Distress about social problems and tobacco and cannabis use outcomes among young adults in Los Angeles County

OBJECTIVE

To examine associations of concern, worry, and stress about discrimination, shootings/violence, and police brutality and exclusive and dual tobacco and cannabis use among young adults.

METHODS

A prospective, racially/ethnically diverse cohort of young adults (n = 1960) living in Los Angeles, California completed a baseline survey in 2020 (age range: 19-23) and a follow-up survey in 2021. Exploratory factor analysis (EFA) was employed on nine variables assessing levels of concern, worry, and stress about societal discrimination, societal shootings/violence, and community police brutality at baseline. Past 30-day tobacco and cannabis use at follow-up was categorized as current exclusive tobacco, exclusive cannabis, and dual tobacco and cannabis (vs never/former) use based on eleven use variables. Multinomial logistic regressions estimated adjusted associations between each factor score (translated to standard deviation units) with exclusive and dual tobacco and cannabis use.

RESULTS

The EFA produced four factor scores representing concern/worry/stress (i.e., distress) about community police brutality (F1), distress about societal shootings/violence (F2), and distress about societal discrimination (F3), as well as generalized stress about police brutality, shootings/violence, and discrimination (F4). F1, F2, and F3 were associated with subsequent exclusive current cannabis use, with F1 having the strongest association (OR: 1.35, 95% CI: 1.18-1.55), while only F1 (OR: 1.51, 95% CI: 1.27-1.78) was associated with dual tobacco and cannabis use. None of the factors were associated with exclusive tobacco use.

CONCLUSIONS

Young adult concern, worry, and/or stress about social problems may increase risk of cannabis use with or without concurrent tobacco use 6-12 months later.

Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults

INTRODUCTION

Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear.

METHODS

We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification.

RESULTS

We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09-5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18-3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults.

CONCLUSION

We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.

James S. Jackson and the program for research on Black Americans: Contributions to psychology and the social sciences

James S. Jackson (1944-2020) is remembered as a groundbreaking social psychologist whose career contributions in scholarship, research, and service were fundamental to the field of psychology. This article briefly outlines his career-long work and contributions. A strong believer in interdisciplinary work, his research spanned other related social science disciplines (e.g., sociology, political science), as well as health and social welfare professions (public health, social work, medicine). As the founding director of the Program for Research on Black Americans at the Institute for Social Research, James Jackson initiated and led a long-standing program with a dual focus on research and training and mentoring doctoral students, postdoctoral scholars, and early career scientists. Jackson's efforts in the development of several nationally representative surveys of the Black population in the United States (e.g., National Survey of Black Americans, National Survey of American Life) revolutionized research focusing on the lives of Black Americans. James Jackson's international influence and reputation included numerous prestigious positions within national science organizations and honors and awards for his scientific contributions. Among James S. Jackson's most enduring legacies is the vast network of current scientists, researchers, and academics who were trained under his direction and leadership. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Racial/ethnic discrimination and tobacco and cannabis use outcomes among US adults

INTRODUCTION

Racial/ethnic discrimination (hereafter, discrimination) is associated with use of individual tobacco and cannabis products. However, we know little about how discrimination affects dual/polytobacco and cannabis use and associated use disorders.

METHODS

We used cross-sectional data on adults (18+) from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 35,744). We defined past-year discrimination as a summary scale (range: 0-24) based on six scenarios. We created a mutually exclusive six-category use variable: noncurrent, individual tobacco and noncannabis, individual tobacco and cannabis, individual cannabis and nontobacco, dual/polytobacco and noncannabis, and dual/polytobacco and cannabis based on past 30-day tobacco use of four products (i.e., cigarettes, electronic nicotine delivery systems, other combustibles (cigars, pipe), smokeless tobacco) and cannabis use. We also examined past-year tobacco use disorder (TUD) and cannabis use disorder (CUD) as a four-level variable: no disorders, TUD only, CUD only, and TUD and CUD. We estimated associations between discrimination and each outcome using adjusted multinomial logistic regression and assessed effect modification by stratifying adjusted models by race/ethnicity (i.e., Hispanic, non-Hispanic (NH) White, NH Black, and another race/ethnicity).

RESULTS

Experiencing more discrimination was associated with each outcome but was most strongly associated with dual/polytobacco and cannabis use (OR: 1.13, 95 % CI: 1.07-1.19) and joint TUD and CUD (OR: 1.16, 95 % CI: 1.12-1.20). Models stratified by race/ethnicity showed that discrimination was associated with dual/polytobacco and cannabis only among NH White adults, and with joint TUD and CUD only among NH Black and NH White adults.

CONCLUSIONS

Discrimination was associated with tobacco and cannabis use outcomes among multiple adult racial/ethnic populations, but associations were more profound for NH White and NH Black adults than adults from other racial/ethnic populations.

The contribution of research to racial health equity? Blame and responsibility in navigating the status quo of anti-black systemic racism

Thirty-seven years ago, the Secretary's Task Force on Black and Minority Health called attention to a "national paradox" of persistent Black-White health disparities despite overall health improvements for the nation (HHS, 1985). Subsequent updates to the "Heckler Report" came to the same conclusion; Black Americans continued to exhibit poorer health in comparison to White Americans (Satcher et al., 2005). Current population health statistics demonstrate Black-White health disparities comparable to 1985 (AHRQ, 2018; Shiels et al., 2021; Wall et al., 2018). Although psychological, behavioral, social, and economic factors all contribute to Black-White differences in health, there is a noticeable increase in discussions about the importance of systemic racism in producing racial health disparities. This article addresses three questions relevant to research on racism and the health of Black Americans: (1) Why has academic public health research on racism failed to reduce racial health disparities? (2) What can academic public health scientists do differently to reduce the impact of systemic racism on inequities among Black and White Americans? (3) What can Black Americans do in the face of present-day anti-Black systemic racism? We argue that to convert the vision of health equity into a visible reality, health equity research scientists must move beyond discussion, observation, and description. We also argue that to demonstrate progress in reducing racial health disparities, health equity scientists will need to work much more directly on eradicating racism as a fundamental cause of health differences between Black and White Americans. As scientists, the challenge we face is how to accomplish this mission without leaving the realm of science. Racism is a social determinant of Black health and social determinants are political problems. Political problems require political solutions.

