Mental health service utilization among African American and Caucasian mothers and fathers.

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors influencing service utilization from the parents' perspective. A total of 194 African American and Caucasian parents were recruited from the community to participate. Parents completed measures on barriers and attitudes toward treatment for themselves and for their children, history of mental health service utilization for themselves and for their children, and their own current psychological symptoms. Results indicated that 36.3% and 19.4% of parents and children, respectively, had used mental health services during their lifetime. Parents perceived fewer barriers and had more positive attitudes toward seeking services for their children than for themselves. Race and gender differences were found in parents' perceptions of barriers and attitudes toward treatment. Furthermore, barriers, attitudes, and psychopathology predicted parents' plans for future utilization of mental health services. The clinical implications of this study and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race differences in psychopathology and disparities in treatment seeking: Community and jail-based treatment-seeking patterns.

Whites in community samples use mental health services at a much higher rate than African Americans (Kessler et al., 2005). Is this also the case among those in jails? In this study of jail inmates (229 African American, 185 White), there were no race differences in the overall need for mental health treatment (63% of participants had significant symptoms on the Personality Assessment Inventory), but race differences in the level and types of symptoms were evident. In addition, although Whites were more likely to report preincarceration treatment, there were no differences in treatment seeking or access to mental health programs while in jail, implying that if barriers to treatment in the community were removed (cost/insurance, location/transportation, time), racial disparities in treatment utilization may be reduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial microaggressions and worldviews.

Comments by on an article entitled "Racial microaggression? How do you know?" by Rafael S. Harris Jr. (see record2008-05553-011). The author states that in our original article we asserted that the racial reality of POC was generally different from the racial reality of White Americans and that often times interpretations of situations and events are the result of worldviews or racial identity. When references are made to POC, or to “visible racial/ethnic groups,” reference is being made not only to the shared cultural characteristics, norms, values, and attitudes of the group (African American, Asian American, American Indian, and Latino/Hispanic American) but to a self-designation of racial identity formed from sociopolitical experiences of unequal social, economic, legal, and political power in U.S. society that are based on visible racial characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why are African Americans under-represented in medical research studies? Impediments to participation

OBJECTIVES: In accordance with the NIH Revitalization Act of 1993, the National Institutes of Health and the Alcohol, Drug and Mental Health Administration require grant applicants and cooperative agreement participants to include minorities in human subject research. In an environment characterized by diminishing research dollars, this mandate has increased the pressure on investigators to determine factors that impede minority participation and to develop strategies to overcome these impediments. METHODS: An extensive review of the literature was conducted to identify the factors possibly responsible for the low participation levels of African Americans in medical research studies and to highlight areas for further research. The items examined included the historical relationship between African Americans and medical researchers and the attitudes, perceptions and beliefs of potential participants and researchers as they relate to the low representation of African Americans in medical research. RESULTS: The factors identified as possible impediments to African American participation included distrust of the medical/scientific community, poor access to primary medical care, the failure of researchers to recruit African Americans actively, the alienation of minority health professionals, lack of knowledge about clinical trials, language and cultural barriers. CONCLUSIONS: Well-designed, relevant, ethical research in conjunction with an appreciation of the many barriers to participation are paramount to increasing African American presence in clinical research.     

Cultural mistrust: An important psychological construct for diagnosis and treatment of African Americans.

Although clinicians are encouraged to be more sensitive to cultural factors in the diagnosis and treatment of mental disorders, as evidenced by the significant changes in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), little information is provided to help them determine which aspects of culture are important to the mental health of African Americans. This article discusses the importance of cultural mistrust as a psychological construct in the lives of African Americans. The origins of the construct, the research it has generated over the past 2 decades, and implications for improving interventions with Black clients seeking mental health care are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward professional counseling among Asian-American college students: Acculturation, conceptions of mental illness, and loss of face.

The present study attempted to examine the influence of culture-bound barriers such as acculturation status, loss of face, and conception of mental health on the attitudes of Asian American college students (n = 134) toward seeking professional psychological help. An adapted Acculturation Attitude Scale (AAS; U. Kim, 1988), Zane's (1991) Loss of Face Scale (LOFS), a 10-factor Conception of Mental Health Scale (CMHS; Nunnally, 1961), and a modified version of the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS) with four subscales (Fischer & Turner, 1970) were used in this study. Results support the hypothesis that acculturation and conceptions of mental health were significantly correlated with attitudes toward mental health services. Loss of face was also significantly correlated with attitudes of being open to professional counseling. Implications for mental health professionals working with Asian Americans are highlighted. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Anxiety psychopathology in African American adults: Literature review and development of an empirically informed sociocultural model.

