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Participation in and outcome of treatment for Major Depression among low income Asian Americans
Abstract
This study examined the relationship of four aspects of psychiatric treatment (use of medication, client-therapist ethnic match, treatment in an Asian-specific clinic, and professional therapist) to participation in treatment and outcome of treatment in low income Asian-American clients (n = 273) of the Los Angeles County mental health system who were diagnosed with major depression. Based on cultural responsiveness theory, the study tested the hypothesis that use of medication in treatment would have the greatest effect on participation and outcome followed, in order, by client-therapist ethnic match, treatment in an Asian-specific clinic, and treatment by a professional therapist. The hypotheses were largely supported: treatment with medication had a significant relationship to total number of treatment sessions (participation) and improvement in the admission-discharge Global Assessment Scale (GAS) score (outcome). Treatment by a therapist of the same ethnicity as the client and treatment in an agency designated to provide services to Asian clients both had significant relationships to the number of treatment sessions but not to GAS score improvement. Four covariates included in the analysis and treatment by a professional therapist had no relationship to either of the dependent variables.
... Over the past three decades, many authors have noted that people of color tend to underutilize mental health services, seek therapy only when their problems have become severe, and drop out of therapy prematurely (e.g., Flaskerud & Hu, 1994;Zane, Enomoto, & Chun, 1994). There are several explanations for these trends. ...
... Second, clients of color are sometimes mistrustful of mental health services because of historic racial disparities and a scarcity of therapists from their own ethnic background who speak the same native language (Flaskerud & Hu, 1994;Marger, 2002;S. Sue, 1988;S. ...
... Third, there is a lack of mental health services available in many communities where people of color reside (Flaskerud & Hu, 1994;Marger, 2002;S. Sue, 1988;S. ...
There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
... However, another study of Asian American clients at ethnic-specific services reported significant differences in pre-and post-treatment GAS scores, suggesting these clients at an ethnic-specific program experienced better treatment outcomes than those who attended mainstream services (Lau & Zane, 2000 ). Some studies that examined ethnicspecific services also found subtle Asian American subgroup differences in pre-and post-treatment GAS scores (Ying & Hu, 1994), while other studies found no significant differences among Asian American subgroups (Flaskerud & Hu, 1994; Zane et al., 2004). ...
... M. Lin & Cheung, 1999; Smith & Lin, 1996). However, one study found that concomitant medication use was the most significant predictor of increased treatment length, and positive change in pre-and posttreatment GAF scores for low-income Asian Americans with major depression (Flaskerud & Hu, 1994). Given the strong relationship between severe forms of psychopathology, and the likelihood of receiving psychiatric medication care, evaluating the impact of psychiatric service use on psychotherapy treatment outcome is essential. ...
... In general, clients in this clinical sample completed an average of 23 sessions in a given episode of treatment. On face value, this reported number of completed sessions is comparable to the average treatment length found at ethnic-specific service providers and significantly higher than treatment lengths at mainstream providers for Asian Americans reported in previous studies (Flaskerud & Hu, 1994; S. Sue et al., 1991; Takeuchi et al., 1995). Unfortunately, accurate comparisons with past studies about treatment length are somewhat difficult due to different methods used for analyzing the mean of completed sessions (e.g., geometric mean or log transformations), and the temporal constraints (e.g., analyzing one versus two years of clinical data) that each individual study employed. ...
The present study examined several client demographic, clinical, and service provider variables and their relationship to treatment outcome as defined as premature termination in the first month of treatment, treatment length (total number of completed psychotherapy sessions), and change in pre/post-treatment Global Assessment of Functioning (GAF) scores for 1,030 Asian Americans (193 Cambodian, 349 Chinese, 134 Iu Mien, 113 Korean, and 241 Vietnamese) seeking individual psychotherapy from an ethnic-specific mental health service provider.
Results showed that more educated clients, who spoke English as their primary language, were client-therapist Asian language matched, or assigned their intake therapist as their primary therapist were less likely to prematurely terminate from treatment. Korean Americans also reported the highest rates of premature termination in this sample.
To account for clients who discontinued treatment in the first month, subsequent analyses on treatment length and pre/post-treatment GAF scores were completed on a smaller sample of 937 Asian Americans (187 Cambodian, 318 Chinese, 127 Iu Mien, 91 Korean, and 214 Vietnamese). Results showed that clients who were women, Cambodian or Iu Mien American, completed more medication consultation appointments, or averaged more therapy sessions per week reported longer treatment lengths. In contrast, clients who were discharged or referred to other facilities by therapists or diagnosed with an adjustment disorder completed shorter treatment lengths.
Results also showed that clients who completed more medication consultation appointments, were discharged or referred to other facilities by their therapists, had longer treatment lengths, or were diagnosed with an adjustment disorder reported a larger difference in pre/post-treatment GAF scores. In contrast, Cambodian Americans and clients who averaged more therapy sessions per week reported with smaller differences in pre/post-treatment GAF scores.
In general, the results of this dissertation study suggest there may be culturally related factors unique to specific Asian American ethnic groups that may influence differential treatment outcome. Furthermore, the findings suggest the need for greater care and consideration in studying how ethnic-specific services are being delivered to various Asian American groups and underscores the importance of evaluating the treatment needs of Asian American groups separately rather than an aggregate whole.
... Matching clients from a non-English-speaking background with bilingual, bicultural mental health clini-cians is one of the most commonly suggested strategies for improving access to and use of mental health services by ethnic minorities (16,(23)(24)(25)(26)(27)(28)(29)(30). However, to our knowledge, no research on the effectiveness of this strategy has been conducted in Australia, even though research in the United States has suggested that client-clinician ethnic matching reduces clients' rates of premature termination of therapy (16,(24)(25)(26), increases their contact with clinical services (16,25,(27)(28)(29), reduces their contact with emergency or crisis services (28,30), and reduces the number of days they spend in the hospital (28). ...
... Matching clients from a non-English-speaking background with bilingual, bicultural mental health clini-cians is one of the most commonly suggested strategies for improving access to and use of mental health services by ethnic minorities (16,(23)(24)(25)(26)(27)(28)(29)(30). However, to our knowledge, no research on the effectiveness of this strategy has been conducted in Australia, even though research in the United States has suggested that client-clinician ethnic matching reduces clients' rates of premature termination of therapy (16,(24)(25)(26), increases their contact with clinical services (16,25,(27)(28)(29), reduces their contact with emergency or crisis services (28,30), and reduces the number of days they spend in the hospital (28). Ethnic matching may also improve the effectiveness of therapeutic processes such as counseling (31). ...
... Like several studies of client-clinician ethnic matching in the United States (16,25,(27)(28)(29), this Australian study found that clients with a non-English-speaking background who were matched with a bilingual, bicultural case manager had a higher frequency and longer duration of contact with community services than similar clients who were not matched with a bilingual case manager. This result was found for both direct and telephone contacts. ...
Research in the United States has indicated that matching clients from a minority group with clinicians from the same ethnic background increases use of community mental health services and reduces use of emergency services. This study assessed the effects of matching clients from a non-English-speaking background with bilingual, bicultural clinicians in a mental health system in Australia that emphasizes community-based psychiatric case management.
In an overall sample of 2,935 clients served in the western region of Melbourne from 1997 to 1999, ethnic minority clients from a non-English-speaking background who received services from a bilingual, bicultural case manager were compared with ethnic minority clients who did not receive such services and with clients from an English-speaking background. The clients' engagement with three types of services-community care teams, psychiatric crisis teams, and psychiatric inpatient services-was assessed.
Compared with ethnic minority clients who were not matched with a bilingual clinician, those who were matched generally had a longer duration and greater frequency of contact with community care teams and a shorter duration and lower frequency of contact with crisis teams. Clients born in Vietnam who were matched with a bilingual clinician had a shorter annual mean length of hospital stay and a lower annual mean frequency of hospital admission than Australian-born clients.
The benefits of matching clients with psychiatric case managers on the basis of ethnic background include a lower level of need for crisis intervention and, for clients from some ethnic groups, fewer inpatient interventions. These Australian results support findings of the effectiveness of client-clinician ethnic matching in the United States.
... Most of the research in this area has been conducted in the mental health field. Studies have reported that client-therapist language or ethnic match positively affected participation in treatment and increased the number of sessions of mental health treatment (Blank et al., 1994;Flaskerud, 1986;Flaskerud and Hu, 1994;Flaskerud andLiu, 1990, 1991;Takeuchi, Sue, and Yeh, 1995;Wade and Bernstein, 1991). Combined ethnic and language match has been shown to be associated with reduced emergency room visits by mental health patients (Snowden, Hu, and Jerrell, 1995), and language match alone has been associated with lower hospi tal admission rates (Lee and Rosenberg, 1998). ...
... Most studies that examined concordance's impact on health outcomes did not document improvements in health status of functioning (Flaskerud and Hu, 1994;Flaskerud andLiu, 1990, 1991;1994;Takeuchi, Sue, and Yeh, 1995. The one exception was Porter and Beuf (1994), who found that African-American patients with vitiligo (a disfiguring skin disease) show better adjustment after treatment in predominantly a black hospital than African-American patients treated at a hospital where staff was mostly white. ...
This document is the final report for the Cultural Competence Research Agenda project, sponsored by OMH and AHRQ to examine how cultural competence affects health care delivery and health outcomes.
Many health care providers and policymakers have fundamental questions about the intrinsic and relative value of different cultural competence methods and programs. These questions may relate to:
Access and outcomes (which interventions increase access for culturally and linguistically diverse populations to health care services and/or improve their health outcomes?)
Quality and reduction in errors (which interventions increase the provision of appropriate care to and/or reduce the incidence of medical errors among diverse populations?)
Cost (which interventions are cost effective—e.g., reduce diagnostic testing and emergency room use or increase preventive services lowering future health costs?)
Comparative analyses (which approaches or interventions work best under which circumstances?)
The main goal of the Cultural Competence Research Agenda Project is to produce and disseminate to key stakeholders a research agenda on the relationship between cultural competence interventions and health care delivery and health outcomes. This goal has been accomplished through completion of the following tasks:
Developing a working consensus on the parameters and specifics of cultural competence interventions for the purposes of conducting health care delivery and health outcomes research.