Mental health care treatment seeking among African Americans and Caribbean Blacks: what is the role of religiosity/spirituality?

OBJECTIVES

As adults increase in age, the likelihood for using mental health care services decrease. Underutilization, expecially among racial/ethnic minorities such as African American and Caribbean Blacks, can result in a decrease in quality of life, as well as significant costs to families, employers, and health systems.

METHODS

The study explored the differences in relationships between mental health care usage and strength of religious/spiritual beliefs between African American and Caribbean Black older adults (54 years or older) and adults (18-53 years) using data from the National Survey of American Life (NSAL). Descriptive statistics and logistic regression analyses were conducted using Stata version 13.1.

RESULTS

Subjective ratings about the strength of religious/spiritual beliefs (OR = 1.26; 95 CI: 0.99, 1.61), age (OR = 0.62; 95 CI: 0.48, 0.81), and sex (OR = 1.59; 95 CI: 1.25, 2.02) were significantly associated with the odds of seeking mental health care. Additionally, persons living in the South were less likely to seek mental health care services (OR = 0.47; 95 CI: 0.37, 0.60).

CONCLUSION

Strong religious/spiritual beliefs may promote mental health care usage. Future studies should examine the strength of religious/spiritual beliefs on mental health care usage among different demographic groups.

Income and Self-Rated Mental Health: Diminished Returns for High Income Black Americans

Background: The minorities' diminished return theory suggests that socioeconomic position (SEP) generates smaller health gains for racial/ethnic minorities compared to Whites. The current study was a Black⁻White comparison of the association between household income and self-rated mental health (SRMH). Methods: This cross-sectional study used data from the 2017 State of the State Survey (SOSS). With representative sampling, the SOSS generates results that are generalizable to the state of Michigan. This study included 881 adults, (n = 92) Black and (n = 782) White. The independent variable was household income. The dependent variable was SRMH, measured using a single item. Age, gender, and participation in the labor force were covariates. Race/ethnicity was the focal moderator. Logistic regression models were used for data analysis. Results: Overall, higher household income was associated with better SRMH, net of covariates. An interaction was found between race/ethnicity and household income on SRMH, suggesting a smaller, or nonexistent, protective effect for Blacks compared to Whites. In race/ethnicity-stratified models, higher household income was associated with better SRMH for Whites but not Blacks. Conclusion: Supporting the minorities' diminished return theory, our study documents differential effects for income on SRHM for Blacks and Whites, where Whites but not Blacks appear to benefit from their income. Given this, researchers and policy makers are cautioned against making assumptions that racial groups benefit equally from similar economic resources.

Is Acute Care-Oriented Research Ethical in Resource-Limited Settings?

In this case scenario, a medical student, Jenny, is conducting congenital heart disease research in a resource-limited setting faced with water insecurity. She has concerns about how ethical it is for her to conduct advanced clinical research in a region with more basic health needs. The first commentary argues that advanced clinical research in resource-limited settings follows the ethical principle of beneficence and interactional justice but violates the principle of distributive justice. The second commentary questions whether beneficence is enough, since the Belmont Report states that beneficence is the obligation to simultaneously reduce harm and increase benefit. It calls upon public health physician-scientists to think deeply about how to involve communities in their research-and how to insert themselves into health policy development processes.

Interactive Effect of Immigration-Related Factors with Legal and Discrimination Acculturative Stress in Predicting Depression Among Asian American Immigrants

This study examined the impact of discrimination and legal acculturative stress on Major Depression Episode lifetime among Asian American immigrants. It further examined the role of immigration related-factors (age at immigration, reason for immigration, and years spent in the U.S.) on the relationship of acculturative stress and Major Depression Episode lifetime. The National Latino and Asian American Study 2002-2003 dataset was used. The study findings were: (1) high discrimination and legal acculturative stress were associated with Major Depression Episode lifetime; (2) age at immigration buffered the relationship of discrimination acculturative stress and Major Depression Episode lifetime as well as the relationship of legal acculturative stress and Major Depression Episode lifetime; and (3) years spent in the U.S. buffered the relationship of discrimination acculturative stress and Major Depression Episode lifetime only. These findings highlight the complex relationship of factors that impact the mental health of the Asian American immigrants.

Racial Discrimination, John Henryism, and Depression Among African Americans

Evidence from previous studies indicates that racial discrimination is significantly associated with depression and that African Americans with higher levels of socioeconomic status (SES) report greater exposure to racial discrimination compared to those with lower SES levels. Coping strategies could alter the relationship between racial discrimination and depression among African Americans. This study first examined whether greater levels of SES were associated with increased reports of racial discrimination and ratings of John Henryism, a measure of high-effort coping, among African Americans. Second, we examined whether high-effort coping moderated the relationship between racial discrimination and depression. Data were drawn from the National Survey of American Life Reinterview (n = 2,137). Analyses indicated that greater levels of education were positively associated with racial discrimination (p < .001) and increased levels of racial discrimination were positively related to depression (p < .001), controlling for all sociodemographic factors. Greater levels of John Henryism were associated with increased odds of depression but there was no evidence to suggest that the relationship between discrimination and depression was altered by the effects of John Henryism.

Racial Discrimination, John Henryism, and Depression Among African Americans

Evidence from previous studies indicates that racial discrimination is significantly associated with depression and that African Americans with higher levels of socioeconomic status (SES) report greater exposure to racial discrimination compared to those with lower SES levels. Coping strategies could alter the relationship between racial discrimination and depression among African Americans. This study first examined whether greater levels of SES were associated with increased reports of racial discrimination and ratings of John Henryism, a measure of high-effort coping, among African Americans. Second, we examined whether high-effort coping moderated the relationship between racial discrimination and depression. Data were drawn from the National Survey of American Life Reinterview (n = 2,137). Analyses indicated that greater levels of education were positively associated with racial discrimination (p < .001) and increased levels of racial discrimination were positively related to depression (p < .001), controlling for all sociodemographic factors. Greater levels of John Henryism were associated with increased odds of depression but there was no evidence to suggest that the relationship between discrimination and depression was altered by the effects of John Henryism.

