Length of stay, admission types, psychiatric diagnoses, and the implications of stigma in African Americans in the nationwide inpatient sample

African Americans purportedly have a higher prevalence of mental illnesses but are often misdiagnosed and less likely to seek treatment. Delayed treatment has been associated with the stigma related to these disorders. The demographic characteristics, length of stay, most prevalent psychiatric diagnoses, and hospital admissions of African Americans were compared to other U.S. populations using a nationwide sample (N = 4,474,732). African American participants were younger, had significantly longer lengths of stay, and were admitted more often through the emergency room than the other groups in this sample. Psychosis, alcohol/drug dependence, and depressive neurosis were the most prevalent psychiatric diagnoses reported for African American participants. Research is needed to explain these results so that strategies can be instituted to improve the poor mental health outcomes often observed in African American populations.

Suicidality in African American men: the roles of southern residence, religiosity, and social support

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.

Help-seeking behaviour regarding mental health problems of Mediterranean migrants in the Netherlands: familiarity with care, consultation attitude and use of services

BACKGROUND

Ethnic minority groups differ in the pattern of their seeking help, and in their use of and attitude towards mental health systems. To meet the mental health needs of ethnic minority populations, insights into determinants of their help-seeking orientations are of great concern.

AIM

To investigate help-seeking behaviour regarding mental health problems in terms of familiarity, attitude and service use among Mediterranean migrants in the Netherlands.

METHODS

Samples of Mediterranean citizens in the general population (N = 292) and of Mediterranean (N = 114) and indigenous Dutch outpatients (N = 59) currently treated in mental health care were included. Data were acquired by administering a semi-structured interview. Quantified data were analysed using multivariate techniques.

RESULTS

More recently arrived participants were less familiar with mental health services. Moroccan, lower educated and recently arrived respondents reported a more negative attitude towards consulting these agencies. The help-seeking behaviour of the Mediterranean participants was relatively similar to that of the indigenous Dutch subjects.

CONCLUSIONS

With regard to care-seeking routes and use of mental health services, more inter-ethnic similarities than differences emerged. Sociodemographic variables like age, education and length of residence shape the process of help-seeking and service use.

Stigmatization of Hispanic children, pre-adolescents, and adolescents with mental illness: exploration using a national database

This paper examines descriptive statistics for the primary payer, length of stay, and admission source of an acute care hospitalization of Hispanic children--pre-adolescents, and adolescents with a primary psychiatric Diagnostic Related Group (DRG)--and relates these variables to the concept of stigma. This paper was a secondary analysis that used data from the National Inpatient Sample database. Psychosis was the most frequent diagnosis of Hispanic youth who were hospitalized. More Hispanic pre-adolescents had a psychiatric DRG than any other ethnic group but fewer Hispanic adolescents were diagnosed with a psychiatric DRG than any other ethnic group. For Hispanic pre-adolescents and adolescents, the primary payer was Medicaid versus private insurance for White pre-adolescents and adolescents. The length of stay was approximately the same for all ethnic groups. The admission source differed for Hispanic pre-adolescents and adolescents with the majority of pre-adolescents being admitted routinely and the majority of Hispanic adolescents being admitted through emergency departments. Recommendations are made for future research, clinical practice, and public policy related to the stigmatization of Hispanic children and adolescents with mental illness.

Stigma: barrier to mental health care among ethnic minorities

This paper explicates the stigma of mental illness as it is experienced by four ethnic minority groups in the United States. Concerns about prejudice and discrimination among individuals who suffer burdens related to mental illness are delineated. It is proposed that ethnic minority groups, who already confront prejudice and discrimination because of their group affiliation, suffer double stigma when faced with the burdens of mental illness. The potency of the stigma of mental illness is one reason why some ethnic minority group members who would benefit from mental health services elect not to seek or adequately participate in treatment. The combination of stigma and membership in an ethnic minority group can impede treatment and well-being, creating preventable and treatable mortalities and morbidities. The article concludes with recommendations for research and health policy implications.

