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Yeh PG, Tsai J. Differential prevalence of psychiatric disorders and mental health characteristics associated with lifetime suicide attempts in the Asian American and Pacific Islander adult population. J Psychiatr Res 2024; 180:86-95. [PMID: 39383714 DOI: 10.1016/j.jpsychires.2024.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/27/2024] [Accepted: 09/29/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND Asian American and Pacific Islander (AAPI) adults are an understudied group in terms of their mental health and mental healthcare needs. This has been complicated by the difficulty of recruiting adequate national samples of AAPI adults for research. OBJECTIVE This study aimed to analyze national data to examine the lifetime prevalence of major psychiatric disorders among AAPI adults relative to non-AAPI adults, as well as to identify and compare sociodemographic and clinical characteristics associated with lifetime suicide attempts among AAPI and non-AAPI adults. METHODS Cross-sectional data on 36,109 adults, including 1801 AAPI adults, from the National Epidemiological Survey of Alcohol and Related Conditions-III (NESARC-III), were analyzed with a series of chi-square and logistic regression analyses. RESULTS We found a significantly lower lifetime prevalence of mental health disorders in the AAPI versus the non-AAPI population nationally, including 2% of AAPI adults reporting lifetime suicide attempts as compared to about 5% of non-AAPI adults. Female sex and a history of major depressive disorder diagnosis were associated with lifetime suicide attempts in the AAPI and non-AAPI populations. Several unique factors were associated with having a history of suicide attempts in only the AAPI population, including a military service history and a diagnosis of panic disorder. DISCUSSION Our analysis demonstrated the significant sectors of the AAPI population that merit research, support, and intervention, including the AAPI veteran population. This study identifies several characteristics among AAPI adults that may make them particularly vulnerable to psychiatric problems and suicide risk, which may inform targeted prevention and efforts to provide culturally competent care to this population.
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Affiliation(s)
- Paul Gerardo Yeh
- Department of Kinesiology, Rice University, Houston, TX, USA; Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.
| | - Jack Tsai
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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2
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Lewis-Fernández R, Chen CN, Olfson M, Interian A, Alegría M. Clinical significance of psychotic-like experiences across U.S. ethnoracial groups. Psychol Med 2023; 53:7666-7676. [PMID: 37272381 PMCID: PMC10755236 DOI: 10.1017/s0033291723001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Prevalence of psychotic-like experiences (PLEs) - reports of hallucinations and delusional thinking not meeting criteria for psychotic disorder - varies substantially across ethnoracial groups. What explains this range of PLE prevalence? Despite extensive research, the clinical significance of PLEs remains unclear. Are PLE prevalence and clinical severity differentially associated across ethnoracial groups? METHODS We examined the lifetime prevalence and clinical significance of PLEs across ethnoracial groups in the Collaborative Psychiatric Epidemiology Surveys (N = 11 139) using the Composite International Diagnostic Interview (CIDI) psychosis symptom screener. Outcomes included mental healthcare use (inpatient, outpatient), mental health morbidity (self-perceived poor/fair mental health, suicidal ideation or attempts), and impairment (role interference). Individuals with outcome onsets prior to PLE onset were excluded. We also examined associations of PLEs with CIDI diagnoses. Cox proportional-hazards regression and logistic regression modeling identified associations of interest. RESULTS Contrary to previous reports, only Asian Americans differed significantly from other U.S. ethnoracial groups, reporting lower lifetime prevalence (6.7% v. 8.0-11.9%) and mean number (0.09 v. 0.11-0.18) of PLEs. In multivariate analyses, PLE clinical significance showed limited ethnoracial variation among Asian Americans, non-Caribbean Latinos, and Afro-Caribbeans. In other groups, mental health outcomes showed significant ethnoracial clustering by outcome (e.g. hospitalization and role interference with Caribbean-Latino origin), possibly due to underlying differences in psychiatric disorder chronicity or treatment barriers. CONCLUSIONS While there is limited ethnoracial variation in U.S. PLE prevalence, PLE clinical significance varies across U.S. ethnoracial groups. Clinicians should consider this variation when assessing PLEs to avoid exaggerating their clinical significance, contributing to mental healthcare disparities.