Ethnic and Gender Differences in Help Seeking for Substance Disorders Among Black Americans

This paper uses the National Survey of American Life (NSAL) to examine within group differences regarding help-seeking for substance disorders among a US sample of African American and Caribbean Black men and women. We examined ethnic and gender differences in the type of providers sought for substance disorder treatment, as well as reasons for avoiding treatment. Results indicate that overall, few ethnic differences exist; however, African Americans are more likely than Caribbean Blacks to seek help from human service professionals (including a religious or spiritual advisor) and from informal sources of treatment such as self-help groups. Black men with a substance disorder were more likely to see a psychiatrist than Black women. Findings regarding reasons for avoiding treatment suggest that there may be a need to provide better education about the utility of substance disorder treatment, even before problems reach a high level of severity.

Gardening/Yard Work and Depressive Symptoms in African Americans

BACKGROUND

The purpose of this study was to examine the frequency of gardening/yard work in relation to depressive symptoms in African-Americans while controlling for biological and social factors.

METHODS

A secondary analysis was performed on the National Survey of American Life (n=2,903) using logistic regression for complex samples. Gardening/Yard work was measured by self-reported frequency. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale.

RESULTS

Biological and social factors, not gardening/yard work, were associated with depressive symptoms.

CONCLUSIONS

Biological and social factors may need to be addressed before the association between gardening/yard work and depressive symptoms can be determined.

Racial and Ethnic Differences in Self-Reported Periodontal Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

PURPOSE

Racial and ethnic disparities in periodontal disease exist in the United States. This study examined the prevalence of self-reported periodontal disease, and the extent to which racial/ethnic disparities in the reported disease were reduced or eliminated after controlling for various risk factors in a multi-ethnic study population of older adults.

MATERIALS AND METHODS

Information from the baseline examination (July 2000-August 2002) of the Multi-Ethnic Study of Atherosclerosis (MESA) was used. Study participants (N = 6256) were age 45-84 years and identified themselves as either: white, black, Hispanic or Chinese. Periodontal disease was assessed by self-report; demographic and socioeconomic status (SES) indicators, biomedical risk factors and psychosocial stress factors were used as predictors of self-reported periodontal disease.

RESULTS

Chinese displayed the highest prevalence of self-reported periodontal disease (39.8%), followed by blacks (32.0%) and whites (26.0%), with Hispanics displaying the lowest prevalence (17.4%). Chinese and black participants had a significantly higher prevalence of disease compared to whites that persisted after adjusting for demographic and SES indicators, biomedical risk factors and psychosocial stress factors. After such adjustment, Hispanics did not differ significantly from whites in their reporting of disease.

CONCLUSION

Racial/ethnic disparities in self-reported periodontal disease persisted after adjusting for all study covariates. This study highlights the need for continued research into the determinants of racial/ethnic disparities in periodontal disease in order to better target interventions aimed at reducing the burden of disease in all segments of the U.S. population.

Depressive Symptoms and Walking in African-Americans

OBJECTIVE

Although increased frequency of physical activity is associated with fewer depressive symptoms in African-Americans, most studies do not focus on a specific type of activity. Identifying the activity can provide helpful information for designing interventions that focus on depressive symptoms. The objective of this study was to examine the odds of depressive symptoms in relation to walking in African-Americans.

DESIGN AND SAMPLE

A secondary analysis was performed on the National Survey of American Life. The sample was made up of community-dwelling African-American women (n = 1,903) and men (n = 1,075) who did not meet the DSM-IV-TR criteria for depression.

MEASURES

Walking was measured by self-reported frequency (i.e., never, rarely, sometimes, often). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the odds of depressive symptoms in relation to walking.

RESULTS

Women who reported often walking had lower odds for depressive symptoms than women who reported never walking (OR = 0.56, 95% CI = 0.38-0.82). Walking frequency was not related to depressive symptoms in men.

CONCLUSIONS

Walking frequency is a modifiable risk factor for elevated depressive symptoms in African-American women.

An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life

OBJECTIVE

. To examine racial-ethnic differences in the endorsement and attribution of psychotic-like symptoms in a nationally representative sample of African-Americans, Asians, Caribbean Blacks, and Latinos living in the USA.

DESIGN

Data were drawn from a total of 979 respondents who endorsed psychotic-like symptoms as part of the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). We use a mixed qualitative and quantitative analytical approach to examine sociodemographic and ethnic variations in the prevalence and attributions of hallucinations and other psychotic-like symptoms in the NLAAS and NSAL. The lifetime presence of psychotic-like symptoms was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) psychotic symptom screener. We used logistic regression models to examine the probability of endorsing the four most frequently occurring thematic categories for psychotic-like experiences by race/ethnicity (n > 100). We used qualitative methods to explore common themes from participant responses to open ended questions on their attributions for psychotic-like symptoms.

RESULTS

African-Americans were significantly less likely to endorse visual hallucinations compared to Caribbean Blacks (73.7% and 89.3%, p < .001), but they endorsed auditory hallucinations symptoms more than Caribbean Blacks (43.1% and 25.7, p < .05). Endorsing delusions of reference and thought insertion/withdrawal were more prevalent for Latinos than for African-Americans (11% and 4.7%, p < .05; 6.3% and 2.7%, p < .05, respectively). Attribution themes included: supernatural, ghosts/unidentified beings, death and dying, spirituality or religiosity, premonitions, familial and other. Respondents differed by race/ethnicity in the attributions given to psychotic like symptoms.

