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This study investigates the use of religious coping among African Americans and Black Caribbeans with 12-month DSM-IV psychiatric disorders. Data from the National Survey of American Life is used to examine three indicators of religious coping: 1) using prayer and other spiritual practices for mental health problems, 2) the importance of prayer in stressful situations, and 3) looking to God for strength. Three out of four respondents who had a mental health problem reported using prayer as a source of coping. Agoraphobia and drug abuse disorder were associated with the importance of prayer during stress. Individuals with generalized anxiety disorder were more likely to report that prayer was important during stressful experiences and that they looked to God for strength. These findings contribute to the limited, but growing body of research on the ways that African Americans and Black Caribbeans cope with psychiatric disorders.

Although civic engagement and human rights are critical values in social work education, few empirical studies have explored the association between civic engagement and human rights exposure and attitudes. This study aims to examine the relationship between the exposure to human rights information, human rights attitudes, normative beliefs, and civic engagement behaviors among university students. A total of 214 students at a public university in the Midwest of the United States responded to the study survey. Findings indicate that students with more exposure to human rights issues showed more civic engagement. This relationship between human rights exposure and civic engagement was mediated by students’ attitudes toward human rights, but not moderated by normative beliefs. In addition, students majoring in social work revealed higher civic engagement and more positive attitudes toward human rights issues than those in other disciplines.

This study examined racial and ethnic differences in professional service use by older African Americans, Black Caribbeans, and Non-Hispanic Whites in response to a serious personal problem. The analytic sample (N = 862) was drawn from the National Survey of American Life. Findings indicated that African Americans and Black Caribbeans were less likely to use services than Whites. Type and race of providers seen varied by respondents' race and ethnicity. Among respondents who did not seek professional help, reasons for not seeking help varied by ethnicity. Study findings are discussed in relation to practice implications.

Stroke is one of the leading causes of adult disability in the United States, affecting almost 800,000 United States citizens annually. Inadequate care during the transition back to home can lead to poor outcomes and delayed recovery. Although the transitional care period is often complex and multifaceted, providing patients and caregivers with timely, relevant education and informational resources remains an important foundation to any transitional care service. Utilizing technology to enhance post-stroke transitional care services and provide unlimited access to information may increase survivors’ understanding and ability to manage their stroke recovery during the transition period.

Background: Navigating the transition after returning home following a stroke can be associated with substantial psychosocial and health-related challenges. The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of a social work case management (SWCM) program and access to an online information and support resource (MISTT Website) to improve outcomes in acute stroke patients who returned home. Methods: MISTT was a randomized, pragmatic, open, 3-group parallel designed trial conducted in 3 Michigan hospitals. Eligible subjects were acute stroke patients who returned home either directly or within 4 weeks of being discharged to a rehab facility. A total of 265 patients were randomized to one of 3 groups: 1) usual care, 2) SWCM program only, or 3) SWCM plus MISTT Website access. Interventions concluded after 90-days. Primary outcomes including Quality-of-Life (PROMIS Global-10 physical- and mental-health subscales) and the Patient Activation Measure (PAM) were collected by telephone at 7- and 90-days. The change in outcomes (90-day minus 7-day) between the three treatment groups was assessed using a differences-in-differences (D-in-D) analysis. Results: The mean age of the 265 randomized subjects was 66 years, 49% were female, 21% non-white, 14% had hemorrhagic stroke, 56% were discharged to a rehab facility. Following the intervention there were statistically significant treatment group differences in PROMIS physical-health (p=0.003) and PAM (p=0.042), but not PROMIS mental-health (p=0.56). Mean change in physical-health scores for group-3 (SWCM+Website) was significantly higher than both group-1 (Usual Care) (difference= 3.4; 95%CI=1.41, 5.33; p Conclusion: An intervention that combined social worker-led case management with access to online stroke-related information produced greater gains in patient-reported physical health and activation compared to usual care or case management alone. [ClinicalTrials.gov: NCT02653170].

Introduction: Stroke transitions-of-care are complex and effective self-management is required for success. Patient activation, measured by the Patient Activation Measure (PAM), is a self-management construct that measures knowledge, skill, and confidence to manage one’s own health. Scores from this 13-item instrument range from 0-100 with mean scores of 62 (SD=13). PAM has been validated among ill and healthy populations, however, little is known about what factors are associated with PAM among stroke survivors. Methods: This cross-sectional analysis of the Michigan Stroke Transitions Trial (MISTT) utilized interview data collected 7 days after stroke survivors returned home. Multivariable linear regression was used to identify independent associations between PAM scores and a range of patient factors including sociodemographic, perceived support, general health, and stroke-related characteristics. Age and education were forced into the model. Results: Of 265 participants, 180 (70%) completed the 7-day interview. Mean age was 66 years (range 27-90), 49% were female, 18% were non-white, 88% had ischemic stroke, and 53% were discharged to acute or sub-acute rehab. 64% also had a caregiver enrolled in the MISTT trial. The mean PAM score was 64.5 (SD=16). Perceived emotional support was positively associated with PAM score, while having a consented caregiver and higher self-reported post-stroke disability were negatively associated with PAM (Table). Conclusions: Perceived emotional support, caregiver involvement, and post-stroke disability were associated with patent activation. These may represent intervention targets for enhancing post-stroke transitions.

