Commentary: Race and mental health - More questions than answers
Available from: Margarita Alegria
- "For example, compared to Whites, Blacks have lower rates of mood, anxiety, and substance disorder, but elevated rates of schizophrenia. Blacks also have lower levels of psychological well-being (happiness and life satisfaction) than Whites, but higher levels of psychological distress (Williams and Earl 2007). "
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. To examine racial-ethnic differences in the endorsement and attribution of psychotic-like symptoms in a nationally representative sample of African-Americans, Asians, Caribbean Blacks, and Latinos living in the USA.
Data were drawn from a total of 979 respondents who endorsed psychotic-like symptoms as part of the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). We use a mixed qualitative and quantitative analytical approach to examine sociodemographic and ethnic variations in the prevalence and attributions of hallucinations and other psychotic-like symptoms in the NLAAS and NSAL. The lifetime presence of psychotic-like symptoms was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) psychotic symptom screener. We used logistic regression models to examine the probability of endorsing the four most frequently occurring thematic categories for psychotic-like experiences by race/ethnicity (n > 100). We used qualitative methods to explore common themes from participant responses to open ended questions on their attributions for psychotic-like symptoms.
African-Americans were significantly less likely to endorse visual hallucinations compared to Caribbean Blacks (73.7% and 89.3%, p < .001), but they endorsed auditory hallucinations symptoms more than Caribbean Blacks (43.1% and 25.7, p < .05). Endorsing delusions of reference and thought insertion/withdrawal were more prevalent for Latinos than for African-Americans (11% and 4.7%, p < .05; 6.3% and 2.7%, p < .05, respectively). Attribution themes included: supernatural, ghosts/unidentified beings, death and dying, spirituality or religiosity, premonitions, familial and other. Respondents differed by race/ethnicity in the attributions given to psychotic like symptoms.
Findings suggest that variations exist by race/ethnicity in both psychotic-like symptom endorsement and in self-reported attributions/understandings for these symptoms on a psychosis screening instrument. Ethnic/racial differences could result from culturally sanctioned beliefs and idioms of distress that deserve more attention in conducting culturally informed and responsive screening, assessment and treatment.
Ethnicity and Health 06/2014; 20(3):1-20. DOI:10.1080/13557858.2014.921888 · 1.67 Impact Factor
Available from: Giyeon Kim
- "This study addressed the national priority of reducing or eliminating disparities in health and health care between racial/ethnic minority and nonminority older adults. Despite inconsistent findings on racial/ethnic differences in mental health problems (Barrio et al., 2008; Miranda et al., 2008; Vega & Lopez, 2001; Williams & Earl, 2007), racial and ethnic minorities—especially blacks and Latinos—continue to utilize mental health services at only half the rate of non-Hispanic whites, even after accounting for their mental health status (AHRQ, 2010; Alegría et al., 2002; Cooper-Patrick et al., 1999; Dobalian & Rivers, 2008; Neighbors et al., 2007; Snowden, 1999, 2001; U.S. Department of Health and Human Services, 2001; Wang et al., 2005). It is especially alarming in the field of gerontology that older adults in general are less likely to use mental health services than younger adults (Mackenzie, Pagura, & Sareen, 2010). "
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Given the paucity of research on the role of geography in mental health care, this study examined whether racial differences in mental health service use varied across geographic regions among older adults.
Design and methods:
Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), blacks (n = 1,008) and whites (n = 1,870) aged 60 and older were selected for analysis. Logistic regression analyses were conducted.
Results showed significant racial disparities in mental health service use in the overall sample, as well as significant variation by region. Although no racial differences were observed in the Northeast, West, or Midwest regions, black elders in the South were significantly less likely than whites to use mental health services (odds ratios [OR], 2.08; 95% confidence interval [CI], 1.34-3.23).
The findings suggest that improving the access to mental health care in certain regions, the South in particular, may be essential to reduce racial disparities at the national level. Policy implications are discussed.
The Gerontologist 08/2012; 53(4). DOI:10.1093/geront/gns107 · 3.21 Impact Factor
Available from: Ilan H Meyer
- "As we illustrated in Fig. 1a, disparities in outcome is a condition for showing a mediational effect in the causal relationship of social structures and mental health problems. We find it perplexing that while there is growing recognition in the field that there is no racial mental health disparity (e.g., Kessler et al., 1999; Schulz et al., 2000; Williams et al. 2007), researchers continue to suggest that discrimination is a mediational process that explains mental health disparities. The implications for social stress theory of such inconsistencies are rarely discussed. "
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ABSTRACT: Social stress models are the predominant theoretical frame for studies of the relationship between social statuses and mental health (Dressler, Oths, & Gravlee, 2005; Horwitz, 1999). These models propose that prejudice, discrimination and related social ills exert an added burden on socially disadvantaged populations (populations subjected to stigma, prejudice and discrimination) that can generate mental health problems. Researchers have used a variety of methodological approaches to study this hypothesis. In this paper we argue that researchers have not paid sufficient attention to the implications of this methodological variability, particularly the distinction between studies of within-group and studies of between-groups variation, in interpreting empirical tests of social stress theory. To fully evaluate the evidence, we need to carefully consider the convergence and divergence of results across diverse methodologies.
Social Science [?] Medicine 04/2010; 70(8):1111-8. DOI:10.1016/j.socscimed.2009.11.032 · 2.89 Impact Factor
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