Scant research exists for interventions that are accessible and effective for rural Latine youth with mental health needs. The current study examines the feasibility and preliminary effectiveness of a community health worker-facilitated, attention bias modification (ABM) intervention for rural Latine youth with anxiety. Sixty-nine Latine youth (Mage = 11.74; 67% males; 44.5% low-income) with clinical levels of anxiety were randomized to either ABM (n = 34) or to an attention control condition (ACC) (n = 35). ABM included the dot-probe attention training task, where probes appeared in the location of neutral faces on 100% of trials. For ACC, probes appeared in the location of neutral faces on 50% of trials. Participants completed questionnaires, measures of attention bias and attention control, and clinician administered interviews at baseline, post-treatment, and 3-month follow-up. Findings revealed low attrition, excellent training adherence, and favorable treatment satisfaction. There were no statistically significant differences between groups, but both groups showed significant decreases in anxiety symptoms at post-treatment. Clinician ratings of global improvement were 51% and 53% for the ABM and ACC groups respectively. Exploratory analyses examining attention bias and attention control as mechanisms of change on treatment outcomes were not significant. This is the first feasibility study of ABM in a rural Latine community, using a novel mode of delivery. Findings are promising, given excellent rates of engagement and significant decreases in anxiety over time. However, additional research is necessary to optimize anxiety improvement and identify the mechanisms of change in ABM interventions.

OBJECTIVES:There is a paucity of research focused on risk and protective factors for depression in rural Latine adolescents. The present study first identified variables commonly described in conceptual models of depression etiology and maintenance in Latine adolescents and rural populations, including demographic (i.e., age, sex), cultural (i.e., acculturation), familial (i.e., family conflict, familism), and contextual factors (i.e., socioeconomic strain, parental education level, discrimination-related stress). A machine learning approach was then used to understand the relative contributions of these variables to depression in rural Latine adolescents. METHOD:Participants (n = 670; Mage = 15.74; 53% female) were Latine adolescents in grades 9-12 recruited from a high school in a low-income rural area, who completed a battery of self-report measures. A data-driven recursive partitioning method was used to examine the joint contribution of these variables to depression severity. RESULTS:Using a conditional inference framework, adolescents with low depression scores were characterized by high familism and low discrimination-related stress, whereas adolescents with high depression scores endorsed low familism. Female adolescents had higher depression severity than their male counterparts. CONCLUSIONS:These findings are consistent with both conceptual models of depression in Latine youth and previous empirical studies, particularly those showing that familism and discrimination-related stress play a significant role as protective and risk factors, respectively. The identification of crucial variables using data-driven approaches could help improve screening for and treatment of depression in rural Latine youth who experience significant mental health inequities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BackgroundCommunity college (CC) students face significant mental health concerns but are unlikely to receive treatment. Barriers to mental health service uptake among CC students have been delineated, but few studies have identified strategies to improve uptake. Text messaging has been used to address engagement barriers to mental health services among adolescents and adults, but little research has explored this strategy for CC students. ObjectiveThe goal of this study was to partner with CC students to co-design and conduct pilot usability testing of a text messaging intervention to address barriers and increase uptake of a mental health screening and treatment program, called Screening and Treatment for Anxiety and Depression (STAND), offered to CC students. MethodsWe conducted 2 parallel sets of 4 co-design focus groups with CC students who had varying levels of engagement with STAND. We used rapid qualitative analysis to extract key themes, create text message prototypes and refine them, and present updated prototypes to gather feedback across workshops. We also assessed six usability factors on a 5-point Likert scale: satisfaction, helpfulness, attractiveness, readability, comprehension, and likelihood of getting started with STAND after receiving texts. ResultsKey themes emerged about perceptions of texting, barriers to STAND, a basic framework for the text message intervention, feedback about the format of messages, and feedback about the content of messages. Students expressed positive regard for text messaging and general agreement on key barriers to STAND. Students codeveloped a framework for the intervention, including (1) delivering introductory texts to engage students in the text messages, (2) providing a personalized approach for students to select barriers most salient for them, and (3) delivering tailored content designed by students to address each barrier. Across workshops, several themes emerged with regard to how messages should be formatted and delivered, including the following: use short messages; use not too many messages; use relevant language; use images, memes, and short videos; and make messages “human-like.” Themes related to the content of messages included the following: reminders that you are not alone, knowledge that STAND has worked for other students, expressing understanding of student context and stressors, and providing an option to speak to a team member. Mean ratings on usability factors ranged from 3.88 (SD 0.64) to 4.25 (SD 0.46). ConclusionsThis study describes a process for co-designing a text messaging mental health engagement intervention with CC students that is grounded in a human-centered design approach. Further research is needed to rigorously test this intervention and make iterative refinements to improve response and effectiveness.