Past research has identified a link between discrimination and health outcomes among people of color. Perceptions of the cause of discrimination (racial vs. other) seem to be important for mental health; however, this relationship has not been fully examined for physical health. Using data from the National Survey of American Life, we find that, among African Americans, racial discrimination and overall discrimination regardless of attribution are associated with negative health outcomes while non-racial discrimination is not. The results suggest that racial discrimination has a unique adverse effect on physical health for African Americans that practitioners need to better understand.

As individuals live longer with multiple health conditions, approaches to health care for older adults are increasingly focusing on chronic versus acute care models. Most of the research in this area focuses on physical, not behavioral health. However, co-occurring physical, mental, and substance use issues can lead to complex needs for services. The purpose of this study is to identify the profiles of physical and behavioral health conditions among adults aged 50 and older people, examine age-cohort difference in these profiles, and explore their effects on mental health service use. Data are from 1,279 respondents of Midlife in the United States (MIDUS) wave 3. Latent class analysis was conducted using physical health (i.e., heart, cancer, respiratory, stroke, diabetes, lung, high blood pressure) and behavioral health indicators (i.e., depression/anxiety, daily and heavy drinking) to identify three distinct patterns of health conditions: a healthy group, a physically vulnerable group, and group most at risk. Age cohort, gender, education, and income were significant indicators to these groups. Compared to pre-boomers, baby boomers were more likely to belong to the physically vulnerable group. The physically vulnerable group were less likely to use mental health services than healthy group. Identification of subgroups with multiple health conditions among older adults has important implications for older health policy and programs. By providing initial evidence on the heterogeneity among this population, our findings provide information that can improve our ability to address complex health care needs and quality of life among older adults.

Objective This study examined the influence of church- and family-based social support on depressive symptoms and serious psychological distress among older African Americans. Methods The analysis is based on the National Survey of American Life. Church- and family-based informal social support correlates of depressive symptoms (CES-D) and serious psychological distress (K6) were examined. Data from 686 African Americans aged 55 years or older who attend religious services at least a few times a year are used in this analysis. Results Multivariate analysis found that social support from church members was significantly and inversely associated with depressive symptoms and psychological distress. Frequency of negative interactions with church members was positively associated with depressive symptoms and psychological distress. Social support from church members remained significant but negative interaction from church members did not remain significant when controlling for indicators of family social support. Among this sample of churchgoers, emotional support from family was a protective factor and negative interaction with family was a risk factor for depressive symptoms and psychological distress. Conclusion This is the first investigation of the relationship between church- and family-based social support and depressive symptoms and psychological distress among a national sample of older African Americans. Overall, the findings indicate that social support from church networks was protective against depressive symptoms and psychological distress. This finding remained significant when controlling for indicators of family social support.

Background: The period immediately after returning home from the acute care setting is a particularly stressful time for stroke patients. We report on depressive symptoms collected shortly after returning home in stroke patients enrolled in the Michigan Stroke Transitions Trial (MISTT) - a randomized trial designed to improve transition experience. Methods: Acute stroke patients were recruited from 3 Michigan hospitals. Eligible subjects were those discharged home or expected to return home within 4 weeks of discharge to a rehab facility. Baseline data, which included demographics, socio-economic factors, stroke type, medical history, type and duration of rehab care, and recent hospital or ED visits, were abstracted from hospital charts or collected by phone interview conducted 7 days after returning home. Data on depressive symptoms at 7 days was collected using the PHQ-9 instrument (score range 0-27). A depressive disorder was defined as PHQ-9 score >=10 (equivalent to at least moderate depression). Risk factors for depression were identified using multivariable logistic regression. Race, sex and discharge destination were forced into the model regardless of significance. Results: Of 199 subjects randomized in the first 12 months of the study, 156 (78%) had PHQ-9 data collected at 7 days, and 29 (18.6%) had a PHQ9 score of >= 10. Final multivariable model results (Table) indicate that only age and recent ED or hospital use were significantly associated with depression. Depression was much lower in older age groups, and a hospital or ED visit since returning home was associated with a 4-fold increase in the odds of depression. When history of past depression was added to the model the impact of recent hospital or ER visits attenuated. Conclusion: Depressive symptoms are relatively common among stroke survivors within the first week of returning home. Young age, recent hospital visits, and a past diagnosis of depression were significant risk factors for early depression.

