Lawrence H Yang
Lawrence H Yang
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Chair and Professor of Social and Behavioral Sciences
Associate Director, Global Center for Implementation Science
Founding Director, Global Mental Health and Stigma Program
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Professional overview
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Dr. Lawrence Yang is Professor and Chair of the Department of Social and Behavioral Sciences; Associate Director of the Global Center for Implementation Science at NYU; and Founding Director of NYU’s Global Mental Health and Stigma Program. He is also PI of a generous donor gift from the Li Ka Shing Foundation to fund an initiative to promote Global Mental Health and Wellness (see link).
Dr. Yang has received extensive interdisciplinary training, including clinical psychology (Boston University), psychiatric epidemiology (Columbia University) and medical anthropology (Harvard University). Dr. Yang has received six national awards in stigma, including the Maltz Prize for Innovative and Promising Schizophrenia Research in 2021 (Brain and Behavior Research Foundation; see link). Dr. Yang has >175 peer-reviewed publications, including in journals such as the JAMA, JAMA Psychiatry, British Journal of Psychiatry, and the American Journal of Public Health. Regarding currently-funded NIH grants, he is PI of three separate R01 grants (below), is multiple PI of a D43 Implementation Science Training Grant in Vietnam, and is co-investigator on 4 R01-level grants. Lawrence is also applying his expertise to address the novel topic of “Migration Stigma”, where he led a think tank and conference sponsored by the prestigious Ernst Strüngmann Forum (June, 2022; see link), which has resulted in a recently-published book by MIT press (Migration Stigma (mit.edu)) and a publication in JAMA (see link).
Brief Research Narrative: If every public health researcher had a calling card, Dr. Lawrence Yang's would be stigma.
What began as a curiosity to think, study and write about his own culture -- Chinese culture and its influences on how stigma is expressed-- drove the GPH Professor to develop a framework for how stigma acts to impede social recovery that could be applied to cultural groups to improve the lives of countless people with mental illness and their families around the world. Dr. Yang also conducts several ongoing research studies on the forefront of global mental health and implementation science.
Building upon dissertation research conducted in Beijing, China, Lawrence initiated his stigma research via an NIMH K-award (2005-2010). Lawrence conducted a study in New York City of how stigma shapes the course of mental illness among Chinese immigrants. Lawrence formulated how culture relates to stigma--i.e. the “What Matters Most” framework—to help implement interventions to improve recovery for stigmatizing conditions. He learned that upholding face (to achieve lineage obligations) was essential, as it is for Asians in many countries. Lawrence then formulated an anti-stigma intervention to help people with mental illness take a powerful step towards regaining face. To inform global programs, Lawrence then applied the ‘what matters most’ approach to HIV stigma in Botswana. Lawrence identified that “womanhood” in Botswana is signified by “having and caring for children” (AJPH, 2021). These cultural imperatives bring pregnant women into contact with free antenatal services, including routine HIV testing, where their HIV status is discovered before their male partners, leading women diagnosed with HIV to be blamed and stigmatized. Lawrence used this framework in a completed NIMH-funded R21 grant to implement an intervention to counter culturally-salient aspects of HIV stigma that impede anti-retroviral treatment. This stigma intervention, by utilizing the perspective that a woman in Botswana who achieves ‘what matters most’ can be protected from HIV stigma, has shown promising results. Lawrence has received a new R01 (R01 TW012402) to expand this intervention for use with women with HIV with serious mental illness in Botswana. He also participated as a Scientific member of the “NIH Office of AIDS Research & NIMH HIV-Related Intersectional Stigma” Working Group (2020).
