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Women tend to be more vulnerable to the adverse psychological effects of "network events" (stressors that occur to loved ones). The cost-of-caring hypothesis is regarded as the primary mechanism for this vulnerability and posits that women's relatively high level of emotional involvement in the lives of network members causes women to experience greater empathetic reactions when loved ones encounter stressors. Drawing on the stress process model, gender theory, and research on the collateral consequences of incarceration, we theorize stress proliferation , the process by which an initial stressor induces secondary stressors, as an additional mechanism and empirically test our theoretical propositions using the case of African Americans with an incarcerated family member. Using data from the National Survey of American Life, we ask: are African American women more vulnerable to the depressive effects of familial incarceration compared to African American men? If so, to what extent might African American women's heightened vulnerability be explained by their greater susceptibility to stress proliferation? Results suggest that familial incarceration is associated with greater chronic strains, financial strain, and family conflict only among African American women. Further, the magnitude of the association between familial incarceration and depressive symptoms is significantly larger among African American women; however, after adjusting for stress proliferation variables, the gender difference in vulnerability attenuates and becomes statistically nonsignificant. We conclude that the emotional cost of caring may be compounded by social and economic costs of caregiving , heightening women's vulnerability to depression following disruptive network events. [ABSTRACT FROM AUTHOR]

Prior research documents higher levels of depressive symptoms among Black Americans relative to Whites. Yet, we know less about the role of other dimensions of stratification (e.g. skin tone) in shaping mental health inequality between Black and White adults, and whether mental health trajectories by race and skin tone among Black adults are contingent upon social contexts in childhood and adolescence. To address these gaps, this study asks: (1) to what extent do self-identified race and interviewer-rated skin tone among Black respondents shape inequalities in depressive symptoms between Black and White Americans across ages 12–42? (2) Are trajectories of depressive symptoms by race and skin tone among Black respondents contingent on school racial contexts (e.g. school racial composition)? Using five waves of data from the National Longitudinal Study of Adolescent to Adult Health and growth curve models, results suggest trajectories of depressive symptoms across ages 12–42 vary by race, school racial context, and skin tone among Black respondents. Specifically, Black students rated as having very dark, dark, and medium brown skin who attended high proportion Black schools in adolescence experienced lower levels of depressive symptoms than their White and light-skinned Black counterparts, particularly across the teen years and early 20s. Conversely, attending higher proportion White schools led to increases in depressive symptoms across earlier ages for Black students, particularly those who fell within the middle of the skin color continuum. Findings highlight competing advantages and disadvantages of navigating racialized spaces in childhood/adolescence for Black Americans of different skin tones. [ABSTRACT FROM AUTHOR]

The current study examined how African American children's experiences of perceived personal racial discrimination and perceived vicarious racial discrimination were linked with depressive and anxiety symptoms, and whether there were significant sex differences in these relations. The sample included 73 African American children (48% male), ranging from 7 to 12 years of age (M = 8.82, SD = 2.06). Models specified children's personal discrimination and vicarious discrimination as predictors of depressive and anxiety symptoms. Nested model comparisons were also used to examine whether associations varied as a function of children's sex. The current study hypothesized that both forms of discrimination would be associated with greater anxiety and depressive symptoms. Findings indicated that children's personal racial discrimination significantly predicted greater child anxiety symptoms for both boys and girls. No significant sex differences emerged. Neither personal nor vicarious discrimination significantly predicted depressive symptoms. Our findings highlight that racialized experiences occur early in childhood and have important implications for children's mental health. Highlights: Racial discrimination is known to have detrimental effects on African American adolescents' and emerging adults' mental health, but limited work has tested these effects among school-aged children. Findings indicated that personal racial discrimination experiences predicted greater anxiety symptoms among 7- to 12-year-old children. Clinicians working with African American children, especially those with anxiety symptoms, should assess children's negative racialized experiences. Clinicians are well-positioned to help young African American children process and cope with their racial discrimination experiences in order to prevent negative effects on mental health. [ABSTRACT FROM AUTHOR]

Psychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624–632. https://doi.org/10.2105/AJPH.2021.306631) [ABSTRACT FROM AUTHOR]