CONCLUSION

Findings suggest that variations exist by race/ethnicity in both psychotic-like symptom endorsement and in self-reported attributions/understandings for these symptoms on a psychosis screening instrument. Ethnic/racial differences could result from culturally sanctioned beliefs and idioms of distress that deserve more attention in conducting culturally informed and responsive screening, assessment and treatment.

Race, Gender, and Conceptualizations of Fear

This study used qualitative methods and quantitative statistical analyses to examine whether race and gender are associated with reasons for which adults perceive a situation or object as fearful. The sample consists of 197 African-American and White adults (ages 18-85) recruited through a convenience sample and community sources in the Midwest. A cognitive interviewing instrument was utilized to examine respondents understanding of words and phrases from a mental health instrument. Using qualitative methods, free-response answers were content coded using 5 "fear-codes" (i.e., harm/danger, external locus of control, self-perception, and past experience), developed by the researchers. Results from logistic regression analyses indicate that race significantly predicts usage of specific fear codes (p<.05). In addition, a race by gender interaction was found.

Racial differences in adherence to antidepressant treatment in later life

OBJECTIVE

Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. Although racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients.

DESIGN

Prospective, observational study comparing antidepressant adherence for older African American and white primary care patients.

PARTICIPANTS

A total of 188 subjects age 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician.

MEASUREMENT

Study participants were assessed at study entry and at the 4-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure.

RESULTS

At the 4-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African American subjects (n = 82) had significantly lower rates of 4-month antidepressant adherence than white subjects (n = 106). African American women had the lowest adherence rates (44.4%) followed by African American men (56.8%), white men (65.3%), and white women (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African American women and white women in reported 4-month antidepressant adherence (OR: 3.58, 95% CI: 1.27-10.07, Wald χ(2) = 2.42, df = 1, p <0.02).

CONCLUSIONS

The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for older adults should take into account the potential impact of race and gender on adherence to prescribed medications.

The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication

IMPORTANCE

When men are depressed they may experience symptoms that are different than what is included in the current diagnostic criteria.

OBJECTIVE

To explore whether sex disparities in depression rates disappear when alternative symptoms are considered in the place of, or in addition to, more conventional depression symptoms. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOMES AND MEASURES: Using data from the National Comorbidity Survey Replication, a nationally represented mental health survey, we evaluated sex differences in symptom endorsement in 2 new scales that included alternative depression symptoms. We analyzed sex differences in symptom endorsement using 2-sided, design-based, .05-level t tests and multivariate logistic regression to identify predictors of depression. RESULTS; Men reported higher rates of anger attacks/aggression, substance abuse, and risk taking compared with women. Analyses using the scale that included alternative, male-type symptoms of depression found that a higher proportion of men (26.3%) than women (21.9%) (P = .007) met criteria for depression. Analyses using the scale that included alternative and traditional depression symptoms found that men and women met criteria for depression in equal proportions: 30.6% of men and 33.3% of women (P = .57).

CONCLUSIONS AND RELEVANCE

When alternative and traditional symptoms are combined, sex disparities in the prevalence of depression are eliminated. Further study is needed to clarify which symptoms truly describe men's experiences of depression.

Leisure-time physical activity in relation to depressive symptoms in African-Americans: results from the National Survey of American Life

OBJECTIVE

To examine the frequency of leisure-time physical activity (LTPA) in relation to depressive symptoms in a nationally representative sample of African American (AA) women and AA men with guidance by Stokols' Social Ecological Framework.

METHOD

A secondary analysis of AA women (n=1811) and AA men (n=1038) was performed on the National Survey of American Life, where a four stage national area probability sampling was conducted. Interviews were conducted 2001-2003. Clinically depressed AA were excluded from the current study. LTPA was measured by self-report frequency (never, rarely, sometimes, often) of participation in sports/exercise. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the relationship between LTPA and depressive symptoms, adjusting for biopsychobehavioral and sociophysical environmental factors.

RESULTS

Compared with AA women and AA men who reported never participating in LTPA, the multivariate OR for depressive symptoms in AA women and AA men who reported participating in LTPA often was 0.42 (95% CI=0.24-0.72) and 0.41 (95% CI=0.25-0.69) respectively.

CONCLUSION

Increased frequency of LTPA was associated with fewer depressive symptoms in a nationally representative sample of non-clinically depressed AAs.

Influence of patient race and ethnicity on clinical assessment in patients with affective disorders

CONTEXT

Rates of clinical diagnoses of schizophrenia in African American individuals appear to be elevated compared with other ethnic groups in the United States, contradicting population rates derived from epidemiologic surveys.

OBJECTIVE

To determine whether African American individuals would continue to exhibit significantly higher rates of clinical diagnoses of schizophrenia, even after controlling for age, sex, income, site, and education, as well as the presence or absence of serious affective disorder, as determined by experts blinded to race and ethnicity. A secondary objective was to determine if a similar pattern occurred in Latino subjects.

DESIGN

Ethnicity-blinded and -unblinded diagnostic assessments were obtained in 241 African American individuals (mean [SD] age, 34.3 [8.1] years; 57% women), 220 non-Latino white individuals (mean [SD] age, 32.7 [8.5] years; 53% women), and 149 Latino individuals (mean [SD] age, 33.5 [8.0] years; 58% women) at 6 US sites. Logistic regression models were used to determine whether elevated rates of schizophrenia in African American individuals would persist after controlling for various confounding variables including blinded expert consensus diagnoses of serious affective illness.

SETTINGS

Six academic medical centers across the United States.

PARTICIPANTS

Six hundred ten psychiatric inpatients and outpatients.

MAIN OUTCOME MEASURE

Relative odds of unblinded clinical diagnoses of schizophrenia in African American compared with white individuals.

RESULTS

A significant ethnicity/race effect (χ(2)(2)=10.4, P=.01) was obtained when schizophrenia was narrowly defined, controlling for all other predictors. The odds ratio comparing African American with non-Latino white individuals was significant (odds ratio=2.7; 95% CI, 1.5-5.1). Similar differences between African American and white individuals occurred when schizophrenia was more broadly defined (odds ratio=2.5; 95% CI, 1.4-4.5). African American individuals did not differ significantly from white individuals in overall severity of manic and depressive symptoms but did evidence more severe psychosis.

