Dispersion of ventricular repolarisation: a marker of ventricular arrhythmias in patients with previous myocardial infarction

A growing pool of recent research points to the importance of ethnicity in psychopharmacologic management of depression and anxiety disorders, with sometimes profound implications for efficacy and safety. Such research has provided provocative findings that illustrate important interethnic pharmacogenetic, pharmacokinetic, and pharmacodynamic differences, especially for African Americans. We did a systematic literature review of psychopharmacologic treatment considerations among African Americans with anxiety and mood disturbance seen by primary care physicians, who provide most psychopharmacologic treatment. The findings commonly point to a greater percentage of "poor metabolizers" among African Americans compared with Euro-Americans. General treatment considerations include greater attention to adverse effects and better clinical response and poorer compliance for a given dose, potential need for lower starting doses and slower increases, use of plasma drug levels if available, determination of past responses to a similar drug, and integration of pharmacogenetic information into an overall socioculturally and ethnically sensitive approach to assessment and treatment.     

Explaining Disproportionately High Rates of Adverse Birth Outcomes Among African Americans: The Impact of Stress, Racism, and Related Factors in Pregnancy.

Compared with European Americans, African American infants experience disproportionately high rates of low birth weight and preterm delivery and are more than twice as likely to die during their 1st year of life. The authors examine 5 explanations for these differences in rates of adverse birth outcomes: (a) ethnic differences in health behaviors and socioeconomic status; (b) higher levels of stress in African American women; (c) greater susceptibility to stress in African Americans; (d) the impact of racism acting either as a contributor to stress or as a factor that exacerbates stress effects; and (e) ethnic differences in stress-related neuroendocrine, vascular, and immunological processes. The review of literature indicates that each explanation has some merit, although none is sufficient to explain ethnic disparities in adverse birth outcomes. There is a lack of studies examining the impact of such factors jointly and interactively. Recommendations and cautions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racism as a stressor for African Americans: A biopsychosocial model.

Various authors have noted that interethnic group and intraethnic group racism are significant stressors for many African Americans. As such, intergroup and intragroup racism may play a role in the high rates of morbidity and mortality in this population. Yet, although scientific examinations of the effects of stress have proliferated, few researchers have explored the psychological, social, and physiological effects of perceived racism among African Americans. The purpose of this article was to outline a biopsychosocial model for perceived racism as a guide for future research. The first section of this article provides a brief overview of how racism has been conceptualized in the scientific literature. The second section reviews research exploring the existence of intergroup and intragroup racism. A contextual model for systematic studies of the biopsychosocial effects of perceived racism is then presented, along with recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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.     

African Americans and anxiety disorders research: Development of a testable theoretical framework.

Examines research conducted with African Americans suffering with a Diagnostic and Statistical Manual of Mental Disorders-diagnosed anxiety disorder. Authors first examine previous epidemiological and treatment outcome studies in an effort to ascertain the consistencies and inconsistencies that exist within the literature. A preliminary theoretical framework is provided which can account for previous discrepant findings, and, by incorporating both racial identity and acculturation into its definition of ethnicity, also allows investigators to generate testable hypotheses regarding the manifestation and presentation of anxious symptoms, and to evaluate the efficacy of psychological interventions among African Americans. Suggestions for future investigations in this area are also offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recruitment and retention of African American patients for clinical research: An exploration of response rates in an urban psychiatric hospital.

The issues related to recruiting African American psychiatric inpatients are discussed in the context of a study on the influence of ethnicity on psychiatric diagnosis. Ethnically diverse psychiatric residents interviewed 960 Black and White inpatients in 2 urban psychiatric hospitals. Despite the obstacles cited in the literature about recruiting and retaining African Americans into research, 78% of this sample were African American. In addition, interview completion and refusal rates did not differ by patient ethnicity. Results suggest that matching interviewer and patient ethnicity did not influence African Americans' likelihood of participating in or of refusing an interview. This article summarizes a number of guidelines that others may find useful in conducting clinical research with African Americans, ranging from the formation of academic-public liaisons to interviewer training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial differences in eligibility and enrollment in a smoking cessation clinical trial.