Collecting, reviewing and making available to the public abstracts of published, unpublished, and in-progress research on cultural competence.
Identifying key research questions on cultural competence that have been the subject of research, and describing the strengths and limitations of this research.
Identifying key research questions on cultural competence that have yet to be studied.
Identifying issues related to study design, potential data sources and study sites.
Identifying larger contextual issues related to cultural competence research: how to interest potential researchers, linking content experts with research experts, researcher collaboration/ networking, funding for research, publication, and how to involve and gain the support of research stakeholders (providers, policymakers, consumers) in the identification and utilization of research findings.
Full text:
https://www.minorityhealth.hhs.gov/assets/pdf/checked/agendarptall.pdf
Highlights:
http://archive.ahrq.gov/research/findings/factsheets/literacy/cultural/cultural.html
... Indeed, there is a small but growing body of evidence that the client-clinician ethnic match makes a positive contribution to treatment. Asian (Fujino et al., 1994;Takeuchi, Sue, & Yeh, 1995) and Latino (O' Sullivan & Lasso, 1992;Sue, Fujino, Hu, Takeuchi, & Zane, 1991;Takeuchi et al., 1995) clients who are matched with their clinicians on ethnicity are less likely than unmatched clients to drop-out of treatment after one session and are also likely to have longer treatments (Flaskerud & Hu, 1994;Fujino et al., 1994;O'Sullivan & Lasso, 1992;Sue et al., 1991;Takeuchi et al., 1995;Yeh, Eastman, & Cheung, 1994). Also, clients assessed by ethnically matched clinicians have been reported to receive higher assessment of functioning than non-matched clients (Fujino et al., 1994) and clinicians have reported greater ability to empathize with ethnically matched clients (Arroyo, 1996). ...
... Also, clients assessed by ethnically matched clinicians have been reported to receive higher assessment of functioning than non-matched clients (Fujino et al., 1994) and clinicians have reported greater ability to empathize with ethnically matched clients (Arroyo, 1996). However, the results of most studies have failed to support a significant impact on treatment outcome (Flaskerud & Hu, 1994;Flaskerud & Liu, 1991;Fujino et al., 1994;Sue et al., 1991). The results of at least one study suggest that racial or ethnic non-match may only be significantly associated with drop-out if the clinician is from an ethnic minority (Armbruster & Fallon, 1994). ...
Ethnic matches between mental health providers and clients have been suggested as a strategy for improving the cultural responsiveness of services. Although the research has been limited, the practice has received some empirical support. However, ethnic match may not be a sufficient condition for cultural responsiveness. To examine this possibility, we interviewed Dominican mothers of children with attention-deficit/hyperactivity disorder on: their children’s behaviors, the identification process, diagnosis, causal attributions, management strategies, help-seeking efforts, school relationship and performance, and relationship with school personnel. We interviewed the families’ Latina clinicians on their perspectives on maternal understanding and practices. Maternal and clinicians’ narratives were analyzed qualitatively to develop a portrait of maternal schemas and of clinicians’ schemas of the mothers. The narratives reveal widely differing perspectives and illustrate the collisions that can occur between mothers and clinicians in the treatment process despite an ethnic match.
... The languages have included Spanish (e.g., Armengol 1999, Thompson et al. 2001, Guinn & Vincent 2002, Kopelowicz et al. 2003, Martinez & Eddy 2005), Korean (Shin 2004, Shin & Lukens 2002), and Chinese (Dai et al. 1999). Some studies attempted to see if ethnic match or a related form of match (e.g., cognitive match) between provider and client affected intervention outcomes or processes (Campbell & Alexander 2002, Flaskerud 1986, Flaskerud & Hu 1994, Mathews et al. 2002, Takeuchi et al. 1995, Zane et al. 2005). Rather than examining specific therapist-client matches in language or other aspects, some studies have simply examined institutional resources (e.g., the extent to which agencies had therapists who could conduct treatment in the ethnic language of clients) and then correlated treatment outcomes for ethnic clients (Campbell & Alexander 2002, Flaskerud 1986, Flaskerud & Hu 1994, Gamst et al. 2003, Lau & Zane 2000, Yeh et al. 1994). ...
... Some studies attempted to see if ethnic match or a related form of match (e.g., cognitive match) between provider and client affected intervention outcomes or processes (Campbell & Alexander 2002, Flaskerud 1986, Flaskerud & Hu 1994, Mathews et al. 2002, Takeuchi et al. 1995, Zane et al. 2005). Rather than examining specific therapist-client matches in language or other aspects, some studies have simply examined institutional resources (e.g., the extent to which agencies had therapists who could conduct treatment in the ethnic language of clients) and then correlated treatment outcomes for ethnic clients (Campbell & Alexander 2002, Flaskerud 1986, Flaskerud & Hu 1994, Gamst et al. 2003, Lau & Zane 2000, Yeh et al. 1994). In all of the studies, it is difficult to ascertain the precise factors that account for client outcomes. ...
Cultural competency practices have been widely adopted in the mental health field because of the disparities in the quality of services delivered to ethnic minority groups. In this review, we examine the meaning of cultural competency, positions that have been taken in favor of and against it, and the guidelines for its practice in the mental health field. Empirical research that tests the benefits of cultural competency is discussed.
... The importance of education and information dissemination among minority communities is essential, as is developing the appropriate cultural sensitivity and competency of mental health staff. The concept of cultural competency in mental health service providers has gained traction with evidence of improved access and better engagement in treatment [15,16]. ...
Background
Access to child and adolescent mental health services by ethnic minorities has been poorly studied. Despite rapid growth of the immigrant Korean population, evidence indicates that few Korean families utilise these services in New Zealand. Those that do tend to present late and with significant morbidity. We sought to understand barriers to service access from Korean parents’ perspectives.
Method
Seven focus groups were undertaken with 31 Korean parents of children aged 18 and under. The focus groups were semi-structured, held in the Korean language and utilised two case scenarios of common childhood/adolescent mental illnesses around which a set of broad, open-ended questions were posed. All conversations were audiorecorded, transcribed and translated into English. Thematic analysis was conducted using NVivo software.
Results
Both attitudinal and structural barriers were identified. Attitudinal barriers included attribution of mental illness to external stressors or parenting problems, social stigma, denial or normalization of children’s behaviour, fear of family disempowerment, and mistrust of public mental health services. Structural barriers included parents’ lack of information regarding available services, logistical difficulties in access, communication difficulties, concerns over the quality of translators, and cultural competence of service providers.
Conclusion
Significant barriers prevent Korean immigrant families from accessing child and adolescent mental health services in New Zealand. Measures to improve access, for example by countering stigma, are urgently required.
... The importance of education and information dissemination among minority communities is essential, as is developing the appropriate cultural sensitivity and competency of mental health staff. The concept of cultural competency in mental health service providers has gained traction with evidence of improved access and better engagement in treatment (14,15 Availability of data and materials. Participant information sheets, consent forms, scenario details, and de-identi ed transcripts are available on reasonable request from the corresponding author Competing interests. ...
Background: Access to child and adolescent mental health services by ethnic minorities has been poorly studied. Despite rapid growth of the immigrant Korean population, evidence indicates that few Korean families utilise these services in New Zealand. Those that do tend to present late and with significant morbidity. We sought to understand barriers to service access from Korean parents’ perspectives.
Method: Seven focus groups were undertaken with 31 Korean parents of children aged 18 and under. The focus groups were semi-structured, held in the Korean language and utilised two case scenarios of common childhood/adolescent mental illnesses around which a set of broad, open ended questions were posed. All conversations were audiorecorded, transcribed and translated into English. Thematic analysis was conducted using NVivo software.
Results: Both attitudinal and structural barriers were identified. Attitudinal barriers included attribution of mental illness to external stressors or parenting problems, social stigma, denial or normalization of children’s behaviour, fear of family disempowerment, and mistrust of public mental health services. Structural barriers included parents’ lack of information regarding available services, logistical difficulties in access, communication difficulties, concerns over the quality of translators, and cultural competence of service providers
Conclusion: Significant barriers prevent Korean immigrant families from accessing child and adolescent mental health services in New Zealand. Measures to improve access, for example by countering stigma, are urgently required.
... Early mentions of somatic symptoms and pains may be indicative of a perceived need which contributes to pursuing treatment. Therefore, while it has been suggested that it may be more culturally responsive to treat such patients medically (Flaskerud & Hu, 1994), it may useful to validate and consider the role of physical ailment descriptions (Weisman et al., 2005) as part of a holistic care model for patients already seeking mental health providers. At the same time, improvement of physical symptoms may result in some patients thinking that they are feeling better as mentioned in the clinician notes from this study. ...
As rates of depression continue to increase, problems with mental health service underutilization and premature termination from psychotherapy remain unresolved. This has been most notable for ethnic minority groups in the United States—with Asian Americans showing the greatest mental health service use disparity for over a decade. Asian Americans’ use of mental health services, including psychotherapy, may be influenced by the type of depressive symptom experience. In particular, physical symptoms in Asian Americans' distress, such as pain, may differentiate: (a) the mental health services sought for relief, and (b) retention in psychotherapy. This dissertation is composed of two studies using different analytical approaches to examine the role of physical depressive symptomatology in Asian Americans’ mental health service use behaviors. First, data from 890 National Latino and Asian American Study (NLAAS) participants were quantitatively analyzed to identify symptoms that characterize Asian Americans’ depressive experiences. Then, the relationship between symptom experience and various forms of mental health service utilization was examined. Since the symptom experience may not only influence services sought but also how a person interacts in a psychotherapy setting, the second study analyzed 36 patients’ archival data from an outpatient clinic to explore Asian American psychotherapy dropout. The relevance of physical depressive symptomatology was included in this primarily qualitative examination. The first quantitative study revealed that some experiences fit well within established DSM-defined criteria for depression, while others are better characterized by physical symptoms found in culturally salient idioms of distress. After considering other known predictors of mental health service use, depressive experiences characterized by chronic physical symptoms predicted specific forms of mental health service use (alternative care/self-help and psychological counseling/therapy). The second qualitative mixed-method study gave rise to themes related to psychotherapy dropout and demonstrated that most patients described physical symptoms as part of their depressive distress. However, the clinician-documented physical symptom emphasis did not relate to an early drop from or longer stay in outpatient psychotherapy. Overall, results from this dissertation indicated a presence of heterogeneity in Asian Americans’ depressive experiences, with physical symptoms being an important part of the experience for some Asian Americans. Structural barriers influenced both the utilization of mental health services and retention in psychotherapy, after accounting for the symptom experience. Implications for clinical services and future research are discussed.