For many stroke patients and caregivers, the transition back to home is often complex resulting in hospital readmissions, poor quality of life, and high caregiver burden. Providing access to high quality information on stroke is a potential cost effective intervention to improve stroke transitions. We report on the development and utilization of a patient-centered web-based tool that complemented a case management intervention which were both tested in the Michigan Stroke Transitions Trial (MISTT), an RCT designed to improve the transition experience for stroke patients and caregivers. Methods/Methodology: A social work case management (SWCM) program was designed to address patient and caregiver needs, improve quality of life, and decrease caregiver burden. In addition, we addressed informational needs by developing a curated, patient-centered website with access to communication, information, and support resources. Website content and structure were developed through focus groups with key patient, caregiver, and provider stakeholders. Refinements were made after structured usability and accessibility testing. Acute stroke patients (N=263) discharged home from three acute-care hospitals were randomly assigned to one of three groups: usual care, SWCM, or SWCM plus website access. For the 87 subjects randomized to the website group, utilization was monitored over the 90-days intervention period by Google Analytics ® which generated data on log-in sessions and page views. Results: Utilization data demonstrated that approximately one third (n= 28) of eligible patient/caregiver dyads randomized to the website did not access the website at all. Among website users, 25% (n=14) only accessed the site when assisted during SWCM home visit; another 25% (n=14) logged in 1-5 times in addition to the first home visit; and the remaining 50% (n=28) logged in on their own 1 to 9 times. The most popular pages were stroke information, medication information, stroke recovery, and prevention. Conclusion: Despite the fact that stakeholders report the need to access reliable stroke information during the transition home, we found that utilization of a website designed for this purpose was low. These analyses identify areas for further research and program development.

Background: Poor transitions adversely affect stroke survivors and contribute to readmissions and poor quality of life. More randomized trials are needed to identify effective interventions to improve patient wellbeing during the transitional period. However, the post-discharge period is complex and presents many practical challenges for transition trials when patients move between different care settings. We report on recruitment and retention challenges in the Michigan Stroke Transitions Trial (MISTT) designed to improve the transition experience of stroke survivors. Methods: MISTT, a 3 group pragmatic randomized trial, tested the efficacy of an in-home social work case management (SWCM) program and SWCM with an informational website against usual care. Eligible subjects were acute stroke patients discharged directly home or who had an expected rehab stay Results: Figure 1 shows recruitment and retention data during the first 15 months. Of 242 subjects enrolled, 40 (17%) were dropped pre-randomization largely due to extended rehab stays. Of 136 subjects randomized to SWCM or SWCM+website, the intervention was not started in 14 (10%) due to early withdrawals or unwillingness to participate. A total of 188 subjects were eligible for 90 day follow-up. Lost to follow-up (n=43) occurred in 20%, 24% and 21% of the usual care, SWCM, and SWCM+Website groups, respectively. Half of the LTFU was due to patient withdrawals (n=23); reasons included study demands (n=9), protocol deviations (n=6), and deteriorating health conditions (n=5). Conclusion: The complexity of stroke transitions creates challenges for recruiting and retaining study participants in transition trials. These issues are important to consider in future study design and are relevant to understanding the validity of study results.

There is a paradox in research on African Americans and non-Hispanic whites in the utilization of clergy. Research finds that African Americans have higher levels of religious service attendance and higher levels of contact with clergy. Research also finds that despite this, African Americans are less likely than non-Hispanic whites to seek out assistance from clergy for psychiatric disorders including depression and anxiety. The goal of this paper was to investigate race differences in the use of clergy for counseling for serious personal problems. It uses the National Survey of American Life. We find that non-Hispanic whites were more likely than African Americans to use clergy for a serious personal problem. The significant difference between African Americans and non-Hispanic whites appeared to be mediated by the fact that African Americans were more likely to have seen clergy in a religious setting and non-Hispanic whites were more likely to have seen clergy in other settings including hospitals.

Academic literature on elder care examines the quality of care, the structure of services, and the role of non-professional care. While fairly universal across developed countries, the cultural and social welfare contexts vary suggesting cross-country differences in how these issues are understood and addressed. The media both reflects and shapes what people regard as significant and is, therefore, one place to examine cross-cultural differences in approaches to care; however, studies that compare the discourse across countries with different social welfare structures are almost non-existent. In this study, we analyze print media published in four major newspapers in Finland and the United States. Using quality of care, structure of services, and non-professional care as our guiding framework, we conducted a thematic analysis of news reports, feature stories, and editorials published during May-June 2015 and March-April 2016. Quality of care was the most common theme in Finnish media with a focus on: 1) harmful or dangerous care practices, 2) neglect or lack of care, and 3) care falling behind set quality requirements. Despite the differences in the welfare regime, cost of care to the individual was a common theme in both countries as was a focus on increasing home care and informal care. There are weak signals in both countries of innovations that co-mingle aspects of informal and formal care such as intergenerational housing, employment opportunities for older adults, and co-locating day care and adult day care centers. These tend to be based on local initiative rather than strategic, governmental planning.

