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

Diversity in the study of aging and lifespan development

In psychology, authors have shined a light on a lack of ethnic/racial and cultural diversity in sampling and scholarship. These issues pertain also to the study of aging and lifespan development. This article presents examples of how diverse sampling, across ethnic/racial groups and cultures, enriches theories of aging and adult development. There remain, however, numerous theoretical insights that are yet to be uncovered by future research that seeks to further diversify this sub-discipline. Good practices and avenues to diversification are considered, including targeted sampling of minority groups in the community, online sampling with use of data screening tools, lifespan-orientated surveys initiated in non-Western countries, and a redress of the balance in the perceived value of research from different regions of the world.

The temporal relationship between marriage and risk for suicidal ideation

BACKGROUND

Marriage is consistently identified as a protective factor for suicidality, but it remains unclear whether this relationship varies by time elapsed since the transition to marriage.

METHODS

Participants were 15,870 individuals (52 % female, mean age = 44.63 years, age range = 18-99 years) from the Collaborative Psychiatric Epidemiology Surveys. Cox proportional hazards models were used to test the relationship between marriage, as well as time elapsed since the transition to marriage (0-5 years, 6-10 years, or 11+ years), and suicidal ideation. Years of education and race and ethnicity were included as covariates, and analyses were stratified by sex. Separate hazard ratios were estimated for individuals aged <30 years and 30+ years to address violations of the proportionality assumption.

RESULTS

Being married was associated with lower risk for suicidal ideation across age and sex. Among individuals aged <30 years, marriage was reliably associated with lower risk for suicidal ideation, regardless of the time elapsed since marriage. For individuals aged 30+ years, being married for 0-5 years or 6-10 years was associated with increased risk for suicidal ideation, particularly in females. Being married for 11+ years was associated with decreased risk across sex.

LIMITATIONS

Analyses focused on participants' first marriage and did not examine mediators of the association between marriage and suicidal ideation.

CONCLUSIONS

Overall, being married protects against suicidal ideation. However, among individuals aged 30 years or older, the first 10 years of marriage are associated with elevated risk for suicidal thoughts, and clinical outreach may be warranted.

Ethno-racial variation in psychotic experiences in the United States: Findings from the National Latino and Asian American Survey and the National Survey of American Life

BACKGROUND

Ethno-racial differences in psychosis risk are documented; however, there is less research on whether these differences extend to sub-threshold psychotic experiences, and whether there is significant variation within ethno-racial categories.

METHODS

We analyzed data from the National Latino and Asian American Survey (NLAAS) and the National Survey of American Life (NSAL). Using multivariable logistic regression, we examined the association between race/ethnicity and lifetime psychotic experiences among Latino, Asian, and Black adults in the general population, adjusting for gender, age, nativity, education level, income level, employment status, and everyday discrimination.

RESULTS

Puerto Ricans, Cubans, and other Hispanics had greater odds of lifetime psychotic experiences when compared with Mexicans, though differences diminished when adjusting for covariates. Filipino and other Asians had greater odds of lifetime psychotic experiences when compared with Chinese, though again, differences diminished when adjusting for covariates. Among Black Americans, there were no significant ethnic subgroup differences.

CONCLUSION

Ethno-racial differences extend across the psychosis continuum. There are nuanced health profiles across and within ethno-racial categories. Differences may be attributable to differences in experiences living in the US, underscoring the need for community-specific interventions.

Racial and ethnic disparities in women's mental health: a narrative synthesis of systematic reviews and meta-analyses of the US-based samples

Over 2 decades of research indicate the significance of racial or ethnic disparities in mental illness in the United States. However, minoritized racial or ethnic groups tend to report overall lower prevalence rates of psychiatric disorders than White adults, although this varies depending on gender and race or ethnicity. We conducted a rigorous and systematic narrative synthesis on the differences in the prevalence rates and symptoms that differ across racial or ethnic women in depression, anxiety, eating disorders, and premenstrual syndrome or premenstrual dysphoric disorder. Seven systematic reviews and meta-analyses that examined racial/ethnic differences in depression and eating disorders were included. No review that examined racial/ethnic differences in anxiety or premenstrual syndrome or premenstrual dysphoric disorder met inclusion criteria. Methodological quality of the reviews, which was determined by the Assessment of Multiple Systematic Reviews criteria, revealed that the results of 5 reviews were rated as critically low confidence, one review was rated as low confidence, and one review was rated as high confidence. Findings were inconsistent across systematic reviews and meta-analyses because of the methodological differences in the original studies. Overall, racially or ethnically minoritized women generally report lower prevalence rates in depressive and eating disorders than the White women; however, they exhibit different or greater symptom presentation that could influence prevalence estimates depending on the diagnostic criteria followed. Methodological considerations are provided to strengthen the literature on racial or ethnic mental health disparities in women.

Discrimination, psychotic experiences, and racial identity among Black Americans: Findings from the National Survey of American Life

BACKGROUND

An emerging body of evidence suggests racial and ethnic identity may buffer the effects of discrimination on psychotic experiences, though the buffering effects have not been consistent across studies. More research is needed to clarify the conditions under which aspects of racial identity modify the effects of various forms of discrimination on psychotic experiences among Black Americans.

METHODS

We analyzed data from the National Survey of American Life (2001-2003). Using multivariable logistic regression, we examined the relations between various forms of discrimination and lifetime psychotic experiences, testing the interactive effects of two aspects of racial identity (racial group identification and racial private regard), adjusted for sociodemographic covariates.

RESULTS

The relation between everyday discrimination and psychotic experiences was stronger for African Americans who reported higher levels of racial group identification. Conversely, the relation between major discriminatory events and psychotic experiences was stronger for Caribbean Black Americans who reported lower levels of racial group identification. Higher racial private regard moderated the associations between everyday discrimination and psychotic experiences, and outgroup colorism and psychotic experiences among Caribbean Black Americans.

CONCLUSION

The role of racial identity is complex and appears to moderate the relation between some (but not all) forms of discrimination and lifetime psychotic experiences, depending on ethnicity.

Pushing Past Limits: How Efficacious Is High-Effort Coping for Self-Rated Health among African American and Caribbean Black Women?

Due to systemic oppression, Black women experience distinct risks across the life course, such as exposure to various stressors that shape lower ratings of self-rated health. This is important given that self-rated health is a stronger indicator of current morbidity and subsequent mortality than physician assessments. However, there has been limited consideration of the role of coping in shaping self-rated health among this group. John Henryism, or high-effort coping, is a culturally relevant coping style that reflects the broader societal, cultural, and historical context that shapes lived experiences of Black populations navigating racism and capitalism in the U.S., and has received limited consideration in health research among Black women. Additionally, less is known regarding how ethnicity shapes John Henryism and health processes among Black women specifically. Therefore, the present study examined the association between John Henryism and self-rated health among African American and Caribbean Black women (n = 1580) collectively, and explored this association among Caribbean Black women specifically, utilizing the National Survey of American Life (NSAL 2001-2003). Findings show that while John Henryism was not directly associated with self-rated health among either group, once sociodemographic characteristics and stress exposure were accounted for, John Henryism was associated with lower odds of fair or poor self-rated health among both groups.

