Lawrence H Yang

Lawrence 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

Professional overview

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 >165 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), is multiple PI of a D43 grant in Vietnam, 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 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.

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

Mental health service use among asian americans five to six years after exposure to the world trade center attack

Kung, W. W., Goldmann, E., Liu, X., Wang, X., Huang, D., & Yang, L. H. (n.d.).

Publication year

2019

Journal title

Social Service Review

Volume

93

Issue

1

Page(s)

96-128
Abstract
Abstract
This study uses World Trade Center Health Registry data, based on Andersen’s health-care model, to investigate 2,557 Asians’ mental health service use and associated factors 5–6 years after the World Trade Center attack, compared against 32,111 non-Hispanic white participants. We find that Asians had a lower proportion of service use (15.76 vs. 26.60 percent) than white people. A previous mental health diagnosis and perceived and evaluated mental health needs strongly predicted Asians’ mental health service use, as did having routine medical checkups, being female, and being married or cohabiting. These factors, in addition to other socioeconomic predictors that were nonsignificant among Asians, were significant among white people, as well. Our findings suggest that service providers need to provide clear diagnoses to service users, explore mental health needs during medical checkups, and provide postdisaster mental health education and free treatment.

Out of the silos: Identifying cross-cutting features of health-related stigma to advance measurement and intervention

Van Brakel, W. H., Cataldo, J., Grover, S., Kohrt, B. A., Nyblade, L., Stockton, M., Wouters, E., & Yang, L. H. (n.d.).

Publication year

2019

Journal title

BMC Medicine

Volume

17

Issue

1
Abstract
Abstract
Background: Many health conditions perceived to be contagious, dangerous or incurable, or resulting in clearly visible signs, share a common attribute - an association with stigma and discrimination. While the etiology of stigma may differ between conditions and, sometimes, cultural settings, the manifestations and psychosocial consequences of stigma and discrimination are remarkably similar. However, the vast majority of studies measuring stigma or addressing stigma through interventions employ a disease-specific approach. Main body: The current paper opposes this siloed approach and advocates a generic concept of 'health-related stigma' in both stigma measurement and stigma interventions. Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, such as the Social Distance Scale, Explanatory Model Interview Catalogue, Internalized Stigma of Mental Illness, and Berger stigma scale, and stigma reduction interventions, such as information-based approaches, contact with affected persons, (peer) counselling, and skills building and empowerment, were used successfully across a variety of conditions to measure or address stigma. The results demonstrate that 'health-related stigma' is a viable concept with clearly identifiable characteristics that are similar across a variety of stigmatized health conditions in very diverse cultures. Conclusion: A more generic approach to the study of health-related stigma opens up important practical opportunities - cross-cutting measurement and intervention tools are resource saving and easier to use for personnel working with multiple conditions, allow for comparison between conditions, and recognize the intersectionality of many types of stigma. Further research is needed to build additional evidence demonstrating the advantages and effectiveness of cross-condition approaches to stigma measurement and interventions.

Self-stigma related feelings of shame and facial fear recognition in individuals at clinical high risk for psychosis: A brief report

Larsen, E. M., Herrera, S., Bilgrami, Z. R., Shaik, R. B., Crump, F., Sarac, C., Shen, J., Yang, L. H., & Corcoran, C. M. (n.d.). In Schizophrenia Research (1–).

Publication year

2019

Volume

208

Page(s)

483-485

Understanding the public's profile of mental health literacy in China: A nationwide study

Huang, D., Yang, L. H., & Pescosolido, B. A. (n.d.).