CONCLUSIONS

African American individuals exhibited significantly higher rates of clinical diagnoses of schizophrenia than non-Latino white subjects, even after controlling for covariates such as serious affective disorder.

Interviewer-perceived honesty as a mediator of racial disparities in the diagnosis of schizophrenia

OBJECTIVE

African Americans are disproportionately diagnosed as having schizophrenia, and the factors that contribute to this disparity are poorly understood. This study utilized data from the 1995 MacArthur Violence Risk Assessment Study to examine the impact of racial differences in sociodemographic characteristics, clinical presentation, and perceived honesty on disparities in the diagnosis of schizophrenia among African Americans.

METHODS

Researchers using structured assessments of diagnostic, sociodemographic, and clinical measures interviewed African Americans (N=215) and whites (N=537) receiving inpatient care for a severe mental illness. The impact of interviewers' perceptions of the participants' honesty on racial disparities in the diagnosis of schizophrenia was assessed.

RESULTS

African Americans (45%) were more than three times as likely as whites (19%) to be diagnosed as having schizophrenia. Disparities in sociodemographic and clinical characteristics modestly contributed to disparities in diagnostic rates. In contrast, interviewer-perceived honesty proved to be a significant predictor of racial disparities in schizophrenia diagnoses. After adjustment for perceived honesty, diagnostic disparities between African Americans and whites were substantially reduced. Mediator analyses confirmed that interviewer-perceived honesty was the only consistent mediator of the relationship between race and schizophrenia diagnosis.

CONCLUSIONS

Interviewers' perceptions of honesty among African-American participants are important contributors to disparities in the diagnosis of schizophrenia. Clinicians' perceptions of dishonesty among African-American patients may reflect poor patient-clinician relationships. Methods of facilitating a trusting relationship between patients and clinicians are needed to improve the assessment and treatment of persons from minority groups who are seeking mental health care. (Psychiatric Services 63:875-880, 2012; doi: 10.1176/appi.ps.201100388).

Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men?

BACKGROUND: conventional wisdom suggests that increased socioeconomic resources should be related to better health. Considering the body of evidence demonstrating the significant association between racial discrimination and depression, we examined whether exposure to racial discrimination could attenuate the positive effects of increased levels of socioeconomic position (SEP) among African Americans. Specifically, this paper investigated the joint interactive effects of SEP and racial discrimination on the odds of depression among African Americans. METHODS: racial discrimination was measured using two measures, major and everyday discrimination. Study objectives were achieved using data from the National Survey of American Life, which included a nationally representative sample of African Americans (n =3570). Logistic regression models were used to estimate the effects of SEP and racial discrimination on the odds of depression. RESULTS: reports of racial discrimination were associated with increased risk of depression among American African men who possessed greater levels of education and income. Among African American men, significant, positive interactions were observed between education and experiences of major discrimination, which were associated with greater odds of depression (P = 0.02). Additionally, there were positive interactions between income and both measures of racial discrimination (income x everyday discrimination, P = 0.013; income x major discrimination, P = 0.02), which were associated with increased odds of depression (P = 0.02). CONCLUSIONS: it is possible that experiences of racial discrimination could, in part, diminish the effects of increased SEP among African American men.

The impact of goal-striving stress on physical health of white Americans, African Americans, and Caribbean blacks

OBJECTIVE

To contribute to the growing understanding of U.S. black-white health disparities by examining psychosocial stress as an important contributor to physical health problems.

METHODS

Data are from the National Survey of American Life, an integrated national household probability sample of White Americans, African Americans, and Caribbean blacks. Regression analysis was used to assess associations between goal-striving stress and hypertension, BMI, physical health problems, and self-rated health.

RESULTS

After accounting for sociodemographic factors and three additional stressors--personal problems, lifetime racial discrimination, and everyday racial discrimination-goal-striving stress was a significant predictor of hypertension, physical health problems, and diminished self-rated health. Ethnicity moderated the relationship; the negative association between goal-striving stress and physical health problems was strongest for Caribbean blacks.

CONCLUSIONS

This study extends the research on goal-striving stress and adds to a growing literature documenting relationships between social processes and disease.

Goal-striving stress and the mental health of college-educated Black American men: the protective effects of system-blame

The present study examined the relationship between goal-striving stress and well-being in a survey of 399 college-educated Black American men who were members of a Black fraternal organization. Regression analyses revealed that goal-striving stress was associated with decreased psychological well-being, controlling for demographics and various psychosocial factors. When asked to explain their failure to reach life goals, half of the men attributed setbacks to racial discrimination. The association of goal-striving stress with diminished well-being was stronger among those who did not attribute setbacks to race than among those who did. These findings suggest that even with material success, Black men face blocked opportunities that could be consequential to their well-being.

Ethnicity, nativity, and the health of American Blacks

There have been few empirical studies of ethnic differences in health within the American Black population. Logistic regressions were used to examine the relationships among ethnicity, nativity, depressive symptoms, and physical health in the two largest ethnic groups of American Blacks, African Americans and Caribbean Blacks. The data were from the National Survey of American Life, a national household survey representative of the non-institutionalized U.S. Black population. We found that African Americans, U.S.-born Caribbean Blacks, and Caribbean-born Blacks had significantly different self-ratings of their health and self-reports of being diagnosed with a chronic physical health condition: Caribbean-born Blacks had the best health outcomes and U.S.-born Caribbean Blacks had the worst. This finding remained significant even after considering self-reported depressive symptoms. This study highlights the importance of considering ethnic diversity, nativity and immigration as independent sources of variation in health status within the American Black population.

Determinants of usual source of care disparities among African American and Caribbean Black men: findings from the National Survey of American Life

PURPOSE

The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n=551) and Caribbean Black men (n=1,217).

METHODS

We used the 2001-2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses.

RESULTS

Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men.

CONCLUSIONS

Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men.