Background:Racially and ethnically minoritized individuals (REMs) who experience discrimination are at risk of developing stress, anxiety, and depression, and digital mental health interventions (DMHIs) can make evidence-based treatments such as mindfulness available to these groups. However, REMs are significantly underrepresented in the overall DMHI and mindfulness-based DMHI literature, limiting our understanding of the effectiveness and feasibility of these digital tools to advance mental health equity for these populations. Objective:This randomized controlled trial evaluated the effectiveness of a 4-week self-guided app-based mindfulness DMHI versus treatment as usual (TAU) in reducing discrimination-related stress, anxiety, and depressive symptoms among REMs, while assessing feasibility metrics, including uptake, engagement, dropout, and program satisfaction. Methods:A total of 155 participants (mean age 27.28, SD 9.6 years) were randomized to either receive the DMHI (n=80) or TAU (n=75). Participants in the DMHI group underwent an onboarding procedure and were asked to complete 1 meditation daily for 4 weeks. Participants in the TAU group were encouraged to seek mental health services on their own. The racial and ethnic composition of the sample was 38.7% (60/155) Latinx, 37.4% (58/155) Asian, 11.6% (18/155) Black, 10.3% (16/155) Multiracial, and 2% (3/155) Native American. Mean differences between groups were examined using multilevel regression models, applying a false discovery rate (FDR) correction across all fixed effects. Treatment effect sizes and clinical significance were calculated using pseudo-R2s and the percentage of participants who achieved a minimal clinically significant difference (MCID), respectively. Feasibility outcomes were examined descriptively and included the percentage of participants who accessed the DMHI, days using it, meditations completed, total time meditated, the percentage of participants who dropped out of the study, and self-reported treatment satisfaction. Results:Compared with participants in the TAU group, participants in the DMHI group experienced greater reductions in stress (β=-4.52, 95% CI -6.54 to -2.51; FDR-adjusted P<.001; pseudo-R2=.41; MCID=61%, 49/80), anxiety (β=-3.31, 95% CI -4.89 to -1.74; FDR-adjusted P<.001; pseudo-R2=.45; MCID=48%, 38/80), and depression (β=-2.84, 95% CI -4.57 to -1.12; FDR-adjusted P=.004; pseudo-R2=.53; MCID=54%, 43/80) by the end of the program. All participants in the DMHI group downloaded the app (80/80, 100%) and used it, on average, 16.83 (SD 7.8) days, completed 24.85 (SD 23.3) mediations, and meditated 238.67 (SD 260.7) minutes. Of all participants, 12 (12/155, 8%) dropped out of this study. Most dropouts occurred in the intervention group (11/80, 14%). Participants perceived the DMHI program as satisfactory by the end of treatment (mean treatment satisfaction 23.14, SD 4.9). Conclusions:These findings position this self-guided app-based mindfulness DMHI as an effective and feasible strategy for mitigating the deleterious mental health consequences of exposure to discrimination among REMs.

The present study examined the prevalence of symptoms of depression throughout pregnancy and the early postpartum period (first trimester through six weeks postpartum) in low-income Latina women. Further, this study examined whether established risk factors in non-Latina women also predict perinatal depressive symptom trajectories in low-income Latinas. The sample included 240 Latina women from a federally qualified health center (FQHC). Latent growth curve modeling found that, on average, symptoms of depression decreased from the first trimester of pregnancy through six weeks postpartum. Change in symptoms of depression from the first trimester through six weeks postpartum were predicted by limited English proficiency and age. Findings of the current study add to existing evidence that can guide clinical care for Latina maternal mental health throughout the perinatal period.

Racial/ethnic discrimination is associated with elevated internalizing symptoms. However, the psychological processes through which discrimination affects internalizing symptoms in ethno-racially minoritized youth are less understood. The current study examined the role of emotion dysregulation in the association between racial/ethnic discrimination and internalizing symptoms. Participants were 5,693 ethno-racially minoritized youth (Mage at baseline = 9.89; 48% female; 42.3% Hispanic) enrolled in the Adolescent Brain Cognitive DevelopmentSM Study. Path analysis revealed that experiences of racial/ethnic discrimination were associated with greater emotion dysregulation in the following year, which was, in turn, associated with greater internalizing symptoms concurrently, covarying for sex assigned at birth and caregiver education level. Findings suggest emotion dysregulation may play a key role in the link between racial/ethnic discrimination and internalizing symptom development in minoritized youth. Targeting emotion dysregulation in clinical interventions to address internalizing symptoms related to racial/ethnic discrimination may improve well-being in this population.