The Relationship Between Latinxs' Acculturative Experiences and Mental and Behavioral Disorder in the National Latino and Asian American Study

Mental and behavioral disorders are among the leading contributors to disability among US-residing Latinxs. When treated as a homogeneous group, important disparities in the prevalence of such disorders among Latinx subgroups (e.g., by ethnic heritage) are obscured. However, Latinxs may also be characterized by their acculturative experiences while living in the USA, such as discrimination, neighborhood context and family conflict. Latent Profile Analysis with distal outcomes was used to estimate differences in psychiatric disorder prevalence across acculturative subgroups. Data from 2,541 Latinx participants (age 18 +) in the National Latino and Asian American Study (NLAAS) were used to estimate differences in the proportion of three categories of DSM-IV disorder: depressive, anxiety and substance use by four latent subgroups of Latinxs based on their acculturative experiences. Latinxs reporting more positive acculturative experiences had the lowest prevalence of all three disorders (14.8%, 13.6% and 7.1%, respectively). Those whose lives were characterized by high levels of family conflict and discrimination combined with low levels of social cohesion and neighborhood safety had the highest disorder prevalence (34.0%, 26.6% and 22.5%; all p < 0.01 compared to positive experiences subgroup). Latinxs with moderate levels of discrimination and conflict, along with those with high conflict and cohesion, were better off as compared to those with high negative experiences and low cohesion. These latent subgroups of Latinxs according to their acculturative experiences hold important implications for identifying high-risk groups for developing a psychiatric disorder. Findings also point to the protective role of family and neighborhood cohesion when facing high levels of adversity, which may inform prevention and intervention efforts.

An Intersectional Analysis of Women's Social Role Engagement and Mental Health

Objective

Guided by role theory and the intersectionality framework, this study assesses whether social role volume, role type, and role configuration influence the mental health of Non-Latina White, African American, Afro-Caribbean, Mexican, Cuban, Puerto Rican, Chinese, Filipina, and Vietnamese American women.

Background

Contemporary shifts in the primary roles (i.e., worker, spouse, parent) women occupy and in the ethnic composition of the U.S. necessitate a re-examination of how roles impact U.S. women's mental health. Moreover, family member and friend roles are relatively understudied.

Method

Drawing data from the nationally representative Collaborative Psychiatric Epidemiology Surveys (CPES) (N=7370), ordinary least squares (OLS) regression analysis is used to assess the relationship between role volume, role type, role configuration, and mental health for women across nine ethnic groups. We report ethnicity-stratified models.

Results

On one hand, role accumulation was psychologically beneficial for Non-Latina White, African American, Puerto Rican, and Chinese women. On the other hand, the psychological benefits of social roles diminished after accumulating three social roles for Cuban, Mexican, and Filipina women. The psychological influence of specific roles and role configurations for women was dependent on ethnicity.

Conclusion

This study demonstrates the powerful impact of ethnicity on social role engagement as well as the influence of such roles on women's psychological health.

The differential relationship of common health comorbidities with acculturative experiences in United States Latinxs

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A novel conceptualization of acculturation and related experiences is related to comorbidity.

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Different patterns emerge in the relationship between acculturative experiences and health.

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Toxic stress and social support may play differential roles in the risk for health comorbidities.

Assessing the Validity of Self-rated Health Across Ethnic Groups: Implications for Health Disparities Research

OBJECTIVES

This study examines the association between morbidity (i.e., chronic health conditions) and self-rated health (SRH) with the aim of testing the within-group and across-group validity of SRH across nine ethnic groups: non-Latinx White, Mexican, Puerto Rican, Cuban, African American, Afro-Caribbean, Chinese, Filipino, and Vietnamese Americans. In addition, we assess whether acculturation (i.e., nativity, years of US residency, language of interview) and health-related factors (e.g., mental disorder) account for ethnic distinctions in SRH.

DESIGN

Data are from the National Survey of American Life (NSAL) and the National Latino and Asian American Study (NLAAS) (N = 8338). Weighted proportions and means for SRH and chronic conditions are reported. Ordered logistic regression analysis is used to determine ethnic group patterns in SRH.

RESULTS

Despite evidence of within-group validity of SRH for each ethnic group, our results seriously challenge the across-group validity of SRH. For example, Chinese and Vietnamese respondents report lower SRH despite having fewer chronic conditions relative to non-Latinx Whites. Moreover, Mexican Americans report fewer chronic health problems but lower SRH compared to non-Latinx Whites. Acculturation factors (e.g., language of interview) partially explain the Mexican-White difference in SRH. Among Chinese Americans, completing an interview in English is associated with higher SRH relative to those who completed an interview in Chinese.

CONCLUSION

These findings have implications for health disparities research that uses SRH as the dependent measure. Studies that compare the health profiles of diverse ethnic groups should use the SRH measure with caution, as SRH does not align with ethnic patterns of morbidity.

Is the Black-White mental health paradox consistent across age, gender, and psychiatric disorders?

OBJECTIVES

The Black-White mental health epidemiological paradox (i.e. Black Americans' lower or similar rates of mental disorder relative to Whites) characterizes the literature on race and mental health. Yet, research has generally paid less attention to how such findings may vary across other social statuses that shape mental health. This study assessed whether the Black-White paradox is consistent across gender, age groups, and psychiatric disorders, including lifetime mood, anxiety, and substance use disorders.

METHOD

We used data from the National Comorbidity Survey-Replication (NCS-R) and National Survey of American Life (NSAL), 2001-2003 (N = 4,591 African Americans; 6,668 non-Hispanic Whites). Psychiatric disorders were measured with the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI). Binary logistic regression models were conducted to assess racial patterns of lifetime mental disorders across age and gender. Wald tests were performed to assess age and gender group differences in Black-White patterns of mental disorder.

RESULTS

The Black-White mental health paradox generally extends across lifetime mood, anxiety, and substance use disorders and is consistent across age and gender groups. One exception is middle-aged (45-64 years) Black men, who had higher odds of lifetime substance use disorder relative to their White male middle-aged peers. This difference is no longer statistically significant after accounting for education and employment. We also found more similarity in mental disorders between older Blacks and Whites relative to their younger counterparts, suggesting that Black-White mental health differences are most pronounced among younger age groups.

CONCLUSION

Our findings contribute to the broader literature on the Black-White mental health paradox by demonstrating that this epidemiological pattern persists across various mental disorder types and, at times, depends on age group and gender. Given that Black-Whte differences are less pronounced among older adults, future research should consider the ways life course theory might inform our understanding of the paradox. Findings also suggest that substance use services are critical to address the needs of middle-aged Black men of lower socioeconomic status who are disproportionately affected by substance use disorder, yet have relatively lower mental health care utilization rates.

Early Age of Cannabis Initiation and Its Association With Suicidal Behaviors

Background:

Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older.

Methods:

Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later >14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses.

Results:

Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ2 = 26.99; P < .001) and attempts (χ2 = 26.02; P < .001).

Conclusions:

Significant associations were found between early initiation of cannabis and suicide behaviors. As suicide rates continue to rise, it is recommended that clinicians, treatment providers, and other professionals consider the use of cannabis at an early age as a risk for subsequent suicide behaviors.

