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

A phenomenological, intersectional understanding of coping with ageism and racism among older adults

The aim of this qualitative, phenomenological study was to understand how older adults cope with experiences of ageism and racism through an intersectional lens. Twenty adults 60+ residing in the U.S. Mountain West who identified as Black, Hispanic/Latino(a), Asian-American/Pacific Islander, Indigenous, or White participated individually in a one-hour, semi-structured interview. A team of five coders engaged in an inductive coding process through independent coding followed by critical discussion. Peer debriefing enhanced credibility. Nine themes were organized by three umbrella categories: Coping with ageism: 1) distancing via self-determination/defying stereotypes, 2) distancing by helping others; Coping with racism: 3) resistance, 4) exhaustion; Coping with both ageism and racism: 5) increased awareness through aging, 6) healthy lifestyle, 7) education, 8) acceptance/ 'let it go', and 9) avoidance. Novel findings include how older adults may cope with ageism and racism via increased awareness through aging and with ageism specifically by helping peer older adults, although instances of internalized ageism were noted and discussed. The themes exemplify problem-focused (e.g., helping others) and emotion-focused (acceptance), as well as individual (e.g., self-determination) and collective (e.g., resistance) coping strategies. This study can serve as a resource for practitioners in applying a more nuanced understanding of the ways older adults cope with ageism and racism in later life.

All Shades of Anxiety: A Review of Therapeutic and Psychotropic Considerations for Child and Adolescent Youth of Color

The literature on anxiety in Black, Indigenous, and other persons of color youth is a developing area. This article highlights distinct areas for the clinician to consider in working with these populations. We highlight prevalence and incidence, race-related stress, social media, substance use, spirituality, the impact of social determinants of health (including COVID-19 and the Syndemic), as well as treatment considerations. Our aim is to contribute to the readers' developing cultural humility.

Anxiety-Related Disorders in the Context of Racism

PURPOSE OF REVIEW

The literature on racism and anxiety-related disorders, especially social anxiety, specific phobia, and generalized anxiety disorder, is notably lacking. This report aims to review recent evidence demonstrating the link between racial discrimination and various anxiety-related disorders.

RECENT FINDINGS

Anxiety-related disorders were the most significant mediator for daily discrimination and suicidal thoughts, above both depression and substance use. Further, studies showed that racial discrimination promotes posttraumatic stress and racial trauma among people of color. Systemic racism puts people of color at a higher risk for anxiety disorders than White people. Clinical case examples provide lived evidence of diverse racial and ethnic individuals suffering from anxiety-related disorders, with the development and worsening of symptoms due to racism and microaggressions. There is a prominent need for recent research on anxiety-related disorders and racism. Recommendations for clinicians and future research directions are provided. These actions are required to address bias and mental health inequities and empower people of color.

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.

Persistence, Impairment, Disability and Unmet Treatment of Lifetime and 12-Month Anxiety Disorders in Black Men and Women, 50 Years of Age and Older

Objectives: To examine anxiety disorders in aging Black adults. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime/12-month prevalence of anxiety disorders in Black men and women, age 50+ (N = 1561). Disorder-specific persistence and severity, functional impairment, and mental health service utilization were investigated using multivariate regressions. Results: Black men and women who met criteria for anxiety disorders (lifetime prevalence=12.4%/18.3% in men/women) also demonstrated persistent disorders (percent meeting criteria = 40.3%-61.2%). Those with a 12-month anxiety disorder (6.2%/10.5% of men/women) typically reported severe task interference (38.3%-85.7%). Those with any 12-month anxiety disorder, compared to those without, experienced greater impairment in days out of role, work, family burden, cognition and, in women, mobility (p's < .05). Only 47.0%/65.2% of Black men/women with any lifetime anxiety disorder used mental health services. Discussion: Despite low prevalence, older Blacks with anxiety disorders experience substantial mental health burden in middle age and later.