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Affiliation(s)
- Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Chih-nan Chen
- Department of Economics, National Taipei University, Taipei, Taiwan, Republic of China
| | - Mark Olfson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Alejandro Interian
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Kaur N, Esie P, Finsaas MC, Mauro PM, Keyes KM. Trends in Racial-Ethnic Disparities in Adult Mental Health Treatment Use From 2005 to 2019. Psychiatr Serv 2023; 74:455-462. [PMID: 36321320 PMCID: PMC10151427 DOI: 10.1176/appi.ps.202100700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although U.S. mental health treatment rates increased in the 2000s, gaps in treatment among racial-ethnic groups grew. Little is known, however, about national trends after 2012, when treatment access increased overall. This study assessed trends in racial-ethnic disparities in past-year treatment rates among people with a major depressive episode, serious psychological distress, or serious mental illness. METHODS National Survey on Drug Use and Health (2005-2019) data of adults with a past-year major depressive episode (N=49,791) or serious psychological distress (N=89,233) and of adults with past-year serious mental illness (N=24,944; 2008-2019) were analyzed. Linear risk regressions were used to model trends in past-year use of mental health treatment and included an interaction term between survey year and race-ethnicity. RESULTS Treatment use prevalence (2005-2019) among marginalized individuals with a major depressive episode remained lower than that among White people. The magnitude of the disparity in treatment use between White and Hispanic people with major depressive episode decreased slightly (percentage-point difference=-25.1% to -14.9%), whereas the disparity in treatment use between White people and American Indian/Alaska Native people with serious mental illness increased significantly (percentage-point difference=23.4% to -12.2%), from 2005 to 2019. The magnitude of the disparities for other marginalized racial-ethnic groups did not meaningfully change. CONCLUSIONS Racial-ethnic disparities in past-year mental health treatment use have persisted. Efforts to reduce disparities should consider structural barriers that hinder treatment use among marginalized groups.
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Affiliation(s)
- Navdep Kaur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
| | - Precious Esie
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
| | - Megan C Finsaas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
| | - Pia M Mauro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
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Alden AM. Operationalizing antiracism in health systems: Strategies state government administrative organizations use towards racial and ethnic mental health equity. Soc Sci Med 2023; 322:115809. [PMID: 36893503 DOI: 10.1016/j.socscimed.2023.115809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/10/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023]
Abstract
Although a growing body of literature recommends strategies for improving racial equity in organizations and populations, little is known about how racial equity goals are operationalized in actuality, particularly in the context of state health and mental health authorities (SH/MHAs) attempting to promote population wellness while navigating bureaucratic and political constraints. This article seeks to examine the number of states engaging in racial equity work in mental health care, what strategies SH/MHAs use to improve their state's racial equity in mental health care, and how the workforce understands these strategies. A brief survey of 47 states found that all but one state (98%) is enacting racial equity interventions in mental health care. Through qualitative interviews with 58 SH/MHA employees in 31 states, I created a taxonomy of activities within six overarching strategies: 1) running a racial equity group; 2) gathering information and data about racial equity; 3) facilitating training and learning for staff and providers; 4) collaborating with partners and engaging with communities; 5) offering information or services to communities and organizations of color; and 6) promoting workforce diversity. I describe specific tactics within each of the strategies as well as the perceived benefits and challenges of the strategies. I argue that strategies bifurcate into development activities, which are activities creating higher-quality racial equity plans, and equity-advancing activities, which are actions directly impacting racial equity. The results have implications for how government reform efforts can impact mental health equity.
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Affiliation(s)
- Alexandra M Alden
- Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA.
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Iyer P, Parmar D, Ganson KT, Tabler J, Soleimanpour S, Nagata JM. Investigating Asian American Adolescents' Resiliency Factors and Young Adult Mental Health Outcomes at 14-year Follow-up: A Nationally Representative Prospective Cohort Study. J Immigr Minor Health 2023; 25:75-85. [PMID: 35821295 DOI: 10.1007/s10903-022-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/12/2023]
Abstract
There is scant research on how Asian American adolescents' resiliency relates to mental well-being in adulthood. The objective of this study was to determine the prospective associations between resiliency factors (individual, family, and school community) in adolescence and mental health outcomes in adulthood, among a national sample of Asian Americans. We analyzed data from 1020 Asian American adolescents who were followed for 14 years in the National Longitudinal Study of Adolescent to Adult Health. Of the resiliency factors, individual self-esteem (Adjusted Odds Ratio [AOR] 0.54, 95% Confidence Interval [CI] 0.37-0.79) and family connectedness (AOR 0.78, 95% CI 0.65-0.93) in adolescence were found to be protective against adult mental health outcomes in logistic regression models adjusting for sociodemographic factors and baseline mental health. Our study identified individual and family resiliency factors which can be leveraged to help Asian American adolescents and families in cultivating better mental health.
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Affiliation(s)
- Puja Iyer
- Department of Pediatrics, University of California, San Francisco, Box 0110, 550 16th St, 4th Floor, 94143, San Francisco, CA, USA
| | - Deepika Parmar
- Department of Pediatrics, University of California, San Francisco, Box 0110, 550 16th St, 4th Floor, 94143, San Francisco, CA, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Jennifer Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, Laramie, WY, USA
| | - Samira Soleimanpour
- Institute for Health Policy Studies, University of California, San Francisco, CA, San Francisco, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, Box 0110, 550 16th St, 4th Floor, 94143, San Francisco, CA, USA.