A central paradox in the mental health literature is the tendency for black Americans to report similar or better mental health than white Americans despite experiencing greater stress exposure. However, black Americans' higher levels of certain coping resources may explain this finding. Using data from the Nashville Stress and Health Study (n = 1,186), we examine whether black Americans have higher levels of self-esteem, social support, religious attendance, and divine control than white Americans and whether these resources, in turn, explain the black–white paradox in mental health. In adjusted models, the black–white paradox holds for depressive symptoms and any DSM-IV disorder. Findings indicate that black Americans have higher levels of self-esteem, family social support, and religiosity than white Americans. Causal mediation techniques reveal that self-esteem has the largest effect in explaining black–white differences in depressive symptoms, whereas divine control has the largest effect in explaining differences in disorder. [ABSTRACT FROM AUTHOR]

The present study used data from the American Trends Panel to examine the interplay between the perceived COVID-19 health threat, discriminatory beliefs in medical settings, and psychological distress among Black Americans. We measured psychological distress as an average of five items modified from two established scales and used self-reports of perceived COVID-19 health threat and beliefs about discrimination in medical settings as focal predictors. Ordinary least squares regression was used to examine these relationships. Holding all else constant, we found that perceived COVID-19 health threat and the belief that Black Americans face racial discrimination in medical settings were both positively and significantly associated with higher levels of psychological distress. We also found a significant perceived COVID-19 health threat by belief about discrimination in medical settings interaction in the full model. Future studies should assess how these relationships vary across age groups and over time. [ABSTRACT FROM AUTHOR]

The article compares the conditions of the patients institutionalized at state psychiatric facility Bryce State Hospital and Searcy, the state mental hospital for African Americans in Alabama, as indicated in the cases Wyatt v. Stickney and Marable v. Alabama Mental Health Board. Topics include the history of the Marable case, the reason why the Marable case vanished in mental health law and the use of due process arguments to ensure that institutionalized people were not ignored.

Social isolation is a major problem in the United States that has adverse impacts on health and well-being. However, few studies investigate social isolation among African Americans or the impact of social isolation on psychiatric disorders. This study addresses this gap by investigating the impact of objective (absence of contact with others) and subjective (lacking feelings of closeness to others) social isolation on psychiatric disorders among African Americans. The sample includes 3570 African Americans from the National Survey of American Life. Regression models were used to test the impact of objective and subjective isolation on 12-month MDD, any 12-month DSM disorder and number of 12-month DSM disorders. Analyses indicated that subjective isolation from family only, friends only, and both groups were associated with greater odds of meeting criteria for 12-month MDD, any 12-month disorder and number of 12-month DSM disorders. However, objective isolation was unrelated to either measure of psychiatric disorder. Study findings indicate that affective characteristics of social isolation (feelings of closeness with family and friends) are more significant for psychiatric disorders than are objective features (social contact). Our discussion notes that the connections between subjective and objective social isolation and psychiatric disorders are complex and potentially reciprocally associated with one another. Clinical practice should focus on both possible associations. [ABSTRACT FROM AUTHOR]

The tendency for blacks to report similar or better mental health than whites has served as an enduring paradox in the mental health literature for the past three decades. However, a debate persists about the mechanisms that underlie this paradox. Drawing on the stress process framework, we consider the counterbalancing roles of self-esteem and traumatic stress exposure in understanding the "black-white paradox" among U.S. adolescents. Using nationally representative data, we observe that blacks have higher levels of self-esteem than whites but also encounter higher levels of traumatic stress exposure. Adjusting for self-esteem reveals a net higher rate of mood disorders and distress among blacks relative to whites, and differences in traumatic stress exposure mediate this association. In the full model, we show that self-esteem and stress exposure offset each other, resulting in a null association between race and mood disorders and a reduced association between race and distress. [ABSTRACT FROM AUTHOR]

Background: Mental health is a serious public health concern that is uniquely devastating for African American families. Objective: This study systematically critiques the body of work documenting the mediating role of social support and neighborhood context on the psychological well-being of African American families. Methods: This review used the PRISMA multistate process. Findings: Several important findings are drawn from this study: a) social support and neighborhood context shape psychological well-being, b) existing studies are limited in capacity to capture context despite having contextualized frameworks, c) African centered theory is missing. Conclusions: Social support and neighborhood context matter. Future researchers must employ methods to capture this context and the link to mental health in African American communities where disproportionate risks exist. [ABSTRACT FROM AUTHOR]