... Limited English proficiency and a critical shortage of bilingual social workers are frequently acknowledged as primary service barriers (Engstrom et al. 2009;Liu 2013;Sue et al. 2012). Research indicates that bicultural professionals are preferred by Asian American individuals (Nguyen et al. 2012) and that cultural and linguistic concordance are associated with increased service utilization and improved outcomes (Flaskerud and Hu 1994). However, Asian Americans are vastly underrepresented in the existing workforce (Ro and Ho 2010). ...
This qualitative study used snowball sampling of individuals known to provide informal assistance to Asian American community members with their mental health problems in a locality in the South where there has been an exponential increase of the Asian American population. The major themes found include: (1) the existence of cultural, language, knowledge, and transportation barriers and the importance of policy in addressing them; (2) the impact of the model minority myth and the need for inclusive policymaking; and (3) the unique service and policy needs of immigrants. Findings demonstrate the importance and value of including diverse Asian American individuals in mental health policymaking efforts.
... However this data has provided a good jumping off point for future research in the upcoming year regarding knowledge and opinions of mental health issues among Asian and White American BC students. ENDNOTES i U.S. Census Bureau (2000) ii Report of the Surgeon General (2001) in Lin & Cheung (1999) iv Schoen et al. (1998) v Centers for Disease Control and Prevention (2001) vi Liu (1990) vii Herrick & Brown (1998) viii Herrick & Brown (1998) ix Durvasula & Sue (1996) x Lin & Cheung (1999) xi Rung (2003) xii Report of the Surgeon General (2001) xiii Leong & Lau (2001) xiv Kim et al. (1999) xv Leong & Lau (2001) xvi Sue xvii Leong & Lau (2001) xviii Leong & Lau (2001); Chun et al. (1996) xix Lin & Cheung (1999) xx Masuda et al. (1980) xxi Report of the Surgeon General (2001) xxii Lin & Cheung (1999) xxiii Zheng xxiv Lin & Cheung (1999) xxv Flaherty et al. (1988) xxvi Lopez (1989) xxvii Root (1998) xxviii Report of the Surgeon General (2001) xxix Ying & Miller (1992) xxx Atkinson & Gim (1989) xxxi Takeuchi et al. (1995); Flaskerud & Hu (1994) ;Yeh, Takeuchi, & Sue (1994) xxxii Yeung & Kung (2004) xxxiii Lin & Smith (2000) xxxiv Root (1998Root ( ) xxxv jorm (2000 xxxvi Narikiyo & Kameoka (1992); Suan & Tyler (1990); Sue (1994) xxxvii Kessler et al. (1994) ...
Disparities in mental health care for racial minorities remains a serious and very real problem calling for immediate attention. The 2001 report of the Surgeon General affirmed that ethnic and racial minorities have less access to and availability of mental health services, and are subsequently less likely to receive needed mental health services. This paper examines a range of issues regarding Asian American mental health. It presents the practical and cultural barriers that members of this ethnic group confront when seeking mental health care and explains how cultural differences sometimes result in misdiagnosis and ineffective treatment. It also explores ways that the American mental health care system can improve to accommodate diverse ethnic groups.
... Naturalistic studies of mental health outcomes show that Asian Americans have lower treatment satisfaction, worse outcomes, and higher dropout rates compared with white Americans (21,25). Mood disorders continue to be the most prevalent psychiatric problem among Chinese Americans and the main reason for seeking treatment (26)(27)(28). ...
No randomized controlled trials (RCTs) for adults have compared the effectiveness of a well-specified psychotherapy and a culturally adapted version of the same treatment. This study evaluated the effectiveness of cognitive-behavioral therapy (CBT) and culturally adapted CBT (CA-CBT) in treating depressed Chinese-American adults.
This RCT treated 50 Chinese Americans who met criteria for major depression and sought treatment at community mental health clinics. Screening of participants began in September 2008, and the last assessment was conducted in March 2011. Participants were stratified by whether they were already taking antidepressants when they first came to the clinic and randomly assigned to 12 sessions of CBT or CA-CBT. The study did not influence regular prescription practices. The primary outcomes were dropout rates and Hamilton Depression Rating Scale scores at baseline, session 4, session 8, and session 12.
Participants in CA-CBT demonstrated a greater overall decrease in depressive symptoms compared with participants in CBT, but the groups had similarly high depression rates at week 12. Differences in dropout rates for the two groups approached, but did not meet, statistical significance (7%, CA-CBT; 26%, CBT).
Chinese Americans entered this study with very severe depression. Participants in both CBT and CA-CBT demonstrated significant decreases in depressive symptoms, but the majority did not reach remission. Results suggest that these short-term treatments were not sufficient to address such severe depression and that more intensive and longer treatments may be needed. Results also indicate that cultural adaptations may confer additional treatment benefits.
... In contrast to research that shows decreased likelihood of dropout and increased length of therapy for ethnically-matched client-therapist dyads (Flaskerud & Hu, 1994;Fujino et al., 1994;Lau & Zane, 2000;Sue et al., 1991;Takeuchi, Sue, & Yeh, 1995), White therapists had more sessions with all clients, in general, than Asian therapists. However, researchers in these studies also hypothesized that ethnic match is particularly important for clients who are limited in their English, which was not the case for participants' clients in this study (all dyads were Englishspeaking). ...
... These results seem to corroborate those of other studies that concluded that cultural elements (e.g., racial match) might aid in treatment engagement and/or retention but play only minor roles in treatment outcomes (Beutler, Machado, & Neufeldt, 1994;Cabral & Smith, 2011). It should be noted, however, that number of treatment sessions has been associated with treatment outcomes (Anderson & Lambert, 2001;Flaskerud & Hu, 1994;Howard, Kopta, Krause, & Orlinsky, 1986;Ritsher, Moos, & Finney, 2002), and, in some cases, racial match has itself been associated with treatment outcomes (Cabral & Smith, 2011;Gamst, Dana, Der-Karabetian, & Kramer, 2000;Sue et al., 1991). ...
Clinicians and researchers have pointed to the need for culturally sensitive mental health interventions. Yet it has not been determined if the inclusion of cultural elements affects the way mental health clients experience services. This study examined 102 clients who had received mental health treatment from outpatient mental health clinics to investigate whether culturally related elements involving race and ethnicity were important to clients and whether they were related to client satisfaction and perceived treatment outcomes. Ethnic minority clients generally felt that issues regarding race and ethnicity were more important than did White clients. When these elements were considered important but were not included in their care, clients were less satisfied with treatment. Consistent with the notion of cultural responsiveness, these findings provide empirical evidence that culturally relevant aspects of the mental health service experience are salient to ethnic minority clients and can affect how they respond to services.
... Much research has addressed the important relationship between the provision of culturally competent mental health service delivery and the goal of reducing racial and ethnic disparities in mental health care (Betancourt et al., 2005; Office of the Surgeon General, 2001; Smedley, Stith, & Nelson, 2003;Sue, 2001;Sue, Zane, Nagayama-Hall, & Berger, 2009); still, there is relatively little outcome research in this area (Sue et al., 2009;Zane, Hall, Sue, Young, & Nunez, 2003; for some exceptions see Flaskerud & Hu, 1994;Lau & Zane, 2000;Takeuchi, Sue, & Yeh, 1995;Yeh, Takeuchi, & Sue, 1994;Ying & Hu, 1994). Disparities reflect differences in mental health service delivery that are not attributable to ethnic and racial differences in access, clinical appropriateness, or patient preferences (Smedley et al., 2003). ...
Using Asian Americans as a case example, a community ecology approach is proposed to address a gap in our understanding of cultural competence as a systems/societal level construct. A community ecology approach to cultural competence rests on three assumptions: (1) individual psychological distress is construed as embedded in, and intimately tied to, collective experience; (2) social justice is understood as integral to psychological wellness; and (3) formal mental health services are viewed as a primary, but not exclusive, source of care that can help address the mental health needs of a community. To examine these ideas, the paper is divided into two sections: (1) an examination of a community ecology approach to conceptualizing distress, wellness, and mental health service delivery, and (2) an exploration of the implications of a community ecology approach for providing culturally competent mental health interventions for individuals and for communities. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
... ethnic specific services (i.e., community agencies that specialize in treating specific ethnic minority groups) are more successful at treating ethnic minorities than mainstream clinics (Flaskerud & Hu, 1994;Lau & Zane, 2000;Takeuchi, Sue, & Yeh, 1995;Zane, Hatanaka, Park, & Akutsu, 1994). An important agenda then is to identify why that is, to determine whether individual behaviors and organizational priorities can explain or enhance multicultural counseling competencies, and to identify which practices are most related to culturally competent care so that the use of these mechanisms can be encouraged at other public mental health clinics. ...
