention to maximize perceived threat to COVID-19 and encourage uptake of protective behaviors while protecting psychological wellbeing.

Disengagement from early intervention services for psychosis: A systematic review

Emotional and stigma-related experiences relative to being told one is at risk for psychosis

Woodberry, K. A., Powers, K. S., Bryant, C., Downing, D., Verdi, M. B., Elacqua, K. M., Reuman, A. R., Kennedy, L., Shapiro, D. I., West, M. L., Huang, D., Crump, F. M., Grivel, M. M., Blasco, D., Herrera, S. N., Corcoran, C. M., Seidman, L. J., Link, B. G., McFarlane, W. R., & Yang, L. H. (n.d.).

Publication year

2021

Journal title

Schizophrenia Research

Volume

238

Page(s)

44-51
Abstract
Abstract
Objective: Despite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR participants' emotions about PR upon being told of their PR status and according to whether this was the first time receiving this information. Methods: Participants (n = 54) identified as at PR via structured interview rated their emotions about PR before and after being told they were at PR. Qualitative analyses explored the valence of participant reflections on being given this information. Results: Participants reported significantly less negative emotion after being told of their PR status (p < .001), regardless of whether they were hearing this for the first time (p = .72). There was no change in positive emotions or the predominant belief that they should keep their PR status private. Most participants commented positively about the process of feedback but negatively about its impact on their self-perceptions and/or expectations of others' perceptions of them. Conclusion: This is the first study to collect pre-post data related to being told one is at PR and to examine quantitative and qualitative responses across and within individuals. For a majority of participants, clinical feedback stimulated negative stereotypes even as it relieved some distress. To actively address internalized stigma, clinicians providing feedback to PR youth must attend to the positive and negative impacts on how youth think about themselves as well as how they feel.

Identifying “What Matters Most” to Men in Botswana to Promote Resistance to HIV-Related Stigma

Misra, S., Mehta, H. T., Eschliman, E. L., Rampa, S., Poku, O. B., Wang, W. Q., Ho-Foster, A. R., Mosepele, M., Becker, T. D., Entaile, P., Arscott-Mills, T., Opondo, P. R., Blank, M. B., & Yang, L. H. (n.d.).

Publication year

2021

Journal title

Qualitative Health Research

Volume

31

Issue

9

Page(s)

1680-1696
Abstract
Abstract
Despite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups (n = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the “what matters most” (WMM) and “structural vulnerability” frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.

Naturalistic conceptions of genetic optimism and precision psychiatry among those at clinical high-risk for psychosis

Peer-to-peer contact, social support and self-stigma among people with severe mental illness in Hong Kong

Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging “What Matters Most” to Resist Stigma

Yang, L. H., Ho-Foster, A. R., Becker, T. D., Misra, S., Rampa, S., Poku, O. B., Entaile, P., Goodman, M., & Blank, M. B. (n.d.).

Publication year

2021

Journal title

AIDS and Behavior

Volume

25

Issue

2

Page(s)

459-474
Abstract
Abstract
Perceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify “full personhood” could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to “what matters most” (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both α= 0.90). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r =.39, p =.005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r =.32, p =.026) and social support number (r =.29, p =.047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.

Contact

lawrence.yang@nyu.edu 708 Broadway 6FL New York, NY, 10003