Objective: The purpose of this study was to compare the recruitment, eligibility screening, and enrollment of African American and White smokers into an intensive smoking cessation intervention trial [The Chicago STOP Smoking Trial (C-STOP)]. Methods: We compared demographic, smoking, substance use, and medical/psychiatric screening data from the recruitment records of 1,189 non-Hispanic, African American and White smokers screened for eligibility in the last year of a randomized pharmacological and behavioral smoking cessation trial. The study took place at a large urban medical center and two satellite locations within the Chicago metropolitan area. Results: Interest levels in the study were high among African American smokers, with twice as many African Americans as Whites contacting study staff for information and an initial screening. However, African Americans were nearly three times as likely not to be enrolled in the trial as Whites, because of higher ineligibility rates, failure to attend a screening session, and lower participation rates even among those meeting eligibility requirements. Conclusions: Racial differences were observed nearly at all levels of enrollment determination. These critical barriers to inclusion of African Americans in smoking cessation research limit our understanding of treatment efficacy and ultimately the ability to reduce the health disparities in tobacco-related disease experienced by African Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder

Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.     

Individualistic and collectivistic worldviews: Implications for understanding perceptions of racial discrimination in African Americans and British Caribbean Americans.

Cultural worldviews and perceived racial discrimination were examined among Americans (n = 106) and British Caribbean Americans (n = 95), both of African descent, who were recruited through university student organizations, community organizations, and snowball sampling. Consistent with public perceptions of differences in the experience of race among these 2 groups, multiple regression analyses revealed African Americans were more likely than British Caribbean Americans to perceive racial discrimination in the United States. In addition, a cultural worldview focus on individuality and equality (i.e., horizontal individualism) moderated the relationship between ethnic group and perceived racial discrimination. British Caribbean Americans who endorsed greater agreement with horizontal individualism were less likely to perceive racial discrimination. The same worldview was unrelated to African Americans' perceptions of racial discrimination. The results are discussed with respect to within-group heterogeneity among persons of African descent. Implications for counseling persons of African descent and future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety, anxiety disorders, tobacco use, and nicotine: A critical review of interrelationships.

Smoking is highly prevalent across most anxiety disorders. Tobacco use increases risk for the later development of certain anxiety disorders, and smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders. The authors critically examined the relationships among anxiety, anxiety disorders, tobacco use, and nicotine dependence and reviewed the existing empirical literature. Future research is needed to better understand the interrelationships among these variables, including predictors, moderators, and mechanisms of action. Increased knowledge in these areas should inform prevention efforts as well as the development and improvement of smoking cessation programs for those with anxiety and other psychiatric disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Help-seeking tendencies in Asian Americans with suicidal ideation and attempts.

Among rising concerns surrounding heightened suicide in certain subgroups of Asian Americans, it is important to understand the help-seeking rates and pathways among Asian Americans experiencing suicidality. This study examined perceived need for care, help-seeking behavior, and chosen sources of care among Asian Americans compared with Latinos in the National Latino and Asian American Study who reported a history of lifetime suicidal ideation, suicide attempts, or mental disorders without history of suicide. Consistent with existing literature in Caucasians, suicide attempts in Asian Americans and Latinos were related to greater help seeking and perceived need beyond that of mental disorders only. However, Asian Americans with suicide attempts still reported lower perceived need and help-seeking behaviors compared with Latinos. In contrast to both the existing literature and Latinos in this study, Asian Americans with suicidal ideation were no more likely to perceive a need for help or seek help than Asian Americans with a mental disorder without history of suicide and were less likely to seek and perceive a need for help than Latinos with suicidal ideation. These findings point to the idea that Asian Americans who have serious suicidal ideation or attempts may underestimate the importance of their condition and do not receive the level of attention and support needed. Findings also show that Asian Americans with suicidal ideation and attempts prefer seeking help from nonprofessional rather than professional sources of help, other than medical professionals. Clinical implications for outreach, assessment, and management of suicide are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Structure of anxiety symptoms in urban children: Competing factor models of Revised Children's Manifest Anxiety Scale.

The Revised Children's Manifest Anxiety Scale (RCMAS; C. R. Reynolds & B. 0. Richmond, 1985) is among the most widely used self-report measures of children's anxiety. The authors compared its current empirically derived factor structure with theory-driven models derived from 8 experts on child anxiety using concept mapping. Confirmatory factor analyses compared models using data from 898 seventh graders in an urban public school system serving a high percentage of African Americans. The most parsimonious best-fitting model was an expert-derived model with factors reflecting anxious arousal, social evaluation–oversensitivity, worry, and a higher order factor. This model was theoretically meaningful, excluded items less relevant to anxiety, and was invariant across gender. Future research with the RCMAS should consider use of these dimensions. The combination of qualitative and quantitative methodology used in this study appeared to have considerable utility for refining measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current Issues in Anxiety and Depression: Comorbid, Mixed, and Subthreshold Disorders.