Lawrence has advanced global mental health research in China as PI of two NIMH-funded R01 studies (R01MH108385; R01 MH127631) with co-PI's, Dr.’s Michael Phillips, William Stone and Matcheri Keshavan, seeking to characterize the cognition of completely untreated psychosis in China. Recently, China has implemented programs to detect untreated psychosis countrywide. Ascertaining participants in rural China, the study has enrolled~ 300 untreated psychosis participants, who are then matched with ~300 treated psychosis participants and an additional ~300 healthy control participants. The study’s first publication shows that cognitive performance may continue to decrease as the duration of untreated psychosis becomes prolonged (JAMA Psychiatry, 2020), thus potentially shifting the scientific thinking about schizophrenia by suggesting possible novel neurodegenerative processes in the natural course of chronic psychosis. A 3-year Supplement also examines the neurobiological markers of untreated psychosis to validate three psychosis subgroups that exhibit neurobiologically distinct differences (or ‘biotypes’). A follow-up longitudinal, 5-year R01 proposal (2021-2026) to capitalize upon this rare cohort has been funded by NIMH.
Relevant to implementation science, Lawrence leads a project to help address the gap in global mental health treatment among those who need but do not receive care for mental disorders, which is disproportionately high in low- and middle-income countries. There has been a call to scale-up mental health services via sharing of mental health care with a broader array of nonspecialists (e.g., community health workers). Yet, knowledge on how to successfully implement task-sharing mental health strategies in real-world settings is lacking. Lawrence is PI of a third NIMH-funded R01 (with co-PI, Dr. Judy Bass; R01 MH122851) to validate a newly-developed measure that enables rapid assessment of modifiable critical factors affecting the implementation of task sharing mental health strategies. This R01 is based upon the “Shared Research Project”, where Dr.’s Yang and Bass examined the barriers and facilitators to scale-up task-sharing interventions in four previous, NIMH-funded global regional networks spanning 4 global hubs (i.e., Latin America; Africa, and India/ Pakistan). This current study will validate this measure within three additional, ongoing NIMH-funded task-sharing mental health programs in South Africa, Chile, and Nepal, thus advancing implementation science globally.
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Education
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BA, High Honors and Phi Beta Kappa, Wesleyan University, Middletown, CTPhD, Boston University, Boston, MAClinical Fellowship, Harvard Medical School (Massachusetts Mental Health Center)Postdoctoral Fellowship, Columbia Mailman School of Public Health (NIMH funded T32 Training Program in Psychiatric Epidemiology)
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Honors and awards
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Maltz Prize for Innovative and Promising Schizophrenia Research -- Brain and Behavior Research Foundation (2021)NIH Fellow-Training Institute for Dissemination & Implementation Research in Health (TIDIRH) (2019)Fellow (Elected), American Psychopathological Association (2018)Award for Emerging Leadership, Americal Psychological Association (2012)Award for Advancing Minority Mental Health, American Psychiatric Foundation (2012)Young Investigator Award, NARSAD/ Brain and Behavior Foundation (2010)Emerging Leader Award for Significant Contributions to the Advancement of Ethnic Minority Psychology, American Psychological Association (2010)Calderone Award for Junior Faculty, Columbia University School of Public Health (2009)REACH for the R01 Award, Columbia University Irving Institute for Clinical and Translational Research (2009)Early Career Research Award, American Psychological Association (2008)Early Career Award, Asian American Psychological Association (2008)Dalmas A. Taylor Outstanding Student Dissertation Award, American Psychological Association (Division of Clinical Psychology- Ethnic Minority Focus) (2002)Outstanding Dissertation Award, American Psychological Association (Division of International Psychology) (2002)
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Areas of research and study
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Cognition and PsychosisGlobal HealthImplementation scienceMental HealthStigma of Health Conditions“At-Risk” States for Psychosis
