MarySue V. Heilemann

Latina college students are at a heightened risk for suicidal thoughts and behaviors (STBs) linked to intersectional stressors such as gendered and racial discrimination. Although many express an openness to help‐seeking, they often face barriers to accessing and remaining engaged in formal mental health services and, alternatively, lean more heavily on informal supportive systems such as family members and peers. This qualitative descriptive study explored help‐seeking experiences from the perspectives of 12 Latina college students with STBs, eight informal supportive peers, and 10 campus mental health clinicians across California. Thematic analysis revealed five themes: (1) minimizing concerns and maintaining image; (2) catalysts for change: the role of community; (3) hidden pathways and resources; (4) confronting structural‐level challenges; and (5) beyond the crisis: developing a toolkit for the future. Cultural values, such as familismo, marianismo, confianza , and personalismo , influenced help‐seeking. Informal supports often served as early responders and bridges to formal support, while digital platforms emerged as alternative spaces for awareness and validation. Clinicians highlighted the need for culturally responsive, trust‐centered interventions. Our findings point to the critical role of peer networks and culturally relevant approaches in addressing STBs among Latina college students. Recommendations include peer support training programs rooted in cultural values, expanded access to flexible and immigration context‐informed counseling services, and digital strategies to reduce stigma and promote mental health literacy. This study underscores the urgency of multi‐level, culturally relevant interventions to promote health equity for Latina college students experiencing STBs.

Background: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. Objective: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. Methods: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. Results: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) “Feels like home”—experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) “It’s a one-stop-shop”—judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. Conclusions: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too “professional” or “clinical.” The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma.

BACKGROUND To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. OBJECTIVE This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. METHODS After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. RESULTS Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) “Feels like home”—experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) “It’s a one-stop-shop”—judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. CONCLUSIONS The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too “professional” or “clinical.” The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma.

The COVID-19 pandemic has had a significant impact on individuals, families, and communities, leading to increased stress, anxiety, and mental health issues. To address these needs, Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos), a website providing mental health resources, was created. This study aims to understand the experiences of users of the T4W/Juntos website, to learn about the benefits of the website for its users during the pandemic, and to identify areas for improvement. A thematic analysis was conducted with answers given by 199 participants who responded to at least one of six open-ended questions that were included with other close-ended questions (reported elsewhere) in an electronically administered survey. The open-ended survey questions were developed with input from diverse stakeholders, including under-resourced populations. The sample was recruited through partnerships with 11 state-wide agencies. Five main themes were identified from analysis of the data. The major themes were (1) Disruptions and Challenges Experienced During the COVID-19 Pandemic, (2) Benefiting from an Accessible Website, and (3) Wanting Access to Additional Resources. The University of California, Los Angeles (UCLA), Institutional Review Board (IRB) for Human Subjects approved the study, and participants provided informed consent. The website provided access to resource links that brought needed information, a sense of empowerment, and support for individuals dealing with mental health issues related to the pandemic. Participants highly recommended the website to others. However, they also suggested improvements such as more specific resources and additional languages.

Background: Community input is crucial for identifying characteristics necessary for equitable, sustainable community–academic partnerships (CAPs). A November 2021 conference, honoring the late Dr. Loretta Jones and the Community-Partnered Participatory Research (CPPR) model, was held to gather input for designing a learning institute for community members as co-equal partners with academics in research, program, and policy initiatives. This created an opportunity to explore attendees' perspectives on challenges and opportunities related to CAPs with special focus on promoting equity. Methods: Institutional Review Board approval was obtained. Five break-out discussion group sessions were conducted in November 2021 co-facilitated by both an academic and a community leader. After consent, discussions were recorded and transcribed. An iterative procedure for collaborative-group-thematic-analysis was developed. The six-phase process included rigorous coding, discussion, comparison of data with data, and development and refinement of themes and subthemes. Results: A total of 38 racial-ethnically diverse participants volunteered from the total conference audience of 62 community and academic partners from various sectors including community-based organizations, health care, social services, academia, or policy within Los Angeles County. Analysis led to development of three themes: Being cautious with the extractive tendency of academia and the need for anti-racism within CAPs; Leveraging community power to resist the top-down lens of academia; and bridging two worlds through an equitably structured table. Discussion: Participants described optimism about the future uses of CPPR to enhance CAPs, and the need to address barriers to equitable partnerships owing to unequal social contexts and entrenched power dynamics. Implications include addressing racism, evaluating financial equity in partnerships to promote accountability, and mentoring community leaders to promote equity. Conclusion: Use of a “community lens” for developing sustainable, equitable CAPs is crucial to promote accountability and to responsibly implement authentic CPPR.

