This study examines the role of acculturation, perceived discrimination, and self-esteem in predicting the mental health symptoms and risk behaviors among 1.5 and second generation non-Jewish adolescents born to migrant families compared with native-born Jewish Israeli adolescents in Israel. Participants included n = 65 1.5 migrant adolescents, n = 60 second generation migrant adolescents, and n = 146 age, gender, and socioeconomic matched sample of native-born Jewish Israelis. Participants completed measures of acculturation pattern, perceived discrimination, and self-esteem as well as measures of mental health symptoms and risk behaviors. Results show that migrant adolescents across generations reported worse mental health symptoms compared with native-born Jewish Israelis. However, only the 1.5 generation migrants reported higher engagement in risk behaviors compared with second generation migrants and native-born Jewish Israelis. Our findings further showed that acculturation plays an important role in predicting the mental health status of migrant youth, with those characterized with integrated acculturative pattern reporting lower mental health symptoms compared with assimilated acculturation pattern. Importantly, contextual factors, such as higher perception of discrimination in the receiving culture as well as individual factors such as lower self-esteem and female gender were strongly associated with worse mental health symptoms. The findings manifest the complex relationship between contextual factors and individual level variables in the acculturative process of migrants as well as the importance of examining the effect of migration generation on mental health outcomes.

Racial/ethnic concordance between patients and providers concerning the quality of care has received interest over past decades yielding mixed results. Patients seem to prefer clinicians of their own race/ethnicity, but empirical studies have found small or inconsistent effects on the quality of care. Research on the impact of racial/ethnic concordance and treatment duration appears to suggest that racial/ethnic concordance is associated with retention and completion; however, exactly why racial/ethnic concordance improves treatment length remains unexplored. On the other side, the quality of working alliance is a well-established common factor underlying effective treatments. In this study, we examined the interaction between patient-provider racial/ethnic concordance, length of treatment in the therapeutic dyad, and working alliance as evaluated by both patients themselves and objective raters. The study included 312 patients and 74 providers from 13 community and hospital-based outpatient mental health clinics in Massachusetts. Results indicated that among racial/ethnic concordant therapeutic dyads, longer length of treatment was associated with better quality of working alliance as evaluated by objective raters. Implications for clinical practice and future research on racial/ethnic concordance studies linked to the length of treatment are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The primary purpose of diagnostic systems is to improve the care of individuals suffering from mental disorders. Yet, few studies have explored the clinical use of the DSM. Here, we investigated clinicians' methods of obtaining and using diagnostic information during the mental health intake session. We examined the specific diagnostic information collected in usual care using unstructured interviews and the way this information was applied to make diagnostic decisions within naturalistic settings. We compared these decisions to diagnoses made using independent structured diagnostic interviews that served as the gold standard for psychiatric diagnosis. Finally, we examined ways to improve diagnostic efficiency by identifying the best probes for the diagnosis of major depressive disorder (MDD) in naturalistic settings. A total of 122 intake sessions in 4 community mental health clinics in Israel were audiotaped. Data were collected from October 2012 to April 2013. Immediately following the intake, clinicians listed the service user's diagnoses according to the DSM-IV while the service user completed a structured diagnostic interview with an independent interviewer. Recorded intake sessions were coded by independent clinicians using an information checklist. Overall, clinicians tended to underuse the DSM, not collecting sufficient information to establish a correct diagnosis for most disorders. Accuracy of diagnostic decisions for MDD improved when only 2 screener items (depressed mood and diminished interest or pleasure) were assessed, compared to assessing 5 or more criteria as required by DSM-IV (diagnostic odds ratios = 9.44 and 3.85, respectively). The problem of missing diagnostic information may underlie the poor reliability of the clinical diagnostic decision process. Systematically evaluating clinicians' assessment process in regular care can help identify the best probes to use in clinical practice to increase diagnostic efficiency.