Prevalence, Severity and Burden of Post-Traumatic Stress Disorder in Black Men and Women Across the Adult Life span

Objectives: To examine post-traumatic stress disorder (PTSD) among Black adults in younger, middle, and older ages. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime and 12-month prevalence of PTSD in Black men and women ages 18-34, 35-49, and 50+. We determined PTSD persistence and severity by age group, then associations of PTSD with socio-economic status, chronic stress, and racial discrimination in middle age. Results: The lifetime prevalence of PTSD was higher in Black women/men ages 18-34 (prevalence=14.0%/6.3%) and 35-49 (12.8%/4.6%) versus 50 and older (8.7%/5.1%). Those ages 35-49 were more likely than younger/older Black adults to have severe interference in work, relationships, and activities domains. In middle age, PTSD was associated with unemployment, lower education, poverty, and stress in Black men, and unemployment, divorce, poverty, stress, and discrimination in Black women. Discussion: Black women experience a disproportionate burden of PTSD in middle age.

Chronic Stress, Coping, and Mental Health Among Older African Americans

OBJECTIVES

African Americans experience relatively low rates of mental disorder despite being disproportionately exposed to psychosocial stressors. Coping is an understudied area that may help explain the mental health resilience among this population.

METHODS

Using data from the National Survey of American Life, I use negative binomial logistic regression to investigate the relationships between stress exposure/appraisal, ten coping responses, and mental health among older African American adults.

RESULTS

Seven of 10 coping responses were predictive of psychological distress. I also found evidence of moderation for six responses. Active coping, instrumental social support, looking for something good in what has happened, and two measures of acceptance were protective against psychological distress associated with high levels of stress. Substance use generally exacerbated the association between stress and psychological distress.

DISCUSSION

Problem-focused coping and acceptance responses were effective coping strategies for older African Americans under high levels of stress exposure/appraisal.

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.

Length of Residence and Cardiovascular Health among Afro-Caribbean Immigrants in New York City

Cardiovascular disease (CVD) disproportionately affects non-Hispanic blacks (NHB) in the United States (U.S.). Afro-Caribbean (AC) immigrants comprise over 50% of the immigrant black population and are critical in understanding the health trajectories of blacks in the U.S. We assessed the relationship between length of residence (proxy measure for acculturation) and cardiovascular health (CVH) based on the American Heart Association's (AHA) seven ideal cardiovascular health components among AC immigrants in New York City (NYC). CVH scores were categorized into poor/intermediate CVH (0-3 components) or ideal CVH (≥ 4 components). Multivariable logistic regression was used to examine the association between length of residence in the U.S. and poor/intermediate CVH. In adjusted models, the odds of poor/intermediate CVH were significantly higher for Guyanese (OR = 3.51; 95% CI 1.03-11.95) and Haitian immigrants (OR = 8.02; 95% CI 1.88-34.12) residing in the U.S. for ≥ 10 years than for those living in the U.S. for < 10 years. Length of residence was not significantly associated with CVH among Jamaican immigrants. We found evidence of ethnic differences in the association between acculturation and CVH among AC immigrants in a major metropolitan city. Culturally tailored interventions are needed to improve the CVH of AC immigrants as they become integrated into the U.S., with special consideration of country of birth.

Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?

This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.

Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?

This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Family and friendship informal support networks and social anxiety disorder among African Americans and Black Caribbeans

BACKGROUND

This study explores relationships between Social Anxiety Disorder (SAD) and quality and frequency of involvement with family and friends.

METHODS

Data are from a nationally representative sample of African American and Black Caribbean adults (n = 5191), the National Survey of American Life. SAD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview.

RESULTS

Findings indicated that among both populations, close supportive ties with family members and friends are protective against meeting criteria for SAD. Negative interactions with family (e.g., conflicts), however, are a risk factor for SAD among both African Americans and Black Caribbeans. For African Americans, an interaction indicates that the relationship between negative interaction and social anxiety is much stronger among African Americans who are not emotionally close to their families. For Caribbean Blacks, an interaction suggests that the odds of meeting criteria for SAD were higher among Black Caribbeans who had high negative interaction with family as well as low levels of friendship closeness.

LIMITATIONS

The cross-sectional nature of the study does not allow for causal attributions for findings.

CONCLUSIONS

This study demonstrates that SAD may impact black ethnic subgroups differently, which has important implications for understanding the nature, etiology, and treatment of this disorder.