Obsessive-compulsive disorder among African Americans and blacks of Caribbean descent: results from the National Survey of American Life

A pilot study of experiencing racial microaggressions, obsessive-compulsive symptoms, and the role of psychological flexibility

BACKGROUND

Experiencing racial microaggressions has clear effects on physical and psychological health, including obsessive-compulsive disorder symptoms (OCS). More research is needed to examine this link. Psychological flexibility is an important process to examine in this work.

AIMS

This study aimed to examine if, while controlling for depression and anxiety, experiences of microaggressions and psychological flexibility helped explain OCD symptoms within a university-affiliated sample (undergraduate, graduate and law students). This was a pilot exploration of the relationships across themes.

METHOD

Initial baseline data from a longitudinal study of psychological flexibility, OCD symptoms, depression, anxiety and experience of microaggressions was utilized. Correlations and regressions were utilized to examine which OCD symptom dimensions were associated with experiencing racial microaggressions in addition to anxiety and depression, and the added role of psychological flexibility was examined.

RESULTS

OCD symptoms, experiences of microaggressions and psychological flexibility were correlated. Experiences of racial microaggressions explained responsibility for harm and contamination OCD symptoms above and beyond psychological distress. Exploratory results support the relevance of psychological flexibility.

CONCLUSION

Results support other work that experiences of racial microaggressions help explain OCS and they add some support for psychological flexibility as a relevant risk or protective factor for mental health in marginalized populations. These topics should be studied longitudinally with continued consideration of all OCD themes, larger sample sizes, intersecting identities, clinical samples, and continued exploration of psychological flexibility and mindfulness and values-based treatments.

Black Nativity and Health Disparities: A Research Paradigm for Understanding the Social Determinants of Health

After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.

Lifetime Trauma Exposure and Posttraumatic Stress Disorder Among African Americans and Black Caribbeans by Sex and Ethnicity

OBJECTIVE

Posttraumatic stress disorder (PTSD) is a debilitating disorder requiring timely diagnosis and treatment, with special attention needed for Black populations in the U.S. Yet, stakeholders often fail to recognize Black communities' heterogeneous ethnic composition, thus not allowing diverse sociocultural realities to inform PTSD interventions. This study aims to characterize sex and ethnic differences in lifetime trauma exposure, lifetime PTSD diagnosis and symptoms, and help-seeking among the African Americans and Black Caribbeans in the U.S.

METHOD

This study relied on data from the National Survey of American Life 2001-2003 (NSAL) to investigate the lifetime exposure to traumatic events and prevalence of a clinical PTSD diagnosis based on the DSM-IV among African American (n = 3,570) and Black Caribbean (n = 1,623) adults. 44.5% of respondents were men and 55.5% were women. Logistic regression was utilized to investigate the impact of traumatic events on PTSD.

RESULTS

Several ethnic and sex differences in exposure to potentially traumatic events were identified. African American respondents were more likely to experience spousal abuse and toxin exposure than their Black Caribbean counterparts. Black Caribbeans reported higher lifetime exposure to muggings, natural disasters, harsh parental discipline, being a civilian living in terror and/or being a refugee than African American respondents. Specific to sex, Black men reported more events of combat, a peacekeeper/relief worker, being mugged, toxin exposure, seeing atrocities, and/or injuring someone. Black women were more likely to have been rape/sexual assault and/or intimate partner violence victims. The assaultive violence trauma type was most predictive of lifetime PTSD diagnosis among Black Americans. African American women were more likely to report PTSD symptoms than men, with almost no significant differences in Black Caribbean men and women. Approximately half of Black Americans sought help for their worst traumatic event, commonly engaging family/friends, psychiatrists, and mental health professionals. Further, there were almost no ethnic and sex differences related to professional and non-professional help sought.

CONCLUSION

Future PTSD-related research should aim to characterize the heterogenous experiences of potentially traumatic events within different Black communities. Clinicians working with Black clients should strive to understand the limitations within their tools/interventions in meeting the needs of diverse groups.