This study examined the relationship between therapist characteristics, therapeutic orientations, person-level and agency-level practices with cultural competency among 221 Los Angeles County community mental health clinicians. Results from an online survey indicated that compared to White therapists, ethnic minority therapists were more personally involved in communities of color, more likely to use a cultural framework in clinical practice, and perceived their agencies to be more culturally sensitive. Ethnic minority therapists also reported greater multicultural (MC) awareness and better MC counseling relationships with their clients than White therapists. Personal involvement in communities of color accounted for ethnic differences in MC awareness and MC counseling relationships. Compared to therapists with a strictly nonbehavioral (psychodynamic or humanistic) orientation, therapists with an eclectic (or integrative) therapy orientation reported having a higher level of community knowledge. Therapists with an eclectic orientation reported greater MC awareness than therapists with a nonbehavioral orientation, while both eclectic and behavioral (cognitive–behavioral or behavior modification) therapists recounted better MC counseling relationships with their clients than therapists with a nonbehavioral orientation. Community knowledge mediated eclectic versus nonbehavioral therapeutic orientation differences in MC awareness. Agency resources/linkages and outreach both moderated the relationship between therapeutic orientation and MC skills. Results suggest that if therapists become more personally involved with diverse populations, they will feel more culturally aware and feel like they have a better relationship with ethnic minority clients. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
... Rodriguez, Allen, Frongillo, & Chandra, 1999), Hispanic Americans (e.g.,Alderete, Vega, Kolody, & Aguilar-Gaxiola, 1999;Potter, Rogler, & Moscicki, 1995), AsianAmericans (e.g.,Flaskerud & Hu, 1994;Hinton et al., 1998), and Native Americans (e.g.,Parker et al., 1997;Somervell et al., 1993). This association between race/ethnicity and depression may be a result of the low socioeconomic status and history of social marginalization experienced by racial and ethnic minorities. ...
The purpose of this study was to explore the stress-eating relation established in the literature by examining a naturally occurring stressor, adolescent dating violence, and its effect on eating in adolescent girls. Specifically, analyses focused on assessing the mediating role of depression in the adolescent dating violence-fruit and vegetable intake relation and the moderating role of sports team involvement in the adolescent dating violence-depression relation. A nationally representative sample of 5,892 black, Hispanic, and white adolescent girls were surveyed using measures assessing physical and sexual dating violence experiences, depressed affect, suicidal thoughts, plans, and/or attempts, fruit and vegetable intake and involvement in team sports. This study supported the hypothesis that depression mediates the relation between adolescent dating violence and dietary intake, but only in black adolescent girls. These findings suggest that black girls victimized by dating violence experience depression, which may affect
... Studies with African Americans indicate that while match was not related to direct outcomes (Jones, 1978(Jones, , 1982Lerner, 1972), match was related to greater number of therapy sessions (Rosenheck, Fontana, & Cottrol, 1995;Sue et al., 1991). For both Asian Americans (Flaskerud & Hu, 1994;Fujino et al., 1994;Gamst, Dana, Der-Karabetian, & Kramer, 2001;Lau & Zane, 2000;Sue et al., 1991;Takeuchi, Sue, & Yeh, 1995) and Latinos (Flaskerud, 1986;Gamst, Dana, Der-Karabetian, & Kramer, 2000;Sue et al., 1991;Takeuchi et al., 1995), match is associated with less likelihood of dropout and increased length of therapy. Moreover, it appears that ethnic and language match may be especially important for treatment outcomes with limited-English-speaking clients (Sue et al., 1991). ...
This article reviewed the empirical support for customizing the therapeutic relationship for women, ethnic minorities, gay, lesbian, and bisexual persons, and individuals from lower social classes. Specifically, we examined whether evidence existed that these populations fared less well in treatment than mainstream populations, whether matching of therapists with client demographics (i.e., gender, ethnicity, sexual orientation, and socio class) improved outcomes, and whether population-specific strategies improved treatment outcomes with members of these groups. We found that, in general, there was a paucity of research on treatment outcomes with these populations. Moreover, the available research had methodological limitations. Most studies were effectiveness rather than efficacy studies. Finally, most suggestions for improving treatment outcomes with these groups were not based on empirical research. Based on our review, we offer suggestions for therapeutic practices. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Five ESS providers for Asian American clients were identified a priori. As in previous studies, these ethnic-specific centers were those identified by the county as serving the Asian Pacific communities and had been established specifically to meet their unique mental health needs (Flaskerud & Hu, 1994; Yeh et al., 1994 ). These agencies are located within high-density Asian American communities and employ bicultural, bilingual staff providing treatment programs tailored to the Asians in their catchment area. ...
Ethnic-specific mental health services have developed to meet the unique cultural and linguistic needs of the ethnic client. It has been assumed that this type of service configuration provides more accessible, culturally-responsive mental health care, which in turn, encourages utilization and enhances outcomes. Previous studies have found that ethnic-specific services (ESS) increase utilization of mental health services, but there has only been inconsistent evidence that ESS results in better outcomes. This study compared patterns of the cost-utilization and outcomes of Asian American outpatients using ESS to those Asians using mainstream services. Consistent with earlier studies, cost-utilization for ESS Asian clients was higher than that for mainstream Asian clients. Better treatment outcome was found for ESS clients compared to their mainstream counterparts, even after controlling for certain demographics, pretreatment severity, diagnosis, and type of reimbursement. Moreover, there was a significant relationship between cost-utilization and outcome for ESS clients, whereas for mainstream clients, this relationship was not significant. The findings strongly suggest that mental health services with an ethnic-specific focus provide more effective and efficient care for at least one ethnic minority group. Implications for the delivery of culturally-competent mental health services are discussed. © 2000 John Wiley & Sons, Inc.
... Department of Health andHuman Services, 1999, 2001). Although Asian Americans report limited use of traditional programs, they are more likely to turn to ethnic-specific programs (e.g., Hatanaka, Watanabe, & Ono, 1975;Wong, 1977) where they report fewer dropouts and better outcomes and stay in treatment longer (Flaskerud & Hu, 1994;Lau & Zane, 2000;Takeuchi, Sue, & Yeh, 1995;Yeh, Takeuchi, & Sue, 1994;Zane, Hatanaka, Park, & Akutsu, 1994). Based on these findings, there is some evidence that Asian Americans may prefer to seek ethnic-specific programs as culturally responsive alternatives to traditional or mainstream programs. ...
This study examined the referral patterns of Chinese, Japanese, Filipino, and Korean Americans at ethnic-specific versus mainstream programs in a public mental health system. As predicted, social/community-based services and family/friends to a lesser degree referred each Asian American group to ethnic-specific programs more than other referral sources (e.g., criminal justice and health services). Referrals by social/community-based programs to ethnic-specific versus mainstream programs were the most significant for Chinese Americans, followed by Japanese and Filipino Americans, and the least significant for Korean Americans. These findings suggest Asian American clients themselves and their social networks may view ethnic-specific programs as more culturally responsive than mainstream programs.
... Evidence from several research studies supports this idea. For example, studies on service utilization (Arroyo, Westerberg, & Tonigan, 1998;Cheung & Snowden, 1990;Flaskerud & Liu, 1991;McMiller & Weisz, 1996;Schacht, Tafoya, & Mirabla, 1989), treatment preferences (Aldous, 1994;Constantino, Malgady, & Rogler, 1994;Flaskerud & Hu, 1994;Flaskerud & Liu, 1991;Penn, Kar, Kramer, Skinner, & Zambrana, 1995;Schacht, Tafoya, & Mirabla, 1989), and health beliefs (McMiller & Weisz, 1996;Penn et al., 1995) have reported that members of ethnic minority communities tend to respond differently to treatment than do nonminorities. These differences are most likely due to cultural differences. ...
Over the last few decades, psychologists and other health professionals have called attention to the importance of considering cultural and ethnicminority aspects in any psychosocial interventions. Although, at present, there are published guidelines on the practice of culturally competent psychology, there is still a lack of practical information about how to carry out appropriate interventions with specific populations of different cultural and ethnic backgrounds. In this article, the authors review relevant literature concerning the consideration of cultural issues in psychosocial interventions. They present arguments in favor of culturally centering interventions. In addition, they discuss a culturally sensitive framework that has shown to be effective for working with Latinos and Latinas. This framework may also be applicable to other cultural and ethnic groups. @ 2006 Wiley Periodicals, Inc.
... Each of these approaches has potential benefits and drawbacks (seeTable 1). Moreover, the implications of matching at each of these levels may differ markedly for different ethnocultural groups, communities and individuals (Flaskerud, 1986; Flaskerud & Hu, 1994; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). For example, for a patient Patients may feel exposed to scrutiny by their own community and may wish for the psychological distance or privacy associated with meeting a cultural 'outsider' ...
The article discusses the strengths and limitations of approaches to cultural competence in mental health services. Cultural competence has emerged as an important counter-balance to the movement for evidence-based mental health care, which tends to lead to a ‘‘one-size-fits-all’’ approach. Efforts within heath care systems to develop cultural competence or other modes of responding to diversity represent potential sites of resistance to the forces of assimilation and marginalization of minority groups. However, current approaches to cultural competence have been criticized for essentializing, commodifying and appropriating culture, leading to stereotyping and further disempowerment of patient. Alternative approaches to addressing cultural diversity have been proposed, including the constructs of cultural safety and cultural humility. Each of these approaches draws attention to certain structural or contextual dimensions of intercultural work while downplaying or obscuring others. A cross-national comparative perspective can shed light on the origins and impact of specific methods of addressing culture in mental health care.
... Sue, 2003;U.S. Surgeon General, 2001). Racial and ethnic minorities frequently enter psychological treatment after symptoms have become severe, often receive inferior quality care compared to services received by nonminorities, and more often prematurely terminate participation in treatment (Flaskerud & Hu, 1994;Melfi, Croghan, Hanna, & Robinson, 2000;Zane, Enomoto, & Chun, 1994). In response, researchers have defined and identified a wide array of multicultural principles theorized to increase the cultural compatibility of psychotherapy for underserved ethnic and racial minority clients (e.g., D. W. Sue et al., 1992). ...
