Skip to main content

Heart-Focused Anxiety Among Trauma-Exposed Latinx Young Adults: Relations to General Depression, Suicidality, Anxious Arousal, and Social Anxiety

Journal of Racial and Ethnic Health Disparities (2021)Cite this article

Abstract

Rates of traumatic event exposure, posttraumatic stress (PTS), and co-occurring mental health symptoms and disorders are conditionally higher among Latinx individuals compared to other racial/ethnic populations. Importantly, Latinx persons are a heterogeneous population, and certain subgroups endorse higher rates of negative mental health outcomes than others, including Latinx young adults born in the USA. Yet, there is little understanding of individual difference factors among trauma-exposed US born Latinx young adults that may be involved in mental health burden among this group. The present investigation sought to evaluate the potential explanatory relevance of heart-focused anxiety as an individual difference factor regarding some of the most common co-occurring mental health problems among trauma-exposed populations. Specifically, we tested whether heart-focused anxiety was related to increased co-occurring anxious arousal symptoms, depression, social anxiety, and suicidality among 169 (84% female, Mage=23.15 years, SD=6.07) trauma-exposed Latinx young adults. Results indicated that heart-focused anxiety was a statistically significant predictor of general depression (ΔR2 = .02, F(1, 161) = 4.25, p = .041), suicidality (ΔR2 = .10, F(1, 161) = 21.49, p < .001), anxious arousal (ΔR2 = .11, F(1, 161) = 27.31, p < .001), and social anxiety (ΔR2 = .03, F(1, 161) = 7.93, p = .005). Overall, this work offers empirical evidence that individual differences in heart-focused anxiety are related to more severe co-occurring anxiety and depressive symptomatology among a particularly at risk Latinx segment of the Latinx population (non-immigrant Latinx young adults s with previous trauma history).

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Bridges AJ, de Arellano MA, Rheingold AA, Danielson CK, Silcott L. Trauma exposure, mental health, and service utilization rates among immigrant and United States-born Hispanic youth: results from the Hispanic family study. Psychol Trauma Theory Res Pract Policy. 2010;2(1):40.

    Article  Google Scholar 

  2. Roberts AL, Gilman SE, Breslau J, Breslau N, Koenen KC. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med. 2011;41(1):71–83.

    CAS  PubMed  Article  Google Scholar 

  3. Alcántara C, Casement MD, Lewis-Fernandez R. Conditional risk for PTSD among Latinos: a systematic review of racial/ethnic differences and sociocultural explanations. Clin Psychol Rev. 2013;33(1):107–19.

    PubMed  Article  Google Scholar 

  4. Crockett LJ, Iturbide MI, Torres Stone RA, McGinley M, Raffaelli M, Carlo G. Acculturative stress, social support, and coping: relations to psychological adjustment among Mexican American college students. Cult Divers Ethn Minor Psychol. 2007;13(4):347–55.

    Article  Google Scholar 

  5. Phipps RM, Degges-White S. A new look at transgenerational trauma transmission: Second-generation Latino immigrant youth. J Multicult Couns Dev. 2014;42(3):174–87.

    Article  Google Scholar 

  6. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93(2):200–8.

    PubMed  PubMed Central  Article  Google Scholar 

  7. Leong F, Park YS, Kalibatseva Z. Disentangling immigrant status in mental health: psychological protective and risk factors among Latino and Asian American immigrants. Am J Orthopsychiatry. 2013;83(2pt3):361–71.

    PubMed  Article  Google Scholar 

  8. Ortega AN, Rosenheck R, Alegria M, Desai RA. Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics. J Nerv Ment Dis. 2000;188(11):728–35.

    CAS  PubMed  Article  Google Scholar 

  9. Alegría M, Alvarez K, Ishikawa RZ, DiMarzio K, McPeck S. Removing obstacles to eliminating racial and ethnic disparities in behavioral health care. Health Aff. 2016;35(6):991–9.

    Article  Google Scholar 

  10. Grant BF, Stinson FS, Hasin DS, Dawson DA, Chou SP, Anderson K. Immigration and lifetime prevalence of DSM-IV psychiatricdisorders among mexican americans and non-Hispanic whites in the United States: results from the national epidemiologic survey on alcohol and relatedconditions. Arch Gen Psychiatry. 2004;61(12):1226–33.

    PubMed  Article  Google Scholar 

  11. Wells KB, Golding JM, Hough RL, Burnam MA, Karno M. Acculturation and the probability of use of health services by Mexican Americans. Health Serv Res. 1989;24(2):237–57.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. NAMI_YouAreNotAlone_2020_FINAL.pdf. [cited 2021 Apr 2]. Available from: https://www.nami.org/NAMI/media/NAMI-Media/Infographics/NAMI_YouAreNotAlone_2020_FINAL.pdf. Accessed 2 April 2021.