Cultural competency in the treatment of obsessive-compulsive disorder: practitioner guidelines

This article provides clinical guidelines for basic knowledge and skills essential for successful work with clients who have obsessive-compulsive disorder (OCD) across ethnic, racial and religious differences. We emphasise multiculturalist and anti-racist approaches and the role of culture in shaping the presentation of OCD in clients. Several competencies are discussed to help clinicians differentiate between behaviour that is consistent with group norms versus behaviour that is excessive and psychopathological in nature. Symptom presentation, mental health literacy and explanatory models may differ across cultural groups. The article also highlights the possibility of violating client beliefs and values during cognitive behavioural therapy (CBT), and subsequently offers strategies to mitigate such problems, such as consulting community members, clergy, religious scholars and other authoritative sources. Finally, there is a discussion of how clinicians can help clients from diverse populations overcome a variety of obstacles and challenges faced in the therapeutic context, including stigma and cultural mistrust.

Key learning aims

(1)

Correlates of Obsessive-Compulsive Symptoms Among Black Caribbean Americans

Despite the rapid growth of the Black Caribbean population in the United States, we know little about the presentation and prevalence of obsessive-compulsive disorder (OCD) among these groups. This study examines the demographic correlates and the effect of racial discrimination on OCD symptoms among a nationally-representative sample of Black Caribbean and African American adults (n = 5,191). Drawing on the Composite International Diagnostic Interview Short Form (CIDI-SF) for OCD, we examine two types of obsessions (harm and contamination) and four types of compulsions (repeating, washing, ordering, and counting). There we no significant differences between Black Caribbeans and African Americans in obsessions and compulsions. Analysis among Black Caribbeans found that compared with Jamaican and Trinidadian Americans, Haitian American individuals reported the fewest number of obsessions and compulsions. We show that Black Caribbean Americans with lower income, lower self-rated physical and mental health, and more experiences with racial discrimination report higher levels of OCD. More specifically, racial discrimination was associated with contamination and harm obsessions, as well as washing and repeating compulsions. Our findings highlight the need to consider specific domains of OCD relative to Black Caribbeans, and the relationship between social and demographic variables on symptomology.

Perceived Stress in Relation to Obsessions and Compulsions in South Asian Adults: Moderating Role of Socio-demographic Characteristics

This study examines perceived stress associated with obsessions and compulsions (OC) in a normative sample of adults. The aim was to discover whether socio-demographic characteristics (i.e., gender, marital status, employment status, age and education) had a moderating effect on perceived stress and OC symptoms. The participants were 362 Pakistani adults (M age = 26.82 years, SD = 4.75; males = 188, females = 174) and the findings were based on a demographic questionnaire, the perceived stress scale (Cohen et al., in Applied multiple correlation/regression analysis for the behavioral sciences, Taylor & Francis, London, 1983), and the Padua inventory of obsessive compulsion disorder symptoms (Burns et al., in Behav Res Ther, 34(2), 163-173, 1996). A series of stepwise regression analyses showed that socio-demographic characteristics (employment status, age, and education) significantly moderated the relationship between perceived stress and OC symptoms. The current findings have implications for clinicians and researchers in generating effective stress management programs and learning mechanism for managing OC symptoms, particularly in the context of socio-demographic characteristics.

Psychiatric Disorders Among Older Black Americans: Within- and Between-Group Differences

Psychiatric disorders impose significant personal, social, and financial costs for individuals, families, and the nation. Despite a large amount of research and several journals focused on psychiatric conditions, there is a paucity of research on psychiatric disorders among Black Americans (i.e., African Americans and Black Caribbeans), particularly older Black Americans. The present literature review examines research on psychiatric disorders among older Black Americans and provides a broad overview of research findings that are based on nationally representative studies. Collectively, this research finds: (1) older African Americans have lower rates of psychiatric disorders than younger African Americans; (2) family support is not protective of psychiatric disorders, whereas negative interaction with family members is a risk factor; (3) everyday discrimination is a risk factor for psychiatric disorders; (4) both older African Americans and African American across the adult age range have lower prevalence rates of psychiatric disorders than non-Latino whites; (5) Black Caribbean men have particularly high rates of depression, posttraumatic stress disorder, and suicide attempts; and (6) a significant proportion of African American older adults with mental health disorders do not receive professional help. This literature review also discusses the “Race Paradox” in mental health, the Environmental Affordances Model, and the importance of investigating ethnicity differences among Black Americans. Future research directions address issues that are directly relevant to the Black American population and include the following: (1) understanding the impact of mass incarceration on the psychiatric disorders of prisoners’ family members, (2) assessing the impact of immigration from African countries for ethnic diversity within the Black American population, (3) examining the impact of racial identity and racial socialization as potential protective factors for psychiatric morbidities, and (4) assessing racial diversity in life-course events and their impact on mental health.

