The development and implementation of the National Comorbidity Survey Replication, the National Survey of American Life, and the National Latino and Asian American Survey

A mixed-methods approach to developing a self-reported racial/ethnic discrimination measure for use in multiethnic health surveys

OBJECTIVE

The development of measures of self-reported racial/ethnic discrimination is an active area of research, but few measures have been validated across multiple racial/ethnic and language groups. Our goal is to develop and evaluate a discrimination measure that is appropriate for use in surveys of racially and ethnically diverse populations.

METHODS

To develop our measure, we employ a mixed-methods approach for survey research, drawing from both qualitative and quantitative traditions, including literature review, cognitive testing, psychometric analyses, behavior coding as well as two rounds of field testing using a split-sample design. We tested our new measure using two different approaches to elicit self-reported experiences of racial/ethnic discrimination.

RESULTS

Our new measure captures four dimensions of racial/ethnic discrimination: 1) frequency of encounters with discrimination across several domains (eg, medical care, school, work, street and other public places); 2) timing of exposure (eg recent, lifetime); 3) appraisal of discrimination as stressful; and 4) responses to discrimination.

CONCLUSIONS

Because of the growing interest in measurement of racial/ethnic discrimination in health surveys, we think this report on the methods informing the development and testing of the discrimination module that will be used on the California Health Interview Survey would be useful to other researchers. The application of mixed methods to rigorously test the validity and reliability of our instrument proves to be a good roadmap for measuring racial/ethnic discrimination in multicultural and multilingual populations.

Correlates of suicidal behaviors among Asian Americans

This study examines the correlates of suicidal ideation, suicide plan and suicide attempt among Asian Americans focusing on nativity and gender. Analyses are performed on data from the National Latino and Asian American Study (N = 2095), the first ever study conducted on the mental health of a national sample of Asian Americans. The sample is comprised of adults with 998 men (47%) and 1,097 (53%) women. Analysis of weighted lifetime prevalence of suicidal behaviors revealed that U.S.-born Asian American women had higher prevalence of suicidal ideation and suicide plan than U.S.-born Asian American men and immigrant Asian American men and women. In multivariate analyses controlling for socio-demographic differences such as ethnicity, marital status and income, differences in suicidal behaviors are found only between U.S.-born women and U.S.-born men. The findings demonstrate the need to disaggregate data by immigrant status as well as socio-demographic correlates.

Political violence, psychosocial trauma, and the context of mental health services use among immigrant Latinos in the United States

OBJECTIVES

We present the prevalence of exposure to political violence (PV) among Latino immigrants in the US, and perceived need for and correlates of mental health services use among this population.

METHODS

We use the National Latino and Asian American Study (NLAAS), a nationally representative epidemiological survey of US Latinos, including a probability sample of 1630 immigrant Latinos. Our conceptual framework assumes a strong role of social and cultural factors in understanding the risk for psychopathology and mental health service use.

RESULTS

Eleven percent of all immigrant Latinos reported PV exposure and 76% described additional lifetime traumas. Among those with a history of PV, an increased likelihood of using mental health services was associated with female gender, English language proficiency, experiencing personal assaults, higher perceived discrimination, and having an anxiety or substance disorder. Latino men and specific subgroups of Latinos were less likely to access mental health services after experiencing PV. Perceived need for mental health services use is the strongest correlate of any lifetime and last-12-months service use.

CONCLUSIONS

Individuals who come from countries with a history of political violence often have multiple traumatic experiences. This suggests a need for systematic screening for trauma and related psychiatric disorders. Specific outreach interventions focused on perceptions of need could be helpful for subgroups of Latinos including men who are particularly underrepresented in mental health services but who exhibit significant trauma histories.

Antidepressant use in black and white populations in the United States

OBJECTIVE

The study objective was to estimate the prevalence and correlates of antidepressant use by black and white Americans.

METHODS

Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) were analyzed to calculate nationally representative estimates of past-year antidepressant use by black and white Americans ages 18 years and older (N=9,723).