Background: Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information. Although mindsets shape health behaviors and outcomes, no study has examined the health mindsets of ethnically and socioeconomically diverse Americans.Purpose: We explored the content, cultural patterning, and health correlates of diverse Americans' health mindsets.Methods: Two studies surveyed approximately equal numbers of African American, Asian American, European American, and Latinx American men and women of lower and higher socioeconomic status (SES). Study 1 (N = 334) used open-ended questions to elicit participants' mindsets about the definitions, causes, and benefits of health. Study 2 (N = 320) used Study 1's results to develop a closed-ended instrument.Results: In Study 1, open-ended questioning revealed six overarching mindset themes: behavioral, medical, physical, psychological, social, and spiritual. The most prevalent mindsets were psychological definitions, behavioral causes, and psychological benefits. Participants mentioned more cause themes than definition or benefit themes, and mindset theme mentions correlated with worse health. Older participants mentioned more themes than younger, women mentioned more definition themes than men, and low-SES participants mentioned more cause themes than high-SES participants. In Study 2, closed-ended scales uncovered more complex and positive health mindsets. Psychological and spiritual benefit mindsets correlated with good mental health. African Americans and women endorsed the widest array of mindsets, and the spiritual benefit mindset partially explained the superior mental health of African Americans.Conclusions: Many Americans hold simplistic, illness-focused health mindsets. Cultivating more complex, benefit-focused, and culturally appropriate health mindsets could support health. [ABSTRACT FROM AUTHOR]

The purpose of this study was to advance a theoretical understanding of the effects of impoverished neighborhoods on mental health and to inform policy measures encouraging residents to leave such neighborhoods. To do this, we investigated whether individuals' perceived neighborhood disadvantage served as a risk factor for clinical depression in a nationally representative sample of African Americans and Caribbean Blacks. We performed logistic regression analysis on stratified socioeconomic status (SES) subsamples from the National Survey of American Life sample of 5,019 African Americans and Caribbean Blacks. The association between perceived neighborhood social disorder and past‐year depression was statistically significant for low‐SES individuals (at or below the federal poverty line; odds ratio [OR] = 1.73, 95% confidence interval [CI] [1.07, 2.81], p = 0.026) and at the boundary of significance for middle‐SES individuals (between 100% and 300% of the poverty line; OR = 1.74, 95% CI [1.00, 3.02], p = 0.052), but not for high‐SES individuals (at or above 300% of the poverty line). Results suggest, at least for low‐ and middle‐income African Americans, perceived neighborhood social disorder is a risk factor for depression. U.S. housing policies aimed at neighborhood improvement and poverty de‐concentration may benefit the mental health of low‐income African Americans and Caribbean Blacks. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) offer a potential means through which to mitigate many of the barriers to mental health services faced by minority youth and their families. The primary aim of the present study was to better understand a core feature of CHWs: their shared community membership with the population served, or social proximity. We conducted qualitative semi‐structured interviews with 16 CHWs implementing a school‐based early intervention program in Latino and African American communities of urban poverty. The program promoted child and parent/caregiver engagement in schooling as a protective factor for children's mental health. Thematic analyses revealed three main themes defining social proximity: (a) experiences of parenthood or caring for children, (b) familiarity with and understanding of culture, and (c) experiences of life hardships and struggles. Additionally, the process of relating with parents/caregivers through shared experiences was the main theme to describe how CHWs leveraged their social proximity. CHWs' accounts illustrated how their experience of social proximity to the population served was central to how they engaged parents/caregivers in services, highlighting the importance of supporting and promoting CHWs' natural traits and lived experiences. Highlights: CHWs defined their social proximity through shared experiences of parenthood, culture, and hardships.The process of relating was central to how CHWs engaged the population served.CHWs' natural traits and lived experiences are defining features of their role.CHWs' natural traits and lived experiences are also what CHWs draw upon to promote service engagement. [ABSTRACT FROM AUTHOR]