Public Recognition and Perceptions of Obsessive Compulsive Disorder

Previous research has indicated that the public's knowledge on obsessive compulsive disorder (OCD) is poor. Public understanding and perception of OCD may be one contributor to this issue. Given that mental health literacy is an important first step for those to receive the appropriate care, we sought to understand more about the public's awareness and perceptions of OCD. Data regarding knowledge of OCD were collected through a New York statewide telephone survey (N = 806). Results indicated that those who had never heard of OCD were more likely to be ethnic minorities, have a lower income, and less education. Most participants described OCD either in terms of compulsions or in terms of perfectionism. Almost half (46.5%) of participants did not think there is a difference between someone with OCD and someone who is obsessive-compulsive. These findings are consistent with previous literature regarding race and treatment seeking behaviors.

Association of Obsessive-Compulsive Disorder With Objective Indicators of Educational Attainment: A Nationwide Register-Based Sibling Control Study

Importance

To our knowledge, the association of obsessive-compulsive disorder (OCD) and academic performance has not been objectively quantified.

Objective

To investigate the association of OCD with objectively measured educational outcomes in a nationwide cohort, adjusting for covariates and unmeasured factors shared between siblings.

Design, Setting, And Participants

This population-based birth cohort study included 2 115 554 individuals who were born in Sweden between January 1, 1976, and December 31, 1998, and followed up through December 31, 2013. Using the Swedish National Patient Register and previously validated International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, we identified persons with OCD; within the cohort, we identified 726 198 families with 2 or more full siblings, and identified 11 482 families with full siblings discordant for OCD. Data analyses were conducted from October 1, 2016, to September 25, 2017.

Main Outcomes and Measures

The study evaluates the following educational milestones: eligibility to access upper secondary school after compulsory education, finishing upper secondary school, starting a university degree, finishing a university degree, and finishing postgraduate education.

Results

Of the 2 115 554 individuals in the cohort, 15 120 were diagnosed with OCD (59% females). Compared with unexposed individuals, those with OCD were significantly less likely to pass all core and additional courses at the end of compulsory school (adjusted odds ratio [aOR] range, 0.35-0.60) and to access a vocational or academic program in upper secondary education (aOR, 0.47; 95% CI, 0.45-0.50 and aOR, 0.61; 95% CI, 0.58-0.63, for vocational and academic programs, respectively). People with OCD were also less likely to finish upper secondary education (aOR, 0.43; 95% CI, 0.41-0.44), start a university degree (aOR, 0.72; 95% CI, 0.69-0.75), finish a university degree (aOR, 0.59; 95% CI, 0.56-0.62), and finish postgraduate education (aOR, 0.52; 95% CI, 0.36-0.77). The results were similar in the sibling comparison models. Individuals diagnosed with OCD before age 18 years showed worse educational attainment across all educational levels compared with those diagnosed at or after age 18 years. Exclusion of patients with comorbid neuropsychiatric disorders, psychotic, anxiety, mood, substance use, and other psychiatric disorders resulted in attenuated estimates, but patients with OCD were still impaired across all educational outcomes.

Conclusions and Relevance

Obsessive-compulsive disorder, particularly when it has an early onset, is associated with a pervasive and profound decrease in educational attainment, spanning from compulsory school to postgraduate education.

Discrimination and symptoms of obsessive-compulsive disorder among African Americans

This study examined symptoms of obsessive-compulsive disorder (OCD) in a nationally representative sample of African American adults (n = 3,570) and correlations between OCD symptom dimensions and experiences of discrimination. Two categories of discrimination were examined, everyday racial discrimination and everyday nonracial discrimination (e.g., because of gender, age, and weight), to determine if racial discrimination had a unique impact on OCD symptoms. Results indicated that everyday racial discrimination was related to both categories of obsessions and all 4 categories of compulsions. Everyday nonracial discrimination, however, was not related to any of the categories of obsessions or compulsions. This indicates that racial discrimination is uniquely related to obsessions and compulsions for African Americans. The implications of these findings are discussed. (PsycINFO Database Record

Demographic and health-related correlates of obsessive-compulsive symptoms among African Americans

This study examined the correlates of the symptoms of obsessive-compulsive disorder (OCD) among a nationally-representative sample of African American adults (n = 3,570). Demographic and several self-rated health variables were examined. Although only 1.6% of the sample met DSM-IV diagnostic criteria for OCD, a sizeable proportion of the sample reported compulsions (12.5%) and obsessions (15.3%). Material hardship was positively associated with nearly all measured symptoms of OCD and fewer years of educational attainment was related to greater compulsive symptoms. Self-rated mental health was related to both compulsions and obsessions, and self-rated physical health was associated with counting and repeating compulsions. Implications and areas for further research with African Americans are discussed, including improving access to care for those most in need of services.