Allergies, infections, and psychiatric disorders among Black Americans: findings from the National Survey of American Life

Objectives: An emerging body of literature shows that allergies and infections are associated with psychiatric disorders, though there is little research to confirm these associations among Black Americans in the United States.Design: We analyzed data from the National Survey of American Life, and used multivariable logistic regression models to examine the associations between past 12-month allergies/infections and past 12-month psychiatric disorders, adjusting for socio-demographic characteristics, tobacco use, lifetime diabetes, and body mass index.Results: We found that allergies/infections were associated with mood, anxiety, and eating disorders, but not alcohol or substance use disorders. We detected effect modification by ethnicity, with stronger odds for mood, anxiety disorders, and alcohol use disorders, with no significant associations for substance use or eating disorders among Caribbean Blacks.Conclusions: Our findings underscore the importance of screening for psychiatric disorders among Black individuals complaining of allergies/infections, and the need to also treat allergies/infections among people with psychiatric disorders.

Perceived colorism and lifetime psychiatric disorders among Black American adults: findings from the National Survey of American Life

Colorism has been propagated across the globe, and skin tone discrimination may partly explain social stratification and health disparities within the Black American population. Using data from a large probability sample of Black American adults (National Survey of American Life; 2001-2003), we examined the relations between perceived colorism and psychiatric disorders. In multivariable logistic regression models, in-group colorism was associated with greater odds of having any lifetime psychiatric disorder (aOR: 1.20; 95% CI: 1.08-1.32; p = 0.00); however, out-group colorism was not significantly associated, net of sociodemographic characteristics and in-group colorism (aOR: 1.08; 95% CI: 0.99-1.18; p = 0.08). When looking at specific disorders, in-group colorism was significantly associated with greater odds of alcohol use disorder, substance use disorder, anxiety disorder, and eating disorder, but was not associated with post-traumatic stress disorder or mood disorder. Out-group colorism was not significantly associated with any psychiatric disorder except anxiety disorder. Our findings show that colorism predicts psychiatric disorders, though more research is needed to understand why the effects of in-group and out-group colorism are related to certain psychiatric disorders but not others.

Urban upbringing and psychiatric disorders in the United States: A racial comparison

BACKGROUND

Studies that link urbanicity to mental health are mixed depending on outcome and context. More research is needed to examine whether the urban upbringing effect holds true across racial populations in a large and diverse country like the United States.

METHODS

We analyzed two large datasets that were administered contemporaneously with similar methods: The National Comorbidity Survey-Replication (NCS-R, Whites) and the National Survey of American Life (NSAL, Blacks). We ran multivariable logistic regression models to examine the associations between area of upbringing (urban/large city, other, rural) and six psychiatric disorders, controlling for sex, age, years of education and income-to-poverty ratio (and ethnicity in the NSAL). We performed these analyses in both the NCS-R and the NSAL separately.

RESULTS

The majority (58.97%) of the White sample grew up in the 'other' category (i.e. small town, small city, or suburb of a large city), whereas a much larger percentage (39.89%) of the Black sample grew up in a large city. In the White sample, urban upbringing was not associated with any of the psychiatric disorders at a conventional level of statistical significance. In the Black sample, urban upbringing was associated with greater odds of having mood disorder, alcohol use disorder and drug use disorder, but was not significantly associated with anxiety disorders, PTSD, or eating disorders.

CONCLUSIONS

Urban upbringing was not associated with psychiatric disorders among Whites, but was associated with greater odds of mood disorders, alcohol us disorder and drug use disorder among Blacks. Future research can elucidate how differences in urban upbringing between Whites and Blacks are linked to differences in risk for psychiatric disorders.

Understanding a mechanism between perceived discrimination and obesity among Latinas in the United States

Objective: Obesity is a prominent public health concern significantly impacting various minority groups, especially Latina Americans. However, little study has explored acculturation-related factors associated with obesity among Latinas in the United States. This study examines the link between acculturation-related factors and obesity among Latinas.Design: Using the National Latino and Asian American Study (NLAAS), we detected the incremental associations of acculturation-related factors, especially perceived discrimination with obesity, after controlling for socio-demographics, among all 1427 Latinas. Two-step logistic regression analyses were conducted to investigate the association.Results: Results indicated perceived discrimination and older age were positively associated with Latinas' obesity. Conversely, income and acculturation stress were negatively associated with obesity. Further, results revealed a significant moderating effect of education on the association between perceived discrimination and obesity.Conclusion: The findings suggest the need for clinical attention towards socio-cultural influences and ethnic backgrounds in obesity assessment and intervention.

Hotline Use in the United States: Results from the Collaborative Psychiatric Epidemiology Surveys

Crisis hotlines are a fixture in providing mental health services to individuals experiencing mental and behavioral problems in the United States (U.S.). Despite this, and the growing need for easily-accessible, anonymous, and free services amidst the suicide and opioid crises, there is no study reporting U.S. national prevalence and correlates of hotline use. Data on n = 18,909 participants from the Collaborative Psychiatric Epidemiology Surveys (CPES), a group of three nationally-representative, population-based studies, were used to estimate the prevalence of lifetime and past 12-month hotline use. A series of logistic regression models examined sociodemographic, clinical history and service use correlates of hotline use. Lifetime and past 12-month hotline use was estimated at 2.5% and 0.5%, respectively. Being female, having a mental or behavioral disorder, experiencing suicidality, or interacting with other formal and informal sectors of the mental health service system were significant correlates of use. This study provides the first national estimates of crisis hotline usage in the U.S. Hotlines are more likely to be used by certain sociodemographic subgroups, but these differences may be due to differing psychiatric history and service use patterns. Efforts should be made to ensure that crisis hotlines are being utilized by other marginalized populations at high risk of suicide or overdose amidst the current public health crises in the U.S., such as racial/ethnic minorities or youth. To evaluate the role that crisis hotlines play in the mental health service system, national surveys should aim to monitor trends and correlates over time.

Epidemiology of disturbing dreams in a diverse US sample

STUDY OBJECTIVES

Disturbing dreams are a common complaint among trauma survivors, but little epidemiological research exists to document the frequency in the general population. In addition, information about their occurrence in diverse adults is lacking.

METHODS

Using the Collaborative Psychiatric Epidemiology Surveys we had the unique opportunity to examine disturbing dreams in a diverse sample of adults in the US. Disturbing dreams were measured in three different variables including trauma dreams, dreams of the worst event, and dreams of separation. A fourth variable was created to assess for any disturbing dream reported across the three categories.

RESULTS

Disturbing dream prevalence varied in the overall sample (N = 20,013) based on the assessment question. Dreams of trauma was 2.01% in the overall sample, dreams of the worst event was 7.21% and dreams of separation was 1.73%. Prevalence rates of all dream variables varied by racial and ethnic group membership, gender, and age. Odds ratios were also calculated for the three variables of interest by racial and ethnic group with significant differences emerging. Women had significantly higher rates of disturbing dreams in all variables assessed (p < 0.01). Older adults reported significantly lower rates of disturbing dreams compared to younger and middle-aged adults (p < 0.001).

CONCLUSIONS

This study establishes prevalence rates for disturbing dreams in a diverse sample of US adults. Understanding the prevalence can aid in reducing barriers to care for evidence-based treatments currently underutilized.

Perceived skin tone discrimination and suicidal ideation Black Americans: Findings from the National Survey of American Life

BACKGROUND

To examine the association between skin tone discrimination and lifetime suicidal ideation and suicide attempt among Black Americans.

METHODS

We analyzed the National Survey of American Life (NSAL), which is a national probability sample of Black American adults residing in the general population of the United States. Using multivariable logistic regression, we examined the associations between skin tone discrimination (from Blacks and from whites) and suicidal ideation and suicide attempt, adjusting for sociodemographic characteristics.