Psychotherapy is a culturally encapsulated healing practice that is created from and dedicated to specific cultural contexts (Frank & Frank, 1993; Wampold, 2007; Wrenn, 1962). Consequently, conventional psychotherapy is a practice most suitable for dominant cultural groups within North America and Western Europe but may be culturally incongruent with the values and worldviews of ethnic and racial minority groups (e.g., D. W. Sue, Arredondo, & McDavis, 1992). Culturally adapted psychotherapy has been reported in a previous meta-analysis as more effective for ethnic and racial minorities than a set of heterogeneous control conditions (Griner & Smith, 2006), but the relative efficacy of culturally adapted psychotherapy versus unadapted, bona fide psychotherapy remains unestablished. Furthermore, one particular form of adaptation involving the explanation of illness-known in an anthropological context as the illness myth of universal healing practices (Frank & Frank, 1993)-may be responsible for the differences in outcomes between adapted and unadapted treatments for ethnic and racial minority clients. The present multilevel-model, direct-comparison meta-analysis of published and unpublished studies confirms that culturally adapted psychotherapy is more effective than unadapted, bona fide psychotherapy by d = 0.32 for primary measures of psychological functioning. Adaptation of the illness myth was the sole moderator of superior outcomes via culturally adapted psychotherapy (d = 0.21). Implications of myth adaptation in culturally adapted psychotherapy for future research, training, and practice are discussed.
... Also, there is a wealth of literature suggesting that treatment models consider the role of culture, ethnicity, and minority issues (Bernal, Bonilla, & Bellido, 1995; Lopez et al., 1989; McGoldrick, Pearce, & Giordano, 1982; Sue & Zane, 1987; Tharp, 1991). There is also evidence from studies on service utilization (Arroyo, Westerberg, & Tonigan, 1998; Cheung & Snowden, 1990; Flaskerud & Liu, 1991; McMiller & Weisz, 1996; Schacht, Tafoya, & Mirabla, 1989), treatment preferences (Aldous, 1994; Constantino, Malgady, & Rogler, 1994; Flaskerud & Hu, 1994; Flaskerud & Liu, 1991; Penn, Kar, Kramer, Skinner, & Zambrana, 1995; Schacht et al., 1989), and health beliefs (McMiller & Weisz, 1996; Penn et al., 1995 ) to suggest that ethnic minorities may respond differently to psychotherapy. Ethnic and cultural concepts may also conflict with mainstream values inherent to traditional psychotherapies. ...
The psychological community has given considerable attention to the problem of establishing empirically supported treatments (ESTs). The authors argue that a scientific practice that discriminates against some approaches to knowledge undermines the EST's relevance for communities of color. They examine the EST project's contribution to knowledge of effective treatments for ethnic minorities by considering both how knowledge is constructed and the limits of research (e.g., external validity). Alternatives on how to best contribute to treatment research of clinical utility with diverse populations are articulated. An approach for treatment research, derived from an integration of the hypothesis-testing and discovery-oriented research approaches, is presented, and recommendations to advance treatment research with ethnic minority communities are offered.
... Psychoeducational interventions, such as videotapes that address concerns relevant to members of ethnic minority groups and use speakers from those same groups, may be particularly helpful in facilitating change in negative attitudes toward treatment [51]. Socioculturally tailored counseling interventions that address concerns and experiences that are of particular importance to a specific ethnic minority may be potentially more efficacious and effective than bstandard interventionsQ [52][53][54][55][56][57][58]. ...
The objective of this work was to describe ethnic differences in attitudes toward depression, depression treatment, stigma and preferences for depression treatment (counseling vs. medication).
This study used a cross-sectional Internet survey measuring treatment preference, stigma and attitudes toward depression. Depressive symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale. Multivariable regression models adjusting for treatment attitudes and demographics estimated the independent effect of ethnicity on treatment preference.
A total of 78,753 persons with significant depressive symptoms (CES-D>22), including 3596 African Americans, 2794 Asians/Pacific Islanders and 3203 Hispanics, participated. Compared to whites, African Americans, Asians/Pacific Islanders and Hispanics were more likely to prefer counseling to medications [odds ratio (OR)=2.6, 95% confidence interval (95% CI)=2.4-2.8; OR=2.5, 95% CI=2.2-2.7; and OR=1.8, 95% CI=1.7-2.0, respectively]. Ethnic minorities were less likely to believe that medications were effective and that depression was biologically based, but were more likely to believe that antidepressants were addictive and that counseling and prayer were effective in treating depression. Attitudes and beliefs somewhat attenuated the association between ethnicity and treatment preference in adjusted analyses.
Racial and ethnic minorities prefer counseling for depression treatment more than whites. Beliefs about the effects of antidepressants, prayer and counseling partially mediate preferences for depression treatment.
... More direct comparisons have been Van Voorhees et al. / Health Disparities in Depressive Disorders 183S made between standard and tailored psychotherapy interventions in which cultural tailoring has shown promise as a modality. Several studies of culturally or religiously tailored interventions outside the United States or before 1995 in the United States have suggested potential benefit from these approaches relative to "standardized treatments" (Chan, Ying, and Muñoz 1986;Flaskerud and Hu 1994;Organista, Muñoz, and Gonzalez 1994;Razali et al. 1998). However, none of the studies included in this review compared culturally tailored interventions with standard approaches in a randomized controlled trial. ...
There are significant disparities in treatment process and symptomatic and functional outcomes in depressive disorders for racial and ethnic minority patients. Using a life-course perspective, the authors conducted a systematic review of the literature to identify modifiable mechanisms and effective interventions for prevention and treatment at specific points -- system, community, provider, and individual patient -- in health care settings. Multicomponent chronic disease management interventions have produced improvements in depression outcomes for ethnic minority populations. Case management appears to be a key component of effective interventions. Socioculturally tailored treatment and prevention interventions may be more efficacious than standard treatment programs. Future research should focus on identifying key components of case management and sociocultural tailoring that are essential for effective interventions and developing new low-cost dissemination mechanisms for treatment and preventive programs that could be tailored to racial and ethnic minorities.
Cambridge Core - Sociology of Science and Medicine - A Handbook for the Study of Mental Health - edited by Teresa L. Scheid
A Handbook for the Study of Mental Health - edited by Teresa L. Scheid June 2017
Much of the literature on culturally appropriate services is focused on barriers to service provision; less is known about how organizations can reduce these barriers. Through qualitative interviews, this study examined how informal helpers within the Asian American community are helping individuals with unmet mental health needs and how mainstream mental health organizations might learn from their experiences. Themes identified include (a) informal assistance, (b) working with the community, (c) gaining trust, and (d) cultural and language appropriateness. By implementing some of the strategies suggested in this paper, mainstream organizations can better serve the mental health needs of Asian Americans.
This study examined (1) the ethnicity and language similarity between professional staff and service users, and (2) client satisfaction in ethnic-specific services (ESS) agencies serving Asian Americans and Pacific Islanders (AAPI). A combined method of agency survey and focus groups was used to collect the data. Findings indicate that ESS served a diverse AAPI population, although some ethnic and language sub-groups remain to be under served. Service users clearly prefer ESS, which is associated with a higher level of trust than mainstream services. However, staff simply sharing similar language or ethnic background does not automatically warrant trust. Trust is developed through a sense of respect that staff demonstrates within a cultural context. The feeling of trust is likely to determine AAPI clients' commitment to remain in treatment, a prior condition for achieving any desirable outcome.
Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes.
To compare the 12-month prevalence of psychiatric disorders in Asian Americans/Pacific Islanders in contrast to non-Hispanic whites; and further compare persistence and treatment-seeking rates for psychiatric disorders among Asian American/Pacific Islanders and non-Hispanic whites, analyses from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, Wave 1 (n=43,093) were conducted for the subsample of 1332 Asian Americans/Pacific Islanders (596 men and 736 women) and 24,507 non-Hispanic whites (10,845 men and 13,662 women). The past 12-month prevalence for any psychiatric disorder was significantly lower in Asian American/Pacific Islander males and females than non-Hispanic white males and females. Asian American/Pacific Islander males were less likely than non-Hispanic white males to have any mood, anxiety, substance use, and personality disorders, whereas the prevalence of mood disorders among Asian American/Pacific Islander females did not differ from those of non-Hispanic white females. In some cases, such as drug use disorders, both male and female Asian Americans/Pacific Islanders were more likely to have more persistent disorders than non-Hispanic whites. Compared to non-Hispanic white females, Asian American/Pacific Islander females had lower rates of treatment-seeking for any mood/anxiety disorders. Although less prevalent than among non-Hispanic whites, psychiatric disorders are not uncommon among Asian Americans/Pacific Islanders. The lower treatment-seeking rates for mood/anxiety disorders in Asian American/Pacific Islander females underscore the unmet needs for psychiatric service among this population.
The importance of providing timely, effective mental health services is increasingly recognized worldwide, and language barriers are a formidable obstacle to achieving this objective. Threshold language policy is one response implemented by California and other states within the U.S., in accordance with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, and national origin in programs receiving federal funding. This policy mandates language assistance services for Medicaid enrollees whose primary language is other than English once their population size reaches a designated level. Medicaid is the federal-state-funded health insurance program for specific classifications of low-income Americans.
The purpose of this study was to explore the stress-eating relation established in the literature by examining a naturally occurring stressor, adolescent dating violence, and its effect on eating in adolescent girls. Specifically, analyses focused on assessing the mediating role of depression in the adolescent dating violence-fruit and vegetable intake relation and the moderating role of sports team involvement in the adolescent dating violence-depression relation. A nationally representative sample of 5,892 black, Hispanic, and white adolescent girls were surveyed using measures assessing physical and sexual dating violence experiences, depressed affect, suicidal thoughts, plans, and/or attempts, fruit and vegetable intake and involvement in team sports. This study supported the hypothesis that depression mediates the relation between adolescent dating violence and dietary intake, but only in black adolescent girls. These findings suggest that black girls victimized by dating violence experience depression, which may affect their desire or motivation to eat properly. This study also supported the hypothesis that sports team involvement, a source of social support and physical activity, moderated the relation between adolescent dating violence and depression and suicidality, but only for white adolescent girls. For this group, participating on a sports team served to protect those girls reporting dating violence from experiencing depression at the high rate reported by those dating violence victims not involved on a sports team. The findings presented in this study provide evidence that depression explains how experiences of dating violence affect eating behavior for a high-risk group, black adolescent girls. Recognizing depression's contribution to this group's high rate of obesity and overweight is an important step in preventing obesity and obesity-related outcomes in this population. Also, this study highlights an important source of social support, sports team involvement, and its potential to protect dating violence victims from experiencing depression and suicidal ideation, plans, and attempts. Text (Thesis). System requirements: PC, World Wide Web browser and PDF reader. Mode of access: World Wide Web. Title from title screen. Sarah L. Cook, committee chair; Jana Kicklighter, Julia Perilla, John L. Peterson, committee members. Electronic text (109 p. : ill.) : digital, PDF file. Thesis (Ph. D.)--Georgia State University, 2005. Includes bibliographical references (p. 90-109). Description based on contents viewed June 4, 2007.