Use of ministers for a serious personal problem among African Americans: findings from the national survey of American life

This study examined use of ministers for assistance with a serious personal problem within a nationally representative sample of African Americans (National Survey of American Life-2001-2003). Different perspectives on the use of ministers-social stratification, religious socialization, and problem-oriented approach-were proposed and tested using logistic regression analyses with demographic, religious involvement, and problem type factors as predictors. Study findings supported religious socialization and problem-oriented explanations indicating that persons who are heavily invested in religious pursuits and organizations (i.e., women, frequent attenders) are more likely than their counterparts to use ministerial assistance. Contrary to expectations from the social stratification perspective, positive income and education effects indicated that higher status individuals were more likely to report use of ministers. Finally, problems involving bereavement are especially suited for assistance from ministers owing to their inherent nature (e.g., questions of ultimate meaning) and the extensive array of ministerial support and church resources that are available to address the issue.

Differences in Professional and Informal Help Seeking among Older African Americans, Black Caribbeans and Non-Hispanic Whites

This study uses a national probability sample of older adults to examine racial and ethnic differences in the use of professional services and informal support for a stressful personal problem. Using data from the National Survey of American Life, this study focuses on African Americans, Black Caribbean immigrants, and Whites aged 55 years and older who experienced a personal problem that caused them significant distress (n=862). Multinomial logistic regression is used to estimate the association of race with the use of professional services only, informal support only, both professional services and informal support, or no help at all, while controlling for demographic and socioeconomic variables, characteristics of the informal support network, the type of problem experienced, and experiences of racial discrimination. Examining the use of professional services and informal support provides a more complete picture of racial and ethnic differences of help-seeking behaviors among older adults, and the factors associated with the sources from which these adults request help. Most respondents use informal support alone or in combination with professional services. Black Caribbeans are more likely than African Americans to rely on informal support only, whereas African Americans are more likely than Whites to not receive help. However, these findings are accounted for by differences in social support and experiences of discrimination.

Depression care in the United States: too little for too few

OBJECTIVE

To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States.

DESIGN

Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care.

SETTING

The 48 coterminous United States.

PARTICIPANTS

Household residents 18 years and older (N = 15 762) participated in the study.

MAIN OUTCOME MEASURES

Past-year depression pharmacotherapy and psychotherapy using American Psychiatric Association guideline-concordant therapies. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode.

RESULTS

Mexican American and African American individuals meeting 12-month major depression criteria consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies despite depression severity ratings not significantly differing between ethnic/racial groups. All groups reported higher use of any past-year psychotherapy and guideline-concordant psychotherapy compared with pharmacotherapy; however, Caribbean black and African American individuals reported the highest proportions of this use.

CONCLUSIONS

Few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report underscores the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States.

Physical Activity Effects on Depressive Symptoms in Black Adults

OBJECTIVES: Randomized trials found physical activity (PA) effective in decreasing depressive symptoms. Few studies included Black participants. The purpose of this systematic literature review was to determine the effects of PA on depressive symptoms in Black adults. METHODS: Articles were abstracted by conducting a computer and hand search of eligible studies. RESULTS: Eight of 13 studies found a significant inverse relationship between PA and depressive symptoms in Black adults. Sources for the heterogeneity were explored. CONCLUSION: Future studies should include representative samples of Black adults, incorporate a theory which considers multiple levels of influence, account for genetic factors in the etiology of depressive symptoms, include individuals diagnosed with depression and with health conditions which may increase the risk of depressive symptoms, account for intra-group ethnic heterogeneity, measure and differentiate between social support and social network, consider aspects of the physical environment and use standardized measurements of PA.

Inconsistencies in diagnosis and symptoms among bilingual and English-speaking Latinos and Euro-Americans

OBJECTIVE

Little information is available about accuracy of diagnoses in clinical care for affective and other major mental disorders experienced by Latino patients. This study addressed two central research questions: Do Latinos have disproportionate rates of clinical diagnoses of major depression based on structured diagnostic interviews? Are diagnostic patterns consistent with patient profiles and medical record information?

METHODS

A total of 259 bilingual Latino, monolingual English-speaking Latino, and Euro-American patients aged 18 to 45 years with a history of severe depression or psychotic symptoms were compared across three clinical sites by using structured interviews.

RESULTS

Compared with Euro-Americans, bilingual Latinos had significantly higher rates of major depression and significantly lower levels of mania. No significant differences were found between monolingual English-speaking Latinos and Euro-Americans.

CONCLUSIONS

Results suggest that the diagnostic process is affected by an apparent association with cultural-linguistic influences, notably speaking English as a second language.

12-month and lifetime prevalence of suicide attempts among black adolescents in the National Survey of American Life

OBJECTIVE

Provide nationally representative data on the prevalence and psychiatric correlates of suicidal ideation and attempts among African American and Caribbean black adolescents in the United States.

METHOD

Data on nonfatal suicidal behavior among 1,170 African American and Caribbean black adolescents aged 13 to 17 years are from the National Survey of American Life-Adolescent, a nationally representative household survey of adults with an attached adolescent sample conducted between February 2001 and June 2003.

RESULTS

Nationwide black adolescents reported having a lifetime prevalence of 7.5% for suicidal ideation and 2.7% for attempts. The 12-month prevalence of suicidal ideation and attempt was 3.2% and 1.4%, respectively. Among all respondents, 4% of black American adolescents and 7% of female subjects were projected to attempt suicide by age 17 years. African American adolescents were approximately five times more likely than Caribbean black adolescents to attempt suicide. Almost half of the National Survey of American Life-Adolescent respondents who reported a suicide attempt had never met criteria for any of the DSM-IV disorders by the time of their attempts.

CONCLUSIONS

Clinicians should be trained to screen for suicidal behavior, even among those without DSM-IV disorders, when treating black adolescents, particularly female subjects. In addition, preventive efforts should consider ethnic differences in suicide risk and targeting nonclinical settings.