Objective: Depressed individuals may require help from different agencies to address health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, explore whether service providers understand client priorities, and describe how providers address them.Methods: Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depression quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients' needs and explained how they addressed them.Results: Physical and mental health were clients' top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program representatives identified housing, employment, mental health, and improving relationships with others as clients' top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strategies used to address client needs.Conclusion: Depressed clients have multiple health and social needs, and program representatives in under-resourced communities understand the complexity of clients' needs. Agencies rely on needs assessment and referrals to meet their clients' needs, which enhances the importance of agency partnership in "whole person" initiatives. Our results illustrate agency capacity to adopt integrated care models that will address clients' multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care. [ABSTRACT FROM AUTHOR]

HBCUs continue to play a pivotal role educating students from underserved communities. Although some HBCUs struggle with high attrition rates, they enroll low-income, first-generation African American male students. However, HBCUs must focus on the mental health needs of African American men. Disproportionately African American men are exposed to traumatic experiences that impact their academic performance and socio-emotional functioning. Unfortunately, in comparison to other subgroups, African American men are hesitant to seek support because of stigmas and misconceptions associated with mental illness. Changing the narrative regarding mental illness is important. HBCUs are uniquely suited to increase the self-help behaviors of African American men because of othermothering and support systems. Thus, the purpose of this article is to explore how othermothering and tenets including religiosity/spirituality, culture awareness, and equilibrium change can increase the self-help behaviors and academic performance of African American males at HBCUs. [ABSTRACT FROM AUTHOR]

Background: Police kill more than 300 black Americans-at least a quarter of them unarmed-each year in the USA. These events might have spillover effects on the mental health of people not directly affected.Methods: In this population-based, quasi-experimental study, we combined novel data on police killings with individual-level data from the nationally representative 2013-15 US Behavioral Risk Factor Surveillance System (BRFSS) to estimate the causal impact of police killings of unarmed black Americans on self-reported mental health of other black American adults in the US general population. The primary exposure was the number of police killings of unarmed black Americans occurring in the 3 months prior to the BRFSS interview within the same state. The primary outcome was the number of days in the previous month in which the respondent's mental health was reported as "not good". We estimated difference-in-differences regression models-adjusting for state-month, month-year, and interview-day fixed effects, as well as age, sex, and educational attainment. We additionally assessed the timing of effects, the specificity of the effects to black Americans, and the robustness of our findings.Findings: 38 993 (weighted sample share 49%) of 103 710 black American respondents were exposed to one or more police killings of unarmed black Americans in their state of residence in the 3 months prior to the survey. Each additional police killing of an unarmed black American was associated with 0·14 additional poor mental health days (95% CI 0·07-0·22; p=0·00047) among black American respondents. The largest effects on mental health occurred in the 1-2 months after exposure, with no significant effects estimated for respondents interviewed before police killings (falsification test). Mental health impacts were not observed among white respondents and resulted only from police killings of unarmed black Americans (not unarmed white Americans or armed black Americans).Interpretation: Police killings of unarmed black Americans have adverse effects on mental health among black American adults in the general population. Programmes should be implemented to decrease the frequency of police killings and to mitigate adverse mental health effects within communities when such killings do occur.Funding: Robert Wood Johnson Foundation and National Institutes of Health. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Major depression is increasingly viewed in the United States public as a medical disorder with biological and psychosocial causes. Yet little is known about how causal attributions about depression vary among low‐income racial minorities. This study examined beliefs about causes of depression and their demographic, clinical and treatment correlates in a lower income African American sample. Method: Volunteers (N = 110) aged 24–79 years, who participated in a family study of depression, completed a 45‐item questionnaire on their beliefs about the causes of depression. We used multidimensional scaling (MDS) to cluster items into causal domains and multivariate regression analyses to test associations of causal domains with demographic and clinical characteristics and treatments received. Results: Three causal domains, conceptualized as Eastern culture/supernatural (ECS), Western culture/natural/psychosocial (WCN‐P), and /neurobiological (WCN‐N) attributions, were derived from MDS clusters. WCN‐P was most commonly endorsed (50%–91%) and ECS least endorsed as causes of depression (10‐44%). This pattern held across gender, age, educational levels, and diagnostic category. WCN‐N items were moderately endorsed, with some distinction between genetic causes and other biological causes. WCN‐N was positively associated with medication as opposed to other forms of treatment (B = 1.17; p = .049). Conclusion: Among low‐income African Americans, beliefs about causes of depression are varied but broadly consistent explanatory models that include a combination of psychosocial causes with genetic/biological contributions. For certain individuals, supernatural and natural causal attributions may coexist without dissonance. Causal attributions may be associated with types of treatment accepted and have implications for treatment compliance and adherence. [ABSTRACT FROM AUTHOR]