The Chinese American population is among the fastest growing ethnic minority groups in the United States. Knowledge of the interaction between culture, disease expression, and utilization of psychiatric treatment by this population is limited. This article gives a general review of the literature on depression among Chinese Americans in order to clarify misconceptions, to increase knowledge of research on depression that has been done on one specific Asian-American group, and to set a direction for future nursing research and intervention.
The United States is becoming more ethnically diverse, and Asian and Pacific Islanders (APIs) are one of the most rapidly growing ethnic minority groups. Of interest to social workers is how the traditional values and practices of these cultures affect their perceptions of disease and use of health services. This article presents information on perceptions of dementia, caregiving, and help seeking for the API group as a whole, with additional information on five of the major API subgroups--Chinese, Japanese, Filipino, Vietnamese, and Hawaiian. Implications for practice, policy, and research are discussed.
This research sought to determine which therapist barriers prevent client-centred practice the most, and which methods are perceived as being most effective in resolving therapist barriers. A list of barriers that therapists bring to client-centred practice and methods to resolve these was identified from the literature and formed the basis of a questionnaire sent to 60 occupational therapists in the United Kingdom. The results showed that the therapist and client having different goals was the barrier which most prevented client-centred practice. The high ratings of other statements suggested that the values, beliefs and attitudes of therapists and of the employment culture make client-centred practice uncomfortable to use and hence prevent its implementation. Case examples showing how to practice in a client-centred fashion were rated as the most effective method of barrier removal.
The purpose of this paper is to review the research on the relationships among ethnicity, culture, neuropsychiatric diagnosis, and treatment. Psychiatric nurses provide care to an ethnically and culturally diverse group of clients. Knowledge of ethnic and cultural differences are essential to diagnosis and treatment. Ethnic diversity affects psychiatric diagnosis. Cross-ethnic differences in genetics, diet, environmental exposure, and fetal, childhood, and adolescent development may result in varied experiences of psychiatric illness among ethnic groups. Ethnic diversity also affects psychiatric treatment. There are dramatic ethnic differences in the metabolism of psychotropic medications and the effects of drugs on target organs. These differences are again due to genetic variation, exposure to different diets and environments, and other medications in use. Cultural diversity influences both diagnosis and treatment. Cultural forces shape symptom formation and the expression of distress, creating many sources for misdiagnosis based on DSM-IV criteria. The culture-bound syndromes represent unique illness forms with a natural history distinct from DSM classification. Culture also influences treatment expectations, therapeutic compliance, family involvement, and the interpretation of side effects, all of which help determine whether or not treatment will be effective. Neuropsychiatric nurses can contribute to research by studying cross-ethnic differences and similarities in biological markers of mental illness. A second significant area for research is that of ethnicity and psychotropic drug metabolism and pharmacodynamics.
Despite the National Institutes of Health (NIH) mandate to include women and diverse ethnic groups in all NIH-funded research projects, these groups are still excluded as participants in health intervention research. This exclusion has denied them access to state-of-the-art treatments and prevention strategies. making them vulnerable to increased morbidity and mortality and decreased longevity. This article compares two conceptual approaches to inclusion: cultural responsiveness and resource provision. Several issues are raised as to why women and ethnic people of color are not involved in health intervention research. For each of these issues, an appraisal is made as to whether cultural responsiveness or resource provision would more successfully address the problem. It is concluded that cultural responsiveness facilitates participation in research but is not sufficient. An equally important, if not more important, approach may be the provision of resources to empower participants to address problems of access and burden.
Using the research framework recommended by L. Rogler, R. Malgady, and D. Rodriguez (1989), the current paper examines the barriers to providing effective mental health services to Asian Americans. Beginning with the recognition that Asian Americans consists of numerous heterogeneous subgroups, the issue of the stereotype of Asian Americans as the "model minority" was also discussed. The primary focus of the paper is on Stages 2, 3, and 4 within the Rogler et al. (1989) model and the identification and discussion of cultural factors that hinder the delivery of mental health services to Asian Americans. The paper is therefore organized into these three sections: (a) help-seeking or mental health service utilization, (b) evaluation of mental health problems, and (c) psychotherapeutic services. In each of the sections, not only are the barriers to delivery of effective mental health services discussed but so are the research and methodological problems as well as some directions for future research. This critical review of the literature has been prepared with the goal of serving as a "blueprint" for us to pursue rigorous but relevant research to identify and reduce these cultural barriers to providing effective mental health services to Asian Americans.
This article examines the role of cultural knowledge and culture-specific techniques in the psychotherapeutic treatment of ethnic minority-group clients. Recommendations that admonish therapists to be culturally sensitive and to know the culture of the client have not been very helpful. Such recommendations often fail to specify treatment procedures and to consider within-group heterogeneity among ethnic clients. Similarly, specific techniques based on the presumed cultural values of a client are often applied regardless of their appropriateness to a particular ethnic client. It is suggested that cultural knowledge and culture-consistent strategies be linked to two basic processes—credibility and giving. Analysis of these processes can provide a meaningful method of viewing the role of culture in psychotherapy and also provides suggestions for improving psychotherapy practices, training, and research for ethnic-minority populations.
In view of the growing interest in the influence of cultural factors in psychological assessment, this article critically evaluates assessment issues with Asian American populations. Examined are issues in (a) the extent and symptoms of psychopathology, (b) personality assessment, and (c) face-to-face clinical assessment. It is argued that, without understanding cultural factors, researchers and practitioners may draw inappropriate and invalid conclusions. Cultural factors are important not only in providing a context for interpreting assessment outcomes but also in suggesting appropriate conceptual and methodological strategies. Suggestions are made for improving assessment strategies and for testing the limitations and generality of constructs.
Reviews the existing literature on counseling and psychotherapy with Asian-Americans and discusses research needs and recommendations for future research. Diagnosis and assessment issues include symptom expression, therapist bias, problems with the use of interpreters, and problems with the use of clinical and personality tests. Client variables in counseling and psychotherapy involve the personality of Asian-Americans, language problems, the acculturation process, and counseling expectations. Therapist variables involve therapist bias, training bias, lack of intercultural skills, and culture-specific knowledge. In a discussion of process and outcome, the author reviews empirical studies, clinical case studies, and articles with treatment strategies and recommendations. Research recommendations for each of the areas reviewed are identified. (3 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study investigated services received, length of treatment, and outcomes of thousands of Asian-American, African-American, Mexican-American, and White clients using outpatient services in the Los Angeles County mental health system. It tested the hypothesis that therapist–client matches in ethnicity and language are beneficial to clients. Results indicate that Asian Americans and Mexican Americans underutilized, whereas African Americans overutilized, services. African Americans also exhibited less positive treatment outcomes. Furthermore, ethnic match was related to length of treatment for all groups. It was associated with treatment outcomes for Mexican Americans. Among clients who did not speak English as a primary language, ethnic and language match was a predictor of length and outcome of treatment. Thus, the cultural responsiveness hypothesis was partially supported.
The applicability of psychodynamic psychotherapy to Chinese-American patients is examined. The interdependent nature of the world of the Chinese "self" is introduced, together with culturally characteristic coping styles. The modifications entailed in conducting insight-oriented therapy with this population are discussed, with particular reference to the content of the therapy and the therapeutic relationship. Clinical vignettes from China and from the Chinese-American community are used as illustration.
We measured the prevalence of depressive symptoms in 2,190 Japanese tax office workers using the Japanese version of the Center for Epidemiologic Studies Depression Scale (CES-D). Score distribution by sex was more symmetrical and the mean score of each sex was higher than in the United States population. A high level of depressive symptoms was found in 15.2 percent of males and 10.6 percent of females by controlling for age and marital status. Males aged 50 years and over had more depressive symptoms than other male age groups. Perceived stress, related both to family life and the workplace, was associated with a high level of depressive symptoms. "Long-distance marriage" ("business bachelorhood"), peculiar to Japanese occupations, had little influence on depressive symptomatology.
A framework is presented that was generated by clinical experiences with Asian clients in predominantly Caucasian therapy groups. Focus is on the impact of differing perceptions of power, authority, interpersonal boundaries, and family process on group dynamics. The applicability of this framework to other ethnic minorities is evaluated.
This paper examines the level of depressive symptomatology in a communitybased Chinese-American sample as measured by the Center for Epidemiological Studies-Depression Scale (CES-D) and assesses its psychometric properties within this group. The CES-D was administered to 360 Chinese-Americans on the telephone. Its internal reliability was found to be good. A factor analysis revealed an inseparability of affective and somatic structures in this sample. This reflects the nature of experience and manifestation of depression in Chinese culture. Level of depressive symptomatology was found to be higher than previously reported in both White and Asian samples. Those who belonged to a lower socioeconomic level (as measured by education and occupation) scored as significantly more depressed than those who are better off.
Because of the dramatic increase in the ethnic diversity of Americans and the shrinking world in which international contacts are commonplace, our society is confronted by problems and issues associated with race/ethnic relations. In the fields of community psychology and community mental health, ethnic diversity has posed challenges and opportunities, as well as problems. How can we better understand the cultural, experiential, and psychological sense of different ethnic communities? What means can be found to facilitate ethnic and racial harmony? What kinds of prevention and intervention strategies can be used to promote the well-being, growth, and development of individuals from diverse ethnic groups?