RESULTS

While respondents on average reported higher frequency of inter-group skin tone discrimination, only intra-group skin tone discrimination was significantly associated with greater odds of lifetime suicidal ideation [aOR: 1.21; 95% CI: 1.08-1.36] and suicide attempt [aOR: 1.22; 95% CI: 1.22; 95% CI: 1.04-1.44] adjusting for sociodemographic characteristics. Inter-group skin tone discrimination was not significantly related to suicidal ideation or suicide attempt. When stratifying by ethnicity, the effect of intra-group skin tone discrimination on suicidal ideation and attempt was stronger among Caribbean Black Americans than it was for African Americans.

LIMITATIONS

All measures in the sample were self-reported and thus vulnerable to recall bias.

CONCLUSIONS

Intra-group skin tone discrimination is a risk factor for suicidal ideation among Black Americans, and especially among Caribbean Black Americans.

Associations between Food Insecurity and Depression among Diverse Asian Americans

Background: Proper nutrition is an essential component to both physical and emotional health. Food insecurity (FI) is a potentially critical public health problem. The link between FI and elevated risk for depression has been well documented. Yet, it is largely unknown how diverse older adult populations experience FI differently. Therefore, the aims of this study were to examine how gender, race/ethnicity, and nativity may impact the magnitude of the association between FI and depression.

Methods: We used a nationally representative sample of the Asian American population from the National Latino and Asian American Study (NLAAS). We built logistic regression models with major depression in the past 12 months as the dependent variable, and FI as the independent variable. Several demographic and socioeconomic characteristics were added to the models to control for potential biases. All statistical estimates were weighted, using the recommended NLAAS sampling weight, to ensure representativeness of the US population.

Results: About 35% (weighted adjusted 95% CI: 29.49–39.00) of Asian Americans experienced some level of FI at the time of survey. Experiencing FI over the past 12 months increased the likelihood of having clinical depression (weighted adjusted odds ratio: 1.44, weight adjusted confidence interval: 0.79–2.10). The magnitude of associations between FI and depression varied by race/ethnicity (F (7, 47) = 6.53, p (3, 41) = 10.56, p (3, 41) = 9.85).

Conclusions: Food insecurity significantly increases the likelihood of clinical depression among Asian Americans. Greater attention is needed towards food-insecure Asian Americans and their mental health.

Perceived skin tone discrimination and psychotic experiences among Black Americans: Findings from the National Survey of American Life

BACKGROUND

Black Americans face significant discrimination, which has been linked to risk for psychotic experiences. However, fewer studies have examined whether perceived skin tone discrimination is associated with psychotic experiences.

METHODS

Drawing data from the National Survey of American Life (NSAL), we used multivariable logistic regression to examine the associations between perceived skin tone discrimination (from Blacks and Whites) and psychotic experiences, adjusting for sociodemographic covariates, common mental disorders, and major discriminatory events.

RESULTS

In bivariate regression models, a one-unit increase in frequency of perceived skin tone discrimination from Blacks was associated with a 24% increase in odds of having any lifetime psychotic experience (AOR: 1.24; 95% CI: 1.11-1.38). A one-unit increase in frequency of perceived skin tone discrimination from Whites was associated with an 18% increase in odds of having any lifetime psychotic experience (AOR: 1.18; 95% CI: 1.03-1.34). When examining perceived skin tone discrimination from Blacks and Whites in the same models, only perceived skin tone discrimination from Blacks was significantly associated with lifetime psychotic experiences, adjusting for sociodemographic characteristics, common metal disorders, and major discriminatory events. Perceived skin tone discrimination was associated with lifetime hallucinatory experiences, but not lifetime delusional ideation.

CONCLUSION

A significant portion of the Black population reported skin tone discrimination from Blacks and Whites, which is related to lifetime psychotic experiences. Future longitudinal and qualitative studies can elaborate on these findings and further contextualize skin tone discrimination and its health effects.

Discrimination and Multimorbidity Among Black Americans: Findings from the National Survey of American Life

OBJECTIVES

There is a notable lack of research on the risk factors for multimorbidity, which has become more common over recent decades. Black Americans experience discrimination more often than their White counterparts, and also have significantly higher prevalence of multimorbidity. This paper examines the associations between discrimination and multimorbidity among Black Americans.

METHODS

We analyzed data from the National Survey of American Life to calculate the prevalence of two types of discrimination (everyday discrimination, major discriminatory events) and multimorbidity (physical, psychiatric, mixed, any). Using multivariable logistic regression, we examined the associations between discrimination and multimorbidity, adjusting for age, sex, years of education, income-to-poverty ratio, and ethnicity. The everyday discrimination scale was discretized into five categories (none, low, medium, high, very high), but was also treated as a continuous variable. The major discriminatory events were analyzed in separate adjusted models, and as a count of events.

RESULTS

When compared with those who did not experience any discrimination, people who experienced everyday discrimination were significantly more likely to report all types of multimorbidity in a dose-response fashion at a conventional level of statistical significance. Most major discriminatory events were associated with greater odds of reporting all types of multimorbidity, as were the counts of major discriminatory events, in a dose-response fashion.

CONCLUSIONS

We found strong evidence to suggest that discrimination was associated with greater odds of reporting multimorbidity. Future studies can expand on these findings using longitudinal data to capture the relations between discrimination and health over time, or by testing preventive interventions that allay the damaging health effects of discrimination.

Refining acculturation measures for health research: Latina/o heterogeneity in the National Latino and Asian American Study

OBJECTIVES

This study factor analyzes six scales relating to acculturation and related experiences among a nationally representative sample of United States-residing Latina/os (n = 2,541) from the National Latino and Asian American Study (NLAAS), using measurement invariance (MI) testing to explore differences in latent constructs by Latina/o subgroup.

METHODS

Factor Analysis (FA) within an Exploratory Structural Equation Modeling framework was used to analyze the factor structure of six scales measuring acculturation and related experiences (i.e., acculturation [language use and preference], enculturation [ethnic identity], discrimination, neighborhood context, and family environment). We tested for MI by two important Latina/o subgroups: ethnic heritage and generational status.

RESULTS

The underlying latent factors resulting from FA strongly aligned with the NLAAS subscales. No scale achieved full MI, yet the degree to which MI held varied greatly by scale and by subgroup.

CONCLUSIONS

Findings show that Latina/os are heterogeneous, but that this often depends on the construct and subgrouping of interest. Future research should use these scales in a latent framework, accounting for the lack of MI, to ensure that the underlying acculturative constructs of interest are validly measured when investigating their association with mental health outcomes in this population.

Urban upbringing and psychotic experiences in the United States: A racial and geographic comparison

Urban upbringing has been associated with greater risk for psychotic experiences, though research is needed to confirm whether this is true in the U.S., and whether the association depends on race, type of experience, and region of the country. We analyzed data from the National Comorbidity Survey Replication (White respondents only) and the National Survey of American Life (Black respondents). Multivariable logistic regression models found that urban upbringing was not significantly associated with lifetime psychotic experiences for Whites, but was significantly associated with lower odds for Blacks, adjusting for socio-demographic covariates and common mental disorders. Rural upbringing was associated with greater odds of lifetime auditory hallucinatory experiences for Blacks. Exploratory analyses suggested growing up in a large city or 'other' environment were associated with greater odds of lifetime psychotic experiences among Whites currently residing in the Northeast, but lower odds among Whites residing in the South. For Blacks currently residing in the West, rural upbringing was associated with significantly greater odds of lifetime psychotic experiences when compared with growing up in a large city. White and Blacks may have different lived experiences in urban and rural settings, calling for more race- and location- specific research to explain these diverging patterns.