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Johnson JCS, Byrne GJ, Pelecanos AM. The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adults. BMC Psychiatry 2022; 22:270. [PMID: 35428242 PMCID: PMC9012038 DOI: 10.1186/s12888-022-03834-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Our aim was to describe a broad number of subthreshold psychiatric symptoms (SPS) in a nationally representative population and evaluate associations with substance use. SPS describe groups of symptoms with significant pathology, but that do not quite meet full psychiatric diagnostic criteria. They have been associated with significant impairment and cost. METHODS The National Epidemiologic Survey on Alcohol and Related Conditions-III was a multistage, weighted, cross-sectional survey completed in the United States in 2013 comprising 36,309 noninstitutionalized adults. We report lifetime prevalence rates of 14 SPS related to mood, anxiety, trauma, eating, and personality disorders. We then evaluate associations with lifetime alcohol use disorders (AUD) and all substance use disorders (SUD) using logistic regression and adjusted odds ratios. SPS and psychiatric diagnoses were mutually exclusive (could not co-occur). RESULTS Lifetime prevalence of having at least one of 14 SPS was 57% compared with 37% for the related psychiatric disorders. This was similar for males and females, in contrast to psychiatric disorders in which prevalence was 42% in females and 31% in males. Otherwise, overall SPS and disorders had similar prevalence patterns across sociodemographic characteristics. Subthreshold personality symptoms had the highest prevalence rates (schizotypal 21.3%, antisocial 18.3%, and borderline 17.6%), followed by posttraumatic stress (13.1%). Subthreshold bipolar and depression had lifetime prevalence rates of 2.7 and 8.5%, respectively. Prevalence rates of subthreshold anxiety symptoms ranged from 2.2% (agoraphobia) to 9.8% (specific phobia). Subthreshold eating disorder related symptoms had the lowest prevalence rates (anorexia 1.5% and bulimia 1.7%). Half (seven) of the SPS had significantly increased odds of lifetime AUD. This number increased to 12 for all SUD. Subthreshold antisocial personality symptoms had the highest odds of AUD (2.2; 95% CI 2.00-2.37) and SUD (3.5; 95% CI 3.22-3.81). CONCLUSIONS We found high lifetime SPS prevalence rates and significant associations with AUD and SUD. To our knowledge, this is the first published study evaluating a broad number of SPS. This indicates possible opportunities for early intervention and prevention but requires additional research and development of infrastructure and guidelines to better understand and manage patients who experience SPS.
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Affiliation(s)
- Jeremy C. S. Johnson
- grid.1003.20000 0000 9320 7537The University of Queensland, Mental Health Centre, K Floor, Royal Brisbane & Women’s Hospital, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Department of Psychiatry, Royal Brisbane & Women’s Hospital, Butterfield St, Herston, QLD 4029 Australia
| | - Gerard J. Byrne
- grid.1003.20000 0000 9320 7537The University of Queensland, Mental Health Centre, K Floor, Royal Brisbane & Women’s Hospital, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Department of Psychiatry, Older Persons’ Mental Health Service, Royal Brisbane & Women’s Hospital, Butterfield St, Herston, QLD 4029 Australia
| | - Anita M. Pelecanos
- grid.1049.c0000 0001 2294 1395Statistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, QLD 4006 Australia
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Anxiety Symptoms, Depressive Symptoms, and Traditional Chinese Medicine Use in U.S. Chinese Older Adults. J Immigr Minor Health 2020; 22:746-753. [PMID: 31586266 PMCID: PMC9943582 DOI: 10.1007/s10903-019-00935-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study examined the association between anxiety symptoms, depressive symptoms, and Traditional Chinese Medicine (TCM) use among U.S. Chinese older adults. Data was obtained from the Population Study of Chinese Elderly in Chicago (N = 3157; mean age = 72.8). Anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS-A). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9). TCM modalities included herbal products, acupuncture, massage therapy, Taichi, and other types of TCM. Although not significant, there was a trend indicating that higher levels of anxiety symptoms showed a higher rate of acupuncture use and massage therapy. Older Chinese Americans with depressive symptoms were more likely to use acupuncture and massage therapy; and they were less likely to use other TCM. Future research is needed to identify reasons for TCM use; and how these factors mediate or moderate the relationship between psychiatric symptoms and TCM use.