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Publications
Publications
Botswana's HIV response: Policies, context, and future directions
AbstractRamogola-Masire, D., Poku, O., Mazhani, L., Ndwapi, N., Misra, S., Arscott-Mills, T., Blank, L., Ho-Foster, A., Becker, T. D., & Yang, L. (n.d.).Publication year
2020Journal title
Journal of Community PsychologyVolume
48Issue
3Page(s)
1066-1070AbstractThis brief report describes key periods in the history of the national public health response to the human immunodeficiency virus (HIV) epidemic in Botswana. It reveals the context leading to the development of HIV policies presently in place and current challenges that remain. The report concludes with opportunities for future directions, initiatives, and policy changes to reduce the high rates of HIV.HIV and Depression: Examining Medical Students Clinical Skills
AbstractRivera-Segarra, E., Carminelli-Corretjer, P., Varas-Díaz, N., Neilands, T. B., Yang, L. H., & Bernal, G. (n.d.).Publication year
2020Journal title
Frontiers in PsychiatryVolume
11AbstractMajor depression is a prevalent psychiatric disorder among people living with HIV (PWH). Major depression symptoms, including suicidal ideation, can hinder clinical care engagement and anti-retroviral treatment adherence. Research suggests that inquiry about major depression symptomatology and suicidal ideation should be standard practice when offering primary care services to PWH. However, studies examining depression and suicidal ideation inquiry are scarce. This study’s aim was to describe medical students’ clinical skills for dealing with major depression symptomatology and suicidal ideation among PWH in Puerto Rico. A total of 100 4th year medical students participated in a Standardized Patient simulation with a trained actor posing as a PWH and with a previous major depression diagnosis. One-way frequency tables were used to characterize the sample and the percentage of each observed clinical skill. Two key findings stem from these results only 10% of the participants referred the patient to psychological/psychiatric treatment, and only 32% inquired about suicidal ideation. Our findings highlight the need for enhancing medical students’ competencies regarding mental health issues, particularly when providing services to at risk populations such as PWH within primary care settings.Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries
AbstractMascayano, F., Toso-Salman, J., Ho, Y. C. S., Dev, S., Tapia, T., Thornicroft, G., Cabassa, L. J., Khenti, A., Sapag, J., Bobbili, S. J., Alvarado, R., Yang, L. H., & Susser, E. (n.d.).Publication year
2020Journal title
transcultural psychiatryVolume
57Issue
1Page(s)
140-160AbstractStigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality—most only included evaluations after intervention or short follow-up periods (1–3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.Mothers moving towards empowerment' intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: Study protocol for a pragmatic clinical trial
AbstractPoku, O. B., Ho-Foster, A. R., Entaile, P., Misra, S., Mehta, H., Rampa, S., Goodman, M., Arscott-Mills, T., Eschliman, E., Jackson, V., Melese, T., Becker, T. D., Eisenberg, M., Link, B., Go, V., Opondo, P. R., Blank, M. B., & Yang, L. H. (n.d.).Publication year
2020Journal title
TrialsVolume
21Issue
1AbstractBACKGROUND: With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children's lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the "What Matters Most" stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the "Mothers Moving towards Empowerment" (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period.METHODS: This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status).DISCUSSION: Our trial will evaluate MME, a culturally based HIV stigma reduction intervention using the "What Matters Most" framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana.TRIAL REGISTRATION: ClinicalTrials.gov NCT03698981 . Registered on October 8, 2018.Promoting insight and recovery in the context of the “insight paradox”
Yang, L. H., Samuel, S. S., Tay, C., & Cho, Y. (n.d.).Publication year
2020Journal title
Schizophrenia ResearchVolume
222Page(s)
6-7Psychological Impact of Anti-Asian Stigma Due to the COVID-19 Pandemic: A Call for Research, Practice, and Policy Responses
AbstractMisra, S., Le, P. T. D., Goldmann, E., & Yang, L. H. (n.d.).Publication year
2020Journal title