Background: Inadequate transitional care contributes to poor patient outcomes including hospital readmissions, delayed recovery, and reduced quality of life. We report perspectives from healthcare providers on challenges and stroke educational needs which were collected to inform an intervention study designed to improve stroke transitions following discharge to home. Methods: During the development phase of the Michigan Stroke Transitions Trial (MISTT), a randomized trial testing a Social Work Case Management (SWCM) intervention, we convened 4 stakeholder meetings with healthcare providers. We aimed to understand provider perspectives regarding patient and system-level challenges and to identify patient educational needs. Michigan providers, including social workers, nurses, neurologists, physiatrists, rehabilitation therapists, and managers were invited to attend the focus groups. Transcriptions were analyzed for common patient and system-level challenges (themes) using qualitative methods and educational needs were determined. Results: Thirty-four providers, representing hospitals, rehabilitation facilities, nursing homes, and home healthcare agencies, attended the 4 meetings. They identified 43 patient-level, 36 healthcare-level, and 13 community-level challenges. The most common challenges were related to medical follow-up (n=10), consistency of care planning across settings (n=10), ability of patients to retain information (n=10), and unrealistic patient expectations (n=10). The most common stroke educational needs were stroke signs and symptoms recognition (n=10), post-stroke expectations (n=10), stroke risk factors (n=9), and post-stroke depression (n=9). Common medication topics included strategies for medication management (n=13), understanding the importance of medications (n=12), managing side effects (n=7), and communicating with physicians (n=5). Conclusion: These data were essential in directing the scope and organization of the MISTT case management intervention. Addressing common challenges and targeting stroke educational needs offers the best opportunity for in-home transitional support to maximize stroke recovery during the early transitional period.

Background: Inadequate stroke transitions adversely affect survivors, caregivers and families, contributing to hospital readmissions, recurrent stroke, and poor quality of life. Unfortunately few evidence-based transitional care programs exist for stroke. We report preliminary experience with a patient-centered Social Work Case Management (SWCM) program, including frequency and type of unmet patient needs and duration of case management services. Methods: The Michigan Stroke Transitions Trial (MISTT) is a pragmatic randomized trial testing the efficacy of an in-home SWCM program against Usual Care for improving stroke survivor and caregiver recovery experiences. The 60 day intervention offers patient-centered case management services addressing psychosocial and medical needs to improve quality of life and increase patient activation and self-management. The SWCM program is designed to address patient identified unmet needs and includes providing support, improving preparedness, and managing stroke prevention. Results: During the first 6 months, 46 patients were randomized to the SWCM intervention group. Initial assessments were initiated a median of 5 days after returning home. Twenty-five patients (56%) identified at least one unmet need during the initial assessment. The mean number of unmet needs was 1.7 (range 0-10) and covered a wide range of psychosocial (n=9) and medical (n=5) domains. Mental health (22%), symptoms requiring assistance (20%), and monthly expenses (20%) were the most common unmet needs. Among cases who completed the intervention (n=35), the intervention duration ranged from 18-118 days (mean= 69). For 8 of these cases (22%) case management exceeded 60 days. Total case interaction time averaged 5.5 hours (0.5 to 21 hours) and communication occurred across diverse individuals and organizations. Conclusion: Psychosocial unmet needs are prevalent among stroke survivors during the first 60 days of in-home recovery. These needs require considerable time to manage and involve communication across multiple service organizations. Given the complexity of in-home stroke transitions, stroke survivors can benefit from short-term case management, with some cases requiring longer term management.

Objectives: Examines combinations of professionals visited for a serious personal problem. Method: The sample includes those aged 55 and above ( N = 862) from the National Survey of American Life (NSAL). Latent class analysis was used to identify groups of respondents based on types of professionals visited. Multinomial logistic regression was used to identify factors associated with group membership. Results: Classes included health provider plus clergy, physician plus mental health provider, and limited provider use. Whites were more likely than African Americans to fall into the health provider plus clergy and physician plus mental health provider classes. Those with physical and emotional problems were more likely to be in the health provider plus clergy and physician plus mental health provider classes, respectively. Discussion: Most respondents were in the limited provider use class suggesting that for many problems, minimal professional help is utilized. Physicians and clergy were important across all three classes.

This study utilized data from the National Survey of American Life to investigate the use of professional services and informal support among Black women with a lifetime mood, anxiety, or substance use disorder. Forty-seven percent combined professional services and informal support, 14% relied on professional services only, 2% used informal support only, and 16% did not seek help. Co-occurring disorders, recent episodes, social networks, marital status, age, and level of education were significantly related to help seeking from professional and informal helpers, demonstrating the importance of both. Targeting interventions in these areas will likely increase treatment effectiveness.

This study examined differences in kin and nonkin networks among African Americans, Caribbean Blacks (Black Caribbeans), and non-Hispanic Whites. Data are taken from the National Survey of American Life, a nationally representative study of African Americans, Black Caribbeans, and non-Hispanic Whites. Selected measures of informal support from family, friendship, fictive kin, and congregation/church networks were utilized. African Americans were more involved in congregation networks, whereas non-Hispanic Whites were more involved in friendship networks. African Americans were more likely to give support to extended family members and to have daily interaction with family members. African Americans and Black Caribbeans had larger fictive kin networks than non-Hispanic Whites, but non-Hispanic Whites with fictive kin received support from them more frequently than African Americans and Black Caribbeans. The discussion notes the importance of examining kin and nonkin networks, as well as investigating ethnic differences within the Black American population.