Publication year

2019

Journal title

BMC psychiatry

Volume

19

Issue

1
Abstract
Abstract
Background: In the wake of China's massive economic development, attention has only recently turned to the enormous treatment gap that exists for mental health problems. Our study is the first comprehensive, national examination of the levels and correlates of the public's ability to recognize mental illness in the community and suggest sources of help, setting a baseline to assess contemporary Chinese efforts. Methods: Data were collected in China as part of the Stigma in Global Context - Mental Health Study (SGC-MHS) through face-to-face interviews using vignettes meeting clinical criteria for schizophrenia and major depression. Our analysis targets the Han Chinese participants (n = 1812). Differences in the recognition of mental health problems were assessed using a chi-square test and further stratified by vignette illness type and urban vs. rural residence. Adjusted regression models estimated the effects of each predictor towards the endorsement three types of help-seeking: medical doctor, psychiatrist, and mental health professional. Results: As expected, recognition of mental health problems is low; it is better for depression and most accurate in urban areas. Perceived severity increases endorsement of the need for care and for treatment by all provider types. Recognition of a mental health problem specifically decreases endorsement of medical doctors while increasing recommendations for psychiatrists and mental health professionals. Neurobiological attributions decrease recommendations for mental health professionals as opposed to general or specialty physicians. Conclusions: Continued efforts are needed in China to promote mental illness recognition within rural areas, and of schizophrenia specifically. Promoting recognition of mental illness, while balancing the special challenges among individuals who understand the neurobiological roots of mental illness, may constitute a key strategy to reduce the sizeable mental health treatment gap in China.

“It’s When the Trees Blossom”: Explanatory Beliefs, Stigma, and Mental Illness in the Context of HIV in Botswana

Becker, T. D., Ho-Foster, A. R., Poku, O. B., Marobela, S., Mehta, H., Cao, D. T. X., Yang, L. S., Blank, L. I., Dipatane, V. I., Moeng, L. R., Molebatsi, K., Eisenberg, M. M., Barg, F. K., Blank, M. B., Opondo, P. R., & Yang, L. H. (n.d.).

Publication year

2019

Journal title

Qualitative Health Research

Volume

29

Issue

11

Page(s)

1566-1580
Abstract
Abstract
Mental illness is a common comorbidity of HIV and complicates treatment. In Botswana, stigma impedes treatment of mental illness. We examined explanatory beliefs about mental illness, stigma, and interactions between HIV and mental illness among 42 adults, from HIV clinic and community settings, via thematic analysis of interviews. Respondents endorse witchcraft as a predominant causal belief, in addition to drug abuse and effects of HIV. Respondents describe mental illness as occurring “when the trees blossom,” underscoring a conceptualization of it as seasonal, chronic, and often incurable and as worse than HIV. Consequently, people experiencing mental illness (PEMI) are stereotyped as dangerous, untrustworthy, and cognitively impaired and discriminated against in the workplace, relationships, and sexually, increasing vulnerability to HIV. Clinical services that address local beliefs and unique vulnerabilities of PEMI to HIV, integration with peer support and traditional healers, and rehabilitation may best address the syndemic by facilitating culturally consistent recovery-oriented care.

Criminal victimization and psychotic experiences: cross-sectional associations in 35 low- and middle-income countries

DeVylder, J. E., Kelleher, I., Oh, H., Link, B. G., Yang, L. H., & Koyanagi, A. (n.d.).

Publication year

2018

Journal title

Acta Psychiatrica Scandinavica

Volume

138

Issue

1

Page(s)

44-54
Abstract
Abstract
Objective: Criminal victimization has been associated with elevated risk for psychotic symptoms in the United Kingdom, but has not been studied in low- and middle-income countries (LMICs). Understanding whether crime exposure may play a role in the social etiology of psychosis could help guide prevention and intervention efforts. Method: We tested the hypothesis that criminal victimization would be associated with elevated odds of psychotic experiences in 35 LMICs (N = 146 999) using cross-sectional data from the World Health Organization World Health Survey. Multivariable logistic regression analyses were used to test for associations between criminal victimization and psychotic experiences. Results: Victimization was associated with greater odds of psychotic experiences, OR (95% CI) = 1.72 (1.50–1.98), and was significantly more strongly associated with psychotic experiences in non-urban, OR (95% CI) = 1.93 (1.60–2.33), compared to urban settings, OR (95% CI) = 1.48 (1.21–1.81). The association between victimization and psychosis did not change across countries with varying aggregated levels of criminal victimization. Conclusions: In the largest ever study of victimization and psychosis, the association between criminal victimization and psychosis appears to generalize across a range of LMICs and, therefore, across nations with a broad range of crime rates, degree of urban development, average per capita income, and racial/ethnic make-up.