  13. Chavez LM, Shrout PE, Alegría M, Lapatin S, Canino G. Ethnic differences in perceived impairment and need for care. J Abnorm Child Psychol. 2010;38(8):1165–77.

    PubMed  PubMed Central  Article  Google Scholar 

  14. Pole N, Gone JP, Kulkarni M. Posttraumatic stress disorder among ethnoracial minorities in the United States. Clin Psychol Sci Pract. 2008;15(1):35–61.

    Article  Google Scholar 

  15. Pérez-Stable EJ, Miranda J, Muñoz RF, Ying Y-W. Depression in medical outpatients: underrecognition and misdiagnosis. Arch Intern Med. 1990;150(5):1083–8.

    PubMed  Article  Google Scholar 

  16. Simon P, Camenga DR, Kong G, Cavallo DA, Morean ME, Gutierrez KM, et al. Low socioeconomic status is associated with e-cigarette and tobacco product use latent class membership among adolescents. Drug Alcohol Depend. 2017;171:e191.

    Article  Google Scholar 

  17. Martin RA, Cassidy RN, Murphy CM, Rohsenow DJ. Barriers to quitting smoking among substance dependent patients predict smoking cessation treatment outcome. J Subst Abus Treat. 2016;64:7–12.

    Article  Google Scholar 

  18. Office of the Surgeon General (US), Center for Mental Health Services (US), National Institute of Mental Health (US). Mental health: culture, race, and ethnicity: a supplement to mental health: a report of the Surgeon General [Internet]. Rockville (MD): substance abuse and mental health services administration (US); 2001 [cited 2020 May 28]. (Publications and Reports of the Surgeon General). Available from: http://www.ncbi.nlm.nih.gov/books/NBK44243/. Accessed 28 May 2020.

  19. Pole N, Best SR, Metzler T, Marmar CR. Why are Hispanics at greater risk for PTSD? Cult Divers Ethn Minor Psychol. 2005;11(2):144–61.

    Article  Google Scholar 

  20. Rayburn NR, Wenzel SL, Elliott MN, Hambarsoomians K, Marshall GN, Tucker JS. Trauma, depression, coping, and mental health service seeking among impoverished women. J Consult Clin Psychol. 2005;73(4):667–77.

    PubMed  Article  Google Scholar 

  21. de Snyder Salgado VN, Cervantes RC, Padilla AM. Migration and post-traumatic stress disorders: the case of Mexicans and Central Americans in the United States. Acta Psiquiatr Psicol Am Lat. 1990;36(3–4):137–45.

    Google Scholar 

  22. Potochnick SR, Perreira KM. Depression and anxiety among first-generation immigrant Latino youth: key correlates and implications for future research. J Nerv Ment Dis. 2010;198(7):470–7.

    PubMed  PubMed Central  Article  Google Scholar 

  23. Hazen AL, Connelly CD, Soriano FI, Landsverk JA. Intimate partner violence and psychological functioning in Latina women. Health Care Women Int. 2008;29(3):282–99.

    PubMed  Article  Google Scholar 

  24. Rodriguez MA, Heilemann MV, Fielder E, Ang A, Nevarez F, Mangione CM. Intimate partner violence, depression, and PTSD among pregnant Latina women. Ann Fam Med. 2008;6(1):44–52.

    PubMed  PubMed Central  Article  Google Scholar 

  25. Cervantes RC, de Snyder VNS, Padilla AM. Posttraumatic stress in immigrants from Central America and Mexico. Psychiatr Serv. 1989;40(6):615–9.

    CAS  Article  Google Scholar 

  26. Eisenman DP, Gelberg L, Liu H, Shapiro MF. Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. Jama. 2003;290(5):627–34.

    PubMed  Article  Google Scholar 

  27. Messias DKH, Lacy EC. Katrina-related health concerns of Latino survivors and evacuees. J Health Care Poor Underserved. 2007;18(2):443–64.

    PubMed  Article  Google Scholar 

  28. Schraufnagel TJ, Wagner AW, Miranda J, Roy-Byrne PP. Treating minority patients with depression and anxiety: what does the evidence tell us? Gen Hosp Psychiatry. 2006;28(1):27–36.

    PubMed  Article  Google Scholar 

  29. Heilemann MV, Kury FS, Lee KA. Trauma and posttraumatic stress disorder symptoms among low income women of Mexican descent in the United States. J Nerv Ment Dis. 2005;193(10):665–72.