The Global Assessment Scale (GAS) is a rating scale for evaluating the overall functioning of a subject during a specified time period on a continuum from psychological or psychiatric sickness to health. In five studies encompassing the range of population to which measures of overall severity of illness are likely to be applied, the GAS was found to have good reliability. GAS ratings were found to have a greater sensitivity to change over time than did other ratings of overall severity or specific symptom dimensions. Former inpatients in the community with a GAS rating below 40 had a higher probability of readmission to the hospital than did patients with higher GAS scores. The relative simplicity, reliability, and validity of the GAS suggests that it would be useful in a wide variety of clinical and research settings.
The purpose of this study was to determine the relationship of ethnic identity to psychiatric diagnosis in white, black, Latino, and Asian clients of the Los Angeles County mental health system. The sample (N = 26,400) consisted of adult inpatient and outpatient clients seen in county mental health facilities between January 1983 and August 1988. Logistic regression analysis was used to determine the relationship of ethnicity to diagnosis in both outpatient and inpatient samples. The covariates included in the analysis were age, gender, socioeconomic status, and primary language. Ethnicity had a significant and consistent relationship to diagnosis in both outpatient and inpatient samples, with black and Asian clients having a greater proportion of psychotic diagnoses than whites, and Latinos a lesser proportion than whites. None of the covariates included in the analysis had a consistent relationship to diagnosis. Whites and Asians received more diagnoses of major affective disorders than blacks or Latinos; blacks and Asians received more diagnoses of schizophrenia and other psychoses than whites, and Latinos received fewer of these diagnoses than whites. Substance abuse was lower for Asians than for the other three groups. Based on the findings, it was concluded that there continues to be a difference in psychiatric diagnosis that is related to ethnicity. Clinical practice issues and recommendations for further research are considered in relationship to these findings.
This study used standardized diagnostic criteria and method to investigate both prevalence rates and nature of symptoms of depressive disorders in three Asian centres--Nagasaki, Shanghai and Seoul. Of the patients who visited a psychiatric clinic in each of the 3 centres for the first time, over 20% suffered from depression. Unlike previous reported prevalence rates for Asian countries, these results suggest that rates in Asia may not be much lower than those reported in Western countries. Although prevalence rates of depression were similar in all 3 centres, differences in symptoms were noted.
This study examined the cultural generalizibility of the negative relationship between depression and self-enhancement. Japanese (n = 116) and American (n = 125) students completed the Zung (1965) Self-Rating Depression Scale and three measures of self-enhancement (i.e., the tendency to see oneself in a positive light). As expected, Japanese subjects were found to be more depressed and less self-serving than Americans. Negative correlations between depression and self-enhancement measures were obtained for both samples. Regression analyses of the relationships between measures indicated that sample differences in self-enhancement were explained largely by sample differences in depression. It is proposed that, relative to the Americans, Japanese students had a negative self-schema that led to higher depression and lower self-enhancement.
The purpose of this study was to examine the relationship of Asian client-therapist ethnicity, language and gender match on two measures of utilization: number of sessions with primary therapist and dropout from therapy; and one measure of client outcome: admission-discharge difference in Global Assessment Scale (GAS) scores. The sample consisted of 1746 Asian client episodes in Los Angeles County mental health facilities between January 1983 and August 1988. Various types of multiple regression analyses were used to investigate the relationship of language, ethnicity, and gender match to the three dependent variables and to eight sociodemographic variables.
Either client-therapist language match or ethnic match significantly increased the number of client sessions with the primary therapist. However, only ethnicity match had a significant effect on dropout rate. Gain in GAS admission-discharge score was not affected by either a client-therapist ethnicity or language match. Gender match had no consistent effect on the dependent variables. Of the covariates examined, only therapist discipline (social worker) had a consistent effect on the dependent variables.
It was concluded that both client-therapist language and ethnicity match are important variables affecting the utilization of treatment. Further research will be needed to separate the effects of language and ethnicity on therapy utilization.
The depressive symptoms and symptom dimensions of 335 undergraduate Chinese medical students were assessed and described using the Beck Depression Inventory (BDI). Although there were subtle sex differences in the endorsement of specific symptoms, male and female medical students did not differ in the degree of depressed mood as reflected in the BDI scores. Using the cutoff scores of 9/10 and 29/30, respectively, close to half of the Chinese medical students would be in the depressed range, and 2% would be in the severely depressed range. While Chinese medical students appeared to have higher mean BDI score than US medical students, their mean score was not higher than that derived from a separate sample of 213 Chinese nonmedical undergraduates.
This paper: (1) reviewed and integrated the small body of cross-cultural literature on Zung SDS scores among college students and (2) reported new SDS data on students in four countries. Its purpose was to facilitate the development of population- and culture-specific norms for the measurement of depression and to identify pat terns in the data available at this time.
The results indicated considerable culture and gender specificity. Females had higher SDS scores in all but one group. There was a slight tendency for scores to increase over time. The pattern of mean scores across cultural groups was somewhat inconsistent. Korean and Philippine students had the highest scores, Caucasian Americans the lowest. There was moderate concordance of ranked symptoms across eleven samples. This concordance increased within cultural groups and especially within nations. Finally, two specific methodological problems were discussed. First, nine of ten of the highest ranked symptoms were stated in negative form, which sug gests that negative wording biases symptom means. Second, there appear to be addi tional problems in the specific wording of the libido and diurnal variation items as applied to college students.
This descriptive study was designed to examine the interrelationships of depression, stress, mastery, and social resources in four ethnocultural women's groups. The random sample (N = 212) was comprised of Chinese (n = 60), Vietnamese (n = 46), Portuguese (n = 56), and Latin American (n = 50) immigrant women. Using the CES-D, high depressive symptoms were reported by all groups. Collectively, the major correlates and predictors of depression were perceived stress and mastery. Group-specific analyses revealed different models for predicting depression in each ethnic group. The findings underscore the need for observation of the indicators of depression in immigrant women--regardless of their phase of resettlement--and a flexible, individualized approach to ethnic women's psychological health care.
This study explores the explanatory models of major depression in a group of 40 recently immigrated Chinese-American women, and demonstrates the significant relationship between problem conceptualization and help-seeking behavior. Respondents are presented a vignette depicting major depression, from which they are asked to conceptualize the problem described and answer questions regarding its cause, impact and potential sources for help-seeking. Those who provide a psychological conceptualization are likely not to suggest professional services, but to turn to themselves and family and friends for assistance. On the other hand, those who hold a physical conceptualization are likely to seek out medical services. Implications for effective mental health service delivery to this population are discussed.
Haloperidol and reduced haloperidol plasma concentrations were measured in age-matched Chinese and non-Chinese patients (n = 32). Steady-state plasma concentrations were obtained 10-12 hours after the bedtime dose. Haloperidol and reduced haloperidol concentrations were measured by liquid chromatography and radioimmunoassay. Haloperidol plasma concentrations did not significantly differ between the populations, but reduced haloperidol levels were 3 times greater in non-Chinese patients than in Chinese patients. The incidence of extrapyramidal side effects was higher in Chinese patients (18 vs. 10), while non-Chinese patients with extrapyramidal symptoms had higher reduced haloperidol plasma levels. Logistic regression analysis revealed that ethnicity and reduced haloperidol/haloperidol ratios were important variables in predicting extrapyramidal symptoms. These results suggest that the metabolism and disposition of haloperidol and reduced haloperidol could differ among ethnic populations.
Although historically research findings about racial and ethnic issues were all too often used to support prevailing concepts of racial inferiority, in recent years racial and ethnic factors have frequently been ignored. However, current findings suggest that racial and ethnic differences exist in the symptom presentations of psychiatric disorders. Significant racial differences have been noted among proposed biological markers for various psychiatric disorders, such as serum creatinine phosphokinase, platelet serotonin, and HLA-A2. Racial and ethnic differences in response to psychotropic medication, such as higher blood levels found among Asians, affect dosage requirements and potential side effects. All of these developments underline the importance of considering ethnic and racial factors in psychiatric research.
This paper examines the level of depressive symptomatology in a community-based Chinese-American sample as measured by the Center for Epidemiological Studies-Depression Scale (CES-D) and assesses its psychometric properties within this group. The CES-D was administered to 360 Chinese-Americans on the telephone. Its internal reliability was found to be good. A factor analysis revealed an inseparability of affective and somatic structures in this sample. This reflects the nature of experience and manifestation of depression in Chinese culture. Level of depressive symptomatology was found to be higher than previously reported in both White and Asian samples. Those who belonged to a lower socioeconomic level (as measured by education and occupation) scored as significantly more depressed than those who are better off.
A study aimed at the standardization of symptom evaluation of patients with depression was carried out as the first step in an extensive collaborative study on affective disorders between centers in Nagasaki, Shanghai and Seoul. This study was initiated in order to clarify the factors affecting the low reported prevalence rates of depressive disorders in Asia. No significant difference in evaluation of psychiatric symptoms was observed between the 3 centers. Nevertheless, the diagnoses given by ICD-9 showed very interesting differences. For any given case, Nagasaki tended to make a diagnosis of an affective psychosis depression, while Shanghai made a diagnosis of neurotic disorder. No significant tendency was observed in the Seoul center. These findings are discussed in terms of their importance for future international collaborative studies.
We compared United States and Japanese university students on self-report measures of depression (Beck Depression Inventory; BDI) and psychological distress (General Weil-Being Scale; GWB). In addition, we reassessed sex differences on these measures for students in the United States and examined sex differences for Japanese students. We found that (a) Japanese students had significantly higher scores than their U.S. counterparts on the BDI but not on the GWB scale and that (b) male and female college students in the U.S. and Japan did not differ in scores on the BDI or the GWB scale.
This study examined a number of psychosocial factors thought likely to contribute to depression among ethnic Korean and Caucasian students. As hypothesized, Koreans (n = 61) were more depressed than Caucasians (n = 69). Stepwise multiple regression analysis revealed different models for predicting depression in the two groups. Value orientations, a neglected element in the prevailing stress paradigm, contributed substantially to variation in depression, especially among Koreans. Two measures of parental values and three coping strategies accounted for a striking 44% of the variance in Korean youths' depression. Perceived parental traditionalism, the strongest predictor, was associated with higher depression; and perceived parental modernism, with lower depression. For Caucasians, in contrast, only 13% of the variance in depression could be accounted for; and the two significant predictors were academic stress and respondents' own modern values (the latter associated with fewer symptoms). The findings of this study argue for greater attention to the importance of values in studying adaptation to stress.