Depressive symptoms and their association with social determinants and chronic diseases in middle-aged and elderly Chinese people

Liu, Q., Cai, H., Yang, L. H., Xiang, Y. B., Yang, G., Li, H., Gao, Y. T., Zheng, W., Susser, E., & Shu, X. O. (n.d.).

Publication year

2018

Journal title

Scientific reports

Volume

8

Issue

1
Abstract
Abstract
Depression is one of the most prevalent mental disorders worldwide. Little information is available regarding association of depressive symptoms (DS) with cancer and chronic diseases among middle-aged and elderly Chinese in a population-based setting. In this study we evaluated the prevalence and examined correlates of DS in two population-based cohort studies. Included in the analyses were 103,595 people with a mean age of 61.8 years at the DS assessment. The prevalence of DS was 2.4% in men and 5.6% in women. We found elderly participants, those with lower BMI, or chronic diseases were more likely to experience DS. Having a history of stroke (odds ratio (OR) = 2.2 in men and 1.8 in women), cancer (OR = 3.3 in men and 1.9 in women), or Parkinson's disease (OR = 3.1 in men and 2.7 in women) was associated with high DS. In women, high income and high education levels were inversely related to DS. Being a single woman, long-term or heavy female smoker was associated with high prevalence of DS. High BMI was correlated with low prevalence of depression in men. Our data suggests a low prevalence of DS among middle-aged and elderly people in Shanghai, China. Age, education, income, marital status, smoking, BMI, and certain health conditions were associated with DS.

Factors Related to the Probable PTSD after the 9/11 World Trade Center Attack among Asian Americans

Kung, W. W., Liu, X., Huang, D., Kim, P., Wang, X., & Yang, L. H. (n.d.).

Publication year

2018

Journal title

Journal of Urban Health

Volume

95

Issue

2

Page(s)

255-266
Abstract
Abstract
Despite the fact that Asians constituted a sizeable proportion of those exposed to the World Trade Center attack on September 11, 2001 due to its proximity to Chinatown and many South Asians working in the nearby buildings, no study had focused on examining the mental health impact of the attack in this group. Based on data collected by the World Trade Center Health Registry from a sample of 4721 Asians 2–3 years after the disaster, this study provides a baseline investigation for the prevalence and the risk and protective factors for PTSD among Asian Americans directly exposed to the attack and compared this population against 42,862 non-Hispanic Whites. We found that Asians had a higher prevalence of PTSD compared to Whites (14.6 vs 11.7%). “Race-specific factors” significantly associated to PTSD in the multivariate analyses were noted among sociodemographics: higher education was protective for Whites but a risk factor for Asians; being employed was protective for Whites but had no effect for Asians; and being an immigrant was a risk factor for Whites but had no effect for Asians. However, income was a protective factor for both races. Other “universal factors” significantly increased the odds of PTSD symptoms but showed no racial differences, including exposure to the disaster and the presence of lower respiratory symptoms which intensified odds of PTSD by the greatest magnitude (3.6–3.9 times). Targeted effort to reach out to Asians is essential for prevention and follow up treatment given this group’s striking history of underutilization of mental health services.

Hidden suicidal ideation or intent among Asian American Pacific Islanders: A cultural phenomenon associated with greater suicide severity

Chu, J., Lin, M., Akutsu, P. D., Joshi, S. V., & Yang, L. H. (n.d.).