Background Previous epidemiological and clinical research on mental disorders has treated Blacks as a homogenous group and yet Blacks of Caribbean descent and African Americans differ with respect to ethnicity, national heritage, living circumstances, and immigration status. The purpose of this article is to examine the prevalence of major depressive disorder (MDD) among African Americans, Caribbean Blacks, and non-Hispanic whites aged 50 and older with data on psychiatric and physical comorbidity, mental illness severity, and service use. Methods Secondary analysis of data from the National Survey of American Life, a national household probability sample of African Americans, Caribbean Blacks, and non-Hispanic Whites in the United States, were used (n = 1,950). The response rate was 72.3%. Results Controlling for age, the lifetime prevalence rate of MDD was 12.1% and the 12-month rate was 5.2%. Older Whites and Caribbean Blacks had significantly higher lifetime prevalence than African Americans but 12-month rates were similar across the three groups. Rates of co-occurring psychiatric disorders and physical conditions were high and were similar for African Americans, Caribbean Blacks, and Whites. Most older adults had either moderate or severe 12-month MDD and most talked to at least one professional, most frequently a family doctor, psychiatrist, or other mental health professional. Conclusion MDD among older adults is highly prevalent, often associated with other psychiatric disorders or chronic physical conditions, and is associated with high overall mental illness severity. Differences among older Blacks highlight the need for further research on this population to ensure appropriate treatment is being provided to these groups.

A key component of social work ethics is social justice and equitable access to resources. Increasingly, this includes access to technology. This study addresses issues related to the ‘digital divide’ by testing a peer tutor model (Technology and Aging Project, TAP2) to teach adults aged 60 and older how to use information and communication technologies (ICTs) such as email, the internet, online chat rooms and discussion groups, internet-based support groups, and voice technology and webcams. Participants from the control group of a previous programme, TAP1 (N=19) participated in a six-month computer training programme. Six participants who had successfully completed the TAP1 training were selected to be peer tutors. Data were collected from tutors and learners at baseline, three months, six months and nine months (three months after the end of training). The current study reports on learner outcomes only. Measures include computer, social support, and mental health-related outcomes. Learners reported a significant and consistent increase over time in their confidence completing certain computer-related tasks and their overall use of ICTs. Mental health and social support outcomes did not change. Overall, the peer tutor model appeared to be at least as effective as the previous staff-directed model.

Objectives To examine the demographic correlates of lifetime and 12-month prevalence of major depressive disorder (MDD) among older African Americans, Black Caribbeans, and non-Hispanic Whites. Methods Data are from adults aged 55 years and older (n = 1439) recruited to the National Survey of American Life (NSAL; 2001–2003). The Diagnostic and Statistical Manual Version IV World Mental Health Composite International Diagnostic Interview was used to assess the 12-month and lifetime MDD. Weighted logistic regression was used to model demographic correlates of MDD. Results The population prevalence of lifetime and 12-month MDD were 11.2% and 4.1%, respectively. Bivariate analyses revealed that younger respondents and those with greater disability had a higher prevalence of both lifetime and 12-month MDD compared with those who were older and who had lower disability. Multivariable logistic regressions controlling for demographic characteristics revealed that non-Hispanic Whites had the greatest odds of lifetime MDD (OR = 2.27, 95% CI = 1.32, 3.93). Women had significantly greater odds of lifetime MDD compared with men (OR = 2.49, 95% CI = 1.14, 5.41); there were no gender differences in 12-month MDD. Other significant predictors of MDD were marital status and region of residence. Conclusions The distribution, correlates, and nature of associations with MDD vary as a function of whether we examined lifetime vs. 12-month MDD. Future work should account for within group differences among older adults with depression. Understanding MDD correlates and the nature of intergroup diversity can inform the identification of particularly vulnerable subgroups as well as appropriate treatment approaches. Copyright © 2011 John Wiley & Sons, Ltd.

Objectives The purpose of this study is to estimate lifetime prevalence of seven psychiatric affective disorders for older non-Hispanic White people, African Americans, Caribbean Black people, Latinos, and Asian Americans and examine demographic, socioeconomic, and immigration correlates of those disorders. Design Data are taken from the older sub-sample of the Collaborative Psychiatric Epidemiology Surveys. Selected measures of lifetime DSM-IV psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder, major depressive disorder, and dysthymia). Setting Community epidemiologic survey. Participants Nationally representative sample of adults 55 years and older (n = 3046). Measurements Disorders were assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. Results Major depressive disorder and social phobia were the two most prevalent disorders among the seven psychiatric conditions. Overall, non-Hispanic White people and Latinos consistently had higher prevalence rates of disorders, African Americans had lower prevalence of major depression and dysthymia, and Asian Americans were typically less likely to report affective disorders than those of their counterparts. There is variation across groups in the association of demographic, socioeconomic, and immigration variables with disorders. Conclusions This study furthers our understanding of the racial and ethnic differences in the prevalence of DSM-IV disorders among older adults and the correlates of those disorders. It highlights the importance of examining both between-group and within-group differences in disorders and the complexity of the mechanisms associated with differences across groups. Findings from this study underscore the need for future research that more clearly delineates subgroup differences and similarities. Copyright © 2011 John Wiley & Sons, Ltd.