A growing body of research suggests that greater exposure to spiritual struggles is associated with more physical and mental health problems. Spiritual struggles involve difficulties that a person may encounter with his or her faith, which may include having a troubled relationship with God, encountering difficulties with religious others, or being unable to find a sense of meaning in life. However, little is known about the way in which spiritual struggles may differ across racial/ethnic groups. The purpose of this study was to assess variations in spiritual struggles, health, and well-being among Whites, Blacks, and Hispanics. We examined two ways in which race/ethnic variations may arise. First, the differential-exposure perspective suggests that some groups may experience more spiritual struggles than others. Findings from a recent nationwide survey suggest that Blacks experience more spiritual struggles than either Whites or Hispanics. Second, the differential-impact perspective suggests that the relationship between spiritual struggles, health, and well-being varies across racial/ethnic groups. Findings from the current study suggest that when spiritual struggles arise, Blacks experience fewer symptoms of physical illness, less anxiety, and they tend to be happier than Whites or Hispanics. The theoretical implication of these findings is discussed. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objective: We examined the prevalence and extent of informed decision-making (IDM) and patient-centered decision-making (PCDM) in primary care visits of African Americans with depression.Methods: We performed a cross-sectional analysis of audiotaped clinical encounters and post-visit surveys of 76 patients and their clinicians. We used RIAS to characterize patient-centeredness of visit dialogue. IDM entailed discussion of 3 components: the nature of the decision, alternatives, and pros/cons. PCDM entailed discussion of: lifestyle/coping strategies, knowledge/beliefs, or treatment concerns. We examined the association of IDM and PCDM with visit duration, overall patient-centeredness, and patient/clinician interpersonal ratings.Results: Approximately one-quarter of medication and counseling decisions included essential IDM elements and 40% included at least one PCDM element. In high patient-centered visits, IDM was associated with patients feeling respected in counseling and liking clinicians in medication decisions. IDM was not related to clinician ratings. In low patient-centered visits, PCDM in counseling decisions was positively associated with patients feeling respected and clinicians respecting patients.Conclusions: The associations between IDM and PCDM with interpersonal ratings was moderated by overall patient-centeredness of the visit, which may be indicative of broader cross-cultural communication issues.Practice Implications: Strengthening partnerships between depressed African Americans and their clinicians may improve patient-engaged decision-making. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine whether specific religious coping styles and cultural worldview would be associated with thoughts of suicide given higher levels of stress in a community-based sample of African American adults. African American men and women (n = 134) completed measures of religious coping, cultural worldview, stressful life events, depression symptoms, and suicide ideation. Higher ratings of suicide ideation were observed for African Americans who endorsed a more self-directing religious coping style. The self-directing religious coping was more frequently endorsed by participants who identified with a more Eurocentric cultural worldview that espouses an individualist philosophy. Together, these findings provide some insight to how religious coping and culture are related to suicide vulnerability for African Americans who are not in clinical care. [ABSTRACT FROM PUBLISHER]

Close relationships are a resource for mental and physical health that, like other social resources, is unequally distributed in the population. This article focuses on racial disparities in the loss of relationships across the life course. Racial disparities in life expectancy in the United States mean that black Americans experience the deaths of more friends and family members than do white Americans from childhood through later life. I argue that these losses are a unique type of stress and adversity that, through interconnected biopsychosocial pathways, contribute to disadvantage in health over the life course. I focus particularly on how the interconnected pathways associated with loss undermine opportunities for and increase risks to social ties throughout life, adding to disadvantage in health. I call on social scientists and policy makers to draw greater attention to this unique source of disadvantage for black children, adults, and families. [ABSTRACT FROM AUTHOR]