    PubMed  Article  Google Scholar 

  30. Hass GA, Dutton MA, Orloff LE. Lifetime prevalence of violence against Latina immigrants: legal and policy implications. Int Rev Vict. 2000;7(1–3):93–113.

  31. Angel R, Guarnaccia PJ. Mind, body, and culture: somatization among Hispanics. Soc Sci Med. 1989;28(12):1229–38.

    CAS  PubMed  Article  Google Scholar 

  32. Wickrama KAS, Conger RD, Abraham WT. Early adversity and later health: the intergenerational transmission of adversity through mental disorder and physical illness. J Gerontol Ser B Psychol Sci Soc Sci. 2005;60(Special_Issue_2):S125–9.

    Google Scholar 

  33. Blascovich J, Mendes WB. Social psychophysiology and embodiment. Handb Soc Psychol. 2010;1:194–227.

  34. Good BJ. The heart of what’s the matter the semantics of illness in Iran. Cult Med Psychiatry. 1977;1(1):25–58.

    CAS  PubMed  Article  Google Scholar 

  35. Lewis-Fernández R, Gorritz M, Raggio GA, Peláez C, Chen H, Guarnaccia PJ. Association of trauma-related disorders and dissociation with four idioms of distress among Latino psychiatric outpatients. Cult Med Psychiatry. 2010;34(2):219–43.

    PubMed  PubMed Central  Article  Google Scholar 

  36. Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin. 2011;34(3):511–3.

    Google Scholar 

  37. Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry. 1988;145(11):1358–68.

    CAS  PubMed  Article  Google Scholar 

  38. Shetterly SM, Baxter J, Mason LD, Hamman RF. Self-rated health among Hispanic vs non-Hispanic white adults: the San Luis Valley Health and Aging Study. Am J Public Health. 1996;86(12):1798–801.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  39. Vega WA, Amaro H. Latino outlook: good health, uncertain prognosis. Health Anxiety. 1994;15(1):39–67.

  40. Lopez JH, Fajnzylber P, Acosta P (2007) The impact of remittances on poverty and human capital: evidence from Latin American household surveys. The World Bank. Policy Research Working Papers. https://doi.org/10.1596/1813-9450-4247.

  41. Magaña D. Cultural competence and metaphor in mental healthcare interactions: a linguistic perspective. Patient Educ Couns. 2019;102(12):2192–8.

    PubMed  Article  Google Scholar 

  42. Brudey C, Park J, Wiaderkiewicz J, Kobayashi I, Mellman TA, Marvar PJ. Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease. Am J Phys Regul Integr Comp Phys. 2015;309(4):R315–21.

    CAS  Google Scholar 

  43. Llabre MM, Schneiderman N, Gallo LC, Arguelles W, Daviglus ML, Gonzalez F. Childhood trauma and adult risk factors and disease in Hispanics/Latinos in the US: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. Psychosom Med. 2017;79(2):172–80.

    PubMed  PubMed Central  Article  Google Scholar 

  44. Coughlin SS. Post-traumatic stress disorder and cardiovascular disease. Open Cardiovasc Med J. 2011;5:164–70.

    PubMed  PubMed Central  Article  Google Scholar 

  45. Marshall GN, Schell TL, Miles JN. Ethnic differences in posttraumatic distress: Hispanics’ symptoms differ in kind and degree. J Consult Clin Psychol. 2009;77(6):1169–78.

    PubMed  PubMed Central  Article  Google Scholar 

  46. Edmondson D, Kronish IM, Shaffer JA, Falzon L, Burg MM. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J. 2013;166(5):806–14.

    PubMed  Article  Google Scholar 

  47. Eifert GH, Hodson SE, Tracey DR, Seville L, Gunawardane K. Heart-focused anxiety, illness beliefs, and behavioral impairment: comparing healthy heart-anxious patients with cardiac and surgical inpatients. J Behav Med. 1996;19(4):385–99.

    CAS  PubMed  Article  Google Scholar 

  48. Eifert GH, Thompson RN, Zvolensky MJ, Edwards K, Frazer NL, Haddad JW, et al. The cardiac anxiety questionnaire: development and preliminary validity. Behav Res Ther. 2000;38(10):1039–53.

    CAS  PubMed  Article  Google Scholar 

  49. Eifert GH, Zvolensky MJ, Lejuez CW (2001) Heart-focused anxiety in medical and anxiety-related psychological conditions. Health anxiety: clinical research perspectives on hypochondriasis and related disorders, pp 277–297

  50. Carmin CN, Wiegartz PS, Hoff JA, Kondos GT. Cardiac anxiety in patients self-referred for electron beam tomography. J Behav Med. 2003;26(1):67–80.