This study examined use of clergy for serious personal problems within a representative sample of US black Caribbean adults from the National Survey of American Life. Logistic regression analysis was used and confirmed the importance of problem type, church involvement, and nativity as correlates of clergy use. Findings for black Caribbeans indicate similarities, as well as important departures from prior research on the correlates of clergy assistance among African Americans. These and other findings confirm the position of black Caribbeans as a distinctive ethnic subgroup within the general black population in the United States.

This study used data from the National Survey of American Life to investigate the use of professional services and informal support among African Americans, black Caribbeans, and non-Hispanic whites. Multinomial logistic regression was used to examine the association of race and perceived discrimination with the use of professional services only, informal support only, both professional services and informal support, or no help at all. Fifty-one percent of the sample used both professional services and informal support, 16% relied on professional services only, 20% used informal support only, and 13% did not seek help. Before controlling for other factors, African Americans and black Caribbeans were significantly less likely to receive either professional or informal help compared with whites. When everyday racial discrimination was included, racial differences in not seeking help were no longer significant. Household income also influenced the relationship between race and help-seeking. Other factors significantly associated with help-seeking include age, gender, education, employment status, insurance coverage, type and severity of disorder, and subjective closeness to family and friends. The association of these factors and implication of the findings for future research and mental health service delivery will be discussed.

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 clinical/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 clinical/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.

Unmet needs among stroke survivors cut across the physical, mental, and social domains. Understanding these needs is especially important to maximizing recovery and developing comprehensive treatment plans. Unmet needs among stroke survivors were identified during a biopsychosocial assessment conducted with patients who had enrolled in the Michigan Stroke Transitions Trial (n=160). Descriptive analyses examined the number and type of unmet need as well as bivariate relationships between total number of unmet needs and demographics, stroke type and severity, stroke effects and stroke risks. Regression analysis was used to examine correlates of total unmet needs while controlling for other factors. The number of unmet needs ranged from 2 to 9 with a mean of 4.55 (SD=1.42). The most prevalent type of unmet need was financial. Patients who were married/partnered had significantly fewer unmet needs than those who were not. Higher income and more education were also significantly associated with fewer unmet needs. Number of stroke effects and number of stroke risk factors were both positively associated with number of unmet needs (.38 and .23 (p

This study examined whether training provided to adults age 60+ would increase the use of information and communication technologies (ICTs), such as email and the Internet, and influence participants’ social support and mental health. Participants were randomly assigned to an experimental (n = 45) or a control group (n = 38). The experimental group participated in a six-month training program. Data were collected before, during, and after training on outcomes related to computer use, social support, and mental health. Mixed regression models were used for multivariate analyses. Compared to the control group, the experimental group reported greater self-efficacy in executing computer-related tasks and used more ICTs, perceived greater social support from friends, and reported significantly higher quality of life. Computer self-efficacy had both a direct and indirect effect on ICT use, but not on other variables. With appropriate training, older adults want to and can learn the skills needed to use ICTs. Older adults with ICT skills can access online sources of information regarding Medicare Part D options and utilize patient portals associated with electronic medical records. Agencies may develop services that build upon this technology sophistication, but policies also will need to address issues of access to equipment and high-speed Internet service.

Objectives: This study examined racial and ethnic differences in the use of complementary and alternative medicine (CAM) for the treatment of mental and substance use disorders. Methods: Data were from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R). The analytic sample included 631 African Americans and 245 black Caribbeans from the NSAL and 1,393 nonHispanic whites from the NCS-R who met criteria for a mood, anxiety, or substance use disorder in the past 12 months. Logistic regression was used to examine racial and ethnic differences in the use of any CAM and in the use of CAM only versus the use of CAM plus services in another treatment sector. Results: Thirty-four percent of respondents used some form of CAM. Whites were more likely than blacks to use any CAM, although there was no racial or ethnic difference in CAM use only versus CAM use plus traditional services. A higher proportion of blacks than whites used prayer and other spiritual practices. Among those with a mood disorder, black Caribbeans were less likely than African Americans to use any CAM. Conclusions: Findings of this study were similar to those of previous studies that examined physical illness in relation to CAM use in terms of its overall prevalence, the predominant use of CAM in conjunction with traditional service providers, and racial and ethnic differences in the use of CAM. The use of prayer was a major factor in differences between blacks and whites in CAM use; however, there were also differences among black Americans that warrant further research. (Psychiatric Services 60:1342–1349, 2009)

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.