RESULTS

Among individuals with depressive and anxiety disorders in the past year (N=516), black respondents (14.6%) had significantly lower (p<.001) antidepressant use than white respondents (32.4%). Depression severity was significantly associated with higher antidepressant use for white but not for black respondents. Psychiatric disorders and vascular disease significantly increased the odds of past-year antidepressant use. The increased prevalence of antidepressant use associated with vascular disease was independent of diagnosable psychiatric disorders. Among respondents not meeting criteria for depressive and anxiety disorders in the past year, lifetime depressive and anxiety disorders and vascular disease significantly increased the odds of antidepressant use.

CONCLUSIONS

Few white and fewer black Americans with depressive and anxiety disorders received antidepressant treatment. Higher depression severity was associated with more antidepressant use for white but not for black respondents. Antidepressant use was associated with medical conditions related to vascular disease, and these medical conditions were independent of coexisting psychiatric conditions. The results also indicate that many antidepressants are used for maintenance pharmacotherapy for depressive and anxiety disorders as well as common medical conditions associated with vascular disease.

Family Cohesion and its Relationship to Psychological Distress among Latino Groups

This paper presents analyses of a representative sample of US Latinos (N=2540) to investigate whether family cohesion moderates the effects of cultural conflict on psychological distress. The results for the aggregated Latino group suggests a significant association between family cohesion and lower psychological distress and the combination of strong family cohesion with presence of family cultural conflict was associated with higher psychological distress. However, this association differed by Latino groups. We found no association for Puerto Ricans, Cuban results were similar to the aggregate group, family cultural conflict in Mexicans was associated with higher psychological distress, while family cohesion in Other Latinos was associated with higher psychological distress. Implications of these findings are discussed to unravel the differences in family dynamics across Latino subethnic groups.

Prevalence and Correlates of Everyday Discrimination among U.S. Latinos

OBJECTIVES: This study reports on the prevalence and correlates of perceived discrimination among a national sample of Latinos in the U.S. Understanding the prevalence and correlates of discrimination can help us better address disparities in the healthcare system. We define perceived discrimination as self-reported everyday experiences of unfair treatment. METHODS: Logistic regression analyses were used to assess rates of perceived discrimination among Latinos and identify correlates of discrimination. Data came from the National Latino and Asian American Study (NLAAS). RESULTS: The prevalence of perceived discrimination among Latinos was 30%. Cubans and Latinos with high ethnic identity were less likely to perceive discrimination compared to other Latino subgroups or Latinos with low ethnic identity. U.S.-born Latinos and Latinos arriving to the U.S. at younger ages were more likely to perceive discrimination compared to immigrants arriving at older ages. CONCLUSIONS: Perceived discrimination among Latinos is less prevalent than what has been reported for other minorities. Variations in perceived discrimination are related to sociodemographic and cultural differences across ethnic subgroups.

Unfair treatment, racial/ethnic discrimination, ethnic identification, and smoking among Asian Americans in the National Latino and Asian American Study

OBJECTIVES

We examined the relations of self-report of general unfair treatment and self-report of race/ethnicity-specific discrimination with current smoking among Asian Americans. We investigated whether ethnic identification moderated either association.

METHODS

Weighted logistic regressions were performed among 1977 Asian Americans recruited to the National Latino and Asian American Study (2002-2003).

RESULTS

In weighted multivariate logistic regression models including both general unfair treatment and racial/ethnic discrimination, odds of current smoking were higher among Asian Americans who reported high levels of unfair treatment (odds ratio [OR]=2.80; 95% confidence interval [CI]=1.13, 6.95) and high levels of racial/ethnic discrimination (OR=2.40; 95% CI=0.94, 6.12) compared with those who reported no unfair treatment and discrimination, respectively. High levels of ethnic identification moderated racial/ethnic discrimination (F(3) =3.25; P =.03). High levels of ethnic identification were associated with lower probability of current smoking among participants reporting high levels of racial/ethnic discrimination.

CONCLUSIONS

Our findings suggest that experiences of unfair treatment and racial/ethnic discrimination are risk factors for smoking among Asian Americans. Efforts to promote ethnic identification may be effective in mitigating the influence of racial/ethnic discrimination on smoking in this population.

Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups

OBJECTIVE

Although widely reported among Latino populations, contradictory evidence exists regarding the generalizability of the immigrant paradox, i.e., that foreign nativity protects against psychiatric disorders. The authors examined whether this paradox applies to all Latino groups by comparing estimates of lifetime psychiatric disorders among immigrant Latino subjects, U.S-born Latino subjects, and non-Latino white subjects.

METHOD

The authors combined and examined data from the National Latino and Asian American Study and the National Comorbidity Survey Replication, two of the largest nationally representative samples of psychiatric information.

RESULTS

In the aggregate, risk of most psychiatric disorders was lower for Latino subjects than for non-Latino white subjects. Consistent with the immigrant paradox, U.S.-born Latino subjects reported higher rates for most psychiatric disorders than Latino immigrants. However, rates varied when data were stratified by nativity and disorder and adjusted for demographic and socioeconomic differences across groups. The immigrant paradox consistently held for Mexican subjects across mood, anxiety, and substance disorders, while it was only evident among Cuban and other Latino subjects for substance disorders. No differences were found in lifetime prevalence rates between migrant and U.S.-born Puerto Rican subjects.

CONCLUSIONS

Caution should be exercised in generalizing the immigrant paradox to all Latino groups and for all psychiatric disorders. Aggregating Latino subjects into a single group masks significant variability in lifetime risk of psychiatric disorders, with some subgroups, such as Puerto Rican subjects, suffering from psychiatric disorders at rates comparable to non-Latino white subjects. Our findings thus suggest that immigrants benefit from a protective context in their country of origin, possibly inoculating them against risk for substance disorders, particularly if they emigrated to the United States as adults.

Developmental Contexts and Mental Disorders Among Asian Americans

In this article, we use age of immigration as a proxy for the developmental context for understanding the association between immigration experiences and mental health. Generation defines the context under which immigrants arrive in the United States. We drew data from the National Latino and Asian American Study (N = 2,095), the first ever study conducted on the mental health of a national sample of Asian Americans. Our findings reveal that age of immigration is linked to lifetime and 12-month rates of psychiatric disorder: Immigrants who arrive earlier in life are more likely to have both lifetime and 12-month disorders. U.S. born and immigrants who arrive as children are much more likely to have a mental disorder in their lifetimes than other immigrant generations.

Looking Beyond Nativity: The Relation of Age of Immigration, Length of Residence, and Birth Cohorts to the Risk of Onset of Psychiatric Disorders for Latinos

Past studies yield inconsistent results regarding risk of psychopathology for U.S. Latinos by nativity possibly due to differences across immigrants in their age of arrival to the U.S., their length of residence in the U.S., or birth-cohort differences. This paper seeks to document the relation of age of arrival, time in the U.S., and cohort effects on the risk of onset of psychiatric disorders using a nationally representative sample of 2554 Latinos in the coterminous United States. Risk of onset of psychiatric disorders was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI, Kessler & Ustun, 2004). Findings indicate that Latino immigrants have lower risks of onset for some psychiatric disorders in their country of origin, but once in the U.S., Latino immigrants appear to experience similar risks of onset as U.S.-born Latinos of the same age. The longer Latino immigrants remain in their country of origin, the less cumulative risk of onset they experience, resulting in lower lifetime rates of disorders. These findings could potentially be due to variation in cultural and social norms and expectations across geographical contexts, differences in family structure and gender roles, as well as artifactual-level explanations.

Immigration and generational trends in body mass index and obesity in the United States: results of the National Latino and Asian American Survey, 2002-2003

OBJECTIVES

We examined patterns of body mass index (BMI) and obesity among a nationally representative sample of first-, second-, and third-generation Latinos and Asian Americans to reveal associations with nativity or country of origin.

METHODS

We used data from the National Latino and Asian American Survey (2002-2003) to generate nationally representative estimates of mean BMI and obesity prevalence and explored changes in the distribution of BMI by generational status. Analyses tested the association between generational status and BMI and examined whether this association varied by ethnicity, education, or gender.

RESULTS

We found substantial heterogeneity in BMI and obesity by country of origin and an increase in BMI in later generations among most subgroups. The data suggest different patterns for Latinos and Asian Americans in the nature and degree of distributional changes in BMI with generational status in the United States.

