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Richardson BT, Jackson J, Marable G, Barker J, Gardiner H, Igarabuza L, Leasy M, Matthews E, Zisman-Ilani Y. The Role of Black Churches in Promoting Mental Health for Communities of Socioeconomically Disadvantaged Black Americans. Psychiatr Serv 2024; 75:740-747. [PMID: 38595118 DOI: 10.1176/appi.ps.20230263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Churches in socioeconomically disadvantaged neighborhoods serve as safe havens in many Black communities. Churches provide faith and charitable services but often have limited resources to address the mental health needs of their communities. This article reports on a collaborative effort, driven by members of a Black church, to understand mental health needs, coping strategies, and resilience factors in a community of socioeconomically disadvantaged Black Americans. METHODS A community-based participatory research effort was established among a church, a community mental health organization, clinicians, and researchers to interview and survey individuals residing near the church. RESULTS The sample consisted of 59 adults, most of whom were ages 46-65 years, men (N=34, 58%), and unemployed (N=46, 78%). Mean scores on the Patient Health Questionnaire-9 (9.2±7.7) and Generalized Anxiety Disorder-7 scale (9.4±6.7) were almost three times higher than those reported by studies of other Black populations in the United States. Five themes emerged: prolonged poverty and daily exposure to violence trigger emotional distress, mental health stigma affects help seeking, spirituality promotes mental relief and personal recovery, spirituality helps in coping with poverty and unsafe neighborhoods, and church-based programs are needed. CONCLUSIONS Uptake of traditional mental health services was low, and reliance on faith and resource distribution by the church was high. Church-led interventions are needed to promote mental health at the individual and community levels. Mental health stigma, and negative attitudes toward mental health promotion in the community, may be addressed by integrating traditional mental health services in church-based recreational and leisure activities.
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Affiliation(s)
- Briana T Richardson
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Jacqueline Jackson
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Grace Marable
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Jessica Barker
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Heather Gardiner
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Laura Igarabuza
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Menachem Leasy
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Elizabeth Matthews
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Yaara Zisman-Ilani
- Office of Community-Engaged Research and Practice (Richardson, Barker, Gardiner) and Department of Social and Behavioral Sciences (Gardiner, Zisman-Ilani), College of Public Health, and the Lewis Katz School of Medicine (Igarabuza, Leasy), Temple University, Philadelphia; Bethel Presbyterian Church, Philadelphia (Jackson, Marable); Graduate School of Social Service, Fordham University, New York City (Matthews); Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
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Desai MU, Guy K, Brown M, Thompson D, Manning B, Johnson S, Davidson L, Bellamy C. "That Was a State of Depression by Itself Dealing with Society": Atmospheric racism, mental health, and the Black and African American faith community. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:104-117. [PMID: 37006193 PMCID: PMC10545810 DOI: 10.1002/ajcp.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 06/19/2023]
Abstract
Despite increased societal focus on structural racism, and its negative impact on health, empirical research within mental health remains limited relative to the magnitude of the problem. The current study-situated within a community-engaged project with members of a predominantly Black and African American church in the northeastern US-collaboratively examined depressive experience, recovery, and the role of racism and racialized structures. This co-designed study featured individual interviews (N = 11), a focus group (N = 14), and stakeholder engagement. A form of qualitative, phenomenological analysis that situates psychological phenomena within their social structural contexts was utilized. Though a main focal point of the study was depressive and significantly distressing experience, participant narratives directed us more towards a world that was structured to deplete and deprive-from basic neighborhood conditions, to police brutality, to workplace discrimination, to pervasive racist stereotypes, to differential treatment by health and social services. Racism was thus considered as atmospheric, in the sense of permeating life itself-with social, affective, embodied, and temporal dimensions, alongside practical (e.g., livelihood, vocation, and care) and spatial (e.g., neighborhood, community, and work) ones. The major thematic subsections-world, body, time, community, and space-reflect this fundamental saturation of racism within lived reality. There are two, interrelated senses of structural racism implicated here: the structures of the world and their impact on the structural dimensions of life. This study on the atmospheric nature of racism provides a community-centered complement to existing literature on structural racism and health that often proceed from higher, more population level scales. This combined literature suggests placing ever-renewed emphasis on addressing the causes and conditions that make this kind of distorted world possible in the first place.
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Affiliation(s)
- Miraj U Desai
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly Guy
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mychal Brown
- Beulah Heights First Pentecostal Church, New Haven, Connecticut, USA
| | - Denisha Thompson
- Beulah Heights First Pentecostal Church, New Haven, Connecticut, USA
| | - Bobby Manning
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Spencer Johnson
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Larry Davidson
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chyrell Bellamy
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
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Young AS, Findling RL, Riehm KE, Seegan P, Crum RM, Mojtabai R, Chiappini EA, Youngstrom EA, Fristad MA, Arnold LE, Birmaher B, Horwitz SM. Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics. Psychiatr Serv 2023; 74:1218-1226. [PMID: 37287230 PMCID: PMC10983772 DOI: 10.1176/appi.ps.20220375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics. METHODS Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child's psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children's psychotropic medication treatment. RESULTS Black children (compared with White children; OR=1.84, 95% CI=1.53-2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08-2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor's degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61-0.89) were less likely to receive inadequate pharmacotherapy. CONCLUSIONS The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.