Anxiety and related disorders are a significant public-health burden with rising prevalence in the wake of the COVID-19 pandemic. As demand for effective anxiety treatment increases, so too does the need for strategies to bolster treatment outcomes. Research on the mechanisms of exposure therapy, the frontline behavioral treatment, will be critically important for optimizing clinical outcomes. We outline an initial agenda for future research on the mechanisms of change of exposure therapy, developed in collaboration with a large international team of researchers through the Exposure Therapy Consortium. Key questions and recommendations for future research focus on four priority areas: conceptualization, measurement, study design/analysis, and individual/contextual differences. Rising to the challenge of addressing these questions will require coordinated action and availability of centralized tools that can be used across trials, settings, and research groups.

Objective: The purpose of this randomized controlled trial was to test the effects of an online, coached mindfulness intervention on momentary negative affect (mNA) for youth with high levels of trait negative affectivity. Method: Participants were 111 youth ages 12 to 17 years old (M = 14.17, SD = 1.60). Youth self-identified as 68% female, 29% male, and 4.5% gender diverse; 54.55% identified as White; 31.82 reported being Hispanic/Latinx. Participants were selected for having high levels of trait negative affect and were randomized to receive either the mindfulness program or no intervention. We used ecological momentary assessment to measure stress and emotions and to derive measures of mNA comprised of stressor-independent and stressor-reactive negative affect. The ecological momentary assessment protocol involved participants completing a short survey/diary entry on Qualtrics four times per day for 5 days. Internalizing symptoms were assessed with the Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, and the Screen for Child Anxiety Related Disorders. Results: The mindfulness intervention resulted in a significant reduction in stressor-reactive negative affect (t = 2.001, df = 96, p = .048; Cohen's d = .40), but not stressor-independent mNA or overall mNA. Additionally, reductions in stressor-reactive negative affect significantly correlated with changes in internalizing symptomatology (standardized beta = .26, p = .032). Conclusions: These results indicate that among youth with high levels of trait negative affectivity, a relatively affordable and accessible digital mindfulness program significantly reduced stressor-reactive negative affect. The absence of an effect on stressor-independent or overall average mNA suggests some specificity of the effects of mindfulness to stressor-reactive negative affect in an at-risk sample of adolescents.

Latine individuals who have experienced adverse childhood experiences (ACEs) may be at particularly high risk for increased anxiety in emerging adulthood. However, research has yet to examine links between ACES and subsequent anxiety in college-attending Latine individuals, nor has research considered protective factors that may help mitigate these negative associations. The present study examined the association between ACEs and generalized anxiety symptoms in a sample of 553 Latine emerging adults (aged 18-25) in college students. We also examined the extent to which emotional self-efficacy (ESE), general self-efficacy (GSE), and optimism may moderate association between ACEs and generalized anxiety symptoms. Results indicate that higher ACEs scores were associated with higher generalized anxiety symptoms. Moderation models found that both ESE and GSE moderated the relationship between ACEs and anxiety, such that these links were attenuated among individuals with higher self-efficacy. In contrast, optimism did not function as a moderator. These results highlight the strategic value of fostering self-efficacy among Latine adolescents and young adults who have experienced childhood adversities and can inform improved prevention, early identification, and intervention efforts. Public Significance Statement Latine individuals exposed to adverse childhood experiences (ACEs) are at increased risk of developing symptoms of generalized anxiety during emerging adulthood, compared to those who were not exposed to ACEs. The present study highlights the important roles that emotional and general self-efficacy (GSE) may play in mitigating the negative consequences of ACEs for Latine emerging adult college students. Intervention efforts targeting mental health among Latine emerging adults may benefit from screening for and work to strengthen emotional and GSE to improve symptoms of generalized anxiety.