[Searching for rest in one's soul: the experience of mental health complaints in older Moroccan immigrants]

The number of Moroccan elderly in the Netherlands is growing. Although many have mental health problems, the mental health services have difficulties in reaching them. This study reports on the experience of mental health problems of elderly Moroccan migrants, their search for help and their view on the role of the mental health services. Twenty-two Moroccan elderly (11 men, 11 women) aged 55-75 were interviewed with a semi-structured questionnaire. From the interviews and observations it appeared that these elderly experience their health as bad. When asked, they deny mental health problems. Stress and dejection are not experienced as relating to mental health but as part of life associated with ageing, living in a foreign country, having physical, social and financial problems. The elderly feel that God sets them these tasks to overcome by themselves. Achieving rest in one's soul is central in this process. There is a taboo on serious mental health problems and people are ashamed of them. Only people who neglect religious prescriptions can to be affected by mental health problems. The elderly Moroccans hardly consult mental health services for these problems because then it would become clear that they cannot overcome their problems by themselves. Furthermore, the mental health services are unknown. Therefore, those services have to pay attention to the specific experience of mental complaints of elderly Moroccans. By offering psycho-education the mental health services may come within reach of those elderly.

Are ataques de nervios in Puerto Rican children associated with psychiatric disorder?

OBJECTIVE

To provide the first empirical analysis of a cultural syndrome in children by examining the prevalence and psychiatric correlates of ataques de nervios in an epidemiological study of the mental health of children in Puerto Rico.

METHOD

Probability samples of caretakers of children 4-17 years old in the community (N = 1,892; response rate: 90%) and in clinical services (N = 761; response rate 72%) were administered structured interviews to assess the presence and correlates of ataques de nervios.

RESULTS

Nine percent of children in the community sample and 26% of children in the clinical sample had a reported history of an ataque de nervios. In contrast to the overall community and clinical samples, which had more boys in them, the ataque de nervios groups in both samples had more girls in them. Family history of ataques de nervios was associated with ataques de nervios in children in both samples. Across a wide range of depression, anxiety, and disruptive disorders, children who reported an ataque de nervios were more likely to meet research criteria for psychiatric disorder in both samples.

CONCLUSIONS

Ataques de nervios are a frequently reported cultural syndrome among children in Puerto Rico. Adolescent girls are more likely to report this experience. Ataques de nervios have a significant relationship with psychiatric disorder and impairment in Puerto Rican children.

Psychiatric health laws in Pakistan: from lunacy to mental health

Recent changes in mental health services and in the laws governing treatment if mentally ill individuals are encouraging, but further improvement is needed.

Racial and socioeconomic differences in psychiatric symptoms in nursing home residents: a minimum data set-based pilot study

BACKGROUND

Little research has explored racial and socioeconomic differences in the presence, detection, and treatment of neuropsychiatric symptoms in nursing home residents.

OBJECTIVE

To evaluate racial and socioeconomic differences on mood and behavior Minimum Data Set (MDS) recorded symptoms, MDS recorded psychiatric diagnoses, and MDS identified psychotropic medication use.

METHODS

Data were obtained through a cross-sectional review of MDS data of 290 African-American and white residents of 2 nursing homes. The association between age, gender, race, and pay status with mood and behavior patterns, psychiatric diagnoses, and use of psychotropic medication was evaluated.

RESULTS

White residents were more likely than African American residents to have MDS recorded psychiatric diagnoses (odds ratio, OR = 3.24), but there were no significant racial differences in recorded mood or behavior symptomatology or in the pharmacologic treatment of mental illness. Medicaid recipients were more likely than nonrecipients to have behavior symptoms (OR = 2.09), have a psychiatric diagnosis (OR = 2.91), and receive psychotropic medications in the absence of a psychiatric diagnosis (OR = 3.62).

CONCLUSION

Pay status was associated with recorded symptoms, diagnoses, and medications, but racial differences were found only for recorded diagnoses.

Adult Korean Americans: their attitudes toward seeking professional counseling services

This exploratory study examined the attitudes of 157 adult Korean Americans, who routinely gather at a community center, about obtaining professional counseling services. Data gathered from self-report instruments were used to determine gender, income, and educational differences and preferences for seeking sources of help. No significant gender or income level differences were found among the participants with respect to their attitudes in procuring professional counseling. However, study-participants with higher levels of education indicated more positive attitudes about securing professional assistance. Also significant differences were found between female and male respondents regarding their preferences for help-seeking. Implications for practice and future research are discussed.