Patterns of Intimate Partner Violence Victimization and Survivors' Help-Seeking

Intimate partner violence (IPV) survivors often do not seek critically needed help. A good understanding of the relationship between the pattern of violence and help-seeking is critical to developing adequate services for the survivors, as well as for reaching out to those who do not seek help. This study used the National Intimate Partner and Sexual Violence Survey to examine how IPV survivor's help-seeking varies, depending on the characteristics of the survivors and the pattern of victimization. Logistic regression analyses were conducted, with the survivors' help-seeking and use of formal or informal help as the dependent variables. The study results show that women are the primary victims of IPV, that the pattern of victimization is associated with both whether survivors seek help or not, and which help sources they utilize, if any. IPV consequences are also associated with survivors' help-seeking, as are demographic factors such as age, gender, race, and immigration status.

Lifetime and Twelve-Month Prevalence, Persistence, and Unmet Treatment Needs of Mood, Anxiety, and Substance Use Disorders in African American and U.S. versus Foreign-Born Caribbean Women

There is growing diversity within the Black population in the U.S., but limited understanding of ethnic and nativity differences in the mental health treatment needs of Black women. This study examined differences in the prevalence of psychiatric disorders, their persistence, and unmet treatment needs among Black women in the U.S. Data were from the National Survey of American Life, a nationally representative survey that assessed lifetime and twelve-month mood, anxiety, and substance use disorders according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria, and mental health service use among those meeting disorder criteria. One in three African American women met criteria for a lifetime disorder, compared to one in three Caribbean women born within the U.S. and one in five Caribbean women born outside the U.S. About half of African American women with a lifetime disorder had a persistent psychiatric disorder, compared to two in five Caribbean women born within the U.S. and two in three Caribbean women born outside the U.S. African Americans had more persisting dysthymia and panic disorder and less persisting social phobia compared to foreign-born Caribbean women. Of the three groups, Caribbean women born within the U.S. were most likely to seek mental health treatment during their lifetime. These results demonstrate, despite a lower prevalence of psychiatric disorders in Black women, that there is a great likelihood their disorders will be marked by persistence and underscores the need for culturally specific treatment approaches. As Black immigrants in the United States are increasing in number, adequate mental health services are needed.

Obesity, food insecurity, and depression among females

BACKGROUND

Nutritional psychiatry is an emerging field of research and it is currently exploring the impact of nutrition and obesity on brain function and mental illness. Prior studies links between obesity, nutrition and depression among women. However, less is known how food insecurity may moderate that relationship.

METHODS

Data were employed from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003. Two logistic regression models were Logistic regression was used to determine the association between obesity, gender, food insecurity, and past year Major Depressive Disorder (MDD). We then stratified by gender, and tested the association between obesity and past year MDD, and if food insecurity moderated the association.

RESULTS

Obesity was associated with an increased risk for past year Major Depressive Disorder (MDD) among females (AOR = 1.35; 95% CI 1.17-1.55) and was not associated among males (AOR = 1.07; 95% CI, 0.86-1.32). Women who reported that reported both obesity and food insecurity reported higher odds of past year MDD episode (AOR = 3.16; 95% CI, 2.36-4.21, than women who did not report food insecurity (AOR = 1.08; 95% CI, 1.02-1.38).

CONCLUSION

With rising rates of mental health problems, females should be closely monitored to understand how poor diets, food insecurity, and obesity play a role in mental health outcomes. It is recommended that clinicians and treatment providers consider the patient's diet and access to nutritious foods when conducting their assessment.

Older Latino Mental Health: A Complicated Picture

The aggregation of Latino subgroups in national studies creates an overly simplistic narrative that Latinos are at lower risk of mental illness and that foreign nativity seems protective against mental illness (i.e., immigrant paradox). This broad generalization does not hold up as the Latino population ages. Given that social inequalities for risk appear to widen with age, the social disadvantages of being Latino in the United States increase the risk for mental illness across the life span. This review focuses on the mental health of older Latinos, specifically the 3 subgroups with the longest residential history in the United States—Mexicans, Puerto Ricans, and Cubans. We examine relevant epidemiological and clinical psychopathology studies on aging in these Latino populations and present evidence of the heterogeneity of the older Latino population living in the United States, thus illustrating a limitation in this field—combining Latino subgroups despite their diversity because of small sample sizes. We address the migration experience—how intraethnic differences and age of migration affect mental health—and discuss social support and discrimination as key risk and protective factors. We conclude with a discussion on meeting the mental health needs of older Latinos with a focus on prevention, a promising approach to addressing mental illness in older Latinos, and future directions for mental health research in this population. Success in this endeavor would yield a substantial reduction in the burden of late-life depression and anxiety and a positive public health impact.

Socioeconomic Correlates of Obesity in African-American and Caribbean-Black Men and Women

The high prevalence of obesity among Black Americans warrants additional investigation into its relationship with socioeconomic position (SEP), sex, and ethnicity. This cross-sectional study utilizes 2001–2003 data from the National Survey of American Life, a nationally representative sample of 3570 African-Americans and 1621 Caribbean-Blacks aged 18 years and older. Multivariate logistic regression models stratified by ethnicity and sex describe the independent associations between obesity and multilevel socioeconomic factors after adjustment for age, other SEP measures at the individual, family and neighborhood levels, and health behaviors such as physical activity, alcohol intake, and smoking. A positive relationship was observed between obesity and family income among African-American and Caribbean-Black men. Receipt of public assistance was a strongly associated factor for obesity in Caribbean-Black men and women. Among African-American women, inverse relationships were observed between obesity and education, occupation, and family income; residence within a neighborhood with a supermarket also decreased their odds of obesity. Residence in a neighborhood with a park decreased the odds of obesity only among African-American men, whereas residence in a neighborhood with a supermarket decreased the odds of obesity among Caribbean-Black men. The social patterning of obesity by individual, household, and neighborhood socioeconomic resources differs for African-American and Caribbean-Black men and women within these cross-sectional analyses; an appreciation of these differences may be a prerequisite for developing effective weight control interventions and policies for these two populations.

Predicting second-generation antidepressant effectiveness in treating sadness using demographic and clinical information: A machine learning approach

INTRODUCTION

Current guidelines for choosing antidepressant medications involve a trial-and-error process. Most patients try multiple antidepressants before finding an effective antidepressant. This study uses demographic and clinical information to create models predicting effectiveness of different antidepressants in treating sadness in a nationally representative sample of US adults.

METHODS

A secondary analysis of the Collaborative Psychiatric Epidemiology Survey (CPES) was performed. Participants with or without a mental health diagnosis who reported sadness as a symptom, and were taking fluoxetine (n=156), sertraline (n=224), citalopram (n=91), paroxetine (n=156), venlafaxine (n=69), bupropion (n=92), or trazadone (n=26) within the past year were included. Two sets of principal component analyses (PCAs) and logistic regressions were performed: one determined associations between symptom clusters and antidepressant effectiveness for sadness, and the other created models to predict effectiveness. Both PCAs controlled for psychiatric and medical diagnoses, substance use, psychiatric medications, alternative treatments, and demographics.