Use of professional and informal support by African Americans and Caribbean blacks with mental disorders

OBJECTIVES

This study investigated the use of professional services and informal support among African Americans and Caribbean blacks with a lifetime mood, anxiety, or substance use disorder.

METHODS

Data were from the National Survey of American Life. Multinomial logistic regression was used to test the utilization of professional services only, informal support only, both, or neither. Analyses controlled for sociodemographic characteristics, disorder-related variables, and family network variables.

RESULTS

The analytic sample included 1,096 African Americans and 372 Caribbean blacks. Forty-one percent used both professional services and informal support, 14% relied on professional services only, 23% used informal support only, and 22% did not seek help. There were no significant differences in help seeking between African Americans and Caribbean blacks. Having co-occurring mental and substance use disorders, having a severe disorder in the past 12 months, having more people in the informal helper network, and being female increased the likelihood of using professional services and informal supports. When men sought help, they were more likely to rely on informal helpers. Marital status, age, and socioeconomic status were also significantly related to help seeking.

CONCLUSIONS

The significant proportion of black Americans with a mental disorder who relied on informal support alone, professional services alone, or no help at all suggests potential unmet need in this group. However, the reliance on informal support also may be evidence of a strong protective role that informal networks play in the lives of African Americans and Caribbean blacks.

Using national data sets to improve the health and mental health of Black Americans: challenges and opportunities

National datasets provide a unique opportunity to examine racial and ethnic disparities in health and mental health. In this article, the authors discuss some of the ways in which national datasets can facilitate our understanding of key pathways and mechanisms that explain racial and ethnic disparities and some of the conceptual and measurement issues that continue to hinder disparities research. Utilizing infant mortality and major depression as examples, the authors illustrate the complexity of studying racial and ethnic health and mental health disparities and argue that more thought and precision be utilized to study and explain these differences. Specifically, the authors argue that it is critical to disentangle population-level factors and individual-level characteristics to advance our understanding of disparities. The authors also contend that it is important for researchers to recognize the reciprocal relationship between the theoretical foundations and methodological innovations that must be integrated to effectively examine disparities. The authors conclude by discussing some of the benefits of researchers utilizing national databases that hold particular promise for addressing racial and ethnic disparities.

Religious participation and DSM-IV disorders among older African Americans: findings from the National Survey of American Life

OBJECTIVES

This study examined the religious correlates of psychiatric disorders.

DESIGN

The analysis is based on the National Survey of American Life (NSAL). The African American sample of the NSAL is a national representative sample of households with at least one African American adult 18 years or over. This study uses the older African American subsample (N = 837).

METHODS

Religious correlates of selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress, major depressive disorder, dysthymia, bipolar I & II disorders, alcohol abuse/dependence, and drug abuse/dependence) were examined.

PARTICIPANTS

Data from 837 African Americans aged 55 years or older are used in this analysis.

MEASUREMENT

The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess mental disorders. Measures of functional status (i.e., mobility and self-care) were assessed using the World Health Organization Disability Assessment Schedule-Second Version. Measures of organizational, nonorganizational and subjective religious involvement, number of doctor diagnosed physical health conditions, and demographic factors were assessed.

RESULTS

Multivariate analysis found that religious service attendance was significantly and inversely associated with the odds of having a lifetime mood disorder.

CONCLUSIONS

This is the first study to investigate the relationship between religious participation and serious mental disorders among a national sample of older African Americans. The inverse relationship between religious service attendance and mood disorders is discussed. Implications for mental health treatment underscore the importance of assessing religious orientations to render more culturally sensitive care.

Use of professional and informal support by African Americans and Caribbean blacks with mental disorders

OBJECTIVES

This study investigated the use of professional services and informal support among African Americans and Caribbean blacks with a lifetime mood, anxiety, or substance use disorder.

METHODS

Data were from the National Survey of American Life. Multinomial logistic regression was used to test the utilization of professional services only, informal support only, both, or neither. Analyses controlled for sociodemographic characteristics, disorder-related variables, and family network variables.

RESULTS

The analytic sample included 1,096 African Americans and 372 Caribbean blacks. Forty-one percent used both professional services and informal support, 14% relied on professional services only, 23% used informal support only, and 22% did not seek help. There were no significant differences in help seeking between African Americans and Caribbean blacks. Having co-occurring mental and substance use disorders, having a severe disorder in the past 12 months, having more people in the informal helper network, and being female increased the likelihood of using professional services and informal supports. When men sought help, they were more likely to rely on informal helpers. Marital status, age, and socioeconomic status were also significantly related to help seeking.

CONCLUSIONS

The significant proportion of black Americans with a mental disorder who relied on informal support alone, professional services alone, or no help at all suggests potential unmet need in this group. However, the reliance on informal support also may be evidence of a strong protective role that informal networks play in the lives of African Americans and Caribbean blacks.

Social factors and periodontitis in an older population

OBJECTIVES

We assessed the prevalences of periodontitis by education and income levels among US adults with data from the third National Health and Nutrition Examination Survey.

METHODS

The study was limited to non-Hispanic Blacks, Mexican Americans, and non-Hispanic Whites 50 years of age or older with a complete periodontal assessment during the dental examination.

RESULTS

Blacks with higher education and income levels had a significantly higher prevalence of periodontitis than their White and Mexican-American counterparts. The relationship between income level and periodontitis was modified by race/ethnicity. High-income Blacks exhibited a higher prevalence of periodontitis than did low-income Blacks and high-income Whites.

CONCLUSIONS

Our findings call attention to the importance of recognizing socioeconomic status-related health differences across racial/ethnic groups within the social, political, and historical context.

Racial/ethnic discrimination and health: findings from community studies

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health.