In the present study, I used a top-down approach to examine perfectionism and loneliness as additive predictors of depressive and anxious symptoms in a sample of 168 African American college students. Consistent with expectations, I found perfectionism and loneliness to be associated with both depressive and anxious symptoms. In addition, results of conducting hierarchical regression analyses indicated that certain dimensions of perfectionism, especially doubts about actions, accounted for significant variance in both depressive and anxious symptoms. Moreover, the inclusion of loneliness as a predictor was found to account for additional unique variance in both depressive and anxious symptoms, beyond what was accounted for by perfectionism. Implications of the present findings for future research on negative affective conditions in African American adults are discussed. [ABSTRACT FROM AUTHOR]

The relationship between psychological and behavioral health and bother from non-college attending peers was assessed among 180 African American students attending a historically black university in the southwestern region of the United States in the spring of 2013. Results: Students reporting stress related to influence from non-college attending friends reported significantly higher conflicts with their partners (5.31 vs. 1.26, p < .05), lower personal conflict resolution (2.00 vs. .70, p < .05), and lower family connectedness (30.81 vs. 34.02, p < .05). Study results emphasize college students' need for coping skills to address external culturally-linked stressors. The information gained from this research may provide strategic guidance in understanding the behavioral and psychosocial effects of extended peer networks on the mental health of college students. [ABSTRACT FROM AUTHOR]

This study examined symptoms of obsessive-compulsive disorder (OCD) in a nationally representative sample of African American adults (n = 3,570) and correlations between OCD symptom dimensions and experiences of discrimination. Two categories of discrimination were examined, everyday racial discrimination and everyday nonracial discrimination (e.g., because of gender, age, and weight), to determine if racial discrimination had a unique impact on OCD symptoms. Results indicated that everyday racial discrimination was related to both categories of obsessions and all 4 categories of compulsions. Everyday nonracial discrimination, however, was not related to any of the categories of obsessions or compulsions. This indicates that racial discrimination is uniquely related to obsessions and compulsions for African Americans. The implications of these findings are discussed. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Researchers have documented mental health disparities uniquely affecting African Americans and have identified common help-seeking patterns and barriers to effective mental health care outcomes. However, the literature lacks an integrative framework for mental health service delivery to meet the unique needs of African Americans. This article will draw upon empirical evidence to propose an integrative care framework for mental health service delivery in African American communities. Specifically, it will report barriers experienced by African Americans in attempting to access mental health care systems and receiving effective treatment within these systems. Identified barriers to accessing treatment include stigma, cost of care, and lack of transportation and childcare. Barriers to effective treatment include misdiagnosis, disempowerment in treatment, and lack of social support and specialty care. The authors will propose facilitators to improve treatment access and effectiveness, culminating in a recommended integrative care framework. [ABSTRACT FROM AUTHOR]

Several decades of scholarly research have revealed the significant toll of discrimination experiences on the well-being of African Americans. Given these findings, investigators have become increasingly interested in uncovering any potential resources made available to African Americans for mitigating the psychosocial strains of discrimination. The current study contributes to this literature by testing whether various indicators of religious involvement--e.g., church attendance, prayer, and religious social support--buffer the noxious effects of major discrimination experiences on the mental health outcomes (i.e., depression and life satisfaction) of African Americans. We analyze data from the African American subsample (n = 627) of Vanderbilt University's Nashville Stress and Health Study, a cross-sectional probability sample of adults living in Davidson County, Tennessee between the years 2011 and 2014. Results from multivariate regression models indicated (1) experiences of major discrimination were positively associated with depression and negatively associated with life satisfaction, net of religious and sociodemographic controls; and (2) religious social support offset and buffered the adverse effects of major discrimination on both mental health outcomes, particularly for those respondents who reported seeking support the most often. We discuss the implications and limitations of our study, as well as avenues for future research. [ABSTRACT FROM AUTHOR]