CONCLUSIONS

Generational status is associated with increased BMI and obesity among Latinos and Asian Americans. Aggregate estimates not accounting for nativity and country of origin may mask significant heterogeneity in the prevalence of obesity and patterns of distributional change, with implications for prevention strategies.

Prevalence and correlates of eating disorders in Latinos in the United States

OBJECTIVE

To present national estimates and correlates of lifetime and 12-month DSM-IV eating disorders for Latinos.

METHOD

Data come from the National Latino and Asian American Study (NLAAS), a national epidemiological household survey of Latinos in the United States.

RESULTS

Latinos have elevated rates of any binge eating and binge eating disorder but low prevalence of anorexia nervosa and bulimia nervosa. The US born and those living a greater percentage of their lifetime in the US evidenced higher risk for certain eating disorders while severe obesity and low levels of education were significant correlates. Rates of treatment utilization were exceedingly low.

CONCLUSION

Standard eating disorder criteria may not be appropriate for understanding psychological morbidity of eating disorders for Latinos, particularly less acculturated Latinos, due to cultural differences in the presentation of eating disorder symptoms. Criteria for disturbed eating patterns that are more reflective of the illness experience of Latinos should be developed.

Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults

Growing evidence suggests that lesbian, gay, and bisexual adults may be at elevated risk for mental health and substance use disorders, possibly due to anti-gay stigma. Little of this work has examined putative excess morbidity among ethnic/racial minorities resulting from the experience of multiple sources of discrimination. The authors report findings from the National Latino and Asian American Survey (NLAAS), a national household probability psychiatric survey of 4,488 Latino and Asian American adults. Approximately 4.8% of persons interviewed identified as lesbian, gay, bisexual, and/or reported recent same-gender sexual experiences. Although few sexual orientation-related differences were observed, among men, gay/bisexual men were more likely than heterosexual men to report a recent suicide attempt. Among women, lesbian/bisexual women were more likely than heterosexual women to evidence positive 1-year and lifetime histories of depressive disorders. These findings suggest a small elevation in psychiatric morbidity risk among Latino and Asian American individuals with a minority sexual orientation. However, the level of morbidity among sexual orientation minorities in the NLAAS appears similar to or lower than that observed in population-based studies of lesbian, gay, and bisexual adults.

Modified-Symbol Digit Modalities Test for African Americans, Caribbean Black Americans, and non-Latino Whites: nationally representative normative data from the National Survey of American Life

Normative neuropsychological data for U.S. racial/ethnic minorities are limited. Extant norms are based on small, regional groups that may not be nationally representative. The objectives of this study were to (1) provide norms for a modified Symbol Digit Modalities Test (M-SDMT) based on a nationally representative sample of African Americans, Caribbean Blacks, and non-Latino Whites (NLW) living in areas with large populations of Blacks; and (2) determine significant correlates of M-SDMT performance. The M-SDMT was administered to a subset of respondents from the National Survey of American Life in standard face-to-face interviews. M-SDMT performance was influenced by race/ethnicity, age, education, and gender. African Americans and NLW groups had similar M-SDMT performances, which differed from Caribbean Blacks. The Black ethnic differences in M-SDMT were not explained by the sociodemographic factors considered in this study. Unlike previous work, this study supports the consideration of Black ethnicity when evaluating Black neuropsychological test performance.

Understanding differences in past year psychiatric disorders for Latinos living in the US

This study seeks to identify risk factors for psychiatric disorders that may explain differences in nativity effects among adult Latinos in the USA. We evaluate whether factors related to the processes of acculturation and enculturation, immigration factors, family stressors and supports, contextual factors, and social status in the US account for differences in 12-month prevalence of psychiatric disorders for eight subgroups of Latinos. We report results that differentiate Latino respondents by country of origin and age at immigration (whether they were US-born or arrived before age 6: In-US-as-Child [IUSC]; or whether they arrived after age 6: later-arrival immigrants [LAI]). After age and gender adjustments, LAI Mexicans and IUSC Cubans reported a significantly lower prevalence of depressive disorders than IUSC Mexicans. Once we adjust for differences in family stressors, contextual factors and social status factors, these differences are no longer significant. The risk for anxiety disorders appears no different for LAI compared to IUSC Latinos, after age and gender adjustments. For substance use disorders, family factors do not offset the elevated risk of early exposure to neighborhood disadvantage, but coming to the US after age 25 does offset it. Family conflict and burden were consistently related to the risk of mood disorders. Our findings suggest that successful adaptation into the US is a multidimensional process that includes maintenance of family harmony, integration in advantageous US neighborhoods, and positive perceptions of social standing. Our results uncover that nativity may be a less important independent risk factor for current psychiatric morbidity than originally thought.