Publication year

2018

Journal title

Asian American Journal of Psychology

Volume

9

Issue

4

Page(s)

262-269
Abstract
Abstract
"Hidden suicidal ideation" (HSI)-the concealment or nondisclosure of suicidal distress to others-is often cited in suicide and ethnic minority research as a phenomenon that occurs frequently among ethnic minorities. Yet, there has been limited research to further understanding of this phenomenon, particularly in a within-group investigation among Asian American Pacific Islanders (AAPI). The aims of the current study were to characterize HSI in a community sample of 73 actively suicidal AAPI adults. Results indicated that a majority of participants (N = 44, 60.30%) hid their desire to kill themselves from others. A logistic regression showed that AAPI respondents who endorsed HSI reported greater severity of suicidal distress than their non-HSI counterparts and that HSI among AAPIs was associated with culturally salient suicide risk. These results provide critical information that highlights HSI as a "cultural phenomenon" (defined as having a relationship with cultural risk factors) and potential indicator of suicide disparities and may have implications for culturally responsive detection and management of suicide risk for AAPI populations. The current study represents the first dedicated examination of the phenomenon of HSI among AAPI individuals.

Impact of lifetime traumatic experiences on suicidality and likelihood of conversion in a cohort of individuals at clinical high-risk for psychosis

Grivel, M. M., Leong, W., Masucci, M. D., Altschuler, R. A., Arndt, L. Y., Redman, S. L., Yang, L. H., Brucato, G., & Girgis, R. R. (n.d.).

Publication year

2018

Journal title

Schizophrenia Research

Volume

195

Page(s)

549-553
Abstract
Abstract
Recent research suggests that trauma history (TH) is a strong socio-environmental risk factor for the development of psychosis. While reported rates of childhood trauma are higher among individuals at clinical high-risk (CHR) for psychosis than in the general population, little research has explored the effects of trauma upon the severity of attenuated positive symptoms. We aimed to explore the specific relationships between TH and baseline symptom severity; likelihood of conversion to full-blown psychosis; suicidal ideation (SI); and suicidal behavior (SB) in a cohort of 200 help-seeking CHR individuals. Participants were evaluated every three months for up to two years using the Structured Interview for Psychosis-Risk Syndromes (SIPS). More trauma history was reported by females and Hispanic/Latino participants, while age and race did not significantly distinguish those with and without TH. Individuals with TH reported higher rates of SI and SB than those without. While TH was positively associated with several SIPS subscales, including Unusual Thought Content, Perceptual Abnormalities/Hallucinations, Bizarre Thinking, Sleep Disturbances, and Dysphoric Mood, and negatively associated with Expressed Emotion, results indicated that TH was not significantly related to conversion to psychosis. Moreover, baseline SI was unrelated to conversion and baseline DSM diagnosis, with the exception of Post-Traumatic Stress Disorder (PTSD). These results suggest that traumatic experiences may significantly impact the severity of attenuated positive symptoms and suicidality in the CHR state, providing new windows for further research and potential intervention.

Measuring internalized stigma of mental illness among Chinese outpatients with mood disorders

Smith, M. L., Yang, L. H., Huang, D., Pike, K. M., Yuan, C., & Wang, Z. (n.d.).

Publication year

2018

Journal title

International Journal of Culture and Mental Health

Volume

11

Issue

4

Page(s)

522-535
Abstract
Abstract
Internalized stigma is a barrier to mental health care in China, and stigma reduction is expected to promote treatment utilization, especially for mood disorders and schizophrenia. We aimed to identify the most common domains of internalized stigma of mental illness and to test the hypothesis that people with more severe mood disorders evidence more internalized stigma than those with less severe disorders. The Internalized Stigma of Mental Illness (ISMI) was administered to 366 outpatients with various mood disorders in Shanghai. Reliability statistics were calculated and frequently-endorsed items were identified. The magnitude of internalized stigma was compared among diagnostic categories and among sociodemographic groups. Except for stigma resistance, the ISMI and its subscales had good internal consistency. Across subgroups, stereotype endorsement was most commonly reported. Bipolar (versus depressive) disorders, male gender, and less education were associated with more internalized stigma, especially social withdrawal. Contrasting findings in Western countries, those with family history of mental illness trended toward more internalized stigma. We conclude that anti-stigma interventions should focus on reducing social withdrawal and stereotype endorsement, especially for those with more severe mood disorders, males, less educated individuals, and those with family history of mental illness.