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Yang KG, Rodgers CRR, Lee E, Lê Cook B. Disparities in Mental Health Care Utilization and Perceived Need Among Asian Americans: 2012-2016. Psychiatr Serv 2020; 71:21-27. [PMID: 31575351 DOI: 10.1176/appi.ps.201900126] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective was to examine mental health treatment access disparities between Asians and whites in the United States as well as the role of perceived and objective need and barriers to treatment in these disparities. METHODS Data are five annual cross-sections (2012-2016) of responses from Asian Americans and whites to the nationally representative National Survey on Drug Use and Health. Multivariate logistic regression analyses adjusting for sociodemographic factors were conducted to compare past-year treatment access rates between Asians and whites across three need subgroups: those with perceived need for treatment, those with past-year serious psychological distress, and those with a past-year major depressive episode. Barriers to treatment were compared between Asians and whites with perceived need. RESULTS Asians were less likely than whites to have accessed mental health treatment in the past year in all analyses. Compared with Asians with need determined by structured diagnostic instruments, Asians with perceived need had higher rates of mental health care access, but even among respondents with perceived need, the disparity between whites and Asians remained. Regarding barriers to treatment, only one barrier (not knowing where to go for treatment) was more likely to be reported for Asians than whites. CONCLUSIONS Differences between Asians and whites in perceived need for mental health treatment do not explain the wide disparities in mental health care access between these two groups. Clinical interventions improving the relevance and fit of mental health care and community-based outreach interventions increasing awareness of available services are needed to improve access to mental health treatment among Asians.
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Affiliation(s)
- Kelly Guanhua Yang
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York (Yang, Rodgers); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Lee, Cook)
| | - Caryn R R Rodgers
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York (Yang, Rodgers); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Lee, Cook)
| | - Esther Lee
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York (Yang, Rodgers); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Lee, Cook)
| | - Benjamin Lê Cook
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York (Yang, Rodgers); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Lee, Cook)
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Cook BL, Hou SSY, Lee-Tauler SY, Progovac AM, Samson F, Sanchez MJ. A Review of Mental Health and Mental Health Care Disparities Research: 2011-2014. Med Care Res Rev 2019; 76:683-710. [PMID: 29877136 DOI: 10.1177/1077558718780592] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2024]
Abstract
Racial/ethnic minorities in the United States are more likely than Whites to have severe and persistent mental disorders and less likely to access mental health care. This comprehensive review evaluates studies of mental health and mental health care disparities funded by the National Institute of Mental Health (NIMH) to provide a benchmark for the 2015 NIMH revised strategic plan. A total of 615 articles were categorized into five pathways underlying mental health care and three pathways underlying mental health disparities. Identified studies demonstrate that socioeconomic mechanisms and demographic moderators of disparities in mental health status and treatment are well described, as are treatment options that support diverse patient needs. In contrast, there is a need for studies that focus on community- and policy-level predictors of mental health care disparities, link discrimination- and trauma-induced neurobiological pathways to disparities in mental illness, assess the cost effectiveness of disparities reduction programs, and scale up culturally adapted interventions.
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Affiliation(s)
- Benjamin Lê Cook
- Cambridge Health Alliance, Cambridge, MA, USA
- Uniformed Services University of the Health Sciences, North Bethesda, MD, USA
| | | | - Su Yeon Lee-Tauler
- Uniformed Services University of the Health Sciences, North Bethesda, MD, USA
| | - Ana Maria Progovac
- Cambridge Health Alliance, Cambridge, MA, USA
- Uniformed Services University of the Health Sciences, North Bethesda, MD, USA
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Saraiya T, Smith KZ, Campbell ANC, Hien D. Posttraumatic stress symptoms, shame, and substance use among Asian Americans. J Subst Abuse Treat 2019; 96:1-11. [PMID: 30466541 PMCID: PMC7534512 DOI: 10.1016/j.jsat.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND To examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame. METHODS From 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame. RESULTS Ethnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001). CONCLUSIONS Among Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use.
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Affiliation(s)
- T Saraiya
- The City College of New York, The City University of New York, 160 Convent Avenue, New York, NY 10031, USA; Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, USA.
| | - K Z Smith
- Columbia University Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - A N C Campbell
- Columbia University Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - D Hien
- The City College of New York, The City University of New York, 160 Convent Avenue, New York, NY 10031, USA; Center of Alcohol Studies, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway Township, NJ 08854, USA.
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11
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Wu C, Chiang M, Harrington A, Kim S, Ziedonis D, Fan X. Racial disparity in mental disorder diagnosis and treatment between non-hispanic White and Asian American patients in a general hospital. Asian J Psychiatr 2018; 34:78-83. [PMID: 29674132 DOI: 10.1016/j.ajp.2018.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/08/2018] [Accepted: 04/01/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE The present study sought to examine the diagnosis and treatment of mental disorders comparing Asian American (AA) and non-Hispanic Whites (WNH) drawn from a population accessing a large general hospital for any reason. Socio-demographic predictors of diagnosis and treatment were also explored. METHODS Data were obtained from de-identified medical records in the Partner Health Care System's Research Patient Data Registry. RESULTS The final sample included 345,070 self-identified WNH and 16,418 self-identified AA's between January 1, 2009 and December 31, 2009. WNH patients were more likely than AA patients to carry a diagnosis of a mental disorder (18.1% vs. 8.6%, p < 0.0001) and were more likely to receive psychotropic medication treatment (15.0% vs 8.5%, p < 0.0001). Logistic regression analyses of the AA cohort identified several risk factors (i.e. language, religion, gender, age) predicting the diagnosis of a mental disorder or use of psychotropic medication. CONCLUSIONS Our findings on the racial disparity in mental disorder diagnosis and treatment between AA and WNH patients suggest that mental disorders are under-recognized and mental health services are under-utilized in the AA community. There remains a need for health care providers to improve screening services and to gain a better understanding of the cultural barriers that hinder mental health care among AA patients.