Self-rated health among foreign- and U.S.-born Asian Americans: a test of comparability

OBJECTIVES

We investigated differences between foreign- and U.S.-born Asian Americans in self-rating their physical and mental health. In particular, we tested whether the foreign-born respondents underreport the extreme categories of the scale as compared with U.S.-born respondents.

METHODS

We analyzed data from the National Latino and Asian American Study to examine whether immigrants are less likely to use the extreme ends of the 5-category self-rated health scales than their U.S.-born counterparts. We used propensity score matching to derive groups of U.S.- and foreign-born Asian Americans who share similar demographic and health characteristics. We defined propensity scores as predicted probabilities of being U.S. born, given individual background characteristics. The propensity score framework allowed us to make descriptive comparisons of self-rated health responses controlling for background characteristics. We used log-linear symmetry models to examine cross-tabulations of self-rated physical and mental health reports in matched pairs by the 2 (extreme and nonextreme) and 5 ("excellent," "very good," "good," "fair," and "poor") categories.

RESULTS

Controlling for background characteristics, we found no evidence that foreign-born Asian Americans are less likely to endorse extreme categories in self-rated physical or mental health than U.S.-born Asian Americans, as well as no evidence of imbalances in endorsement of any particular self-rated health category between the 2 groups.

CONCLUSIONS

Controlling for demographic and health characteristics, we find no systematic differences between foreign- and U.S.-born Asian Americans in reporting self-rated physical and mental health on the 5-category scales from "excellent" to "poor."

Smoking prevalence among asian americans: findings from the National Latino and Asian American Study (NLAAS)

OBJECTIVE

National studies suggest that the prevalence of current smoking among Asian Americans is lower than that for other racial/ethnic groups. However, these studies may have yielded inaccurate estimates because of the underrepresentation of non-English-speaking groups. Using data from the National Latino and Asian American Study (NLAAS), the authors estimated the prevalence of current and lifetime smoking among Asian Americans.

METHODS

Current and lifetime smoking status was assessed through a population-based survey administered to Asian American adults aged 18 and older.

RESULTS

An overall current smoking prevalence of 14.9% was found, with notable differences by gender, nativity, and other sociodemographic factors. The prevalence of current smoking was higher among foreign-born vs. U.S.-born men (24.9% vs. 15.6%), while U.S.-born women had a higher prevalence than foreign-born women (6.3% vs. 11.7%). Overall, 28.3% of Asian Americans were ever smokers (including current and former smokers), suggesting that approximately half of ever smokers cease smoking. Results indicated that some Asian American groups are more likely to initiate smoking and/or be more likely to continue smoking.

CONCLUSION

Results revealed that the prevalence of current smoking exceeds that of the general U.S. population for some Asian American groups and suggest that excluding non-English-speaking Asian Americans may underestimate the prevalence of smoking among men. Findings indicate that some Asian American groups are at greater risk for initiating smoking and/or continuing smoking, and highlight the need for tailored interventions that address differential smoking patterns by gender, nativity, and other social characteristics.

Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study

OBJECTIVES

We examined correlates and rates of past-year mental health service use in a national sample of Latinos residing in the United States.

METHODS

We used data from the National Latino and Asian American Study, a national epidemiological household survey of Latinos.

RESULTS

Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status were associated with whether or not Latinos had used mental health services. However, when the analysis was stratified according to past-year psychiatric diagnoses, these associations held only among those who did not fulfill criteria for any of the psychiatric disorders assessed. Rates of mental health service use among those who did not fulfill diagnostic criteria were higher among Puerto Ricans and US-born Latinos than among non-Puerto Ricans and foreign-born Latinos.

CONCLUSIONS

Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.