    PubMed  Article  Google Scholar 

  51. Hoyer J, Eifert GH, Einsle F, Zimmermann K, Krauss S, Knaut M, et al. Heart-focused anxiety before and after cardiac surgery. J Psychosom Res. 2008;64(3):291–7.

    PubMed  Article  Google Scholar 

  52. Marker CD, Carmin CN, Ownby RL. Cardiac anxiety in people with and without coronary atherosclerosis. Depress Anxiety. 2008;25(10):824–31.

    PubMed  PubMed Central  Article  Google Scholar 

  53. Zvolensky MJ, Eifert GH, Feldner MT, Leen-Feldner E. Heart-focused anxiety and chest pain in postangiography medical patients. J Behav Med. 2003;26(3):197–209.

    PubMed  Article  Google Scholar 

  54. Manning K, Rogers AH, Bakhshaie J, Viana AG, Lemaire C, Garza M, et al. Heart-focused anxiety among Latinxs in primary care: relations to anxiety, depression, pain, and functional impairment. J Nerv Ment Dis. 2019;207(8):651–8.

    PubMed  Article  Google Scholar 

  55. Lustig SL, Kia-Keating M, Knight WG, Geltman P, Ellis H, Kinzie JD, et al. Review of child and adolescent refugee mental health. J Am Acad Child Adolesc Psychiatry. 2004;43(1):24–36.

    PubMed  Article  Google Scholar 

  56. Macmillan R. Violence and the life course: the consequences of victimization for personal and social development. Annu Rev Sociol. 2001;27(1):1–22.

    Article  Google Scholar 

  57. Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychol Assess. 1997;9(4):445–51.

    Article  Google Scholar 

  58. Zell E, Strickhouser JE, Krizan Z. Subjective social status and health: a meta-analysis of community and society ladders. Health Psychol. 2018;37(10):979–87.

    PubMed  Article  Google Scholar 

  59. Franzini L, Fernandez-Esquer ME. The association of subjective social status and health in low-income Mexican-origin individuals in Texas. Soc Sci Med. 2006;63(3):788–804.

    PubMed  Article  Google Scholar 

  60. Ostrove JM, Adler NE, Kuppermann M, Washington AE. Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychol. 2000;19(6):613–8.

    CAS  PubMed  Article  Google Scholar 

  61. Reitzel LR, Kendzor DE, Cao Y, Businelle MS. Subjective social status predicts quit-day abstinence among homeless smokers. Am J Health Promot. 2014;29(1):43–5.

    PubMed  Article  Google Scholar 

  62. Cundiff JM, Smith TW, Uchino BN, Berg CA. An interpersonal analysis of subjective social status and psychosocial risk. J Soc Clin Psychol. 2011;30(1):47–74.

    Article  Google Scholar 

  63. Zorotovich J, Johnson EI, Linn R. Subjective social status and positive indicators of well-being among emerging adult college students. Coll Stud J. 2016;50(4):624–35.

    Google Scholar 

  64. Haigh F, Baum F, Dannenberg AL, Harris MF, Harris-Roxas B, Keleher H, et al. The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005–2009. BMC Public Health. 2013;13(1):1188.

    PubMed  PubMed Central  Article  Google Scholar 

  65. Akhtar S, Asghar N. Risk factors of cardiovascular disease in district Swat. J Pak Med Assoc. 2015;65(9):1001–4.

    PubMed  Google Scholar 

  66. Nair LM, Madhu B, Srinath KM, Gopinath A, Yadav K. Magnitude of behavioural risk factors for cardiovascular diseases among college going young adults (18-25 years) in Mysuru, Karnataka, India. Int J Community Med Public Health. 2017;4(1):65–72.

  67. Aikens JE, Michael E, Levin T, Myers TC, Lowry E, McCracken LM. Cardiac exposure history as a determinant of symptoms and emergency department utilization in noncardiac chest pain patients. J Behav Med. 1999;22(6):605–17.

    CAS  PubMed  Article  Google Scholar 

  68. Watson D, O’Hara MW, Simms LJ, Kotov R, Chmielewski M, McDade-Montez EA, et al. Development and validation of the inventory of depression and anxiety symptoms (IDAS). Psychol Assess. 2007;19(3):253–68.

    PubMed  Article  Google Scholar 

  69. Watson D, Clark LA. Measurement and mismeasurement of mood: recurrent and emergent issues. J Pers Assess. 1997;68(2):267–96.