BackgroundSelf-guided web-based interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression and anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such interventions. Previous studies examining motivation as a moderator or predictor of improvement on web-based interventions have defined and measured motivation variably, producing conflicting results. ObjectiveThis secondary analysis of data from a randomized controlled trial aimed to examine constructs of motivation as moderators of improvement for a self-guided 8-week web-based intervention in university students (N=1607). MethodsTested moderators included internal motivation, external motivation, and confidence in treatment derived from the Treatment Motivation Questionnaire. The primary outcome was an improvement in depression and anxiety measured by the Depression Anxiety Stress Scale-21. ResultsPiecewise linear mixed effects models showed that internal motivation significantly moderated symptom change for the intervention group (t1504=–2.94; P=.003) at average and high (+1 SD) motivation levels (t1507=–2.28; P=.02 and t1507=–4.05; P<.001, respectively). Significant results remained even after controlling for baseline severity. The results showed that confidence in treatment did not significantly moderate symptom change for the intervention group (t1504=1.44; P=.15). In this sample, only internal motivation was positively correlated with service initiation, intervention adherence, and intervention satisfaction. ConclusionsThe combination of a web-based intervention and high or moderate internal motivation resulted in greater improvement in the total Depression Anxiety Stress Scale-21 score. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. The results suggest that the combination of a web-based intervention and high or moderate internal motivation results in greater improvement. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. To better understand the moderating role of internal motivation, future research is encouraged to replicate these findings in diverse samples as well as to examine related constructs such as baseline severity and adherence. Understanding these characteristics informs treatment strategies to maximize adherence and improvement when developing web-based interventions as well as allows services to be targeted to individuals likely to benefit from such interventions. Trial RegistrationClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/study/NCT04361045

Objective: Exposure to chronic structural stressors (e.g., poverty, community violence, and discrimination) exacerbates posttraumatic stress disorder (PTSD) symptoms and reduces how adolescents benefit from trauma-focused interventions. However, current evidence-based PTSD interventions seldom include concrete guidance regarding how to target chronic structural stressors in care. Method: This study utilized qualitative thematic analysis of audio-recorded PTSD therapy sessions with 13 racially diverse, low socioeconomic status adolescents to elucidate (a) how often adolescents disclose chronic structural stressors in therapy, (b) the types of chronic structure stressors that are disclosed, and (c) the context in which chronic structural stressors are disclosed and the content of these disclosures. Results: 77% of adolescents disclosed at least one chronic structural stressor and that the presence of stressors exacerbated psychological distress, reduced treatment engagement, and decreased perceptions of intervention effectiveness. Conclusions: Our findings suggest that there is a missed opportunity to improve the effectiveness of treatment for PTSD by incorporating intervention elements that directly target structural stressors. Clinical Impact Statement We hypothesize that if interventions for PTSD included clear evidence-based suggestions for targeting chronic structural stressors within therapy, treatment engagement and response among marginalized groups would significantly improve. In the interim, we recommend that individual clinicians take time to assess and address the range of chronic structural stressors that their clients are facing in service of improving their treatment outcomes. Our results highlight the profound impact of structural inequality on diverse adolescents' mental health. Therefore, clinicians are also advised to participate in public health and policy interventions aimed at decreasing structural inequality on the city, county, state, and national levels.

Objective: Few online interventions targeting anxiety and depression in university students are designed for universal delivery, and none for group-level delivery. This randomized controlled trial (NCT No. 04361045) examined the effectiveness of such a prevention program. Method: StriveWeekly is a web-based intervention designed with weekly self-guided skill modules (e.g., behavioral activation) that are synchronously delivered to all users. Student participants (n = 1,607) were recruited from one large public university, and 65.4% had no prior mental health service use. Participants were randomly assigned to 8 weeks of StriveWeekly (n = 804) or a waitlist condition (n = 803). Participants completed web-based surveys at baseline, posttest, and 3-month follow-up. The primary outcome was the self-reported Depression Anxiety and Stress Scale-21. Results: Piecewise linear mixed-effect models found significant group by time interactions for depression (t = -3.05, p = .002), anxiety (t = -3.01, p = .003), and total symptoms (t = -3.34, p < .001). Relative to the waitlist, students assigned to StriveWeekly improved more from baseline to posttest (between-group d = 0.18-0.21). These small effects were maintained through follow-up, and subsequently replicated by the original waitlist. The intervention was initiated by 73.0% of students in the StriveWeekly condition (modules completed: M = 3.72), and 71.6% of all posttest respondents rated the intervention highly. Conclusion: Findings supported StriveWeekly's effectiveness for large scale indicated prevention of anxiety and depression symptoms in university students. However, further development and research are still needed, as not all students used the intervention, reported satisfaction, or experienced improvement.