Design of the Coordinated Anxiety Learning and Management (CALM) study: innovations in collaborative care for anxiety disorders

BACKGROUND

Despite a marked increase in the number of persons seeking help for anxiety disorders, the care provided may not be evidence based, especially when delivered by nonspecialists. Since anxiety disorders are most often treated in primary care, quality improvement interventions, such as the Coordinated Anxiety Learning and Management (CALM) intervention, are needed in primary care.

RESEARCH DESIGN

This study is a randomized controlled trial of a collaborative care effectiveness intervention for anxiety disorders.

SUBJECTS

Approximately 1040 adult primary care patients with at least one of four anxiety disorders (generalized anxiety disorder, panic disorder, posttraumatic stress disorder or social anxiety disorder) will be recruited from four national sites.

INTERVENTION

Anxiety clinical specialists (ACSs) deliver education and behavioral activation to intervention patients and monitor their symptoms. Intervention patients choose cognitive-behavioral therapy, antianxiety medications or both in "stepped-care" treatment, which varies according to clinical needs. Control patients receive usual care from their primary care clinician. The innovations of CALM include the following: flexibility to treat any one of the four anxiety disorders, co-occurring depression, alcohol abuse or both; use of on-site clinicians to conduct initial assessments; and computer-assisted psychotherapy delivery.

EVALUATION

Anxiety symptoms, functioning, satisfaction with care and health care utilization are assessed at 6-month intervals for 18 months.

CONCLUSION

CALM was designed for clinical effectiveness and easy dissemination in a variety of primary care settings.

Use of mental health services and subjective satisfaction with treatment among Black Caribbean immigrants: results from the National Survey of American Life

OBJECTIVES

We examined the use rates and correlates of formal psychiatric services among the US-born and immigrant Caribbean Black population.

METHODS

We compared overall mental health service use in samples of Caribbean Blacks and African Americans and examined the within-sample ethnic variation among Caribbean Blacks, including for ethnic origin (Spanish Caribbean, Haiti, and English Caribbean), nativity status (those born in or outside the United States), number of years spent living in the United States, age at the time of immigration, and generational status.

RESULTS

African Americans and Caribbean Blacks used formal mental health care services at relatively low rates. Among Caribbean Blacks, generational status and nativity showed the greatest effects on rates of reported use, satisfaction, and perceived helpfulness. Of those study participants who met the criteria for disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, about one third used formal mental health care services. The US-born subjects were more likely to receive care than were first-generation immigrants.

CONCLUSIONS

Our study underscores the importance of ethnicity, immigration, and migration-related factors, within racial categorization, as it pertains to the use of mental health services in the United States. Our findings suggest that timing of migration and generational status of Caribbean Black immigrants and ancestry groups contribute to important differences in rates and sources of use, relative satisfaction, and perception of helpfulness, with regard to formal mental health services.

Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American Study

OBJECTIVES

We examined rates of mental health-related service use (i.e., any, general medical, and specialty mental health services) as well as subjective satisfaction with and perceived helpfulness of care in a national sample of Asian Americans, with a particular focus on immigration-related factors.

METHODS

Data were derived from the National Latino and Asian American Study (2002-2003).

RESULTS

About 8.6% of the total sample (n=2095) sought any mental health-related services; 34.1% of individuals who had a probable diagnosis sought any services. Rates of mental health-related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation. US-born Asian Americans demonstrated higher rates of service use than did their immigrant counterparts. Third-generation or later individuals who had a probable diagnosis had high (62.6%) rates of service use in the previous 12 months.

CONCLUSIONS

Asian Americans demonstrated lower rates of any type of mental health-related service use than did the general population, although there are important exceptions to this pattern according to nativity status and generation status. Our results underscore the importance of immigration-related factors in understanding service use among Asian Americans.

The mental health of Black Caribbean immigrants: results from the National Survey of American Life

OBJECTIVES

We examined the prevalence of psychiatric disorders among Black Caribbean immigrant ("Caribbean Black") and African American populations and the correlates of psychiatric disorders among the Caribbean Black population.

METHODS

We conducted descriptive and age-adjusted analyses of the data from the National Survey of American Life--an in-person household mental health survey of noninstitutionalized US Blacks. We assessed psychiatric disorders as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria with the Composite International Diagnostic Interview.