Posttraumatic stress disorder in the short and medium term following the World Trade Center attack among Asian Americans

Kung, W. W., Liu, X., Goldmann, E., Huang, D., Wang, X., Kim, K., Kim, P., & Yang, L. H. (n.d.).

Publication year

2018

Journal title

Journal of Community Psychology

Volume

46

Issue

8

Page(s)

1075-1091
Abstract
Abstract
This study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predictors among 2,431 Asian American and 31,455 non-Hispanic White World Trade Center (WTC) Registry participants 2–3 years and 5–6 years after the WTC attack. Participants were divided into four PTSD pattern groups: resilient, remitted, delayed onset, and chronic. Asians had a lower proportion in the resilient group (76.5% vs. 79.8%), a higher proportion in the chronic (8.6% vs. 7.4%) and remitted (5.9% vs. 3.4%) groups, and a similar proportion in the delayed onset group (about 9%) compared to Whites. In multinomial logistic regression analyses, disaster exposure, immigrant status, lower income, pre-attack depression/anxiety, and lower respiratory symptoms were associated with increased odds of chronic and delayed onset PTSD (vs. resilience) among both races. Education and employment were protective against chronic and delayed onset PTSD among Whites only. These results can inform targeted outreach efforts to enhance prevention and treatment for Asians affected by future events.

Understanding stigma as a barrier to accessing cancer treatment in South Africa: Implications for public health campaigns

Oystacher, T., Blasco, D., He, E., Huang, D., Schear, R., McGoldrick, D., Link, B., & Yang, L. H. (n.d.).

Publication year

2018

Journal title

Pan African Medical Journal

Volume

29
Abstract
Abstract
Introduction: Cancer contributes to significant illness burden in South Africa, with delayed diagnosis resulting from limited knowledge of cancer, lack of biomedical treatment and stigma. This study examines ways in which people are identified as having cancer through perspectives of traditional healing or the biomedical model. Additionally, we sought to understand the stigma associated with cancer, including stereotypes, anticipated discrimination and coping styles. Methods: Livestrong Foundation conducted 11 semi-structured focus groups with key community stakeholders in three South African townships. Interviews examined the negative consequences of being labeled with a cancer diagnosis as well as causes of, possible prevention of and barriers and methods to improve access to cancer treatment. Analyses were completed using directed content analysis. Results: Revealed three main labeling mechanisms: physical appearance of perceived signs/symptoms of cancer, diagnosis by a traditional healer, or a biomedical diagnosis by a Western physician. Being labeled led to anticipated discrimination in response to prevalent cancer stereotypes. This contributed to delayed treatment, use of traditional healers instead of biomedical treatment and secrecy of symptoms and/or diagnosis. Further, perceptions of cancer were commonly conflated with HIV/TB owing to prior educational campaigns. Conclusion: Our study deepens the understanding of the cancer labeling process in South Africa and the resulting negative effects of stigma. Future anti-stigma interventions should partner with traditional healers due to their respected community status and consider how previous health interventions may significantly impact current understandings of illness.

Understanding the impact of community on the experience of suicide within the Lao Community: An expansion of the cultural model of suicide

Yang, L. H., Lam, J., Vega, E., Martinez, M., Botcheva, L., Hong, J. E., Chu, J., & Lewis, S. E. (n.d.).

Publication year

2018

Journal title

Asian American Journal of Psychology

Volume

9

Issue

4

Page(s)

284-295
Abstract
Abstract
There is a dearth in the scientific literature examining community factors of suicide in a theoretically grounded manner, in particular for Asian American groups. This study used the cultural model of suicide to examine the experience of suicide for a Lao group in California. Interviews were conducted with focus groups and community leaders pooled from the Center for Lao Studies, and then coded using a direct content analysis, in tandem with an inductive approach. The results revealed areas in which the community had a notable impact and shaped suicide risk within the Lao group. The findings also highlighted the need for additions to the current cultural model of suicide to reflect the impact of these community factors.