Ethnic Identity and Regional Differences in Mental Health in a National Sample of African American Young Adults

Prior research has found that a strong positive ethnic identity is a protective factor against anxiety and depression in African Americans. In this study, ethnic identity is examined in a geographically representative sample of African American young adults (n = 242), using the Multigroup Ethnic Identity Measure (MEIM) (Phinney in J Adolescent Res 7:156-76, 15). The two-factor structure of the measure (Roberts et al. in J Early Adolescence 19:301-22, 1) was analyzed using a structural equation model and displayed an acceptable fit only when multiple error terms were correlated. A multigroup confirmatory factor analysis revealed measurement equivalence of the two-factor structure between African Americans from Southern and non-Southern regions of the USA. We found that significantly higher levels of ethnic identity were present among African American in the South compared to other regions, and region significantly predicted total ethnic identity scores in a linear regression, even when controlling for gender, age, urbanicity, and years of education. Furthermore, among African Americans, living in the South was significantly correlated with less help-seeking for diagnosed depression, anxiety, and/or obsessive-compulsive disorder, where help-seeking was defined as obtaining a diagnosis by a professional. The role of ethnic identity and social support are discussed in the context of African American mental health.

Obsessive-compulsive symptoms and negative affect during tobacco withdrawal in a non-clinical sample of African American smokers

The association between obsessive-compulsive (OC) symptomatology and smoking is poorly understood, particularly in African Americans-a group subject to smoking- and OC-related health disparities. In a non-clinical sample of 253 African American smokers, we tested the negative reinforcement model of OC-smoking comorbidity, purporting that smokers with higher OC symptoms experience greater negative affect (NA) and urge to smoke for NA suppression upon acute tobacco abstinence. Following a baseline visit involving OC assessment, participants completed two counterbalanced experimental visits (non-abstinent vs. 16-h tobacco abstinence) involving affect, smoking urge, and nicotine withdrawal assessment. OC symptom severity predicted larger abstinence-provoked increases in overall NA, anger, anxiety, depression, fatigue, urge to smoke to suppress NA, and composite nicotine withdrawal symptom index. African American smokers with elevated OC symptoms appear to be vulnerable to negative reinforcement-mediated smoking motivation and may benefit from cessation treatments that diminish NA or the urge to quell NA via smoking.

Psychiatric Comorbidity and Hoarding Symptoms in African Americans With Obsessive-Compulsive Disorder

This study investigated comorbidity and hoarding symptoms in a sample of African American adults with obsessive-compulsive disorder ( N = 75). For lifetime disorders, 87.9% of participants had at least one other comorbid condition. The most prevalent comorbidities were mood disorders (67.1%), anxiety disorders (51.4%), and substance abuse disorders (38.0%). There was low comorbidity with eating disorders, as only 4.1% had binge-eating disorder and none met criteria for anorexia or bulimia nervosa. In terms of gender differences, females were more likely to have posttraumatic stress disorder and males were more likely to have a comorbid alcohol use disorder. Over half of the participants had hoarding compulsions (56.0%) as indicated by the Yale-Brown Obsessive-Compulsive Scale. Individuals with hoarding compulsions were more likely to have comorbid anxiety-related disorders than those without, and experienced greater indecisiveness, pathological slowness, and doubting; they also had less education and earning power than those without these behaviors. African Americans with obsessive-compulsive disorder tend to have high rates of comorbid disorders, with patterns that resemble findings in non-Hispanic White populations.

Illness perception, help-seeking attitudes, and knowledge related to obsessive-compulsive disorder across different ethnic groups: a community survey

PURPOSE

Despite similar prevalence rates across ethnicities, ethnic minorities with obsessive-compulsive disorder (OCD) are under-represented in research and clinical settings. The reasons for this disproportion have been sparsely studied. We explored potential differences in illness perception, help-seeking attitudes, illness knowledge, and causal attributions that could help explain the lower uptake of treatment for OCD amongst ethnic minorities.

METHODS

Two-hundred and ninety-three parents (139 White British, 61 Black African, 46 Black Caribbean, and 47 Indian) were recruited from the general population in South-East London, UK. Using a text vignette methodology, participants completed a survey including questions on illness perception, help-seeking attitudes, OCD knowledge, and causal attributions.