RESULTS

Compared with African American men, Caribbean Black men had higher risks for 12-month rates of psychiatric disorders. Caribbean Black women had lower odds for 12-month and lifetime psychiatric disorders compared with African American women. Risks varied by ethnicity, immigration history, and generation status within the Caribbean sample. First-generation Caribbean Blacks had lower rates of psychiatric disorders compared with second- or third-generation Caribbean Blacks, and, compared with first-generation Caribbean Blacks, third-generation Caribbean Blacks had markedly elevated rates of psychiatric disorders.

CONCLUSIONS

Mental health risks were associated with ethnic diversity within the US Black population. Increased exposure to minority status in the United States was associated with higher risks for psychiatric disorders among Black Caribbean immigrants, which possibly reflects increased societal stress and downward social mobility associated with being Black in America.

Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study

OBJECTIVES

We examined correlates and rates of past-year mental health service use in a national sample of Latinos residing in the United States.

METHODS

We used data from the National Latino and Asian American Study, a national epidemiological household survey of Latinos.

RESULTS

Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status were associated with whether or not Latinos had used mental health services. However, when the analysis was stratified according to past-year psychiatric diagnoses, these associations held only among those who did not fulfill criteria for any of the psychiatric disorders assessed. Rates of mental health service use among those who did not fulfill diagnostic criteria were higher among Puerto Ricans and US-born Latinos than among non-Puerto Ricans and foreign-born Latinos.

CONCLUSIONS

Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.

Prevalence of and risk factors for lifetime suicide attempts among blacks in the United States

CONTEXT

Lack of data on the lifetime prevalence and age at onset of suicide ideation, plans, and attempts among blacks in the United States limits the creation and evaluation of interventions to reduce suicide among black Americans.

OBJECTIVE

To examine the prevalence and correlates of suicide ideation, planning, and attempts across 2 ethnic classifications of blacks in a nationally representative sample.

DESIGN, SETTING, AND PARTICIPANTS

Data are from the National Survey of American Life, a national household probability sample of 5181 black respondents aged 18 years and older, conducted between February 2001 and June 2003, using a slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. Bivariate and survival analyses were used to delineate patterns and correlates of nonfatal suicidal behavior.

MAIN OUTCOME MEASURES

Self-reports of lifetime suicide ideation, planning, and attempts.

RESULTS

Survey respondents, categorized as African Americans and Caribbean Americans, reported lifetime prevalence of 11.7% for suicide ideation and 4.1% for attempts. Among the respondents who reported ideation, 34.6% transitioned to making a plan and only 21% made an unplanned attempt. Among 4 ethnic-sex groups, the 7.5% lifetime prevalence for attempts among Caribbean black men was the highest among black Americans. The greatest risk of progressing to suicide planning or attempt among ideators occurred within the first year after ideation onset. Blacks at higher risk for suicide attempts were in younger birth cohorts, less educated, Midwest residents, and had 1 or more Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders.

CONCLUSIONS

This study documents the burden of nonfatal suicidality among US blacks, notably Caribbean black men, and individuals making planned attempts. Advancing research on the transition from suicide planning to attempt is vital to the efficacy of health care professionals' ability to screen blacks at risk for suicide.

Evaluating Short-Form Versions of the CES-D for Measuring Depressive Symptoms Among Immigrants From Mexico

This article examines the feasibility of using a short-form version of the Center for Epidemiologic Studies-Depression Scale (CES-D) in community mental health research with Mexican immigrants. Several features of three published short versions of the CES-D were examined using data combined from seven diverse Mexican immigrant samples from across the United States (N = 685). Results indicate that published short-form versions of the CES-D are reliable, they account for most of the variance in scores from the full CES-D, and there is little evidence that the use of short forms attenuates associations with other concepts relevant to understanding the mental health of Mexican immigrants. Although additional validation research is necessary, the results of this study suggest that short-form versions of the CES-D can be used to study mental health among Mexican immigrants.