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Affiliation(s)
- Carrie Wu
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Mathew Chiang
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Amy Harrington
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Sun Kim
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Douglas Ziedonis
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Xiaoduo Fan
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States.
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Luk JW, King KM, McCarty CA, McCauley E, Vander Stoep A. Prospective Effects of Parenting on Substance Use and Problems Across Asian/Pacific Islander and European American Youth: Tests of Moderated Mediation. J Stud Alcohol Drugs 2018; 78:521-530. [PMID: 28728634 DOI: 10.15288/jsad.2017.78.521] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Parental warmth and knowledge are protective factors against substance use, whereas parental psychological control is a risk factor. However, the interpretation of parenting and its effects on developmental outcomes may vary cross-culturally. This study examined direct and indirect effects of three parenting dimensions on substance use across Asian/Pacific Islander (API) and European Americans. METHOD A community sample of 97 API and 255 European Americans were followed from Grades 6 to 12. Participants reported on parenting in Grade 7, academic achievement and externalizing behaviors in Grades 7 and 8, and substance use behaviors in Grades 7, 9, and 12. RESULTS Direct effects of parenting were not moderated by race. Overall, mother psychological control was a risk factor for substance use problems in Grade 9, whereas father knowledge was protective against alcohol use in Grade 9, substance use problems in Grades 9 and 12, and alcohol dependence in Grade 12. Moderated mediation analyses indicated significant mediational links among European Americans only: Mother knowledge predicted fewer externalizing problems in Grade 8, which in turn predicted fewer substance use problems in Grades 9 and 12. Father warmth predicted better academic achievement in Grade 8, which in turn predicted fewer substance use problems in Grades 9 and 12, as well as alcohol and marijuana dependence in Grade 12. CONCLUSIONS Better academic achievement and fewer externalizing behaviors explain how positive parenting reduces substance use risk among European Americans. Promoting father knowledge of adolescents' whereabouts can reduce substance use risk among both European and API Americans.
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Affiliation(s)
- Jeremy W Luk
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Kevin M King
- Department of Psychology, University of Washington, Seattle, Washington
| | - Carolyn A McCarty
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Hospital Center for Child Health Behavior and Development, Seattle, Washington
| | - Elizabeth McCauley
- Seattle Children's Hospital Center for Child Health Behavior and Development, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Ann Vander Stoep
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
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Woo BK. Comparison of Mental Health Service Utilization by Asian Americans and Non-Hispanic Whites versus Their Cardiovascular Care Utilization. Cureus 2017; 9:e1595. [PMID: 29062627 PMCID: PMC5650256 DOI: 10.7759/cureus.1595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION This study will determine whether racial/ethnic disparities persist in various psychiatric disorders among Asian Americans. METHODS Secondary analyses of data from the second largest public health system in the US (total N=22294) were performed. Chi-squared statistics were used to compare the race for mental health service utilization for five psychiatric diagnoses. Cardiovascular care utilization by Asian Americans and non-Hispanic whites was used as a proxy for overall healthcare utilization rates between the two racial groups and constituted the expected values for the analysis. RESULTS Asian Americans were less likely to utilize mental health services for bipolar disorder, schizophrenia, anxiety, depression, and intellectual disabilities. CONCLUSION The results of this study call for ways to increase mental health service utilization on par with cardiovascular healthcare utilization among Asian Americans.
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Blanco C, Compton WM, Saha TD, Goldstein BI, Ruan WJ, Huang B, Grant BF. Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. J Psychiatr Res 2017; 84:310-317. [PMID: 27814503 PMCID: PMC7416534 DOI: 10.1016/j.jpsychires.2016.10.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/07/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to present 12-month and lifetime prevalence, correlates, comorbidity, treatment and disability of DSM-5 bipolar I disorder. METHODS Nationally representative U.S. adult sample (N = 36,309), the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions - III. RESULTS Prevalences of 12-month and lifetime DSM-5 bipolar I disorder were 1.5% and 2.1% and did not differ between men (1.6% and 2.2%) and women (1.5% and 2.0%). Prevalences of bipolar I disorder were greater among Native Americans, and lower among Blacks, Hispanics and Asians/Pacific Islanders than whites. Rates were also lower among younger than older individuals, those previously married than currently married and with lower education and income relative to higher education and income. Bipolar I disorder was more strongly related to borderline and schizotypal personality disorders (adjusted odds ratios (AORS) = 2.2-4.7)), than to anxiety disorders (AORs = 1.3-2.9), and substance use disorders (AORs = 1.3-2.1) overall and among men and women. Quality of life was lower among individuals with bipolar I disorder relative to those without the disorder. Treatment rates among individuals with bipolar I disorder were low in the total sample (46%, SE = 2.63), among men (36.7%, SE = 3.82) and among women (55.8%, SE = 3.32). CONCLUSIONS Bipolar I disorder continues to be common disabling and highly comorbid disorder among men and women, contributing substantially to low quality of life and burden of disease in our society.
