Idioms of Distress Among Depressed White-Non-Mexican and Mexican-Origin Older Men

Centering Culture in Mental Health: Differences in Diagnosis, Treatment, and Access to Care Among Older People of Color

Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.

Experiences of depression in older adults from non-white and ethnic minority groups: A thematic synthesis of qualitative studies

OBJECTIVES

Older adults from black, Asian and minority ethnic communities, sometimes referred to as BAME, are at an increased risk of experiencing depression and yet are underrepresented in healthcare services. Qualitative research could help to provide insight into how the condition is experienced and managed by these groups. The current review is a thematic synthesis of qualitative studies examining lived experience of depression in older adults from BAME groups.

METHODS

A systematic search of five databases was conducted. The methodology of articles was evaluated and findings synthesised.

RESULTS

Twelve articles were identified capturing the experiences of 210 older adults across three continents: North America, South America and Asia. Studies met the majority or all of the quality appraisal criteria. Three themes emerged from the analysis: (i) How depression is understood in minority groups; demonstrating while older adults were familiar with the term depression, their understanding of the condition was limited; (ii) The socio-cultural norms of minority groups for managing depression; suggesting experiences of depression are typically kept hidden and managed in secret; (iii) How minority groups experience Western treatments for depression; reporting there are a number of barriers to seeking treatment, however, those who have received care valued the opportunity to share their difficulties.

CONCLUSIONS

While there is growing interest in this area, the evidence-base and research methodologies utilised to capture and explore experiences remains limited. The findings of this review have implications for informing the diagnosis, management and treatment of depression in older adults from BAME communities.

Examining contradictory evidence on racial/ethnic differences in perceived need for behavioral health treatment

OBJECTIVES

The study aims to investigate apparently contradictory evidence regarding racial/ethnic differences in perceived need for behavioral health treatment in two prominent surveys of the U.S. population, the National Comorbidity Survey Replication (NCS-R) and the National Survey of Drug Use and Health (NSDUH).

METHODS

The two surveys were compared with respect to two components of perceived need: service use and perceived need among the untreated. Logistic regression models were estimated to adjust comparisons for demographic characteristics. Comparisons were conducted in samples representing the entire population, without selection on a mental health assessment, and for samples meeting criteria for lifetime major depression.

RESULTS

The surveys are concordant with respect to racial/ethnic differences in service use and discordant with respect to perceived need among the untreated. For instance, among untreated individuals, the odds of perceiving a need for treatment are significantly higher in Blacks than Whites in the NCS-R (OR = 1.8, 95% CI [1.1, 2.9]) but do not differ between these groups in the NSDUH (OR = 0.9, 95% CI [0.7, 1.2]). Temporal trends do not appear to explain this discordance.

CONCLUSION

Assessments of racial/ethnic differences in perceived need among untreated individuals are affected by methodological differences across surveys. Resolving contradictory evidence is critical to efforts to reduce racial/ethnic disparities.

Racial/ethnic differences in perception of need for mental health treatment in a US national sample

PURPOSE

To resolve contradictory evidence regarding racial/ethnic differences in perceived need for mental health treatment in the USA using a large and diverse epidemiologic sample.

METHODS

Samples from 6 years of a repeated cross-sectional survey of the US civilian non-institutionalized population were combined (N = 232,723). Perceived need was compared across three non-Hispanic groups (whites, blacks and Asian-Americans) and two Hispanic groups (English interviewees and Spanish interviewees). Logistic regression models were used to test for variation across groups in the relationship between severity of mental illness and perceived need for treatment.

RESULTS

Adjusting statistically for demographic and socioeconomic characteristics and for severity of mental illness, perceived need was less common in all racial/ethnic minority groups compared to whites. The prevalence difference (relative to whites) was smallest among Hispanics interviewed in English, -5.8% (95% CI -6.5, -5.2%), and largest among Hispanics interviewed in Spanish, -11.2% (95% CI -12.4, -10.0%). Perceived need was significantly less common among all minority racial/ethnic groups at each level of severity. In particular, among those with serious mental illness, the largest prevalence differences (relative to whites) were among Asian-Americans, -23.3% (95% CI -34.9, -11.7%) and Hispanics interviewed in Spanish, 32.6% (95% CI -48.0, -17.2%).

CONCLUSIONS

This study resolves the contradiction in empirical evidence regarding the existence of racial/ethnic differences in perception of need for mental health treatment; differences exist across the range of severity of mental illness and among those with no mental illness. These differences should be taken into account in an effort to reduce mental health-care disparities.