Using information and communication technologies to prevent suicide among secondary school students in two regions of Chile: A randomized controlled trial

Mascayano, F., Schilling, S., Tapia, E., Santander, F., Burrone, M. S., Yang, L. H., & Alvarado, R. (n.d.).

Publication year

2018

Journal title

Frontiers in Psychiatry

Volume

9
Abstract
Abstract
Background: There is an increasing concern for addressing suicide among adolescents in Latin America. Recent mental health policies encourage the development and implementation of preventive interventions for suicide. Such initiatives, however, have been scarcely developed, even in countries with solid mental health services such as Chile. The use of information and communications technology (ICT) might contribute to create accessible, engaging, and innovative platforms to promote well-being and support for adolescents with mental health needs and suicide risk. Objective: To evaluate a program based on ICT to prevent suicide and enhance mental health among adolescents in Chile. Method: A cluster randomized controlled trial (RCT) will be conducted including 428 high-school students aged 18-14 years in two regions of Chile. Study procedures will take place as follows: (1) design of the intervention model and creation of prototype; (2) selection and randomization of the participating public schools; (3) implementation of the 3-month intervention and evaluation at baseline, post-intervention period, and a 2-month follow-up. Suicidal ideation at the 2-month follow up is the primary outcome in this study. Secondary outcomes include negative psychological outcomes (e.g., stigma, depression, anxiety) as well as a number of protective psychological and social factors. Indicators regarding the study implementation will be also gathered. Discussion: Here we describe a novel program based on technological devices and aimed to target youth suicide in Chile. This is the first clinical trial of such a program in Latin America, and to our knowledge, the first of its kind in any middle income country.

Advances in the cultural assessment of stigma to promote global mental health

Yang, L., Sia, K., & Yang, L. (n.d.). In Stigma Towards Mental Illness: a Public Health Challengs (1–).

Publication year

2017

Attitudes Towards the Mentally Ill: A Study with Health Workers at a University Hospital in Rio de Janeiro

Siqueira, S. R. G., Abelha, L., Lovisi, G. M., Sarução, K. R., & Yang, L. (n.d.).

Publication year

2017

Journal title

Psychiatric Quarterly

Volume

88

Issue

1

Page(s)

25-38
Abstract
Abstract
As there are few studies about evaluation of attitudes of health care workers to people with mental disorders in Brazil, a cross-sectional study was carried out to assess the health professionals’ attitudes working in a university hospital in Rio de Janeiro and also examine the proportion of negative and positive attitudes endorsed by healthcare professionals in Brazil towards people with mental illness in comparison with other parts of the world. Data were collected using the Community Attitudes towards the Mentally Ill (CAMI) in a random sampling frame of health professionals (n = 246) working in a University Hospital in Rio de Janeiro between April 2013 and June 2013. The CAMI consists of four sub-scales: Authoritarianism, Benevolence, Social Restrictiveness and Community Mental Health Ideology. The results showed attitudes that range from neutral to positive, with the Benevolence and Social Restrictiveness sub-scales showing the least stigmatizing results. The following individual characteristics were associated with negative attitudes: lower levels of education and less clinical experience. In general, health workers attitudes towards service users are characterized as positive when compared with other international studies. However, educational programs for health workers should be reinforced to further promote pre-existing positive attitudes towards people with mental health and the implementation of Brazilian Mental Health Policies.

Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort

Brucato, G., Masucci, M. D., Arndt, L. Y., Ben-David, S., Colibazzi, T., Corcoran, C. M., Crumbley, A. H., Crump, F. M., Gill, K. E., Kimhy, D., Lister, A., Schobel, S. A., Yang, L. H., Lieberman, J. A., & Girgis, R. R. (n.d.).