Mad tales from Bollywood: the impact of social, political, and economic climate on the portrayal of mental illness in Hindi films

OBJECTIVE

To study the portrayal of mental illness (especially psychosis) in Hindi films since 1950 and to study the influence of prevalent social, political and economic factors on each portrayal.

METHOD

Using two encyclopedias and one source book, films that had mental illness affecting one of the protagonists were identified. The social, economic and political factors were identified using history texts.

RESULTS

In the 1960s after India became a Republic, the political climate was one of idealism and as a result the portrayal of mental illness was gentle, more international in its outlook, and used psychoanalytic techniques. In the 1970s and 1980s, as a result of increased political and bureaucratic corruption and an unstable political climate, the portrayals became harder and psychopaths were portrayed more often. In the 1980s, the trend continued with female psychopaths, and avenging women emerged as a major force because the political and judicial systems were seen as impotent in delivering justice. In the 1990s, following economic liberalization, the women were seen and used as possessions in society and the cinema, and portrayals of stalking and morbid jealousy increased.

CONCLUSION

Hindi films since the 1950s appear to have been influenced by changing cultural norms which in turn affected the way mental illness is portrayed.

Mental health visits in a pediatric emergency department and their relationship to the school calendar

OBJECTIVES

Over the past decade, there has been a significant increase in the rate at which children and adolescents present to emergency departments (EDs) with mental health complaints. The goal of the current study was to assess the rate of ED usage for children and adolescents and to determine if there was an association between mental health emergencies and the school year.

METHODS

Retrospective chart review of 719 psychiatric consultations to an urban ED affiliated with an academic medical center. Records of consultations from April 2001 to March 2002 were reviewed and abstracted for variables such as age, sex, time and date of presentation, and psychosocial factors.

RESULTS

Chi2 analyses reveal significant associations between presentation to the ED for a psychiatric complaint and time of day, day of week, and month of year. One-way analyses of variance also demonstrated mean differences in presentations for day of week and month of year.

CONCLUSIONS

The current study supports previous research findings of an association between the school year and child and adolescent mental health emergencies. In the current study, the school year appears to exacerbate childhood problems, as there is a greater frequency of psychiatric emergencies while children are in school. Implications for ED program development and school-based mental health service delivery are reviewed.

Test-retest reliability of the Chinese version of the Diagnostic Interview Schedule for Children-Version 4 (DISC-IV)

BACKGROUND

Despite the huge youth population, there is a lack of psychiatric diagnostic instruments with reported psychometric properties in Chinese. This study reports the development of the Chinese version of DISC-IV and examines its test-retest reliability.

METHOD

Seventy-eight parents and 79 youths (mean age 13.1 years) attending child psychiatric clinics were interviewed twice using the Chinese DISC-IV (Diagnostic Interview Schedule for Children-IV) about 22 days apart.

RESULTS

The kappa coefficients were good to excellent for obsessive compulsive disorder (OCD) (both youth (Y) and parent (P) versions), major depressive disorder (MDD) (P), attention deficit hyperactivity disorder (ADHD) (P); fair for anxiety disorder (P), oppositional defiant disorder (ODD) (P, Y), MDD (Y); but poor for anxiety disorder (Y) and ADHD (Y). Parent informants had better test-retest reliability than youth informants.

CONCLUSIONS

The Chinese DISC-IV had comparable test-retest reliability with the original English version.

Generalizability of studies on mental health treatment and outcomes, 1981 to 1996

OBJECTIVE

This study operationalized and measured the external validity, or generalizability, of studies on mental health treatment and outcomes published in four journals between 1981 and 1996.

METHOD

MEDLINE was searched for articles on mental health treatment and outcomes that were published in four leading psychiatry and psychology journals between 1981 and 1996. A 156-item instrument was used to assess generalizability of study findings.