Objectives The objective of this study was to examine mental health services utilization of older African Americans using data from the National Survey of American Life. Methods A subsample of African American respondents aged 55 years or older (N = 837) was used for this study. Thirteen mental disorders, including mood, anxiety, and substance disorders, were assessed using the Diagnostic Statistical Manual-IV World Mental Health Composite International Diagnostic Interview. Seventy-four respondents (9.6%) met criteria for a disorder. Self-reported service use included psychiatric and nonpsychiatric mental health services, general medical care, and nonhealth care (e.g., human services and complementary-alternative medicine). Results Overall, 46.5% (N = 30) of older African Americans with any one 12-month disorder used some form of services in the last year; 47.2% (N = 12) with two or more disorders used any services. Those reporting any mood disorder had higher service use in every sector compared with those with any anxiety or any substance disorder. Age was significantly related with each service sector except for nonhealth care. There were no significant gender or work status differences, and marital status was only significant in nonhealth care use. Those aged 55–64, married, and not residing in the south were more likely to report any service use than their respective counterparts. Conclusions These findings reveal that a significant proportion of African American older adults with mental health disorders do not receive professional help. Future research on system, provider, and patient factors is needed to clarify and explain underutilization of mental health services.

The purpose of this study was to explore potential racial differences in the experience of support offered by consumer-centered services for adults with serious mental illness. The study used hierarchical linear modeling to examine the level of support consumers report receiving from programs and the extent to which program-level characteristics reflecting racial diversity differentially influence white and African American consumers. The study used data from interviews with 1,072 white and African American consumers throughout Michigan and from selected program-level data. African Americans reported that a smaller proportion of their network comes from their program, although this is not related to program-level characteristics. Interaction effects suggest that the proportion of consumers in a program who are African American differentially influences the sense of community reported by white and African Americans. Implications for understanding racial dynamics within consumer-centered services are provided. KEY WORDS: consumer-centered services; race; serious mental illness; social support ********** Since deinstitutionalization and the former-patient movement, mental health consumers have become increasingly involved in mental health services provision. Consumers have worked as advocates for systemic change, developed peer-led self-help groups, been hired to provide services in mental health service agencies, and established services run by and for consumers (Mowbray, Moxley, Jasper, & Howell, 1997; U.S. Department of Health and Human Services [DHHS], 1999). Consumer-centered services have become an important component of publicly funded mental health services. Consumer-centered services share a philosophy of mutual support, community building, and self-help based on the foundation of a similar experience of mental illness. Given the marginalization of those suffering from mental illness, this shared experience can be a powerful means of developing supportive peer relationships. In addition, research on organizational participation has found that individuals feel more connected to an organization when they believe they are similar to its other members (Tsui & O'Reilly, 1989). Mental illness is, however, only one aspect of a consumer's identity. The membership of consumer-centered services includes men and women of different age groups and from a variety of racial and ethnic backgrounds. Each of these characteristics contributes to an individual's experiences, including, but not bruited to, his or her experience of mental illness. This study considers the influence of race on the support that individuals receive from consumer-centered services. Race has been found to be associated with how individuals present symptoms, how and where they seek help for a mental disorder, and the type of treatment they receive (DHHS, 1999). In addition, race is associated with the ways in which individuals structure and use their informal support networks (for example, Ajrouch, Antonucci, & Janevic, 2001; Taylor, Chatters, Tucker, & Lewis, 1990) and the extent to which they feel connected to an organization (Tsui & O'Reilly, 1989). The reasons for these findings are tied to both societal (for example, racial discrimination and fewer outpatient services located in largely African American communities) and cultural factors (for example, beliefs about the causes of mental illness and the role of family or stigma associated with seeking treatment) (LaVeist, 1994). Although the presence of racial differences among consumers does not negate the influence of a similar experience of mental illness, it raises the question of whether this experience is enough to develop supportive peer relationships within a complex social context. However, the influence of race on the experiences of consumers in consumer-centered services in this regard has been largely ignored in the literature to date. …

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The transition from hospital to home is a challenging period for older patients with comorbid illnesses and complex physical, psychological, and social needs. Many patients are slow to recover because of poor access to follow up care, education, and information. Caregivers report high levels of burden and stress. Rehospitalization rates for complex patients are high. While many existing transition-based intervention studies have been effective, most are not patient-centered. For example, they tend to be hospital-based despite patient and caregiver reports that they cannot fully absorb information in the hospital and do not yet know what help they will need. A patient-centered approach that engages patients and caregivers early in the process would suggest that a home-based transition intervention would be preferable. This presentation will provide an overview of patient-centered research, particularly within the context of health care transitions.