    CAS  PubMed  Article  Google Scholar 

  70. Paulus DJ, Bakhshaie J, Lemaire C, Garza M, Ochoa-Perez M, Valdivieso J, et al. Negative affectivity and problematic alcohol use among latinos in primary care: the role of emotion dysregulation. J Dual Diagn. 2016;12(2):137–47.

    PubMed  Article  Google Scholar 

  71. Bogaerts K, Van Eylen L, Li W, Bresseleers J, Van Diest I, De Peuter S, et al. Distorted symptom perception in patients with medically unexplained symptoms. J Abnorm Psychol. 2010;119(1):226–34.

    PubMed  Article  Google Scholar 

  72. Ehlers A, Breuer P, Dohn D, Fiegenbaum W. Heartbeat perception and panic disorder: possible explanations for discrepant findings. Behav Res Ther. 1995;33(1):69–76.

    CAS  PubMed  Article  Google Scholar 

  73. Pollatos O, Gramann K, Schandry R. Neural systems connecting interoceptive awareness and feelings. Hum Brain Mapp. 2007;28(1):9–18.

    PubMed  Article  Google Scholar 

  74. Cheng H-L, Mallinckrodt B. Racial/ethnic discrimination, posttraumatic stress symptoms, and alcohol problems in a longitudinal study of Hispanic/Latino college students. J Couns Psychol. 2015;62(1):38–49.

    PubMed  Article  Google Scholar 

  75. Thoits PA. Stress and health: Major findings and policy implications. J Health Soc Behav. 2010;51(1_suppl):S41–53.

    PubMed  Article  Google Scholar 

  76. Peña JB, Wyman PA, Brown CH, Matthieu MM, Olivares TE, Hartel D, et al. Immigration generation status and its association with suicide attempts, substance use, and depressive symptoms among Latino adolescents in the USA. Prev Sci. 2008;9(4):299–310.

    PubMed  PubMed Central  Article  Google Scholar 

  77. Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G. Prevalence of psychiatric disorders across Latino subgroups in the United States. Am J Public Health. 2007;97(1):68–75.

    PubMed  PubMed Central  Article  Google Scholar 

  78. Hinton DE, Pich V, Chhean D, Safren SA, Pollack MH. Somatic-focused therapy for traumatized refugees: treating posttraumatic stress disorder and comorbid neck-focused panic attacks among cambodian refugees. Psychother Theory Res Pract Train. 2006;43(4):491.

    Article  Google Scholar 

  79. Hinton DE, Kredlow MA, Bui E, Pollack MH, Hofmann SG. Treatment change of somatic symptoms and cultural syndromes among Cambodian refugees with PTSD. Depress Anxiety. 2012;29(2):148–55.

    Article  Google Scholar 

  80. Olatunji BO, Deacon BJ, Abramowitz JS, Valentiner DP. Body vigilance in nonclinical and anxiety disorder samples: structure, correlates, and prediction of health concerns. Behav Ther. 2007;38(4):392–401.

    PubMed  Article  Google Scholar 

  81. Flores E, Tschann JM, Dimas JM, Bachen EA, Pasch LA, de Groat CL. Perceived discrimination, perceived stress, and mental and physical health among Mexican-origin adults. Hisp J Behav Sci. 2008;30(4):401–24.

    Article  Google Scholar 

  82. Pynoos R, Rodriguez N, Steinberg A, Stuber M, Frederick C. UCLA ptsd index for DSM-IV, vol. 101998. Los Angeles: UCLA Trauma Psychiatry Service; 1998.

    Google Scholar 

Download references

Funding

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH) to the University of Houston under Award Number U54MD015946.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA

    Nubia A. Mayorga, Justin M. Shepherd, Lorra Garey, Andres G. Viana & Michael J. Zvolensky

  2. Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Michael J. Zvolensky

  3. HEALTH Institute, University of Houston, Houston, TX, USA

    Michael J. Zvolensky

Authors
  1. Nubia A. Mayorga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Justin M. Shepherd
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorra Garey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andres G. Viana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael J. Zvolensky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael J. Zvolensky.

Ethics declarations

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mayorga, N.A., Shepherd, J.M., Garey, L. et al. Heart-Focused Anxiety Among Trauma-Exposed Latinx Young Adults: Relations to General Depression, Suicidality, Anxious Arousal, and Social Anxiety. J. Racial and Ethnic Health Disparities (2021). https://doi.org/10.1007/s40615-021-01054-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40615-021-01054-z

Keywords

  • Heart-focused anxiety
  • Trauma
  • Latinx
  • Mental health