Pregnancy is a developmental period with distinct practical and attitudinal factors that affect mental health help-seeking. Within the Latine community, the inclusion of family values in therapy is associated with positive outcomes, suggesting that social relationships may contribute to help-seeking behavior for this population. This study aimed to describe the roles that social relationships play in pregnant Latines’ consideration of psychotherapy. We conducted an inductive qualitative content analysis of 25 interview transcripts assessing the acceptability of an evidence-based psychological intervention, exposure therapy, among English-speaking pregnant Latines with elevated anxiety. Emergent themes revealed that participants were motivated to seek anxiety treatment to improve family well-being, experienced internal conflict between prioritizing care for self and fulfilling their familial role, and were impacted by their close others’ attitudes toward and experiences with therapy. Findings suggest a need to address both positive and negative influences of social relationships when engaging pregnant Latines in prospective psychotherapeutic care to improve motivation, engagement, and potential outcomes, which may reduce care disparities during pregnancy.

ObjectiveThe current observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. The aims of the study were to (1) Identify therapist and client factors associated with increased SDM within EBP sessions and (2) Examine the association between SDM and therapeutic alliance between community therapists and Latinx caregivers.MethodThe Observing Patient Involvement in Decision-Making (OPTION) instrument measured SDM in 210 audio-recorded therapy sessions with 62 community therapists (91.94% female; 69.35% Latinx) and 109 Latinx caregivers (91.43% female) of youth who were an average age of 8.26 years (SD = 3.59). We used the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale to measure the caregiver-therapist alliance observationally. Multilevel linear regressions were conducted to examine research questions.ResultsGreater SDM was observed within sessions where therapists targeted conduct problems versus trauma (B = -8.79, 95% CI[-14.09, -3.49], p = .001). There was a trend that SDM was higher in English-language sessions compared to Spanish. We found that the global measurement of SDM (B = .04, 95% CI[.01, .08], p = .03) and the OPTION item Integrate Preferences (B = .69, 95% CI[.07, 1.32], p = .03) were positively associated with alliance.ConclusionsSDM may help foster Latinx caregiver engagement within EBP delivery. Provider training in SDM may be warranted with consideration of the specific clinical contexts (e.g., by presenting problem) that are appropriate for collaborative treatment planning. More research is needed to further establish the benefits of SDM in youth psychotherapy.

OBJECTIVE:Parent-Child Interaction Therapy (PCIT) is a parenting program in which caregivers must achieve "skill criteria" in using Do Skills and avoiding Don't Skills to complete treatment. Despite PCIT's emphasis on these skills, little is known about how Latinx caregivers acquire these Western-based parenting practices and whether cultural mismatches lead to inequities in outcomes. This study compared the trajectories of change in PCIT skills and treatment outcomes of Latinx and non-Latinx White families. METHOD:We analyzed weekly treatment data from 64 families (20.3% Spanish-speaking Latinx, 51.6% English-speaking Latinx, 28.1% non-Latinx White) served in community clinics. Caregivers were mostly females (95.3%), on average 35.13 years old, and lived in poverty (77.6%). PCIT skills were coded using the Dyadic Parent-Child Interaction Coding System, and child behavior problems were reported using the Eyberg Child Behavior Inventory. RESULTS:Latinx and non-Latinx White caregivers acquired Do Skills similarly during treatment. In contrast, some Latinx caregivers began treatment using significantly more Don't Skills and needed more sessions to achieve some aspects of PCIT skill criteria compared with non-Latinx White caregivers. Latinx families also experienced similar or even more pronounced reductions in child behavior problems than non-Latinx White families. There were no significant differences in the percentage of caregivers who achieved PCIT skill criteria or left treatment prematurely. CONCLUSIONS:This study provides evidence that strictly defined PCIT skill criteria may lead to inequities in treatment length for some Latinx families. Informed by these findings, we propose data-driven adaptations to improve the cultural fit of PCIT for Latinx groups.

Abstract Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1–10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.

Attention bias confers risk for anxiety development, however, the influence of sociodemographic variables on the relationship between attention bias and anxiety remains unclear. We examined the association between attention bias and anxiety among rural Latinx youth and investigated potential moderators of this relationship. Clinical symptoms, demographic characteristics, and a performance-based measure of attention bias were collected from 66 rural Latinx youth with clinical levels of anxiety (33.3% female; M-age = 11.74; 92.4% Latinx, 7.6% Mixed Latinx). No moderating effects for age or gender were found. Youth below the poverty line displayed an attention bias away from threat in comparison to youth above the poverty line, who displayed an attention bias towards threat. Among youth below the poverty line, this bias away from threat was associated with increased anxiety. Findings highlight the importance of economic adversity in understanding the relationship between attention bias and anxiety.