Prior research has demonstrated poorer patient-provider communication ratings among African American compared to White patients. The quality of patient-provider communication has been shown to impact treatment outcomes among cancer patients. A secondary data analysis design was used to determine the relationship of six patient-provider communication variables on the physical health quality of life (PHQOL) and mental health quality of life (MHQOL) of African American and White cancer patients (N = 479). We also examined whether the relationship between communication patterns and QOL differed based on race/ethnicity. Mean physical and mental health QOL scores for the sample were 69.8 and 77.6, respectively. After controlling for significant sociodemographic, clinical, and hospital variables, results showed that patients who experienced fewer interpersonal communication barriers who were more satisfied with the information given by providers had higher PHQOL and MHQOL scores. Additionally, patients who felt more comfort in asking questions or had fewer unmet information needs had higher MHQOL. A stratified analysis showed that the relationship of overall satisfaction with information on MHQOL was stronger among African American patients than White patients. Future research should focus on the development of interventions to improve patient-provider communication as a means for enhancing QOL outcomes among cancer survivors. [ABSTRACT FROM AUTHOR]

The purpose of this critical review is to examine the relationship between ethnic-racial socialization (ERS) and African American mental health outcomes to identify the potential value of ERS in psychotherapy. Using the systematic research synthesis (SRS) process, we identified 21 peer-reviewed studies that investigated the relationship between ERS and mental health outcomes such as anger, depression, and self-esteem. We also included articles that tested ERS as a moderator of the relationship between discrimination experiences and mental health. The results support ERS as a protective factor against negative mental health outcomes. Importantly, ERS messages that emphasize culture and racial pride may be more consistently associated with positive outcomes than ERS messages that focus on preparing for racial bias. We also provide implications and suggestions for researchers wanting to expand the ERS literature and clinicians interested in incorporating ERS in their therapeutic practice and parent-training programs. [ABSTRACT FROM AUTHOR]

Objective: This study examined effects of patient-level and hospital-level characteristics on length and cost of hospital stays among adult patients with psychotic disorders.Methods: A subsample of 677,684 adult patients with a primary diagnosis of a psychotic disorder was drawn from the 2003-2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. A nationally representative survey design and census data were used to calculate hospitalization rates. Multilevel models examined variation in length and cost of stay in relation to individual (age, sex, race-ethnicity, household income, payer source, and illness severity) and hospital (region, urban or rural location, ownership, teaching status, and size) characteristics.Results: Admission rates differed dramatically by region, with higher rates in the Northeast. Compared with white patients, African Americans had higher admission rates but shorter stays and lower costs, and Asians/Pacific Islanders and Native Americans had longer stays. Longer stays were also associated with higher versus lower illness severity and use of Medicaid and Medicare versus private insurance. Length and cost of stays were greater in Northeast hospitals and in public hospitals.Conclusions: Strong differences were noted in use of hospitalization to treat psychotic disorders. Higher admission rates and longer stays in the Northeast were striking, as were differences in admission rates and length of stay for African-American patients compared with white patients. Future research should investigate the appropriateness of acute care use from an overuse (Northeast) and underuse (West) perspective. Findings raise questions about the effects of health reform on adult acute care use and have implications for mental health and hospital policy. [ABSTRACT FROM AUTHOR]

Objective: Rural African Americans are disproportionately affected by social stressors that place them at risk of developing psychiatric disorders. This study aimed to understand mental health, mental health treatment, and barriers to treatment from the perspective of rural African-American residents and other stakeholders in order to devise culturally acceptable treatment approaches.Methods: Seven focus groups (N=50) were conducted with four stakeholder groups: primary care providers, faith community representatives, college students and administrators, and individuals living with mental illness. A semistructured interview guide was used to elicit perspectives on mental health, mental health treatment, and ways to improve mental health in rural African-American communities. Inductive analysis was used to identify emergent themes and develop a conceptual model grounded in the textual data.Results: Stressful living environments (for example, impoverished communities) and broader community-held beliefs (for example, religious beliefs and stigma) had an impact on perceptions of mental health and contributed to barriers to help seeking. Participants identified community-level strategies to improve emotional wellness in rural African-American communities, such as providing social support, improving mental health literacy, and promoting emotional wellness.Conclusions: Rural African Americans experience several barriers that impede treatment use. Strategies that include conceptualizing mental illness as a normal reaction to stressful living environments, the use of community-based mental health services, and provision of mental health education to the general public may improve use of services in this population. [ABSTRACT FROM AUTHOR]