RESULTS

Of more than 9,000 citations, 414 eligible studies were identified. Inclusion of community sites and patients from racial or ethnic minority groups were documented in only 12 and 25 percent of studies, respectively. Random or systematic sampling methods were rare (3 percent), and 75 percent of studies did not explicitly address sample representativeness. Studies with funding from the National Institute of Mental Health (NIMH) were more likely than those without NIMH funding to document the inclusion of patients from minority groups (30 percent compared with 20 percent). Randomized studies were more likely than nonrandomized studies to document the inclusion of patients from minority groups (28 percent compared with 17 percent), include patients with comorbid psychiatric conditions (31 percent compared with 19 percent), and attend to sample representativeness (28 percent compared with 15 percent). Modest improvements were seen over time in inclusion of patients from minority groups, inclusion of patients with psychiatric comorbidities, and attention to sample representativeness.

CONCLUSIONS

Generalizability of studies on treatments and outcomes, whether experimental or observational, remained low and poorly documented over the 16-year period.

Ethnic variations in the initial phase of mental health treatment: A study of Sami and non-Sami clients and therapists in northern Norway

Several studies indicate that mental health and mental health service vary with ethnicity. Ethnically linked social differences affect these results. We examined the multiethnic population in northern Norway where social inequalities between the Sami and the non-Sami population are not prominent. Clients (N=347) and therapists (N=32) in outpatient treatments reported demographics, ethnicity and the therapeutic alliance. Clients also reported pretreatment psychosocial status, service utilization and the type of help requested. Therapist recorded clinical and diagnostic assessments and treatment plans. The Sami and non-Sami client groups were similar in demographics and pretreatment psychosocial characteristics. However, the therapists prescribed more sessions and more socially focused interventions when clients were Sami. Verbal therapy was more often used by the non-Sami therapists. Alliance ratings were positively correlated only between Sami therapists and their clients, and Sami therapists rated the largest initial clinical improvement. Clinics located in the high Sami density areas offered their clients more therapy sessions, than in clinics in the high non-Sami density areas. Ethnic similarity between client and therapist were associated with more frequent use of medication and less frequent use of verbal therapy.

Prevalence and predictors of mental incapacity in psychiatric in-patients

BACKGROUND

Little is known about the proportion of psychiatric in-patients who lack capacity to make treatment decisions, or the associations of lack of capacity.

AIMS

To determine the prevalence of psychiatric in-patients who lack capacity to make decisions about current treatment and to identify demographic and clinical associations with lack of mental capacity.

METHOD

Patients (n=112) were interviewed soon after admission to hospital and a binary judgement of capacity was made, guided by the MacArthur Competence Tool for Treatment. Demographic and clinical information was collected from an interview and case notes.

RESULTS

Of the 112 participants, 49 (43.8%) lacked treatment-related decisional capacity. Mania and psychosis, poor insight, delusions and Black and minority ethnic group were associated with mental incapacity. Of the 49 patients lacking capacity, 30 (61%) were detained under the Mental Health Act 1983. Of the 63 with capacity, 6 (9.5%) were detained.

CONCLUSIONS

Lack of treatment-related decisional capacity is a common but by no means inevitable correlate of admission to a psychiatric in-patient unit.

[From Kosovo to Switzerland: mental health perceptions and practical implications for health professionals]

A survey was conducted in Kosovo between 2002 and 2003 among 57 health professionals. Covered topics encompassed mental health and disease representations and access to mental health care in Kosovo following the war. At the time of the survey, health services were still widely disorganized and uncoordinated at the local level, with poor access to health care. This work shows that mental disorders remain very stigmatizing for patients and their relatives. Benzodiazepines are the first choice medication, to the detriment of other psychotropic categories. Traditional and religious representations of mental disease prevail in the general population. A few recommendations addressed to professionals taking care of Kosovar patients, in Switzerland or elsewhere, are drawn from these results.

Public beliefs about causes and risk factors for mental disorders: a comparison of Japan and Australia

BACKGROUND

Surveys of the public in a range of Western countries have shown a predominant belief in social stressors as causes of mental disorders. However, there has been little direct cross-cultural comparison. Here we report a comparison of public beliefs about the causes of mental disorders in Japan and Australia.

METHODS

Surveys of the public were carried out in each country using as similar a methodology as feasible. In both countries, household interviews were carried out concerning beliefs about causes and risk factors in relation to one of four case vignettes, describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. In Japan, the survey involved 2000 adults aged between 20 and 69 from 25 regional sites spread across the country. In Australia, the survey involved a national sample of 3998 adults aged 18 years or over.