Utilization of general medical and mental health services by respondents in the Los Angeles Epidemiologic Catchment Area (ECA) site was compared with that in three ECA sites studied previously (New Haven, Conn, Baltimore, and St Louis). Within the Los Angeles sample, Mexican-American patterns of utilization were compared with those for non-Hispanic whites. Los Angeles respondents were less likely than those at other ECA sites to make ambulatory health care visits and to be hospitalized for physical or mental health reasons. Mexican Americans were less likely than non-Hispanic whites to report ambulatory health care but were as likely to have been hospitalized. Six percent of Los Angeles respondents reported a recent mental-health-care visit as compared with 6% to 7% of respondents at the other ECA sites. However, among respondents with Diagnostic Interview Schedule DSM-III disorders diagnosed within the six months prior to the interview, a lower proportion made a mental health visit in Los Angeles (14%) compared with the other sites (16% to 20%). Of those who made a mental-health-care visit, Los Angeles respondents with a recently diagnosed disorder were more likely than comparable respondents at the other ECA sites to visit a mental health specialist rather than a general medical care provider. Mexican Americans with a recently diagnosed mental disorder were only half as likely as non-Hispanic whites (11% vs 22%, respectively) to have made a mental health visit. However, when Mexican Americans with Diagnostic Interview Schedule/DSM-III did make a mental health visit, they were as likely as non-Hispanic whites to see a mental health specialist.
This study examined the relationship between a culture-compatible approach to mental health service and utilization as measured by dropout and total number of outpatient visits. The sample (N = 300) was 23.5% Mexican, 22.8% White, 18.1% Black, 17.1% Vietnamese, 16.8% Pilipino, and 1.7% other ethnic group. A culture-compatible approach was found to be effective in increasing utilization. Three culture-compatibility components were the best predictors of dropout status: language match of therapists and clients, ethnic/racial match of therapists and clients, and agency location in the ethnic/racial community. Pharmacotherapy, education, previous treatment and a diagnosis of psychosis were significantly related to remaining in therapy.
One hundred and one bipolar patients with at least two episodes during the 2 successive years prior to lithium received continuous lithium treatment for 2 years. The prophylactic efficacy of lithium increased from 60% to 73% when patients with individual standard deviations of plasma lithium of more than 0.2 mM/l were excluded. Most of the good responders showed individual mean plasma lithium levels from 0.5 mM/l to 0.79 mM/l.
Discussions of Mexican American mental health need have been limited to analyses of service utilization statistics, most of which have shown Mexican Americans to use mental health services proportionally less than other racial/ethnic groups. Consequently, Mexican Americans have been viewed as a group having greater unmet mental health needs. Yet, these utilization-based needs assessments make an implicit and untested assumption: that the proportion of the psychologically impaired is comparable across racial/ethnic groups. The purpose of the present investigation was, first, to contribute to a baseline measurement of psychological impairment among Mexican Americans in order to assess what utilization should be for this group and, second, to determine relationships between impairment symptomatology and sociodemographic characteristics which are unique to the Mexican American population. Anglo- and Mexican Americans (n = 515) living in one of three suburban communities in Southern California were selected by way of a random-digit, multistage cluster telephone sampling procedure. Respondents gave responses to a standardized measurement of psychological impairment. Results showed that Anglo- and Mexican Americans did not differ in anxiety, psychosocial dysfunction, and depressive symptoms. Mexican Americans in the three communities, however, were found to use mental health services proportionally less than Anglos. Relationships between age and psychosocial dysfunction symptoms, and between income and anxiety problems were different for Mexican Americans than those for Anglos. Issues related to what constitutes mental health need and the use of self-report measures of impairment to estimate mental health need across culturally diverse groups are discussed.
Black (N = 26), white (N = 26) and Overseas Chinese (N = 32) college students were surveyed with Zung's Self-rating Depression Scale (SDS). With the exception of two items where marginally significant differences were found, there were no quantitative differences in the results across these ethnic groups. Inter-item analyses, factor analyses and comparison of factor profiles indicated that the items clustered in different configurations for the three groups. The factors contributing the most variances differed in their item contents across the ethnic groups: a mixture of affective and somatic complaints characterizes the black group; existential and cognitive concerns characterize the white group and somatic complaints characterize the Overseas Chinese group. Discussion was focused on issues concerning cultural conception of psychological difficulties, communication styles used to communicate these difficulties and situational variables affecting performances on psychological diagnostic tests.
It has often been suggested that Americans tend to seek psychiatric help for depression, whereas Chinese patients are more likely to have somatic symptoms of emotional disturbance. When the authors tested this assumption by studying 99 Taiwanese and 97 American psychiatric outpatients given computerized diagnoses based on information obtained in a standard psychiatric interview schedule, they found that the Chinese patients scored higher on the measures of somatization but also on the measures of depression.
The dearth of population-based studies and epidemiological investigations on the mental health problems of Asian-Americans, especially since the change in the immigration laws in 1965, has led to contradictory speculations about the prevalence rates of mental illness and the general mental health status among Asian-Americans, as opposed to other segments of the population. We administered the Center for Epidemiologic Studies Depression (CES-D) scale to 499 samples drawn from a Northwestern coastal city in order to make an initial assessment of the amount of depression experienced by Asian-Americans. The investigation compared the Asian-Americans' CES-D scores with those of whites and other minority groups, examined the scale's patterns of factor loading by ethnicity, and discovered that, even with statistical controls, there exists a distinction among the individual groups of Chinese, Filipinos, Japanese, and Koreans with respect to their score averages of depressive symptoms.
This study was undertaken to address the issue of data reporting in the psychiatric sector of New York City Medicaid, the largest publicly financed psychiatric health care delivery system in the nation. Six outpatient psychiatric clinics in general hospitals, four with residency programs, and all 29 free standing psychiatric clinics in New York City were audited as were charts from 120 psychiatrists billing for 10 or more Medicaid patients. Overall agreement of chart and Medicaid diagnoses was 91% for psychiatrists, 79% for free-standing clinics, and 77% for hospital clinics. Agreement varied by diagnosis. Bias in the Medicaid diagnosis of Neurosis was found at the four hospitals having residency programs. Patients most likely to be misreported as having minimizing diagnoses were male, or between the ages of 18 and 29 years, or to have a prior history of psychiatric treatment. The errors in reporting in each provider sector would pose a methodological obstacle if Medicaid data were used in epidemiological research.
The author reviews conceptual and empirical issues regarding the interaction of neurasthenia, somatization and depression in Chinese culture and in the West. The historical background of neurasthenia and its current status are discussed, along with the epidemiology and phenomenology of somatization and depression. Findings are presented from a combined clinical and anthropological field study of 100 patients with neurasthenia in the Psychiatry Outpatient Clinic at the Hunan Medical College. Eighty-seven of these patients made the DSM-III criteria of Major Depressive Disorder; diagnoses of anxiety disorders were also frequent. Forty-four patients were suffering from chronic pain syndromes previously undiagnosed, and cases of culture-bound syndromes also were detected. For three-quarters of patients the social significances and uses of their illness behavior chiefly related to work. Although from the researcher's perspective 70% of patients with Major Depressive Disorder experienced substantial improvement and 87% some improvement in symptoms when treated with antidepressant medication, fewer experienced decreased help seeking, and a much smaller number perceived less social impairment and improvement in illness problems (the psychosocial accompaniment of disease including maladaptive coping and work, family and school problems). These findings are drawn on to advance medical anthropology and cultural psychiatry theory and research regarding somatization in Chinese culture, the United States and cross culturally. The author concludes that though neurasthenia can be understood in several distinctive ways, it is most clinically useful to regard it as bioculturally patterned illness experience (a special form of somatization) related to either depression and other diseases or to culturally sanctioned idioms of distress and psychosocial coping.
Blind raters applied research criteria to the charts of patients whose discharge diagnosis changed through several hospital admissions from depression to schizophrenia and to the charts of matched control patients. Fewer diagnostically unstable patients than control patients satisfied research criteria for depression despite matching discharge diagnoses. The use of operational criteria, then, can be expected to reduce diagnostic instability in depression and thus improve prognostic accuracy. Some patients satisfied the research criteria for depression when they were initially admitted and for schizophrenia at their final admission. This suggests that diagnostic error may not account for all cases of major diagnostic instability.
Depression and self-enhancement among Japanese and American students Prevalence of depressive symptoms in a Japanese occupational setting: A preliminary study
- R W Hymes
- M Akiyama
- K Saito
Hymes, R.W., and Akiyama, M. Depression and self-enhancement among Japanese and American students. Journal of Social Psychology, 131:321-334, 1991. Iwata, N.; Okuyama, Y.; Kawakami, Y.; and Saito, K. Prevalence of depressive symptoms in a Japanese occupational setting: A preliminary study. American Journal of Public Health, 79: 1486-1489, 1989.
Psychiatric diagnoses as reported to Medicaid and as recorded in patient charts Cultural factors in the clinical assessment of Asian Americans Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis
- A H Schwartz
- B B Perlman
- M Paris
- K Schmidt
- J C Thornton
- D Sue
- S Sue
Schwartz, A.H.; Perlman, B.B.; Paris, M.; Schmidt, K.; and Thornton, J.C. Psychiatric diagnoses as reported to Medicaid and as recorded in patient charts. American Journal of Public Health, 70:406-408, 1980. Sue, D., and Sue, S. Cultural factors in the clinical assessment of Asian Americans. Journal of Consulting and Clinical Psychology, 55:479-487, 1987. Sue, S.; Fujino, D.C.; Hu, L.; Takeuchi, D.T.; and Zane, N.W.S. Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology, 59:533-540, 199 1.
Counseling and psychotherapy with Asian-Americans: Review of the literature
- Leong
Comparative study of affective disorders in three Asian countries
- Nakane