RESULTS

Anxiety was associated with ineffectiveness of fluoxetine in treating sadness. Low mood scores were associated with ineffectiveness of paroxetine and venlafaxine, and fatigue was associated with ineffectiveness of sertraline. The models for predicting drug effectiveness had a mean accuracy of 83% and internal validity of 72%.

LIMITATIONS

CPES data were collected from 2001-2003, so newer drugs were not included. Effectiveness was for sadness, so results are not directly comparable to studies using overall depressive symptom reductions as outcomes.

CONCLUSION

Since fewer than 50% of patients currently respond to their first antidepressant, this model could provide modest improvement to choosing starting antidepressants in treating sadness.

Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

The Effects of Hopelessness on Chronic Disease Among African Americans and Caribbean Blacks: Findings from the National Survey of American Life (NSAL)

This paper examines the relationship between hopelessness on chronic disease in a national sample of African Americans (3570) and Caribbean Blacks (1438) Using the National Survey of American Life. A multivariate negative binomial regression examined whether chronic disease is associated with hopelessness, controlling for sociodemographic characteristics. Overall, 13.14% of the sample reported they were highly hopeless, and 31.5% indicated they were moderately hopeless. About 19% of respondents experienced chronic disease. Bivariate associations showed that those who have ever had chronic disease significantly differed from those who did not in regard to age, gender and spirituality. Multivariate results showed that respondents who ever have had chronic disease reported significantly higher hopelessness scores than those with no chronic disease. The study findings contribute to the current body of literature by supporting findings from smaller studies on the relationship between depression and hopelessness in African Americans and Caribbean Blacks.

Gendered tri-racial stratification and health disparities

Despite extensive evidence confirming racial and gender health disparities, little research considers how race theory might aid in understanding these patterns. Using the Collaborative Psychiatric Epidemiology Surveys (CPES), this study fills this void by integrating two research areas-sociology of race and medical sociology-to assess the utility of Bonilla-Silva's tri-racial stratification perspective in predicting health patterns. More specifically, I address the following questions: is the tri-racial stratification thesis aligned with the health profiles of racial groups in the U.S.? Does the applicability of this perspective differ for women and men? Last, do the health patterns suggested by tri-racial stratification persist after adjusting for social factors (socioeconomic status and social support) often invoked to explain health disparities? Results indicate that the racial patterning of life-threatening conditions lend partial support for tri-racial stratification for women and men. Self-rated health findings yield counterintuitive patterns. Furthermore, social factors do not explain the majority of ethnic differences in health. Research and theoretical implications of these findings are discussed.

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.

Associations between perceived everyday discrimination, discrimination attributions, and binge eating among Latinas: results from the National Latino and Asian American Study

PURPOSE

The aim of the study was to quantify the association between perceived everyday discrimination and binge eating among Latinas in the United States.

METHODS

Participants included 1014 Latinas from the 2002-2003 National Latino and Asian American Study. Modified Poisson models with robust standard errors were used to estimate sociodemographic-adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) of binge eating associated with overall and attribution-specific discrimination.

RESULTS

Approximately 7% of Latinas reported binge eating. Increased frequency of discrimination was associated with a higher prevalence of binge eating (aPR, 1.59; 95% CI, 1.23-2.06), and Latinas reporting frequencies of discrimination in the top tertile had the greatest prevalence elevation (aPR, 3.63; 95% CI, 1.32-10.00). There were important differences by discrimination attribution: Latinas experiencing primarily height/weight-based or skin color-based discrimination had the greatest prevalence elevation relative to those reporting no discrimination (aPR, 10.24; 95% CI, 2.95-35.51; and aPR, 8.83; 95% CI, 2.08-37.54, respectively), whereas Latinas reporting primarily race-based discrimination had the lowest prevalence elevation (aPR, 1.64; 95% CI, 0.47-5.69).

CONCLUSIONS

Discrimination may be an important social determinant of Latinas' binge eating. Future research should incorporate expanded conceptual models that account for Latinas' complex social environment, focusing on intersecting dimensions of identity.

Race-Ethnicity, Social Roles, and Mental Health: A Research Update

Social role involvement engenders sense of purpose and meaning to life, which sustains positive mental health. Racism within American society, however, results in experiences that disadvantage ethnoracial minorities, thus making it likely that social roles do not have universal remunerations. Using the Collaborative Psychiatric Epidemiology Surveys (N = 12,526), this study explores the association between role participation and psychological distress across nine ethnoracial groups. Results indicate that engaging in many roles is associated with better mental health for all ethnoracial groups. However, the combination of social roles has distinct effects for certain groups. We discuss the implications of the study findings for medical sociology, in general, and the social roles literature, in particular.

Major discriminatory events and suicidal thoughts and behaviors amongst Black Americans: Findings from the National Survey of American Life

BACKGROUND

Risk for suicide is growing among certain groups of Black Americans, yet the topic remains understudied. Discrimination appears to increase risk for suicidal thoughts and behaviors, but the evidence has been mixed for Black Americans. This study aimed to examine the association between major discriminatory events and suicidal thoughts and behaviors among Black American adults.

METHODS

We drew data from the National Survey of American Life, a representative sample of Black Americans, and used multivariable logistic regression to examine the associations between nine major discriminatory events and suicidal thoughts and behaviors (ideation, plan, attempt), adjusting for sociodemographic characteristics and psychiatric disorders.

RESULTS

We found that some major discriminatory events increased odds of reporting suicidal thoughts and behaviors, while others did not. Further, findings suggest the mediating role of psychiatric disorders.

LIMITATIONS

The study drew from cross-sectional data and did not allow for causal inferences.

CONCLUSIONS

Major discriminatory events have important implications for clinical practice, as well as diagnostic criteria when considering race-related stressors as a precipitator of suicidal thoughts and behaviors.

Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States

Numerous studies describe mental health effects of pre-migration trauma and post-resettlement stress among refugees, yet less research examines these associations with non-refugee immigrants. Additionally, few studies assess the prevalence and impact of traumatic experiences after settlement in a new country. Using a U.S.-based representative sample of Asian (n = 1637) and Latino (n = 1620) refugees and immigrants, we investigated how traumatic events prior to and after migration, and post-migration stressors, are associated with mental illness and distress. Pre-migration trauma posed risk across a broad range of psychological outcomes for Asian refugees and Latino immigrants. Deleterious effects of post-migration trauma were notable for both groups of refugees and immigrants. Discrimination, acculturative stress, and family conflict increased risk for disorder and distress across groups in complex ways. Findings highlight the importance of examining trauma and stress at pre- and post-migration phases across migrant populations, including those not labeled as refugees.

Physical multimorbidity and suicidal behavior in the general population in the United States

BACKGROUND

As yet, there has been little research on the association between physical multimorbidity (the co-occurrence of two or more physical illnesses) and suicide, and results have been mixed. This study examined if physical multimorbidity is associated with suicidal behavior in the general population in the United States.

METHOD

Data were analyzed from 15,311 adults that were obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES). Information was obtained on nine self-reported physical health conditions and lifetime suicidal behavior (suicidal ideation, plan, and attempts). Logistic regression analysis was used to examine associations.

RESULTS

An increasing number of physical health conditions was associated with higher odds for suicidal behavior. Compared to those with no physical conditions, individuals with ≥ 4 physical illnesses had 2.99, 4.82, and 4.39 times higher odds for reporting suicidal ideation, a suicide plan, and suicide attempts, respectively. An interaction analysis showed that for suicide attempts the association was stronger in younger rather than older adults.