Psychological Trauma: Theory, Research, Practice, and PolicyVolume
12Issue
5AbstractThe COVID-19 pandemic is linked to a rise in stigma and discrimination against Chinese and other Asians, which is likely to have a negative impact on mental health, especially when combined with additional outbreak-related stressors. We discuss the need to consider the potential harms of these anti-Asian sentiments during both the height of the pandemic and longer-term recovery through (a) research-examining how it affects mental health and recovery; (b) practice-implementing evidence-based stigma reduction initiatives; and (c) policy-coordinating federal response to anti-Asian racism including investment in mental health services and community-based efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).Psychosis risk stigma and help-seeking: Attitudes of Chinese and Taiwanese residing in the United States
AbstractHe, E., Eldeeb, S. Y., Cardemil, E. V., & Yang, L. H. (n.d.).Publication year
2020Journal title
Early Intervention in PsychiatryVolume
14Issue
1Page(s)
97-105AbstractAim: Intervention during the clinical high-risk phase for psychosis (CHR) can reduce duration of untreated psychosis and associated negative outcomes. Early treatment access and sustained engagement are important to understand for effective intervention. Understanding stigma and help-seeking processes is particularly important for groups that experience mental healthcare disparities such as those of Chinese heritage living in the United States. Methods: Chinese and Taiwanese participants (N = 215) residing in the United States were randomly assigned to one of three CHR vignette conditions based on the “what matters most” stigma framework for Chinese groups, which identifies capacities that define “personhood” and thereby shapes stigma for members of a particular cultural group. Participants completed measures of help-seeking attitudes, family stigma and individual stigma. Results: More stigma towards the CHR vignette character's family was associated with positive CHR help-seeking attitudes. Participants who read the vignette describing CHR affecting family obligations, “what matters most” and participants who read the vignette describing CHR symptomology only had more positive CHR help-seeking attitudes compared to participants who read the vignette describing CHR affecting individual aspirations. Conclusions: Chinese and Taiwanese residing in the United States may perceive professional mental healthcare to be especially relevant for persons with CHR when symptoms are particularly stigmatizing for the person's family and when symptoms threaten the person's ability to fulfil family obligations (ie, “what matters most”). Clinical implications of findings include the importance of emphasizing positive treatment outcomes that increase an individual's ability to engage in valued life domains.Stigma associated with the labeling of schizophrenia, depression, and hikikomori in Japan.
AbstractDeVylder, J. E., Narita, Z., Horiguchi, S., Kodaka, M., Schiffman, J., Yang, L. H., & Koyanagi, A. (n.d.).Publication year
2020Journal title
Stigma and HealthVolume
5Issue
4Page(s)
472-476AbstractLabeling is a fundamental component of stigma, which allows the identification of features or behaviors that are then stereotyped and made into targets of discrimination. In Japan, the label applied to the condition known in the DSM and International Statistical Classification of Diseases and Related Health Conditions as “schizophrenia” was revised in 2002 from “mind-split disease” to “integration disorder,” intending to alleviate stigma associated with this condition. However, there has been little research examining the effect of the label itself on stigmatizing attitudes, particularly in relation to other mental health conditions, such as depression, or nonclinical cultural idioms of distress, such as hikikomori (i.e., social withdrawal or, literally, “pulling inward”). In this vignette study, we examined the influence of labeling on mental illness stigma by randomizing the label attached to a set of diagnostically ambiguous cases and assessing attitudes regarding these cases among an Internet-based sample of Japanese adults (N = 192). Using within-subjects analysis of variance, we found that both schizophrenia labels, “integration disorder” and “mind-split disease,” were similarly associated with the greatest levels of stereotype awareness but not any other components of stigma. The schizophrenia-labeled cases were also viewed as being more biologically rather than socially caused, compared to depression and hikikomori. Compared to hikikomori, all 3 clinical label conditions (both schizophrenia labels, plus depression) were rated as having a greater need for clinical treatment. Overall, there were no significant differences between the 2 schizophrenia labels on any outcome measure, whereas the nonclinical label was associated with less perceived need for treatment, greater social causation, and less perceived unpredictability.The immigrant mental health advantage in the US among ethnic minority and other groups