Recent attention has been given to the high frequency of coexisting anxiety and depressive symptoms that has served to challenge the more traditional view that these two disorders are typically discrete syndromes. Furthermore, research suggests that less severe states of anxiety and depression continue to be overlooked, despite their capacity to produce significant psychosocial impairment. Given the implications for diagnostic and treatment outcome, psychologists need to be aware of the epidemiology, clinical presentations, and treatment strategies surrounding comorbid and subthreshold anxiety and depression. We review the literature, present issues related to these syndromes, and discuss the implications for diagnostic and clinical activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of multiple attachments on well-being: A model for African Americans attending historically black colleges and universities.

Numerous studies have examined the relationship between attachment and well-being among college students. However, within this literature, at least two issues remain unaddressed. First, African American students have been inadequately sampled. Second, most of these studies have only examined the associations between parental attachment and well-being. The small variance in well-being for which parental attachment accounts suggests that there are additional factors, such as other forms of attachment, that are predictive of well-being. This study sought to determine the extent to which multiple types of attachment would predict emotional and social well-being among African Americans by examining the fit of a hypothesized attachment model. The model demonstrated a close fit to the data, and several significant paths were evidenced. The implications of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnicity and psychopathology: A meta-analytic review of 31 years of comparative MMPI/MMPI-2 research.

Meta-analyses were performed on 25 comparative Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2 studies of 1,428 male African Americans versus 2,837 male European Americans, 12 studies of 1,053 female African Americans versus 1,470 female European Americans, and 13 studies of 500 male Latino Americans and 1,345 male European Americans. Aggregate effect sizes suggest higher scores for ethnic minority groups than for European Americans on some MMPI/MMPI-2 scales and lower scores on others. However, none of the aggregate effect sizes suggest substantive differences from either a statistical or clinical perspective. The MMPI and MMPI-2 apparently do not unfairly portray African Americans and Latinos as pathological. Effect sizes across studies generally did not vary as a function of sociodemographic variables, research setting, or use of the MMPI versus MMPI-2. It is recommended that additional between- and within-ethnic groups psychopathology research continue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-cultural differences in tolerance for crowding: Fact or fiction?

It is widely believed that cultures vary in their tolerance for crowding. There is, however, little evidence to substantiate this belief, coupled with serious shortcomings in the extant literature. Tolerance for crowding has been confused with cultural differences in personal space preferences along with perceived crowding. Furthermore, the few studies that have examined cultural variability in reactions to crowding have compared subgroup correlations, which is not equivalent to a statistical interaction. Although the authors found a statistical interaction indicating that Asian Americans and Latin Americans differ in the way they perceive crowding in comparison to their fellow Anglo-American and African American citizens, all four ethnic groups suffer similar, negative psychological distress sequelae of high-density housing. These results hold independently of household income. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical implications of attentional bias in anxiety disorders: An integrative literature review.

Research on information processing biases has been motivated by the hope that it would lead to new and more efficient psychotherapeutic interventions. The literature is abundant with empirical data of attentional biases toward threat stimuli in anxiety disorders. This article aims to review the existing literature on the topic of attentional bias in anxiety disorders and discuss important implications for clinical practice. We adopted an integrative approach to link research data on attentional bias, information processing, and cognitive accounts (automaticity and controllability) with clinical practice in cognitive-behavioral therapy. It is important to develop and apply therapeutic interventions that can effectively reduce negative attentional biases while treating the main problems associated with anxiety disorders. However, it remains to be seen whether cognitive therapy interventions targeting more voluntary, strategic information processing can have a positive impact on automatic, involuntary processing involved in attentional biases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caring for the caregiver: expanding ways of knowing through experiments in self-care

When compared to Caucasians, diabetes mellitus and its complications are more prevalent among African Americans. Locus of control and social support were suggested as correlates of diabetes outcomes and health care practices that might have clinical implications. A sample of 24 African Americans and 80 Caucasians with Type II diabetes completed questionnaires and gave venous blood specimens. African Americans had significantly higher glycohemoglobin values (p = .049) and BMI values (p = .048). African Americans also took fewer doses of medication (p = .046) and tested their blood glucose less frequently (p = .062). Correlation patterns for the two groups differed as well. Social support variables were more often related to health care practices and outcomes for African Americans than for Caucasians. The findings indicate that nursing interventions resulting in increased social support could be especially effective for African Americans with Type II diabetes.     

Afrocentric perspective of adolescent pregnancy in African American families: a literature review

This article gives a detailed overview of the literature on adolescent pregnancy in African American families. According to the latest data available from the National Center for Health Statistics (1998), the greatest decline in adolescent pregnancy was among African Americans. In spite of the decline of 21% from 1991-1996, African American adolescent's birth rate was still almost twice the rate of European Americans. The purpose of this paper was to provide information that may assist health care professionals or others interested in repeat adolescent pregnancy to more effectively provide care and/or to conduct research from an Afrocentric perspective.