Studies of health care access and use among historically resilient populations, while common, often field a limited sample size and rarely ask the groups most impacted by health inequities to weigh in. This is especially so for research and programs that focus on the American Indian and Alaska Native (AIAN) population. The present study addresses this gap by examining data from a cross-sectional survey of AIANs in Los Angeles County. To better interpret project findings and generate culturally relevant contexts, qualitative feedback was gathered at a community forum held in Spring 2018. Because recruitment of AIANs has historically been challenging, purposive sampling was employed to strategically identify a larger eligible pool. Among those who were eligible, 94% completed the survey (n = 496). AIANs who were enrolled in a tribe were 32% more likely to use the Indian Health Service (IHS), compared with those who were not enrolled (95% CI: 20.4%, 43.2%; p < .0001). In multivariable modeling, the strongest factors influencing IHS access and use were: tribal enrollment, preference for culturally-specific health care, proximity of the services to home or work, having Medicaid, and having less than a high school education. Feedback from the community forum indicated cost and trust (of a provider) were important considerations for most AIANs. Study findings reveal heterogeneous patterns of health care access and use in this population, suggesting a need to further improve the continuity, stability, and the image of AIANs’ usual sources of care (e.g., IHS, community clinics).

Background: The COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic. Objective: The study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California. Methods: A pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6–week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores≥3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up. Results: Of 366 eligible participants, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up surveys. Of baseline participants, 72.6% identified as female, and 21.3% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0% identified as Hispanic, 17.8% as African American, 26.9% as non-Hispanic white, and 11.4% as other ethnicity. Overall, 32.7% had moderate anxiety or depression (GAD2/PHQ2≥3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity (β=.27, 95% CI .10-.44; P=.002) and number of COVID-19–related behavior changes (β=.09, 95% CI .05-.13; P<.001). Predictors of comfort using the website were preferring English for website use (odds ratio [OR] 5.57, 95% CI 2.22-13.96; P<.001) and COVID-19–related behavior changes (OR 1.37, 95% CI 1.12-1.66; P=.002); receiving overnight behavioral health treatment in the prior 6 months (OR 0.15, 95% CI 0.03-0.69, P=.015) was associated with less comfort in website use. The main predictor of depression at follow-up (PHQ2≥3) was baseline depression (OR 6.24, 95% CI 2.77-14.09; P<.001). Engagement in T4W/Juntos was associated with lower likelihood of depression (OR 0.54, 95% CI 0.34-0.86; P=.01). Website use the month before follow-up was associated with a post-pre reduction in PHQ2 score (β=–.62, 95% CI –1.04 to –0.20; P=.004). The main predictor of GAD2≥3 at follow-up was baseline GAD2≥3 (OR 13.65, 95% CI 6.06-30.72; P<.001). Greater baseline website engagement predicted reduced hotline use (OR 0.36, 95% CI 0.18-0.71; P=.004). Conclusions: Ethnicity/language and COVID-19–related behavior changes were associated with website engagement; engagement and use predicted reduced follow-up depression and behavioral hotline use. Findings are based on participants recommended by community agencies with moderate follow-up rates; however, significance was similar when weighting for nonresponse. This study may inform research and policy on digital mental health prevention resources.

BACKGROUND The COVID-19 pandemic increased disparities for communities burdened by structural barriers, such as shortage of affordable housing or work opportunities, with mental health consequences. These impacts are noted across age groups, with mental health consequences. OBJECTIVE To evaluate engagement in and impact of free, digital mental health resources, Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) developed with stakeholder input to support well-being during COVID-19 in California. METHODS T4W/Juntos was evaluated by stakeholder groups inviting providers, clients and partners to visit website and complete surveys at baseline (9/20/21-4/4/22) and 4-6 week follow-up (10/22/21-5/17/22). Engagement in website use was assessed by mean of three items (ease of use, satisfaction, relevance), comfort in use, and actual use (any and across six resource categories). Outcomes at follow up were depression (PHQ2) and anxiety (GHQ2) symptoms (primary); and behavioral health hotlines and services use (secondary). Multiple regression was used to identify predictors. Of 366 eligible, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up. RESULTS Mean baseline website engagement was associated with Hispanic ethnicity, English language preference for website, and COVID behavior changes; and those with more COVID behavior changes reported greater comfort using the website, each p<=.002. Greater website engagement was associated with less follow-up depression (PHQ2>=3) (p=.01); and website use predicted reduced pre-post PHQ2 score (p=.004). Greater engagement and comfort using the website predicted reduced follow-up hotline use (each p<.05). CONCLUSIONS Ethnicity/language and COVID behavior changes were associated with website engagement, which predicted reduced follow-up depressive symptoms and hotline use. Findings may inform future research and policy on digital resources. CLINICALTRIAL Not applicable