LIMITATIONS

The data were cross-sectional and information on physical conditions and suicidal behavior was self-reported and may have been subject to reporting bias.

CONCLUSIONS

As multimorbidity has increased in recent decades in the United States, alerting medical practitioners to the increased risk of suicidal behavior in adults who have multiple medical conditions as well as screening for suicidality in this group may be important preventive measures to help reduce suicidal behavior in the general population.

Weathering Probation and Parole: The Protective Role of Social Support on Black Women’s Recent Stressful Events and Depressive Symptoms

Despite an overrepresentation of Black women in the criminal justice system, Black women’s mental health at the precarious intersection of race, gender, and community-based correctional supervision has been underresearched. Building on weathering theory, this study conceptualized criminal justice involvement as a social inequality that negatively affects Black women’s mental health. This study investigated the relationships between recent stressors, forms of social support, and depression through moderated regression analyses with a sample of 169 Black women on probation and parole. Almost half of the women met criteria for clinical levels of depression. Distinct forms of social support served as statistically significant protective factors between stressors and depression symptoms. Our findings highlight the importance of studying the mental health of Black women under correctional surveillance and bolstering multiple forms of support to promote their well-being. The impact of criminal justice involvement and institutional racism on Black women’s mental health requires further research.

Newcomers and Old Timers: An Erroneous Assumption in Mental Health Services Research

Based on the premise that treatment changes people in ways that are consequential for subsequent treatment-seeking, we question the validity of an unrecognized and apparently inadvertent assumption in mental health services research conducted within a psychiatric epidemiology paradigm. This homogeneity assumption statistically constrains the effects of potential determinants of recent treatment to be identical for former patients and previously untreated persons by omitting treatment history or modeling only main effects. We test this assumption with data from the 2001-2003 Collaborative Psychiatric Epidemiology Surveys; the weighted pooled sample is representative of noninstitutionalized U.S. adults (18+; analytic n = 19,227). Contrary to the homogeneity assumption, some associations with recent treatment are conditional on past treatment, including psychiatric disorder and race-ethnicity-measures of need and treatment disparities, respectively. We conclude that the widespread application of the homogeneity assumption probably masks differences in the determinants of recent use between previously untreated persons and former patients.

Racial and ethnic differences in individual-level and area-based socioeconomic status and 12-month DSM-IV mental disorders

The purpose of this study was to: (1) examine the associations of individual-level objective socioeconomic status (OSS), subjective socioeconomic status (SSS), and area-based indicators of socioeconomic status, with 12-month DSM-IV mood, anxiety, alcohol use, and drug use disorders; and, (2) determine the extent of racial/ethnic differences in these associations across non-Latino White, non-Latino Black, Latino, and Asian participants. Data are from the Collaborative Psychiatric Epidemiology Studies dataset, a collection of three population-based surveys of mental disorders among U.S. residents aged 18 and older (n = 13,775). Among all indicators of socioeconomic status, SSS was most consistently associated with 12-month mental disorders. Income was negatively associated with mood and anxiety disorders; education was negatively associated with alcohol use and drug use disorders. Significant interactions with race/ethnicity were found for the associations of socioeconomic indicators with anxiety, alcohol use, and drug use disorders but not with mood disorders. SSS was not associated with any of the 12-month mental disorders among Blacks. Education had stronger associations with 12-month anxiety and alcohol use disorders among Whites than among other racial/ethnic groups. Among Asians, low income compared to high income was associated with a lower risk of anxiety disorders and less than high school completion compared to college or more was associated with a lower risk of alcohol use disorders. Finally, tract-level income inequality was associated with a greater risk of drug use disorders only among Blacks. The patterns and magnitudes of the associations of individual-level and area-based socioeconomic indicators differed by type of disorder and race/ethnicity.

Association between unintended pregnancy and internalizing disorders among Latina and Asian American mothers

BACKGROUND

Pregnancy, whether intended or unintended, is associated with internalizing symptoms among women; for some, these symptoms cause impairment and develop into an internalizing disorder (ID). With the growing diversity of the US population, there is a need to understand how pregnancy relates to IDs among minorities. This study examines the association between unintended pregnancy and lifetime and 12-month history of IDs among Latina and Asian mothers.

METHODS

Data come from the National Latino and Asian American Study (NLAAS), a nationally representative sample of Latino and Asian adults. Pregnancy intention was self-reported. ID history was assessed with the CIDI (DSM-IV). Logistic regression was used to examine the association between pregnancy intention and likelihood of lifetime and 12-month IDs.

RESULTS

Among 1915 mothers, 24.1% and 14.7% met criteria for a lifetime and 12-month ID, respectively. Relative to those who only reported intended pregnancies, Asian mothers reporting an unintended pregnancy had the highest odds of lifetime (Odds ratio (OR): 2.51, 95% Confidence Interval (CI): 1.55-4.08) and 12-month IDs (OR: 5.73, 95% CI: 2.67-12.29). Latina mothers reporting unintended pregnancies also had higher odds of lifetime (OR: 1.96, 95% CI: 1.41-2.72) and 12-month IDs (OR: 1.70, 95% CI: 1.12-2.59). Socioeconomic status had no significant modifying effect.

LIMITATIONS

Cross-sectional data and retrospective recall and social desirability could misclassify pregnancy intention.

CONCLUSIONS

Unintended pregnancy is associated with higher odds of IDs among mothers. Findings underscore the complex relationship between unintended pregnancy and maternal mental health.

Gender differences in exposure to potentially traumatic events and diagnosis of posttraumatic stress disorder (PTSD) by racial and ethnic group

OBJECTIVE

There is a robust literature base documenting gender differences and racial/ethnic differences in exposure to potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) diagnosis. Yet, to the best of our knowledge, this is the first study to evaluate the risk of PTEs and PTSD between genders, stratified by race/ethnicity. We aimed to better understand whether factors associated with poor psychological adjustment following PTEs (e.g., PTE type, sociodemographic factors, social support) varied by gender and race/ethnicity.

METHOD

Data were collected from three U.S.-based national studies comprising the Collaborative Psychiatric Epidemiologic Surveys (CPES; N = 13,649). Trained lay interviewers administered questionnaires and collected data on PTE exposure, PTSD, and psychosocial covariates. Regression analyses were conducted to investigate relations between PTEs, PTSD, and gender, stratified by race/ethnicity.

RESULTS

Adjusting for sociodemographic variables, mental health comorbidity, social support, and PTE frequency, White, African-American, and Afro-Caribbean women had higher odds of PTSD than men in their respective racial/ethnic groups, whereas gender differences were not observed for Latinos or Asians.

CONCLUSION

Findings suggest that risk of exposure to PTEs and PTSD may differ by gender and race/ethnicity. Future studies should consider the contributions of social, cultural, and contextual factors in estimating PTSD risk.

Racial/ethnic variation in trauma-related psychopathology in the United States: a population-based study

BACKGROUND

The prevalence of mental disorders among Black, Latino, and Asian adults is lower than among Whites. Factors that explain these differences are largely unknown. We examined whether racial/ethnic differences in exposure to traumatic events (TEs) or vulnerability to trauma-related psychopathology explained the lower rates of psychopathology among racial/ethnic minorities.