Health insurance coverage for vulnerable populations: contrasting Asian Americans and Latinos in the United States

This paper examines the role that population vulnerabilities play in insurance coverage for a representative sample of Latinos and Asians in the United States. Using data from the National Latino and Asian American Study (NLAAS), these analyses compare coverage differences among and within ethnic subgroups, across states and regions, among types of occupations, and among those with or without English language proficiency. Extensive differences exist in coverage between Latinos and Asians, with Latinos more likely to be uninsured. Potential explanations include the type of occupations available to Latinos and Asians, reforms in immigration laws, length of time in the United States, and regional differences in safety-net coverage. Policy implications are discussed.

Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES)

This paper provides an overview of the probability sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES): the National Comorbidity Survey Replication (NCS-R), the National Study of American Life (NSAL) and the National Latino and Asian American Study of Mental Health (NLAAS). The multi-stage sample design and respondent selection procedures used in these three studies are based on the University of Michigan Survey Research Center's National Sample designs and operations. The paper begins with a general overview of these designs and procedures and then turns to a more detailed discussion of the adaptation of these general methods to the three specific study designs. The detailed discussions of the individual study samples focus on design characteristics and outcomes that are important to analysts of the CPES data sets and to researchers and statisticians who are planning future studies. The paper describes how the expected survey cost and error structure for each of these surveys influenced the original design of the samples and how actual field experience led to changes and adaptations to arrive at the final samples of each survey population.

Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES)

This paper provides an overview of the probability sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES): the National Comorbidity Survey Replication (NCS-R), the National Study of American Life (NSAL) and the National Latino and Asian American Study of Mental Health (NLAAS). The multi-stage sample design and respondent selection procedures used in these three studies are based on the University of Michigan Survey Research Center's National Sample designs and operations. The paper begins with a general overview of these designs and procedures and then turns to a more detailed discussion of the adaptation of these general methods to the three specific study designs. The detailed discussions of the individual study samples focus on design characteristics and outcomes that are important to analysts of the CPES data sets and to researchers and statisticians who are planning future studies. The paper describes how the expected survey cost and error structure for each of these surveys influenced the original design of the samples and how actual field experience led to changes and adaptations to arrive at the final samples of each survey population.

The National Survey of American Life: a study of racial, ethnic and cultural influences on mental disorders and mental health

The objectives of the National Survey of American Life (NSAL) are to investigate the nature, severity, and impairment of mental disorders among national samples of the black and non-Hispanic white (n = 1,006) populations in the US. Special emphasis in the study is given to the nature of race and ethnicity within the black population by selecting and interviewing national samples of African-American (N = 3,570), and Afro-Caribbean (N = 1,623) immigrant and second and older generation populations. National multi-stage probability methods were used in generating the samples and race/ethnic matching of interviewers and respondents were used in the largely face-to-face interview, which lasted on average 2 hours and 20 minutes. The Diagnostic and Statistical Manual (DSM) IV World Mental Health Composite Interview (WHO-CIDI) was used to assess a wide range of serious mental disorders, potential risk and resilience factors, and help seeking and service use patterns. This paper provides an overview of the design of the NSAL, sample selection procedures, recruitment and training of the national interviewing team, and some of the special problems faced in interviewing ethnically and racially diverse national samples. Unique features of sample design, including special screening and listing procedures, interviewer training and supervision, and response rate outcomes are described.

Cultural relevance and equivalence in the NLAAS instrument: integrating etic and emic in the development of cross-cultural measures for a psychiatric epidemiology and services study of Latinos

This paper describes the development, translation and adaptation of measures in the National Latino and Asian American Study (NLAAS). We summarize the techniques used to attain cultural relevance; semantic, content and technical equivalency; and internal consistency of the measures across languages and Latino sub-ethnic groups. We also discuss some of the difficulties and thallenges encountered in doing this work. The following three main goals are addressed in this paper: (1) attaining cultural relevance by formulating the research problem with attention to the fundamental cultural and contextual differences of Latinos and Asians as compared to the mainstream population; (2) developing cultural equivalence in the standardized instruments to be used with these populations; and (3) assessing the generalizability of the measures - i.e., that the measures do not fluctuate according to culture or translation. We present details of the processes and steps used to achieve these three goals in developing measures for the Latino population. Additionally, the integration of both the etic and emic perspectives in the instrument adaptation model is presented.