RESULTS

The groups did not differ in socio-demographic characteristics and family history of OCD. White British parents perceived that the OCD difficulties would have more negative impact on their children and that treatment would be more helpful, compared to the ethnic minorities; the largest differences were observed between White British and Indian parents. Ethnic minorities were more prone to say that would seek help from their religious communities. Black African parents were more in favor of not seeking help for the described difficulties and, in general, perceived more treatment barriers. White British parents seemed to be better informed about OCD than ethnic minority parents.

CONCLUSIONS

The results offer some plausible explanations for the large inequalities in access to services amongst ethnic minorities with OCD. Clinicians and policy-makers need to be aware of these socio-cultural factors when designing strategies to encourage help-seeking behaviors in these populations.

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive-compulsive disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) has similar prevalence rates across ethnic groups. However, ethnic minorities are underrepresented in clinical trials of OCD. It is unclear whether this is also the case in clinical services.

AIMS

To explore whether ethnic minorities with OCD are underrepresented in secondary and tertiary mental health services in the South London and Maudsley (SLaM) NHS Foundation Trust.

METHOD

The ethnic distribution of patients with OCD seen between 1999 and 2013 in SLaM (n = 1528) was compared with that of the general population in the catchment area using census data. A cohort of patients with depression (n = 22 716) was used for comparative purposes.

RESULTS

Ethnic minorities with OCD were severely underrepresented across services (-57%, 95% CI -62% to -52%). The magnitude of the observed inequalities was significantly more pronounced than in depression (-29%, 95% CI -31% to -27%).

CONCLUSIONS

There is a clear need to understand the reasons behind such ethnic inequalities and implement measures to reduce them.

Race/Ethnicity and Treatment Outcome in a Randomized Controlled Trial for Trichotillomania (Hair-Pulling Disorder)

OBJECTIVE

Treatment outcome was compared among non-Hispanic White and racial/ethnic minority participants with trichotillomania (TTM), or hair-pulling disorder.

METHOD

Symptom severity, quality of life, and TTM-related disability were compared in a behavior therapy trial with a stepped care approach: web-based self-help and then individual behavior therapy. The sample comprised 72% (n = 38) non-Hispanic White participants and 28% (n = 15) minority participants.

RESULTS

The ethnic groups responded differently to treatment, with fewer minority participants showing improvement during web-based self-help. Response rates were equivalent between ethnic groups during the in-person behavior therapy. These results should be interpreted with caution because of the small sample size of minorities in the study and consequent inability to analyze results for each racial/ethnic group individually.

CONCLUSIONS

Future studies should focus on the investigation of factors that may enable or hinder racial and ethnic minority participants to benefit from online and/or self-help behavior therapy for TTM.

Prevalence, incidence, and comorbidity of clinically diagnosed obsessive-compulsive disorder in Taiwan: a national population-based study

Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder significant in intrusive thoughts and compensation repetitive behaviors. Few studies have reported on this condition Asia. This study estimated the prevalence, incidence and psychiatric comorbidities of OCD in Taiwan. We identified study subjects for 2000-2008 with a principal diagnosis of OCD according to the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic criteria by using National Health Research Institute database. These patients received either outpatient or inpatient care for their condition. Rates were directly age- and sex-adjusted to the 2004 Taiwan population distribution. The estimated mean annual incidence was 27.57 per 10(5) inhabitants and the one year prevalence was 65.05 per 10(5) inhabitants. Incidence and prevalence increased with age, peaking at age 18-24 years in males and at 35-44 years in females. About 53% of adults (≥18 years) and 48% of child and adolescent patients (6-17 years) had one or more comorbid psychiatric conditions. The most common comorbid diagnosis was depressive disorders for both adult and child-adolescent patients. We found a lower prevalence and incidence of clinically diagnosed OCD than that of community studies. Many Asian patients with OCD also had various psychiatric comorbidities, a clinically relevant finding.

Treatment of obsessive-compulsive disorder in a nationwide survey of office-based physician practice

OBJECTIVE

This study examined treatment of obsessive-compulsive disorder (OCD) in office-based practice.

METHODS

Data from the 2003– 2010 National Ambulatory Medical Care Survey, a nationally representative survey of visits to U.S. office-based physicians, were used to examine outpatient visits involving treatment of adults with OCD.