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Affiliation(s)
- Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Kira E Riehm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Paige Seegan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Rosa M Crum
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Erika A Chiappini
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Eric A Youngstrom
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Boris Birmaher
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Sarah M Horwitz
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
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Hankerson SH, Moise N, Wilson D, Waller BY, Arnold KT, Duarte C, Lugo-Candelas C, Weissman MM, Wainberg M, Yehuda R, Shim R. The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression. Am J Psychiatry 2022; 179:434-440. [PMID: 35599541 PMCID: PMC9373857 DOI: 10.1176/appi.ajp.21101000] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.
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Affiliation(s)
- Sidney H. Hankerson
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, Department of Population Health Sciences & Policy, 1425 Madison Avenue, New York, NY 10029
| | - Nathalie Moise
- Columbia University Irving Medical Center, Department of Medicine, 622 West 168 Street, PH 9, New York, NY 10032
| | - Diane Wilson
- Icahn School of Medicine at Mount Sinai, New York; Department of Medicine Columbia University Irving Medical Center, New York; City University of New York
| | - Bernadine Y. Waller
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Kimberly T. Arnold
- University of Pennsylvania Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania Center for Public Health Initiatives, University of Pennsylvania Leonard Davis Institute of Health Economics, Penn Presbyterian Medical Center, Andrew Mutch Building, Floor 6, 51 N. 39th Street, Philadelphia, PA 19104
| | - Cristiane Duarte
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Claudia Lugo-Candelas
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Myrna M Weissman
- Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 24, New York, New York 10032
| | - Milton Wainberg
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, The Bronx James J. Peters VA Medical Center, 1 Gustave L. Levy Pl, New York, NY 10029
| | - Ruth Shim
- University of California at Davis, Department of Psychiatry
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Leung LB, Chu K, Rose D, Stockdale S, Post EP, Wells KB, Rubenstein LV. Electronic Population-Based Depression Detection and Management Through Universal Screening in the Veterans Health Administration. JAMA Netw Open 2022; 5:e221875. [PMID: 35267029 PMCID: PMC8914576 DOI: 10.1001/jamanetworkopen.2022.1875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In 2016, the US Preventive Services Task Force newly recommended universal screening for depression, with the expectation that screening would be associated with appropriate treatment. Few studies have been able to assess the population-based trajectory from screening to receipt of follow-up and treatment for individuals with depression. OBJECTIVE To examine adherence to guidelines for follow-up and treatment among primary care patients who newly screened positive for depression in the Veterans Health Administration (VA). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used VA electronic data to identify patients who newly screened positive for depression on the 2-item Patient Health Questionnaire at 82 primary care VA clinics in California, Arizona, and New Mexico between October 1, 2015, and September 30, 2019. Data analysis was performed from December 2020 to August 2021. MAIN OUTCOMES AND MEASURES Receipt of guideline-concordant care for screen-positive patients who were determined by clinicians as having depression was assessed. Timely follow-up (within 84 days of screening) was defined as receiving 3 or more mental health specialty visits, 3 or more psychotherapy visits, or 3 or more primary care visits with a depression diagnosis according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Completing at least minimal treatment (within 12 months) was defined as having 60 days or more of antidepressant prescriptions filled, 4 or more mental health specialty visits, or 3 or more psychotherapy visits. RESULTS The final cohort included 607 730 veterans (mean [SD] age, 59.4 [18.2] years; 546 516 men [89.9%]; 339 811 non-Hispanic White [55.9%]); 8%, or 82 998 of 997 185 person-years, newly screened positive for depression. Clinicians identified fewer than half with depression (15 155 patients), of whom 32% (5034 of 15 650 person-years) met treatment guidelines for timely follow-up and 77% (12 026 of 15 650 person-years) completed at least minimal treatment. Younger age (odds ratio, 0.990; 95% CI, 0.986-0.993; P < .001), Black race (odds ratio, 1.19; 95% CI, CI 1.05-1.34; P = .01), and having comorbid psychiatric diagnoses were significantly associated with timely follow-up. Individual quality metric components (eg, medication or psychotherapy) were associated differently with overall quality results among patient groups, except for age. CONCLUSIONS AND RELEVANCE In this cohort study, most patients met the guidelines for completing at least minimal treatment, but only a minority received timely follow-up after screening positive and being identified as having depression. More research is needed to understand whether the discrepancy between patients who screened positive and patients identified as having depression reflects a gap in recognition of needed care.
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Affiliation(s)
- Lucinda B. Leung
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Susan Stockdale
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Edward P. Post
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - Kenneth B. Wells
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Lisa V. Rubenstein
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California
- RAND Corporation, Santa Monica, California
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Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211049482. [PMID: 37089985 PMCID: PMC9978668 DOI: 10.1177/26334895211049482] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - April Oh
- Division of Cancer Control and Population Sciences, Implementation Science Team, National Cancer Institute, Rockville, USA
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Derek M. Griffith
- Georgetown University, Racial Justice Institute, Washington, USA
- Georgetown University, Center for Men’s Health Equity, Washington, USA
- Department of Health Systems Administration at the School of Nursing & Health Studies, Georgetown University, Washington, USA
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