In this review, the extant literature concerning anxiety psychopathology in African American adults is summarized to develop a testable, explanatory framework with implications for future research. The model was designed to account for purported lower rates of anxiety disorders in African Americans compared to European Americans, along with other ethnoracial differences reported in the literature. Three specific beliefs or attitudes related to the sociocultural experience of African Americans are identified: awareness of racism, stigma of mental illness, and salience of physical illnesses. In our model, we propose that these psychological processes influence interpretations and behaviors relevant to the expression of nonpathological anxiety as well as features of diagnosable anxiety conditions. Moreover, differences in these processes may explain the differential assessed rates of anxiety disorders in African Americans. The model is discussed in the context of existing models of anxiety etiology. Specific follow-up research is also suggested, along with implications for clinical assessment, diagnosis, and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions of mental illness and judgments about help seeking among Japanese-American and White American students.

Perceived causes of mental illness and help-seeking preferences among Japanese-American and White American college students (72 men and 72 women in each ethnic group) were compared in order to investigate the reported underuse of mental health services by Japanese Americans. Results of a 2 (ethnicity of S)?×?2(severity of disorder)?×?2(gender of person with disorder)?×?2(gender of S) multivariate analysis of variance (MANOVA) revealed that Japanese-American students were more likely than White American students to attribute mental illness to social causes, to resolve problems on their own, and to seek help from family members or friends or both. Possible barriers to use of services by this sample of Japanese Americans include both a preference for informal resources and the stigmatization of mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural mistrust and mental health help-seeking attitudes among Filipino Americans.

As low as the rate of mental health help-seeking is among Asian Americans, Filipino Americans seek mental health services at a much lower rate even compared with other Asian Americans. Despite the field’s progress in identifying and understanding factors that may influence mental health help-seeking attitudes among Asian Americans, despite research on other minority groups suggesting that cultural mistrust may influence attitudes toward seeking professional psychological help, and despite the abundance of literature documenting the historical and contemporary experiences of oppression by Filipino Americans, the possibility that cultural mistrust may play a significant role in Filipino Americans’ mental health help-seeking attitudes have yet to be empirically investigated. Thus, using a sample of 118 Filipino Americans, the current study demonstrates that higher levels of cultural mistrust is related to lower likelihood of seeking professional psychological help. Furthermore, cultural mistrust predicted variance in mental health help-seeking attitudes that are not accounted for by income, generational status, loss of face, and adherence to Asian cultural values. Implications for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health values and preference for mental health resources of Japanese-American and Caucasian-American students.

The authors investigated Asian-American underuse of mental health resources as a function of attitudes about the nature of mental health (mental health values) and resource preference for assistance with serious personal problems, with 91 Caucasian-American and 90 Japanese-American undergraduates. Results from a mental health values questionnaire (MHVQ) revealed that Japanese Americans more strongly related several MHVQ scales to mental health (good interpersonal relations, trustworthiness, and absence of negative personal traits) than did Caucasian Americans. Nevertheless, they were less likely than Caucasian Americans to rank mental health professionals as first choice for assistance with serious interpersonal/emotional problems and more likely to prefer close friends for assistance. Mental health values and attitudes about appropriate help-seeking behavior are discussed in relation to the Asian-American underuse phenomenon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural themes in the psychotic symptoms of African American psychiatric patients.

Professional psychologists need to recognize ethnic/racial differences between African Americans and European Americans in psychotic symptom expression to treat individuals with severe mental illness from various cultural backgrounds. Specifically, they need to understand confluent paranoia or the interaction between culture and pathology in psychotic symptom expression. To assist mental health professionals, the present study identified cultural themes in the delusions and hallucinations of a sample of 156 African American psychiatric patients via content analysis. Race-related themes and religious themes were observed in the psychotic symptoms of these patients assessed with the Structured Clinical Interview for DSM IV. Race-related and religious content were manifested in different types of delusions. Race-related themes were more common in persecutory delusions, whereas religious themes occurred more often in other delusions. Race-related themes were associated more with delusions, while religious themes correlated with both delusions and hallucinations. Implications for the treatment of confluent paranoia in African Americans are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panel VI: Ethnic minorities, health care systems, and behavior.

This article presents an overview of research on health care use and provider behavior, on doctor–patient relationships, adherence to medical regimens, self-care, practices and avoidance health care behaviors, and attitudes of 4 ethnoracial groups: African Americans, American Indians, Asian Americans, and Latinos. Although issues within the groups varied, common themes between the groups emerged. It became apparent, after discussion, that whatever the issues and health problems, these can be resolved most effectively when addressed within the social contexts of each ethnoracial group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health.