RESULTS

Among the 316 visits with a diagnosis of OCD, most were to a physician seen previously by the patient (96%), usually a psychiatrist (86%), and most patients (56%) had seen the physician at least six times in the previous year. Most visits included psychotropic medications (84%), most commonly a serotonin reuptake inhibitor (SRI) (69%). Visits less commonly included psychotherapy (39%).

CONCLUSIONS

OCD was predominantly treated by psychiatrists using SRIs, despite the prevalence of OCD in primary care and SRI prescribing practices in that setting. Given the potential shift in OCD treatment patterns after health care reform, research on OCD treatment in primary care is warranted.

Validation of the Yale-Brown Obsessive-Compulsive Severity Scale in African Americans with obsessive-compulsive disorder

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is widely used in the assessment of obsessive-compulsive disorder (OCD), but the psychometric properties of the instrument have not been examined in African Americans with OCD. Therefore, the purpose of this study is to explore the properties of the Y-BOCS severity scale in this population. Participants were 75 African American adults with a lifetime diagnosis of OCD. They completed the Y-BOCS, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II), and the Multigroup Ethnic Identity Measure (MEIM). Evaluators rated OCD severity using the Clinical Global Impression Scale (CGI) and their global assessment of functioning (GAF). The Y-BOCS was significantly correlated with both the CGI and GAF, indicating convergent validity. It also demonstrated good internal consistency (α=0.83) and divergent validity when compared to the BAI and BDI-II. Confirmatory factor analyses tested five previously reported models and supported a three-factor solution, although no model exhibited excellent fit. An exploratory factor analysis was conducted, supporting a three-factor solution. A linear regression was conducted, predicting CGI from the three factors of the Y-BOCS and the MEIM, and the model was significant. The Y-BOCS appears to be a valid measure for African American populations.

Panic disorder among African Americans, Caribbean blacks and non-Hispanic whites

INTRODUCTION

This study investigated co-morbidities, level of disability, service utilization and demographic correlates of panic disorder (PD) among African Americans, Caribbean blacks and non-Hispanic white Americans.

METHODS

Data are from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R).

RESULTS

Non-Hispanic whites are the most likely to develop PD across the lifespan compared to the black subgroups. Caribbean blacks were found to experience higher levels of functional impairment. There were no gender differences found in prevalence of PD in Caribbean blacks, indicating that existing knowledge about who is at risk for developing PD (generally more prevalent in women) may not be true among this subpopulation. Furthermore, Caribbean blacks with PD were least likely to use mental health services compared to African Americans and non-Hispanic whites.

CONCLUSION

This study demonstrates that PD may affect black ethnic subgroups differently, which has important implications for understanding the nature and etiology of the disorder.

Obsessive-compulsive disorder: Evidence-based treatments and future directions for research

Over the past three decades, obsessive-compulsive disorder (OCD) has moved from an almost untreatable, life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments (which appears to be only a portion of the overall population) are not effectively treated. Suggestions for future avenues of research are also presented. These are primarily focused on (1) increased dissemination of effective therapies; (2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and (3) the impact of comorbid disorders on treatment outcome.

The epidemiology of obsessive--compulsive disorder in Spanish school children

We aimed to assess the prevalence (at three levels of severity) and other epidemiological data of OCD in a sample of 1,514 Spanish non-referred children. The estimated prevalence was 1.8% for OCD, 5.5% for subclinical OCD and 4.7% for OC symptomatology. We did not find significant differences between genders or academic grade regarding OC symptoms and OCD, but more subclinical prevalence was found in males than in females. Socio-demographic variables were not related to any level of OCD, but academic performance was significantly lower in clinical OCD. The co-morbidity between OCD and any psychiatric disorder was high (85%) and higher for emotional disorders than for behavioral disorders. The impairment was associated with comorbidity and was worse for OCD with comorbid emotional problems. The results suggest that OCD is not rare in school children and adolescents and that it has an impact on their personal functioning. We suggest the possibility of an early diagnosis and treatment.