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Affiliation(s)
- Carlos Blanco
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., Rockville, MD, 20852, USA.
| | - Wilson M. Compton
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd. Rockville, MD 20852
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Benjamin I. Goldstein
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room FG 53, Toronto, Canada, M4N 3M5
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD, 20852, USA.
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
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Cook BL, Trinh NH, Li Z, Hou SSY, Progovac AM. Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004-2012. Psychiatr Serv 2017; 68:9-16. [PMID: 27476805 PMCID: PMC5895177 DOI: 10.1176/appi.ps.201500453] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study compared trends in racial-ethnic disparities in mental health care access among whites, blacks, Hispanics, and Asians by using the Institute of Medicine definition of disparities as all differences except those due to clinical appropriateness, clinical need, and patient preferences. METHODS Racial-ethnic disparities in mental health care access were examined by using data from a nationally representative sample of 214,597 adults from the 2004-2012 Medical Expenditure Panel Surveys. The main outcome measures included three mental health care access measures (use of any mental health care, any outpatient care, and any psychotropic medication in the past year). RESULTS Significant disparities were found in 2004-2005 and in 2011-2012 for all three racial-ethnic minority groups compared with whites in all three measures of access. Between 2004 and 2012, black-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.2% to 10.8% and from 7.6% to 10.0%. Similarly, Hispanic-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.4% to 10.9% and 7.3% to 10.3%. CONCLUSIONS No reductions in racial-ethnic disparities in access to mental health care were identified between 2004 and 2012. For blacks and Hispanics, disparities were exacerbated over this period. Clinical interventions that improve identification of symptoms of mental illness, expansion of health insurance, and other policy interventions that remove financial barriers to access may help to reduce these disparities.
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Affiliation(s)
- Benjamin Lê Cook
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Nhi-Ha Trinh
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Zhihui Li
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Sherry Shu-Yeu Hou
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Ana M Progovac
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
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Ran MS, Mendez AJ, Leng LL, Bansil B, Reyes N, Cordero G, Carreon C, Fausto M, Maminta L, Tang M. Predictors of Mental Health Among College Students in Guam: Implications for Counseling. JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration; University of Hong Kong; Hong Kong China
| | - Ana Joy Mendez
- School of Nursing and Health Sciences; University of Guam; Mangilao Guam
| | - Ling-Li Leng
- Department of Social Work and Social Administration; University of Hong Kong; Hong Kong China
| | - Bryan Bansil
- School of Nursing and Health Sciences; University of Guam; Mangilao Guam
| | - Nicole Reyes
- School of Nursing and Health Sciences; University of Guam; Mangilao Guam
| | - Gem Cordero
- School of Nursing and Health Sciences; University of Guam; Mangilao Guam
| | - Cheenee Carreon
- School of Nursing and Health Sciences; University of Guam; Mangilao Guam
| | - Michelle Fausto
- School of Nursing and Health Sciences; University of Guam; Mangilao Guam
| | - Loida Maminta
- School of Nursing and Health Sciences; University of Guam; Mangilao Guam
| | - Maureen Tang
- School of Nursing and Health Sciences; University of Guam; Mangilao Guam
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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Luk JW, Patock-Peckham JA, King KM. Are Dimensions of Parenting Differentially Linked to Substance Use Across Caucasian and Asian American College Students? Subst Use Misuse 2015; 50:1360-9. [PMID: 26441023 PMCID: PMC6023674 DOI: 10.3109/10826084.2015.1013134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Parental warmth and autonomy granting are commonly thought of as protective factors against substance use among Caucasians. However, limited research has examined whether associations between parenting dimensions and substance use outcomes are the same or different among Asian Americans. METHOD A final analytic sample of 839 college students was used to test whether race (Caucasian vs. Asian American) moderated the relations between parenting dimensions and substance use outcomes across Caucasians and Asian Americans. We utilized the Parental Bonding Instrument (Parker, Tupling, & Brown, 1979) to measure maternal and paternal warmth, encouragement of behavioral freedom, and denial of psychological autonomy. RESULTS Multivariate regression models controlling for covariates including age, gender, and paternal education indicated four significant parenting by race interactions on alcohol problems and/or marijuana use. Specifically, maternal warmth was inversely associated with both alcohol problems and marijuana use among Caucasians but not among Asian Americans. Both maternal and paternal denial of psychological autonomy were positively associated with alcohol problems among Caucasians but not among Asian Americans. CONCLUSIONS Consistent with emerging cross-cultural research, the associations between parenting dimensions and substance use behaviors observed in Caucasian populations may not be readily generalized to Asian Americans. These findings highlight the importance of considering different parenting dimensions in understanding substance use etiology among Asian Americans. Future research should use longitudinal data to replicate these findings across development and seek to identify other parenting dimensions that may be more relevant for Asian American youth.