Objective: Previous minority stress scholarship has investigated racism as both a constituent to stress and as an independent psychosocial stressor. It is generally understood that experiences of racism operate differently to affect mental health outcomes compared to general life stress. Racism is consistently implicated in poor psychological health outcomes among Arab Americans. Experiences of racism may be particularly harmful among Arab American adolescents who are in a critical developmental period. This study tested a minority stress framework among Arab American adolescents by examining the association between racism and psychological symptoms both directly and indirectly via stress. Method: The sample included 223 Arab American adolescents whose ages ranged from 13 to 18 (M = 15.63, SD = 1.26; 51.1% boys; 49.3% Lebanese) drawn from the Detroit metropolitan area. Participants responded to measures of racism, stress, and internalizing and externalizing psychological symptoms. Results: The structural equation model provided good model fit to the data and indirect effects testing showed that the association between racism and psychological symptoms via general stress was statistically significant (z = 3.48, p < .001). Greater racism was associated with more psychological symptoms in the presence and absence of general stress. The magnitude of the association between racism and psychological symptoms was attenuated with stress included in the model. The association remained statistically significant and reasonably robust. Conclusions: Findings support racism as both a unique construct and an adjunct to general stress that is positively correlated with psychological symptoms among Arab American adolescents. Public Significance Statement Experiences of racism both magnify and operate separate from general life stress. Both suppositions were supported in this study of Arab American adolescents. Racism was positively associated with psychological symptoms both in the presence and absence of general stress. Findings provide empirical support for a fundamental minority stress process among Arab American adolescents.

The translation of mental health services into digital formats, deemed digital mental health interventions (DMHIs), has the potential to address long-standing obstacles to accessing care. However, DMHIs have barriers of their own that impact enrollment, adherence, and attrition in these programs. Unlike in traditional face-to-face therapy, there is a paucity of standardized and validated measures of barriers in DMHIs. In this study, we describe the preliminary development and evaluation of such a scale, the Digital Intervention Barriers Scale-7 (DIBS-7). Following an iterative QUAN → QUAL mixed methods approach, item generation was guided by qualitative analysis of feedback from participants (n=259) who completed a DMHI trial for anxiety and depression and identified barriers related to self-motivation, ease of use, acceptability, and comprehension of tasks. Item refinement was achieved through DMHI expert review. A final item pool was administered to 559 treatment completers (mean age 23.02 years; 438/559, 78.4% female; 374/559, 69.9% racially or ethnically minoritized). Exploratory factor analyses and confirmatory factor analyses were estimated to determine the psychometric properties of the measure. Finally, criterion-related validity was examined by estimating partial correlations between the DIBS-7 mean score and constructs related to treatment engagement in DMHIs. Statistical analyses estimated a 7-item unidimensional scale with high internal consistency (α=.82, ω=0.89). Preliminary criterion-related validity was supported by significant partial correlations between the DIBS-7 mean score and treatment expectations (pr=–0.25), number of modules with activity (pr=–0.55), number of weekly check-ins (pr=–0.28), and treatment satisfaction (pr=–0.71). Overall, these results provide preliminary support for the use of the DIBS-7 as a potentially useful short scale for clinicians and researchers interested in measuring an important variable often associated with treatment adherence and outcomes in DMHIs.

Objective: Exposure therapy is the frontline treatment for anxiety among adults but is underutilized during pregnancy. We qualitatively assess the prospective acceptability of exposure therapy among pregnant Latinas with elevated anxiety, a group that experiences mental health disparities.Method: Pregnant Latinas (N = 25) with elevated anxiety were interviewed regarding their acceptability of exposure therapy following the receipt of an informational clinical video vignette. Interviews were analyzed using deductive content analysis guided by the Theoretical Framework of Acceptability to understand pregnant Latinas' views about exposure therapy.Results: Nineteen themes were identified across seven theoretically driven subdomains of acceptability. Women expressed acceptability enhancing factors for exposure therapy including feeling hopeful about its effects, a belief that treatment could benefit their broader family, and a preference for treatment during pregnancy as opposed to the postpartum period. Women also expressed challenges to exposure therapy acceptability such as managing family reactions to prenatal psychotherapy, conflict with cultural conceptions of the maternal role, and perceived difficulty using exposure for avoidance related to prenatal health.Conclusion: Identified themes provide insights about exposure acceptability among pregnant women and can be used to bettter engage Latinas in anxiety interventions, ultimately improving clinical outcomes.