METHODS

We estimated the prevalence of TE exposure and associations with onset of DSM-IV depression, anxiety and substance disorders and with lifetime post-traumatic stress disorder (PTSD) in the Collaborative Psychiatric Epidemiology Surveys, a national sample (N = 13 775) with substantial proportions of Black (35.9%), Latino (18.9%), and Asian Americans (14.9%).

RESULTS

TE exposure varied across racial/ethnic groups. Asians were most likely to experience organized violence - particularly being a refugee - but had the lowest exposure to all other TEs. Blacks had the greatest exposure to participation in organized violence, sexual violence, and other TEs, Latinos had the highest exposure to physical violence, and Whites were most likely to experience accidents/injuries. Racial/ethnic minorities had lower odds ratios of depression, anxiety, and substance disorder onset relative to Whites. Neither variation in TE exposure nor vulnerability to psychopathology following TEs across racial/ethnic groups explained these differences. Vulnerability to PTSD did vary across groups, however, such that Asians were less likely and Blacks more likely to develop PTSD following TEs than Whites.

CONCLUSIONS

Lower prevalence of mental disorders among racial/ethnic minorities does not appear to reflect reduced vulnerability to TEs, with the exception of PTSD among Asians. This highlights the importance of investigating other potential mechanisms underlying racial/ethnic differences in psychopathology.

Heterogeneity of Latina/os' acculturative experiences in the National Latino and Asian American Study: a latent profile analysis

PURPOSE

This study characterized unobserved subgroups of acculturative experiences among a nationally representative sample of U.S.-residing Latina/os (n = 2541) from the National Latino and Asian American Study.

METHODS

Latent profile analysis was used to characterize the sample by acculturative experiences using nine-factor score indicators regarding discrimination, neighborhood context, family environment, acculturation (language use and preference), and enculturation (ethnic identity). Predictors of profile membership are also examined, including sociodemographics, Latina/o heritage (i.e., ethnic group), generational status, and two acculturative stress domains (legal and interpersonal).

RESULTS

Four Latina/o subgroups were identified based on acculturative experiences. Profiles were differentiated by family context, neighborhood context, and discrimination: (1) positive experiences (n = 1,743, 69%), (2) cohesive conflict (n = 424, 17%), (3) marginalized conflict (n = 237, 9%), and (4) marginalized (n = 137, 5%). Generational status, heritage, and marital status were the salient predictors of profile membership. Among the foreign-born sample (n = 1617), legal acculturative stress also predicted profile membership.

CONCLUSIONS

Latina/os have heterogeneous experiences living in the United States. Discrimination, family context, and neighborhood environment are more related to varying experiences as opposed to traditional measures of acculturation and enculturation. Future research should characterize Latina/o heterogeneity using these experiences rather than strictly by observed demographics, such as heritage or generational status.

Depression moderates the relationships between hallucinations, delusions, and suicidal ideation: The cumulative effect of experiencing both hallucinations and delusions

Suicide is a leading cause of preventable death in the United States and worldwide, with symptoms of depression and psychosis relating to increases in risk for ideation, attempt, and completion. This study examined moderating effects of depression in the relationships between three categories of psychotic symptoms (experiencing only hallucinations, only delusions, and both hallucinations and delusions) and suicidal ideation. Data (n = 12,195) were obtained from the cross-sectional Collaborative Psychiatric Epidemiology Surveys data which include large general population-based samples of households in the United States. Data were examined using Structural Equation Modeling (SEM) in Mplus 8. Approximately 19% of the sample met criteria for major depression and 13% reported having the experience of suicidal ideation. Only 16% of the sample reported having a diagnosis of schizophrenia and/or a psychotic disorder. Depression functioned as a moderator and among those who experienced depression, increases in all psychotic symptom categories significantly related to increased likelihood of experiencing suicidal ideation. Among those who were not depressed, increases in two psychotic symptom categories (only hallucinations and both hallucinations and delusions) were significantly related to greater likelihood of experiencing suicidal ideation. Findings emphasize the high-risk for ideation among individuals who experience hallucinations or delusions, with the cumulative effect of experiencing both hallucinations and delusions being most harmful in relation to the likelihood of experiencing suicidal ideation; particularly so among those who were depressed. Assessment of risk factors for suicidal ideation is imperative given its relationship to the potential of suicide attempt and/or completion.

Mental health treatment and work among African American and Caribbean Black welfare recipients

OBJECTIVE

Untreated depression among Temporary Assistance for Needy Families (TANF) participants greatly reduces chances of securing and holding gainful employment.

METHOD

Logistic regression models were estimated on data describing 1,000 African American and Caribbean Black TANF recipients and 2,123 African American and Caribbean Black non-TANF recipients obtained from the National Survey of American Life (NSAL).

RESULTS

Black TANF participants were more likely than Black non-TANF participants to be depressed and treated. Treatment odds were lower for Caribbean Black than for U.S.-born Black TANF participants.

CONCLUSION

Results indicated that mental health treatment was likely among Black TANF participants if depression was identified. TANF participants working less than full-time did not receive as much treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Quitting Mental Health Services among Racial and Ethnic Groups of Americans with Depression

Research on racial/ethnic differences in quitting mental health services has yet to examine the multiple forms of services offered and reasons why racial/ethnic groups quit. Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) examined whether race/ethnicity was related to quitting nine types of mental health services within a multivariate framework, and whether any racial/ethnic differences emerged among 16 assessed reasons for quitting mental health services (N = 437). Odds of quitting mental health services provided by social workers, non-medical health professionals, counselors, psychiatrists, and psychologists varied significantly by race/ethnicity. The most common reasons for quitting services included individuals wanting to handle the problem on their own, getting better, or not needing help anymore. The increased likelihood of quitting services represents an underexplored area for mental health service disparities and calls for improved efforts to retain racial and ethnic minorities in the mental health system.

Allergies, asthma, and psychopathology in a nationally-representative US sample

BACKGROUND

Symptoms of depressed mood and anxiety have been associated with immune dysregulation and atopic disorders, however it is unclear whether this relationship spans other forms of psychopathology. The objective of this study was to use a large, population-based sample to examine the association between several common psychiatric conditions and two atopic disorders: seasonal allergies and asthma. This study also examined whether comorbidity between psychiatric disorders confounded the relationship between atopy and each psychiatric disorder.

METHODS

Data come from the Comprehensive Psychiatric Epidemiology Surveys, a nationally-representative sample of US adults (N = 10,309). Lifetime history of major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), and post-traumatic stress disorder (PTSD) was assessed using the Composite International Diagnostic Inventory. History of seasonal allergies and asthma were assessed by self-report. Weighted logistic regression was used to evaluate the association between allergies and asthma and psychopathology. Psychiatric comorbidities were also examined as potential confounders.

RESULTS

Approximately 36.6% had a history of allergies and 11.5% a history of asthma. Seasonal allergies were positively associated with odds of MDD (Odds ratio (OR): 1.24, 95% Confidence Interval (CI): 1.06-1.46), GAD (OR: 1.54 (1.28-1.84)), PD (OR: 1.54 (1.24-1.91)), and PTSD (OR: 1.32 (1.09-1.59)). Asthma was not significantly associated with any psychiatric disorder. All significant associations persisted after adjustment for psychiatric comorbidities.

LIMITATIONS

Limitations include self-reporting of atopic disorder status and of all disorder ages of onset.

CONCLUSIONS

This study confirms the association between MDD and PD and seasonal allergies, and extends this relationship to GAD and PTSD.