AbstractBarnes, D. M., Lieff, S. A., Eschliman, E. L., Li, Y. P., & Yang, L. H. (n.d.). In Mental and Behavioral Health of Immigrants in the United States: Findings and potential mechanisms (1–).Publication year
2020Page(s)
219-252AbstractThis chapter will address the prevalence of mental disorders among the ethnic minority groups (African American, Latinx, and Asian American) in the United States according to immigration status. We will utilize the most current psychiatric epidemiology studies to characterize the prevalence of mental disorders in these groups, and describe the possible mechanisms accounting for the apparent advantage for foreign-born individuals for the ethnic minority and other groups. We will utilize Black Americans as a case example to illustrate how various mechanisms influence psychopathology among immigrant groups.The impact of China-to-US immigration on structural and cultural determinants of HIV-related stigma: implications for HIV care of Chinese immigrants
AbstractBecker, T. D., Poku, O. B., Chen, X., Wong, J., Mandavia, A., Huang, M., Chen, Y., Huang, D., Ngo, H., & Yang, L. H. (n.d.).Publication year
2020Journal title
Ethnicity and HealthVolume
27Issue
3Page(s)
1-20AbstractObjectives: Asian Americans have poor HIV-related outcomes, yet culturally salient barriers to care remain unclear, limiting development of targeted interventions for this group. We applied the ‘what matters most’ theory of stigma to identify structural and cultural factors that shape the nature of stigma before and after immigration from China to the US. Design: Semi-structured interviews were conducted with 16 immigrants to New York from China, recruited from an HIV clinic and community centers. Deductive followed by focal inductive qualitative analyses examined how Chinese cultural values (lian, guanxi, renqing) and structural factors influenced stigma before and after immigration. Results: In China, HIV stigma was felt through the loss of lian (moral status) and limited guanxi (social network) opportunities. A social structure characterized by limited HIV knowledge, discriminatory treatment from healthcare systems, and human rights violations impinged on the ability of people living with HIV to fulfill culturally valued goals. Upon moving to the US, positions of structural vulnerability shifted to enable maintenance of lian and formation of new guanxi, thus ameliorating aspects of stigma. Conclusions: HIV prevention and stigma reduction interventions among Chinese immigrants may be most effective by both addressing structural constraints and facilitating achievement of cultural values through clinical, peer, and group interventions.A new brief opioid stigma scale to assess perceived public attitudes and internalized stigma: Evidence for construct validity
AbstractYang, L. H., Grivel, M. M., Anderson, B., Bailey, G. L., Opler, M., Wong, L. Y., & Stein, M. D. (n.d.).Publication year
2019Journal title
Journal of Substance Abuse TreatmentVolume
99Page(s)
44-51AbstractOne key strategy to improve treatment access for persons with opioid use disorder (OUD) is overcoming stigma that is internalized by such individuals. Because few theoretically-derived, multidimensional measures of substance abuse stigma exist, we contribute a brief, theoretically-based measure of opioid-related stigma (adapted from Corrigan's Self-Stigma of Mental Illness Scale) to assess perceived stigma and internalized stigma among individuals with OUD. This study presents initial validation of the newly-developed Brief Opioid Stigma Scale among 387 adults who entered an inpatient opioid managed-withdrawal program. The scale assesses: (1) Stereotype awareness (“Aware”), or the extent to which individuals who use opioids perceive community members to believe OUD-related stereotypes; (2) Stereotype agreement (“Agree”), or the endorsement of stigmatizing beliefs by individuals