Publication year

2017

Journal title

Psychological Medicine

Volume

47

Issue

11

Page(s)

1923-1935
Abstract
Abstract
Background. DSM-5 proposes an Attenuated Psychosis Syndrome (APS) for further investigation, based upon the Attenuated Positive Symptom Syndrome (APSS) in the Structured Interview for Psychosis-Risk Syndromes (SIPS). SIPS Unusual Thought Content, Disorganized Communication and Total Disorganization scores predicted progression to psychosis in a 2015 NAPLS-2 Consortium report. We sought to independently replicate this in a large single-site high-risk cohort, and identify baseline demographic and clinical predictors beyond current APS/APSS criteria. Method. We prospectively studied 200 participants meeting criteria for both the SIPS APSS and DSM-5 APS. SIPS scores, demographics, family history of psychosis, DSM Axis-I diagnoses, schizotypy, and social and role functioning were assessed at baseline, with follow-up every 3 months for 2 years. Results. The conversion rate was 30% (n = 60), or 37.7% excluding participants who were followed under 2 years. This rate was stable across time. Conversion time averaged 7.97 months for 60% who developed schizophrenia and 15.68 for other psychoses. Mean conversion age was 20.3 for males and 23.5 for females. Attenuated odd ideas and thought disorder appear to be the positive symptoms which best predict psychosis in a logistic regression. Total negative symptom score, Asian/Pacific Islander and Black/African-American race were also predictive. As no Axis-I diagnosis or schizotypy predicted conversion, the APS is supported as a distinct syndrome. In addition, cannabis use disorder did not increase risk of conversion to psychosis. Conclusions. NAPLS SIPS findings were replicated while controlling for clinical and demographic factors, strongly supporting the validity of the SIPS APSS and DSM-5 APS diagnosis.

Stigma and substance use disorders: An international phenomenon

Yang, L. H., Wong, L. Y., Grivel, M. M., & Hasin, D. S. (n.d.).

Publication year

2017

Journal title

Current Opinion in Psychiatry

Volume

30

Issue

5

Page(s)

378-388
Abstract
Abstract
Purpose of review To collect and update published information on the stigma associated with substance abuse in nonclinical samples, which has not been recently reviewed. Recent findings Searching large databases, a total of only 17 articles were published since 1999, with the majority of studies conducted outside the United States. Using major stigma concepts from a sociological framework (stereotyping, devaluation in terms of status loss, discrimination, and negative emotional reactions), the studies reviewed predominantly indicated that the public holds very stigmatized views toward individuals with substance use disorders (SUDs), and that the level of stigma was higher toward individuals with SUDs than toward those with other psychiatric disorders. Summary The prevalence of SUDs is increasing in the US general population, but these disorders remain seriously undertreated. Stigma can reduce willingness of policymakers to allocate resources, reduce willingness of providers in nonspecialty settings to screen for and address substance abuse problems, and may limit willingness of individuals with such problems to seek treatment. All of these factors may help explain why so few individuals with SUDs receive treatment. Public education that reduces stigma and provides information about treatment is needed.

The family economic status and outcome of people with schizophrenia in Xinjin, Chengdu, China: 14-year follow-up study

Ran, M. S., Yang, L. H., Liu, Y. J., Huang, D., Mao, W. J., Lin, F. R., Li, J., & Chan, C. L. W. (n.d.).

Publication year

2017

Journal title

International Journal of Social Psychiatry

Volume

63

Issue

3

Page(s)