Barriers to treatment among African Americans with obsessive-compulsive disorder

African Americans are underrepresented in OCD treatment centers and less likely to experience a remission of symptoms. This study examines the barriers that prevent African Americans with OCD from receiving treatment. Seventy-one adult African Americans with OCD were recruited and administered the modified Barriers to Treatment Participation Scale (BTPS) and the Barriers to Treatment Questionnaire (BTQ). Comparing the BTQ between a European American Internet sample (N=108) and the African American OCD sample (N=71) revealed barriers unique to African Americans, including not knowing where to find help and concerns about discrimination. A Mokken Scale Analysis of the BTPS in the African American participants identified seven major barriers, including the cost of treatment, stigma, fears of therapy, believing that the clinician will be unable to help, feeling no need for treatment, and treatment logistics (being too busy or treatment being too inconvenient). Pearson and point-biserial correlations of the scales and demographic and psychological variables were conducted. Significant relationships emerged between age, gender, income, education, insurance status, and ethnic affirmation/belonging among several of the Mokken scales. A one-way ANOVA demonstrated that concerns about cost were significantly greater for those without insurance, versus those with public or private plans. Suggestions for overcoming barriers are presented, including community education, affordable treatment options, and increasing cultural competence among mental health providers.

Treating ethnic minority adults with anxiety disorders: current status and future recommendations

The past three decades have witnessed an increase in the number of empirical investigations examining the phenomenology of anxiety and related conditions. There has also been an increase in efforts to understand differences that may exist between ethnic groups in the expression of the anxiety disorders. In addition, there is now substantial evidence that a variety of treatment approaches (most notably behavioral and cognitive behavioral) are efficacious in remediating anxiety. However, there continues to be comparatively few treatment outcome studies investigating the efficacy of anxiety treatments among minority populations. In this paper, we review the extant treatment outcome research for African American, Hispanic/Latino[a] American, Asian American, and Native Americans suffering with one of the anxiety disorders. We discuss some of the specific problems with the research in this area, and then provide specific recommendations for conducting treatment outcome research with minority populations in the future.

Religious involvement and obsessive compulsive disorder among African Americans and Black Caribbeans

Prior research is equivocal concerning the relationships between religious involvement and obsessive-compulsive disorder (OCD). The literature indicates limited evidence of denomination differences in prevalence of OCD whereas findings regarding OCD and degree of religiosity are equivocal. This study builds on prior research by examining OCD in relation to diverse measures of religious involvement within the National Survey of American Life, a nationally representative sample of African American and Black Caribbean adults. Bivariate and multivariate analyses (logistic regression) examine the relationship between lifetime prevalence of OCD and religious denomination, service attendance, non-organizational religiosity (e.g., prayer, religious media) subjective religiosity, and religious coping. Frequent religious service attendance was negatively associated with OCD, whereas Catholic affiliation (as compared to Baptist) and religious coping (prayer when dealing with stressful situations) were both positively associated with OCD. With regard to demographic factors, persons of older age and higher education levels were significantly less likely to have OCD.

The relationship between contamination cognitions, anxiety, and disgust in two ethnic groups

BACKGROUND AND OBJECTIVES

Obsessive-compulsive disorder (OCD) is understudied in African Americans, thus little is known about factors that might predispose this group to obsessive-compulsive anxiety. Prior research has shown that African Americans endorse more concerns about contamination, but it is not known how these differences relate to variables, such as beliefs or cognitions about contamination, the emotion of disgust, and anxiety sensitivity. The current study examined Black-White differences in contamination cognitions in a non-clinical sample (N = 245).

METHODS

European American and African American participants completed measures of contamination cognitions, anxiety, OCD, and disgust.

RESULTS

African Americans exhibited significantly stronger contamination cognitions, as measured by the Contamination Concerns Scale. Multiple regression analysis showed that contamination concerns were predicted by disgust sensitivity, ethnicity/race, and gender. Neither anxiety sensitivity nor pathological washing behaviors were significant factors in the model.

LIMITATIONS

Study should be replicated in additional populations as generalizability beyond a college student population is not known.

CONCLUSIONS

African Americans are no more sensitive to disgust or anxiety than European Americans, but nonetheless have greater concerns about the severity of contamination surrounding certain items. This may predispose African Americans with OCD to symptoms involving contamination.

Recruitment of a hidden population: African Americans with obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a leading cause of disability worldwide, however for reasons that are poorly understood ethnic minority groups are not well represented in clinical research studies. Thus, although African Americans experience equivalent rates of OCD according to epidemiological surveys, the generalizability of findings from clinical trials remains unknown. Research designed to improve identification, assessment and treatment of OCD is an important public health priority. The purpose of this study is to report outreach methods used to recruit African American adults for participation in an OCD research study. A variety of methods were employed, including radio advertisements, public transportation advertising, community outreach, and online advertising. A total of 83 African American adult participants were recruited over a 9.5 month period at the University of Pennsylvania in Philadelphia, and given comprehensive psychiatric assessments. African Americans with OCD symptoms were reliably identified and assessed, for a total of 75 with lifetime OCD (4 past and 71 current diagnoses). There was variability in the success and cost effectiveness of study recruitment methods. Radio ads were the most expensive means of recruitment, newspaper ads accounted for the largest number of eligible participants, and no cost methods such as Craig's List and word of mouth were also effective. The authors conclude that, with focused efforts, there are many effective methods for recruiting African Americans with OCD. Guidelines for recruitment are discussed, with a focus on cultural considerations.