who use opioids; (3) Self-esteem decrement (“Harm”), or the diminution of self-esteem due to these negative stereotypes’ impacts on self-worth. Psychosocial measures including self-esteem, depressive symptoms, mental and physical functioning, and desire for aftercare OUD medication treatment, were administered to assess construct validity. Results showed that greater endorsement of the “harm” stigma subscale was associated with greater depressive symptoms, lower self-esteem, and poorer mental and physical functioning. The “aware” stigma subscale displayed similar overall patterns of associations with self-esteem and depression but to a lesser magnitude. The “aware” stigma subscale was positively associated with desire for aftercare methadone and naltrexone treatment, and the “harm” subscale was positively associated with desire for aftercare buprenorphine treatment. Results indicated good initial construct validity. Tailored stigma interventions are recommended for specific aftercare OUD medication treatments.A predictive model for conversion to psychosis in clinical high-risk patients
AbstractCiarleglio, A. J., Brucato, G., Masucci, M. D., Altschuler, R., Colibazzi, T., Corcoran, C. M., Crump, F. M., Horga, G., Lehembre-Shiah, E., Leong, W., Schobel, S. A., Wall, M. M., Yang, L. H., Lieberman, J. A., & Girgis, R. R. (n.d.).Publication year
2019Journal title
Psychological MedicineVolume
49Issue
7Page(s)
1128-1137AbstractBackground The authors developed a practical and clinically useful model to predict the risk of psychosis that utilizes clinical characteristics empirically demonstrated to be strong predictors of conversion to psychosis in clinical high-risk (CHR) individuals. The model is based upon the Structured Interview for Psychosis Risk Syndromes (SIPS) and accompanying clinical interview, and yields scores indicating one's risk of conversion.Methods Baseline data, including demographic and clinical characteristics measured by the SIPS, were obtained on 199 CHR individuals seeking evaluation in the early detection and intervention for mental disorders program at the New York State Psychiatric Institute at Columbia University Medical Center. Each patient was followed for up to 2 years or until they developed a syndromal DSM-4 disorder. A LASSO logistic fitting procedure was used to construct a model for conversion specifically to a psychotic disorder.Results At 2 years, 64 patients (32.2%) converted to a psychotic disorder. The top five variables with relatively large standardized effect sizes included SIPS subscales of visual perceptual abnormalities, dysphoric mood, unusual thought content, disorganized communication, and violent ideation. The concordance index (c-index) was 0.73, indicating a moderately strong ability to discriminate between converters and non-converters.Conclusions The prediction model performed well in classifying converters and non-converters and revealed SIPS measures that are relatively strong predictors of conversion, comparable with the risk calculator published by NAPLS (c-index = 0.71), but requiring only a structured clinical interview. Future work will seek to externally validate the model and enhance its performance with the incorporation of relevant biomarkers.Impact of “psychosis risk” identification: Examining predictors of how youth view themselves
AbstractYang, L. H., Woodberry, K. A., Link, B. G., Corcoran, C. M., Bryant, C., Shapiro, D. I., Downing, D., Girgis, R. R., Brucato, G., Huang, D., Crump, F. M., Verdi, M., McFarlane, W. R., & Seidman, L. J. (n.d.).Publication year
2019Journal title
Schizophrenia ResearchVolume
208Page(s)
300-307AbstractBackground: Identifying young people as at clinical high-risk (CHR) for psychosis affords opportunities for intervention to possibly prevent psychosis onset. Yet such CHR identification could plausibly increase stigma. We do not know whether these youth already perceive themselves to be at psychosis-risk (PR) or how their being told they are at PR might impact how they think about themselves. Methods: 148 CHR youth were asked about labels they had been given by others (labeling by others) or with which they personally identified (self-labeling). They were then asked which had the greatest impact on how they thought about themselves. We evaluated whether being told vs. thinking they were at PR had stronger effects. Findings: The majority identified nonpsychotic disorders rather than PR labels as having the greatest impact on sense of self (67.6% vs. 