203-211
Abstract
Abstract
Background: Little is known about whether family economic status might influence the long-term (e.g. over 10 years) outcome of persons with schizophrenia in the community. Aim: To examine the differences in outcome at 14-year follow-up of persons with schizophrenia from high versus low family economic status backgrounds in a Chinese rural area. Method: A prospective 14-year follow-up study was conducted in six townships in Xinjin County, Chengdu, China. All participants with schizophrenia (n = 510) were identified in an epidemiological investigation of 123,572 people aged 15 years and older and followed up from 1994 to 2008. Results: Individuals from low family economic status (<mean) in 1994 had significantly higher rate of homelessness (9.9%) and lower rate of survival (63.8%) in 2008 than those from high family economic status (3/4mean; 3.2% and 76.6%, respectively). Individuals from low family economic status had significantly lower rates of marriage and complete remission, higher mean scores on Positive and Negative Syndrome Scale (PANSS) and lower mean score on Global Assessment of Functioning (GAF) than those from high family economic status in 2008. The predictors of low family economic status of individuals in 2008 encompassed the baseline low family economic status, poor families' attitude toward the patient, younger age, older age of first onset and longer duration of illness. Conclusion: Low family economic status is a predictive factor of poor long-term outcome of persons with schizophrenia in the rural community. Individuals' family economic status should be considered in making mental health policy and providing community-based mental health services.

The importance of symbolic interaction in mental illness stigma

He, E., Yang, L., & Link, B. G. (n.d.). In Stigma Towards Mental Illness: A Public Health Challenge (1–).

Publication year

2017

The role of culture in population mental health: prevalence of mental disorders among Asian and Asian american populations

Yang, L., & Benson, J. (n.d.). In Handbook of Cultural Neuroscience (1–).

Publication year

2017

Violating clan and kinship roles as risk factors for suicide and stigma among lao refugees: An application of the cultural model of suicide and “what matters most” frameworks

Mandavia, A., Huang, D., Wong, J., Ruiz, B., Crump, F., Shen, J., Martinez, M., Botcheva, L., Vega, E., Chu, J., Lewis, S., & Yang, L. H. (n.d.).

Publication year

2017

Journal title

Israel Journal of Psychiatry and Related Sciences

Volume

54

Issue

1

Page(s)

39-49
Abstract
Abstract
Background: While Asian groups have immigrated worldwide, suicide risk models have neglected to integrate cultural components. This study incorporates how stigma associated with failure to uphold clan/kinship roles can increase suicide risk in highly-marginalized Lao-Americans. Methods: One focus group with five Lao participants and 21 individual semi-structured interviews with community family members were conducted. Transcripts were coded via directed content analysis using the “What Matters Most” and Cultural Theory of Suicide frameworks. Results: Violating role-expectations associated with youth, adults and older adults appears to be associated with risk for suicide. This suggests that the failure of adults to fulfill their roles might potentially threaten loss of “full personhood” and trigger stigma, thus potentially evoking greater suicide risk. Conclusion: Interventions would benefit from cultural considerations of fulfilling role-expectations and “personhood” to combat suicide and stigma within cultural communities.

attitudes toward judicial lenience and government assistance for individuals with mental illness: A comparison of Chinese and European Americans

Huang, D., Yang, L. H., Wonpat-Borja, A., Lam, J., Link, B. G., & Phelan, J. C. (n.d.).

Publication year

2016

Journal title

Journal of Community Psychology

Volume

44

Issue

4

Page(s)

516-523

Experiences of Social Support Among Chinese Immigrant Mental Health Consumers with Psychosis

Cheng, Z. H., Tu, M. C., & Yang, L. H. (n.d.).

Publication year

2016

Journal title

Community mental health journal

Volume

52

Issue

6

Page(s)

643-650
Abstract
Abstract
Limited research has investigated how culture impacts expressions of social support, which is crucial in developing culturally sensitive care. Using a classification based on theories of social support, we examined the social support experiences of 49 Chinese immigrant mental health consumers with psychosis, paying particular attention to frequency and sources. We found that the most common forms of social support were belonging and companionship, perceived emotional support, social control, and perceived instrumental support, while self-esteem and sense of mastery were the least common forms. Family and friends were the main sources of support. These results demonstrate the influence of Confucian values of renqing (or fulfillment of relational obligations) and guanxi (or social networks) and the negative effects of stigma in diminishing the social standing of these consumers by compromising ‘personhood.’ Clinical implications for increasing the cultural competency of clinicians and improving the mental health outcomes of Chinese immigrants are discussed.

Contact

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