This study examines how the Medicare Part D coverage gap impacts non-dually eligible older adults with a mental illness. Qualitative, semistructured interviews were conducted with 11 case managers from community-based agencies serving persons, age 55 and over, with a mental disorder. Five themes illustrating the central difficulties associated with the Part D gap emerged: medication affordability, beneficiary understanding, administrative barriers, Low-Income Subsidy income and asset guidelines, and medication compliance. Although the Patient Protection and Affordable Care Act gradually reduces cost sharing within the gap, findings suggest that medication access and adherence may continue to be impacted by the benefit's structure.

OBJECTIVE This study investigated choice of service provider for treatment of a mental or substance use disorder and its association with consumers' age. METHODS Data were from the Collaborative Psychiatric Epidemiology Surveys. Service users born between 1946 and 1964 were compared with those born in 1945 or earlier (N=4,082). Latent class analysis was used to identify groups of service users according to nine dichotomous items reflecting lifetime visits with different types of professionals. Multinomial logistic regression was used to analyze factors predicting latent class membership, with particular focus on both the direct and moderating effects of age. Analyses controlled for sociodemographic characteristics and disorder-related variables. RESULTS Five classes of service user were identified. Class 1 (10.8%) included individuals who visited six of the nine types of providers (multiple providers visited). Class 2 (21.9%) had low probability of visiting most providers (limited providers visited). Class 3 (24.1%) visited a psychiatrist (primarily psychiatrist). Class 4 (28.1%) visited a family physician or other physician (primarily family physician). Class 5 (15.1%) visited a psychologist (primarily psychologist). A higher proportion of service users born before 1946 were in the primarily family physician class. Although 21% of service users born later also fell into this class, overall they were more evenly distributed across the five classes. CONCLUSIONS Family physicians played a significant role in behavioral health treatment for both age groups. However, findings suggest that younger adults may rely on more complex combinations of service providers that will require greater coordination between the behavioral and general health care systems in the future.

This study utilized data from the National Survey of American Life (NSAL) to investigate the use of professional services and informal support among African American and Caribbean black men with a lifetime mood, anxiety, or substance use disorder. Thirty-three percent used both professional services and informal support, 14% relied on professional services only, 24% used informal support only, and 29% did not seek help. African American men were more likely than Caribbean Blacks to rely on informal support alone. Having co-occurring mental and substance disorders, experiencing an episode in the past 12 months, and having more people in the informal network increased the likelihood of using professional services and informal supports. Marital status, age, and socioeconomic status were also significantly related to help seeking. The results suggests potential unmet need. However, the reliance on informal support also suggests a strong protective role that informal networks play in the lives of Black men.

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.

Both emotional support and negative interaction with family members have been linked to mental health. However, few studies have examined the associations between emotional support and negative interaction and psychiatric disorders in late life. This study investigated the relationship between emotional support and negative interaction on lifetime prevalence of mood and anxiety disorders among older African Americans.The analyses utilized the National Survey of American Life.Logistic regression and negative binomial regression analyses were used to examine the effect of emotional support and negative interaction with family members on the prevalence of lifetime DSM-IV mood and anxiety disorders.Data from 786 African Americans aged 55 years and older were used.The DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to assess mental disorders. Three dependent variables were investigated: the prevalence of lifetime mood disorders, the prevalence of lifetime anxiety.Multivariate analysis found that emotional support was not associated with any of the three dependent variables. Negative interaction was significantly and positively associated with the odds of having a lifetime mood disorder, a lifetime anxiety disorder and the number of lifetime mood and anxiety disorders.This is the first study to investigate the relationships among emotional support, negative interaction with family members and psychiatric disorders among older African Americans. Negative interaction was a risk factor for mood and anxiety disorders among older African Americans, whereas emotional support was not significant.

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.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.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.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.

Objective: To examine the prevalence and burden of general medical conditions (GMCs) among a nationally representative sample of adults with bipolar I disorder. Method: Data for this study were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093), which included US adults aged 18 years and older. This study focused on the sub-sample of adults with DSM-IV-diagnosed bipolar I disorder (n = 1,548). The past-year prevalence of 11 GMCs was examined. Associations between GMCs, bipolar I disorder, and disability measures (12-Item Short-Form Health Survey) were tested using multivariate regression analyses. Results: Approximately 32.4% of adults with bipolar I disorder had 1 or more GMCs. In the general population, diagnosis with bipolar I disorder was a significant risk factor for 7 of 11 GMCs in adjusted analyses. Among adults with bipolar I disorder, those with 1 or more GMCs evidenced significantly greater disability across all disability measures compared to those without a GMC. Individual GMCs were significantly associated with physical, mental, and psychosocial disability in adjusted analyses and predicted specific patterns of disability. Conclusions: GMCs were found disproportionately among persons with bipolar I disorder and associated with significant impairments in health and psychosocial functioning. Health care providers should screen for and treat GMCs in service populations including persons with bipolar disorder, given the heightened rates of morbidity, mortality, and disability that attend untreated GMCs in this client group. Integrated and collaborative treatment approaches could significantly improve overall functioning and quality of life for persons with this treatable disorder.