27.7%). However, participants who identified themselves as at PR had an 8.8 (95% CI = 2.0-39.1) increase in the odds of the PR label having the greatest impact (p < 0.01). Additionally, having been told by others that they were at PR was associated with a 4.0 increase in odds (95% CI = 1.1-15.0) that the PR label had the most impact (p < 0.05). Interpretation: Nonpsychotic disorder labels appear to have a greater impact on CHR youth than psychosis-risk labels. However, thinking they are at PR, and, secondarily, being told they are at PR, appears to increase the relative impact of the PR label. Understanding self- and other-labeling may be important to how young people think of themselves, and may inform early intervention strategies.Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users
AbstractAgrest, M., Le, P. T. D., Yang, L. H., Mascayano, F., Alves-Nishioka, S., Dev, S., Kankan, T., Tapia-Muñoz, T., Sawyer, S., Toso-Salman, J., Dishy, G. A., Jorquera, M. J., Schilling, S., Pratt, C., Price, L. S., Valencia, E., Conover, S., Alvarado, R., & Susser, E. S. (n.d.).Publication year
2019Journal title
International Journal of Social PsychiatryVolume
65Issue
1Page(s)
38-45AbstractBackground: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. Aims: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America – specifically, in Santiago (Chile) from a user perspective. Method: We analyzed 15 in-depth interviews (n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. Results: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users’ perceptions of the peer support workers and the community mental health workers. Conclusions: CTI-TS was generally acceptable in this Latin American context. Users’ perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities
AbstractMascayano, F., Alvarado, R., Andrews, H. F., Jorquera, M. J., Lovisi, G. M., De Souza, F. M., Pratt, C., Rojas, G., Restrepo-Toro, M. E., Fader, K., Gorroochurn, P., Galea, S., Dahl, C. M., Cintra, J., Conover, S., Burrone, M. S., Baumgartner, J. N., Rosenheck, R., Schilling, S., … Susser, E. (n.d.).Publication year
2019Journal title
Cadernos de saude publicaVolume
35Issue
4AbstractSeveral Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.Mental health service use among asian americans five to six years after exposure to the world trade center attack
AbstractKung, W. W., Goldmann, E., Liu, X., Wang, X., Huang, D., & Yang, L. H. (n.d.).Publication year
2019Journal title
Social Service ReviewVolume
93Issue
1Page(s)
96-128AbstractThis 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
AbstractVan Brakel, W. H., Cataldo, J., Grover, S., Kohrt, B. A., Nyblade, L., Stockton, M., Wouters, E., & Yang, L. H. (n.d.).Publication year
2019Journal title
BMC MedicineVolume
17Issue
1AbstractBackground: 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
2019Volume
208Page(s)
483-485Understanding the public's profile of mental health literacy in China: A nationwide study
AbstractHuang, D., Yang, L. H., & Pescosolido, B. A. (n.d.).Publication year
2019Journal title
BMC psychiatryVolume
19Issue
1AbstractBackground: 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
AbstractBecker, 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
2019Journal title
Qualitative Health ResearchVolume
29Issue
11Page(s)
1566-1580AbstractMental 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
AbstractDeVylder, J. E., Kelleher, I., Oh, H., Link, B. G., Yang, L. H., & Koyanagi, A. (n.d.).Publication year
2018Journal title
Acta Psychiatrica ScandinavicaVolume
138Issue
1Page(s)
44-54AbstractObjective: 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
AbstractLiu, 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
2018Journal title
Scientific reportsVolume
8Issue
1AbstractDepression 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
AbstractKung, W. W., Liu, X., Huang, D., Kim, P., Wang, X., & Yang, L. H. (n.d.).Publication year
2018Journal title
Journal of Urban HealthVolume
95Issue
2Page(s)
255-266AbstractDespite 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
AbstractChu, J., Lin, M., Akutsu, P. D., Joshi, S. V., & Yang, L. H. (n.d.).Publication year
2018Journal title
Asian American Journal of PsychologyVolume
9Issue
4Page(s)
262-269Abstract"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
AbstractGrivel, 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
2018Journal title
Schizophrenia ResearchVolume
195Page(s)
549-553AbstractRecent 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.