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Affiliation(s)
- Jeremy W. Luk
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | | | - Kevin M. King
- Department of Psychology, University of Washington, Seattle, Washington, USA
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Lee SY, Martins SS, Lee HB. Mental disorders and mental health service use across Asian American subethnic groups in the United States. Community Ment Health J 2015; 51:153-60. [PMID: 24957253 DOI: 10.1007/s10597-014-9749-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
This study analyzed the National Epidemiological Survey on Alcohol and Related Conditions data, 2001-2002, to compare the prevalence and odds of DSM-IV mood, anxiety, and substance use disorders and mental health service use across Asian American subethnic groups (648 East Asians, 485 Southeast Asians, 298 South Asians). Asian American subethnic groups varied in lifetime prevalence of psychiatric disorders (p=0.004), mainly due to differences in the presence of any substance use disorder (p=0.06), and specifically, drug use disorders (p=0.02). While Southeast Asians had the highest prevalence of substance use disorders (16.7%), fewer Southeast Asians with substance use disorders used mental health services (11.1%) compared to South Asians with substance use disorders (24.2%). East Asians compared to South Asians had significantly lower odds of mental health service use for substance use disorders (confidence interval=0.08-0.84). Asian American subethnic groups vary in the prevalence of mental disorders and in mental health service use, especially for substance use disorders.
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Affiliation(s)
- Su Yeon Lee
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD, 21205, USA,
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Hong S, Walton E, Tamaki E, Sabin JA. Lifetime Prevalence of Mental Disorders among Asian Americans: Nativity, Gender, and Sociodemographic Correlates. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2014; 5:353-363. [PMID: 25621123 PMCID: PMC4299873 DOI: 10.1037/a0035680] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This study examines lifetime prevalence estimates of mental disorders among Asian Americans with a focus on differences by nativity, gender, and other relevant sociodemographic correlates. We analyze cross-sectional data from the National Latino and Asian American Study (NLAAS), the first national epidemiological survey of Asian Americans which used a probability sample of household resident adults in the United States (N=2,095). US-born Asian Americans are more likely to experience lifetime mood disorders, substance use disorders, and any mental disorders compared to immigrants. Lifetime substance use disorders are more likely to occur among men rather than women. Nativity and gender show joint associations with different mental disorders: US-born women are at the greatest risk for any mood disorders; US-born men are at the greatest risk for any substance use disorders; and immigrant women are at the lowest risk for substance use disorders compared to all other groups. Analysis of the sociodemographic correlates reveals that the youngest immigrant women showed significantly higher rates of any mood disorder compared to other immigrant women. Additionally, among immigrant men, those with low household income are at a higher risk for mood disorders, and those who report fair/poor English proficiency have a higher prevalence of anxiety and mood disorders. This study provides documentation of prevalence differences in detailed mental health categories along salient axes of stratification among Asian Americans and provides a foundation for future research aimed at understanding the causes and correlates of mental health disparities.
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Affiliation(s)
- Seunghye Hong
- Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa
| | | | - Emi Tamaki
- Ritsumeikan University, College of Social Sciences
| | - Janice A Sabin
- University of Washington, Department of Biomedical Informatics and Medical Education
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Cho H, Kim I, Velez-Ortiz D. Factors associated with mental health service use among Latino and Asian Americans. Community Ment Health J 2014; 50:960-7. [PMID: 24659219 DOI: 10.1007/s10597-014-9719-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
Literature concur that there is a disparity between epidemiological prevalence and mental health services (MHS) utilization rates for Latino and Asian Americans. This study adapted the behavioral model of health service use to examine factors associated with MHS use among Latino and Asian Americans. The model consists of predisposing, enabling, and need factors. This study used the National Latino and Asian American Study data, including six ethnic groups. The outcome measure for this study was the use of MHS in the past 12 months. Age, sex, and education predicted higher odds of MHS use among Latinos, none of which were significant among Asians. Needs factors were strongly associated with higher odds of MHS use among Latinos and Asians.
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Affiliation(s)
- Hyunkag Cho
- School of Social Work, Michigan State University, 254 Baker Hall, 655 Auditorium Road, East Lansing, MI 48824, USA.