A prospective study of outcome and predictors of subclinical and clinical depression in an older biracial sample of psychiatric outpatients

OBJECTIVES

There continues to be a debate about the long-term prognosis of psychiatric treatment of depression in later life. There have been no long-term naturalistic studies of psychiatric outpatient treatment of older adults in the United States. This study examines outcome and predictors of various levels of depression among a biracial sample of geropsychiatric outpatients in Brooklyn, NY.

METHODS

We conducted a naturalistic study (median: 33 months) of 143 persons aged 55 and over with diagnoses of depression drawn from 15 psychiatry outpatient clinics and 2 geriatric day programs. Their mean age was 68 years, 87% were female, and 43% were white and 57% were black, among whom 37% were African Caribbeans. Using George's Social Antecedent Model of Depression, we examined the impact of 15 predictor variables on two outcome measures: presence of any either subclinical or clinical depression (CES-D score > or = 8) and presence of clinical depression (CES-D score > or = 16).

RESULTS

On follow-up, 84% and 90% of subclinically and clinically depressed persons at baseline, respectively, were depressed (CES-D > or = 8); 62% of those in remission at baseline were depressed. In logistic regression, 3 variables were significant predictors of any level of depression on follow-up: baseline depression, baseline anxiety, greater increase in anxiety symptoms during the follow-up period. These 3 variables along with financial strain were significant predictors of clinical depression on follow-up. There were no inter- or intra-racial differences in outcome.

CONCLUSIONS

The bleak outcome findings among older psychiatric outpatients in Brooklyn were consistent with unfavorable results reported in European studies. Because there were only a few predictors of outcome, strategies that target high risk persons - e.g., such as those with subclinical depression, anxiety, or in more economic distress - may prevent transition to severe and persistent depressive states.

The international prevalence, epidemiology, and clinical phenomenology of Tourette syndrome: a cross-cultural perspective

The overall international prevalence of Tourette syndrome (TS) is 1% in the majority of cultures of the world. Both TS and tics are certainly more obvious and may be more common in younger people. Moreover, TS is seen less frequently in some cultures. However, in all cultures where it has been reported, the phenomenology is similar, highlighting the biological underpinnings of the disorder. This article reviews the international prevalence, epidemiology, and clinical phenomenology of TS, from a cross-cultural perspective.

Depression outcome among a biracial sample of depressed urban elders

OBJECTIVES

There are a paucity of long-term studies from the United States concerning predictors of outcome among depressed older community adults. This article examines predictors of depression in a biracial sample of older persons in Brooklyn, NY.

METHODS

The authors conducted a naturalistic study of 110 persons aged 55 years and older living in randomly selected block groups who had a Center for Epidemiologic Studies-Depression (CES-D) score of > or = 8 at baseline. Persons were reassessed on an average of 3 years later. Their mean age was 69 years, 52% were women, and 35% were whites, and 65% were blacks, among whom 71% were African Caribbeans. Using George's Social Antecedent Model of Depression, the authors examined the impact of 13 predictor variables on two outcome measures: presence of either subsyndromal or syndromal depression (CES-D score > or = 8) and presence of syndromal depression (CES-D score > or = 16). To control for design effects, the authors used SUDAAN for the data analysis.

RESULTS

On follow-up, 82% and 88% of subsyndromally and syndromally depressed persons at baseline, respectively, were depressed (CES-D > or = 8). In logistic regression, baseline depressive symptoms, baseline anxiety symptoms, greater increase in anxiety symptoms during the follow-up period, and higher locus of control were predictors of any level of depression. These four variables along with greater paranoid ideation and/or psychoses and more reliable social contacts were significant predictors of syndromal depression on follow-up. There were no inter- or intraracial differences in outcome.

CONCLUSION

Depressed community elders in Brooklyn have highly unfavorable outcomes. Preventive strategies that target at-risk persons-i.e., especially those with baseline subsyndromal depression, greater anxiety symptoms, and more paranoid ideation and/or psychoses-may reduce the development of severe or persistent depression.