RESULTS

In both countries, both social and personal vulnerability causes were commonly endorsed across all vignettes. The major differences in causal beliefs were that Australians were more likely to believe in infection, allergy and genetics, while Japanese were more likely to endorse "nervous person" and "weakness of character". For risk factors, Australians tended to believe that women, the young and the poor were more at risk of depression, but these were not seen as higher risk groups by Japanese.

CONCLUSION

In both Japan and Australia, the public has a predominant belief in social causes and risk factors, with personal vulnerability factors also seen as important. However, there are also some major differences between the countries. The belief in weakness of character as a cause, which was stronger in Japan, is of particular concern because it may reduce the likelihood of seeking professional help and support from others.

Psychometric Properties of the Spanish Version of Two Mental Health Outcome Measures: World Health Organization Disability Assessment Schedule II and Lehman’s Quality of Life Interview

This study presents data on the cultural adaptation to Latino populations of two outcome measures that respond to the need for developing comprehensive instruments for outcome assessments in minority populations. We examined the psychometric properties of outcome measures designed to assess impairment in functioning, and quality of life. Impairment in functioning was measured with the Disability Assessment Schedule II (WHO-DASII) developed by the World Health Organization (1997) and quality of life was measured with A. F. Lehman's (A. F. Lehman, 1983; A. F. Lehman, 1988) shortened Quality of Life Interview (QOLI). Spanish speaking consumers (N = 198) from Fresno (CA), San Antonio (TX) and San Juan (PR) participated in this study. They were recruited from both mental health outpatient clinics and primary care rural clinics. The WHO-DASII showed good to excellent internal consistency in all sites (alpha = .72 to .97) except for one subscale (Self-Care alpha = .47). Test-retest reliability estimates were mostly moderate to substantial (.57 to .83), again with one exception, the Self-Care subscale (.46). For the QOLI internal consistency ranged from .34 to .98 and test-retest reliability ranged from .40 to .86 across all sites. An initial validation strategy using both known-groups and concurrent validity produced promising evidence of the construct validity of both measures. The Spanish versions of the WHO-DASII and the QOLI lend support to the translation and adaptation process to which these instruments were subjected.

[Program for promoting social attachment among Poles in Australia in relation to their mental status]

Among the Polish community in Sydney in 1989 there was a significantly higher percentage of men than women. Compared to the Australian population, there was also a high percentage of single people (especially men), a high rate of childlessness and a majority of incomplete families. The data on admission to psychiatric institutions in New South Wales indicate, that Polish-born persons (males) hospitalized with psychiatric disorders were 2.5 times more than the population of Australian-born. Sociologists pointed that because of lesser contacts with other members of their ethnic groups, people find themselves isolated. There were also limited family members or relatives who could provide support. From the South Western Sydney Area Health Service initiative a 2-year programme "Gazeta seniora". The strategic goal was to reduce number of isolated Polish-born older people through a number of regular initiatives: newspaper supplement, radio programmes, meeting groups, phone line. According to the information obtained from health and social services and from the respondents survey, letters and interviews, there was an increased access to medical services (15 percent), number of ethic meeting groups (40 percent). The programme has encouraged community leaders to provide personal contact and support for isolated people. After two years there were twice as many programme participants "satisfied with life" mainly because of "other peoples and the community's" involvement (from 7.0 to 21.4 percent). In the discussion part the authors stressed a holistic and long-term aspect of social and environmental support of any community based health promotion intervention related to psychic health improvement.

Mental health services in a multicultural society: interculturalization and its quality surveillance

The purpose of this article is to present a model to promote and assess interculturalization of mental healthcare services in western multicultural society. We define interculturalization as the adaptation of mental health services to suit clients from different cultures. The suggested measures aim to introduce changes in four contexts: (i) the clinical interface or the relations between the immigrant patient and the healthcare workers and the treatment team; (ii) organizational adaptations required in the treatment context of the mental healthcare facility; (iii) the relation between the mental health facility and the ethnic communities; and (iv) the relation between the mental healthcare system, other facilities and society at large. To monitor the desired changes, the model describes qualitative and quantitative criteria and indicators to be applied in the four contexts.