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Mental health service use from a religious or spiritual advisor among Asian Americans. Asian J Psychiatr 2013; 6:599-605. [PMID: 24309881 PMCID: PMC3855663 DOI: 10.1016/j.ajp.2013.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 03/09/2013] [Accepted: 03/30/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Asian Americans experience significant underuse of mental health treatment. Religious clergy and spiritual advisors play a critical role in delivering mental health care in the United States. Limited knowledge exists about their use among Asian Americans. OBJECTIVE We describe mental health service use from a religious/spiritual advisor among Asian Americans. METHODS We analyzed data from 2095 respondents in the 2002-2003 National Latino and Asian American Study. RESULTS Lifetime and 12-month prevalence of mental health service use from a religious/spiritual advisor (5.5% and 1% overall, respectively) was generally higher among U.S.-born Asians and those with a 12-month mental disorder (23.6% and 7.5%, respectively). Religious/spiritual advisors were seen by 35% of treatment-seeking Asian Americans with a lifetime mental disorder. They were seen as commonly as psychiatrists but less commonly than a mental health specialist or general medical provider. Approximately 70% of those seeking treatment had a mental disorder, significant proportions of whom sought treatment in the absence of a psychiatrist, a mental health specialist or even a healthcare provider. A significant majority with 12-month use perceived the care as helpful, felt accepted/understood and satisfied (71-86%). However, only 31% rated the care as excellent, 28% quit completing care, and referral rates for specialty mental health treatment were low, even among those with a mental disorder (9.5%). CONCLUSIONS Religious/spiritual advisors are a key source of treatment-seeking for Asian Americans with a mental disorder. Quality of care and low referral rates for specialty mental health treatment warrant further attention and need for increased collaboration with the mental health system.
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Blanco C, Morcillo C, Alegría M, Dedios MC, Fernández-Navarro P, Regincos R, Wang S. Acculturation and drug use disorders among Hispanics in the U.S. J Psychiatr Res 2013; 47:226-32. [PMID: 23128062 PMCID: PMC3529964 DOI: 10.1016/j.jpsychires.2012.09.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 08/24/2012] [Accepted: 09/27/2012] [Indexed: 11/18/2022]
Abstract
The authors' objective was to examine the relationship between degree of acculturation across five different dimensions of acculturation and risk of drug use disorders (DUD) among US Hispanics. Data were derived from a large national sample of the US adult population, the National Epidemiological Survey on Alcohol and Related Conditions, collected using face-to-face interviews. The sample included civilian non-institutionalized U.S. population aged 18 years and older, with oversampling of Hispanics, Blacks and those aged 18-24 years. Interviews of more than 34,000 adults were conducted during 2004-2005 using the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV Version. A total of 6359 subjects who identified themselves as Hispanics were included in this study. Acculturation measures used in this study assessed:, time spent in the U.S., age at immigration, language preference, social network composition, and ethnic identification. Among Hispanics, there was an inverse relationship between five complementary dimensions of acculturation and DUD. Moreover, this relationship showed a significant gradient across all acculturation dimensions and DUD. The prevalence of DUD increases with acculturation in Hispanics, across several measures of acculturation in a dose-response relationship. Hispanic cultural features and values exert a protective effect on risk of DUD. Preservation and promotion of Hispanic values may be an important component of preventive interventions for Hispanics.
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Affiliation(s)
- Carlos Blanco
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY 10032, USA.
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Lee SY, Martins SS, Keyes KM, Lee HB. Mental health service use by persons of Asian ancestry with DSM-IV mental disorders in the United States. Psychiatr Serv 2011; 62:1180-6. [PMID: 21969644 PMCID: PMC3698479 DOI: 10.1176/ps.62.10.pss6210_1180] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study compared the prevalence and odds of mental health service utilization among people of Asian ancestry with lifetime DSM-IV mood, anxiety, alcohol, and drug use disorders with utilization by members of other racial and ethnic groups with similar disorders. METHODS Between 2001 and 2002, a total of 43,093 noninstitutionalized individuals were assessed by the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study of lifetime prevalence of DSM-IV psychiatric disorders and mental health service utilization among various ethnic and racial groups. RESULTS Among individuals with lifetime mood disorders, Asians had significantly lower mental health service utilization compared with whites (odds ratio [OR]=.31, 95% confidence interval [CI]=.21-.46), Hispanics (OR=.49, CI=.33-71), and Native Americans (OR=.27, CI=.15-.48) but similar utilization compared with blacks. There were no statistically significant differences in lifetime mental health service utilization for alcohol and drug use disorders among racial and ethnic groups. CONCLUSIONS Asians with lifetime mood disorders underutilized mental health services even after adjustment was made for socioeconomic variables and years of residency in the United States. Future studies of culture-specific attitudes, correlates, and barriers to mental health service utilization are warranted.
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Affiliation(s)
- Su Yeon Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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