Objective: To explore how familism, burden, and coping styles mediate the relationships between ethnicity and the mental and physical health of caregivers. Design: A probability sample of 65 White and 95 African Americans respondents caring for an older family member with dementia was used to test hypotheses from a sociocultural stress and coping model using path analysis. Main outcome measures: Measures of caregivers' health included subjective health, self-reported diseases, blood pressure, and heart rate. Mental health measures included self-reported depression and psychological symptoms. Results: Contrary to the hypothesis, familism had an adverse effect on outcomes and was related to low education levels rather than to African American ethnicity. A buffering effect of active coping between being African American and diastolic blood pressure was found even after controlling for levels of education. Conclusions: Findings supported a core stress and coping model in which more behavior problems of care recipients were associated with poorer mental health of caregivers via greater burden and more use of avoidant coping. Results also demonstrate that this core model can be extended to physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural adaptation of a group treatment for Haitian American adolescents.

As the psychology field moves towards establishing more evidence-based treatment (EBT), the applicability of EBT for different racial and immigrant groups (i.e., African American, Asian Americans and Pacific Islander, and Native American/Native Alaskan) is paramount. The current paper highlights the process of culturally adapting an EBT group cognitive behavioral therapy (CBT) intervention for use with Haitian American adolescents diagnosed with depression. Overall the main objective of this project was to culturally adapt the Adolescent Coping with Depression Course (ACDC) to ensure that it includes cultural factors that are likely to engage and retain Haitian adolescents in mental health treatment. The paper summarizes the cultural training of the focus group leaders, the focus group sessions with a group of Haitian middle-school students, and the feedback received from the participants regarding the intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of specialty mental health services by Asian Americans with psychiatric disorders.

Research suggests that Asian Americans underutilize mental health services but an understanding of the multiple factors involved in utilization has not been examined in a nationally representative sample. The current study analyzed data from the National Latino and Asian American Study (NLAAS) and examined 368 individuals with disorders to understand utilization and what factors were related to the utilization of specialty mental health services. Significant underutilization was found for Asian Americans; moreover, underutilization was especially acute among Asian American immigrants. For U.S.-born Asian Americans, use of primary care services was significantly associated with use of mental health services, but for foreign-born Asian Americans, use of primary care services was unrelated to mental health services use. For both U.S.-born and foreign-born Asian Americans, use of alternative services appeared to significantly affect whether Asian Americans with disorders utilize mental health services, but the nature of the influence varied depending on the individual’s level of English-language proficiency. These findings revealed that a major mental health disparity, the underutilization of mental health services by Asian Americans, was nuanced by use of other health-related services and immigration-related factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The African American minister as a source of help for serious personal crises: bridge or barrier to mental health care?

Using data from the National Survey of Black Americans, this article explores the role of African American ministers in the help seeking of African Americans for serious emotional problems. The authors explore which demographic characteristics and psychosocial factors are related to contacting Black clergy for help, whether certain types of personal problems increase the likelihood of clergy contact, and whether those who go to ministers are also likely to seek help from other professional help sources. Results indicate that women are more likely than men to seek help from ministers. People with economic problems are less likely to contact clergy, while those with death or bereavement problems are more likely to seek help from the clergy. Regardless of the type or severity of the problem, those who contact clergy first are less likely to seek help from other professionals. It is recommended that African American clergy and mental health professionals engage in a mutual exchange of information to increase access to professional care among African Americans with serious personal problems.     

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Doctoral training issues in school and clinical child psychology.

Do clinical child and school psychologists feel that broadening their training to include aspects of other professional child psychology specialties would enable better service provision to their clients? Do they feel that children, adolescents, and families would be better served if the 2 specialties were merged? An exploratory questionnaire was sent to a random sample of 300 members of American Psychological Association (APA) Division 16 (School Psychology) and a random sample of 300 members from APA Division 12 (Clinical), Section 1 (Clinical Child). Implications from their responses for training of psychology health service providers to children and families are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Underlying mechanisms in the relationship between Africentric worldview and depressive symptoms.

This study examines underlying mechanisms in the relationship between an Africentric worldview and depressive symptoms. Participants were 112 African American young adults. An Africentric worldview buffered the association between perceived stress and depressive symptoms. The relationship between an Africentric worldview and depressive symptoms was mediated by perceived stress and emotion-focused coping. These findings highlight the protective function of an Africentric worldview in the context of African Americans’ stress experiences and psychological health and offer promise for enhancing African American mental health service delivery and treatment interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)