Effects of goal-striving stress on the mental health of black Americans

Although many scholars have theorized about how responding to the stress of blocked opportunities can affect the well-being of black Americans, few scholars have empirically examined the relationships between striving efforts, personal goals, and mental health among black Americans. This investigation examines the relationship between goal-striving stress and mental health in a national sample of black Americans. Results indicate that goal-striving stress is significantly related to lower levels of happiness, life satisfaction, self-esteem, and higher levels of psychological distress. We find that poverty status moderates the relationship between goal-striving stress and mental health. Compared to poorer persons, individuals above poverty with high goal-striving stress have significantly lower levels of happiness and life satisfaction. Overall, the findings provide a more complete context for understanding associations among socioeconomic status, goal-striving stress, and adverse mental health outcomes among black Americans.

Prevalence of substance use disorders among African Americans and Caribbean Blacks in the National Survey of American Life

OBJECTIVES

We sought to estimate the prevalence of substance disorders for African Americans and Caribbean Blacks in the United States using data from the National Survey of American Life.

METHODS

A national household probability sample of noninstitutionalized African Americans (n=3570) and Caribbean Blacks (n=1621) was obtained between February 2001 and June 2003 using a slightly modified version of the Composite International Diagnostic Interview.

RESULTS

Overall differences in prevalence of substance disorders between the ethnic groups were not significant. Prevalence rates of substance disorders among African Americans exceeded that of Caribbean Blacks among women, those aged 45 to 59 years, and those who were divorced. African Americans in major metropolitan areas had higher prevalence rates, and those in the South had lower ones, compared with those living in other areas. Overall, first-generation Caribbean Blacks were significantly less likely, but second-generation more likely, than were African Americans to meet criteria for overall substance disorders.

CONCLUSIONS

Failure to distinguish between African Americans and Caribbean Blacks masks important differences in substance use patterns among the Black population in the United States.

Lifetime and 12-month prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders among older African Americans: findings from the National Survey of American Life

OBJECTIVE

The purpose of this study was to estimate lifetime and 12-month prevalence of 13 psychiatric disorders for older African Americans.

METHODS

Data are from the older African American subsample of the National Survey of American Life. Selected measures of lifetime and 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder (PTSD), major depressive disorder, dysthymia, bipolar I and II disorders, alcohol abuse/dependence, and drug abuse/dependence).

RESULTS

Twenty-three percent of older African Americans reported at least one lifetime disorder and 8.54% reported at least one 12-month disorder. Alcohol abuse, PTSD, and major depression were the most prevalent lifetime disorders. The most prevalent 12-month disorders were PTSD, major depression, and social phobia. Age, sex, education, and region were significantly associated with the odds of having a lifetime disorder.

CONCLUSION

This is the first study of prevalence rates of serious mental disorders for older African Americans based on a national sample. Demographic correlates of the prevalence of disorders are discussed with an emphasis on age and regional differences.

Uses of ministerial support by African Americans: a focus group study

This focus group study examines the use of ministerial support among African American adults with regard to (1) the issues taken to ministers by church members, (2) the issues not taken to ministers by church members, and (3) the factors that inform people's decisions about whether or not to seek ministerial support. Content analysis of narratives from 13 focus groups revealed significant overlap in the range of concerns for which people seek support and those issues for which they will not seek ministerial help. The factors that influence peoples' decisions included shame as well as evaluations of minister character, sincerity, and skill set. Narrative examples are used to elucidate each theme, and the implications of the findings for theory, research, and practice are discussed.

Race, Ethnicity, and the Use of Services for Mental Disorders

CONTEXT

Little is known about differences in the unmet need for mental health service use between African Americans and Caribbean blacks.

OBJECTIVE

To extend the National Survey of Black Americans by examining 12-month mental health service use for African Americans and Caribbean blacks from the recently completed National Survey of American Life.

DESIGN AND SETTING

National household probability samples of noninstitutionalized African Americans and Caribbean blacks (blacks from Caribbean area countries now living in the United States) conducted between February 2001 and June 2003, using a slightly modified World Mental Health version of the World Health Organization's Composite International Diagnostic Interview.

PARTICIPANTS

A total of 3570 African Americans and 1621 Caribbean blacks 18 years and older (N = 5191).

MAIN OUTCOME MEASURES

Proportion of respondents with 12-month DSM-IV disorders who sought help in the specialty mental health, general medical, human service, and complementary-alternative medicine treatment sectors. The percentage receiving minimally adequate treatment was also assessed.

RESULTS

Overall, 10.1% of respondents used some form of mental heath care services in the past year. Use of services was much higher among those who met criteria for a 12-month DSM-IV disorder (31.9%) than among those who did not (5.4%). Forty-nine percent of respondents with serious mental illness used services, whereas 39.3% had contact with mental health care specialists. The youngest and oldest age groups were least likely to obtain any services. Among African Americans, women were more likely than men to use general medical care and services from any sector. Respondents with the most years of education showed the highest use of services.

CONCLUSIONS

The underuse of mental health services among black Americans remains a serious concern. Educational interventions that focus on both consumers and mental health care professionals are needed.

Use of mental health services and subjective satisfaction with treatment among Black Caribbean immigrants: results from the National Survey of American Life

OBJECTIVES

We examined the use rates and correlates of formal psychiatric services among the US-born and immigrant Caribbean Black population.

METHODS

We compared overall mental health service use in samples of Caribbean Blacks and African Americans and examined the within-sample ethnic variation among Caribbean Blacks, including for ethnic origin (Spanish Caribbean, Haiti, and English Caribbean), nativity status (those born in or outside the United States), number of years spent living in the United States, age at the time of immigration, and generational status.

RESULTS

African Americans and Caribbean Blacks used formal mental health care services at relatively low rates. Among Caribbean Blacks, generational status and nativity showed the greatest effects on rates of reported use, satisfaction, and perceived helpfulness. Of those study participants who met the criteria for disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, about one third used formal mental health care services. The US-born subjects were more likely to receive care than were first-generation immigrants.

CONCLUSIONS

Our study underscores the importance of ethnicity, immigration, and migration-related factors, within racial categorization, as it pertains to the use of mental health services in the United States. Our findings suggest that timing of migration and generational status of Caribbean Black immigrants and ancestry groups contribute to important differences in rates and sources of use, relative satisfaction, and perception of helpfulness, with regard to formal mental health services.