Obsessive-compulsive disorder (OCD) is a serious condition that remains understudied in ethnoracial minority populations. The presence of OCD and the individual, familial, and cultural factors that influence this condition can interfere with healthy development and cause lifelong disability. To date, there has not been a single published research article focused on OCD in African American youth. Ethnic and racial minorities with OCD are underrepresented or altogether absent from treatment centers and research studies, although evidence suggests that OCD may be particularly persistent in these populations. This article reviews risk factors, protective factors, and barriers to treatment in African American children and adolescents with OCD. This review conceptualizes cultural differences in symptomology, low income, reduced access to care, racism, and mental health stigma, as risk factors. Also discussed are the roles of family factors in the development and maintenance of the disorder, including family accommodations, conflictual family communication, and parenting styles. Potential protective factors are also examined, including a positive ethnic identity, social support, present-centered time orientation, and religious communities. Implications of findings are discussed. There is an urgent need for research to understand the needs of African American children and adolescents with OCD. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

The current study examined pathways in a model of desensitization, the Pathologic Adaptation Model, in adolescent males of color. Specifically, the current study examined depressive symptoms and deviant beliefs as mediators of the association between community violence exposure and subsequent violent behavior. The current study included 250 African-American (67%) and Latino (33%) male adolescents (T1 mean age = 15.32) from the Chicago Youth Development Study. Consistent with the Pathologic Adaptation Model, results demonstrated that depressive symptoms mediated the association between the quadratic violence exposure term in middle adolescence and violent behaviors in late adolescence, but the direction of the mediation effect was dependent upon the levels of violence exposure in middle adolescence. However, deviant beliefs were not found to be a significant mediator. Emotional desensitization effects may increase the likelihood of violence perpetration in adolescent males exposed to community violence, and the implications for future research and intervention efforts are discussed. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objective: To report descriptive and normative data for the Montreal Cognitive Assessment (MoCA) in a population-based African American sample. Method: The MoCA was administered to 1,419 African American participants (mean age 49.89 years, range 18-75, 64% female). After excluding those with subjective cognitive complaints (n = 301), normative data were generated by education and overlapping age ranges (n = 1,118). Pearson correlations and analysis of variance were used to examine the relationship to demographic variables, and frequency of missed items was reviewed. Results: Total MoCA scores (mean 22.3, SD 3.9) were lower than previously published normative data derived from an elderly Caucasian Canadian population with 80% falling below the suggested cutoff (<26) for impairment. Several MoCA items were missed by a large portion of the sample, including cube drawing (72%), delayed free recall (66% <4/5 words), sentence repetition (63%), and abstraction items (45%). Conclusion: This is the first study to examine normative performance on the MoCA specific to community-dwelling African Americans. Findings suggest that certain aspects of this measure and previously established cutoff scores may not be well-suited for some populations. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the relationship between informal social support from extended family and friends and suicidality among African Americans.Methods: Logistic regression analysis was based on a nationally representative sample of African Americans from the National Survey of American Life (N = 3263). Subjective closeness and frequency of contact with extended family and friends and negative family interaction were examined in relation to lifetime suicide ideation and attempts.Results: Subjective closeness to family and frequency of contact with friends were negatively associated with suicide ideation and attempts. Subjective closeness to friends and negative family interaction were positively associated with suicide ideation and attempts. Significant interactions between social support and negative interaction showed that social support buffers against the harmful effects of negative interaction on suicidality.Conclusions: Findings are discussed in relation to the functions of positive and negative social ties in suicidality. [ABSTRACT FROM AUTHOR]

This mixed method study examined factors associated with parents not attending their child's mental health treatment after initially seeking help for their 2-5 year old child. It was part of a larger study comparing two evidence-based treatments among low-income racial/ethnic minority families seeking child mental health services. Of 123 parents who initiated mental health treatment (71 % African American or multi-racial; 97.6 % low-income), 36 (29.3 %) never attended their child's first treatment session. Socio-demographic characteristics, parenting stress, depression, severity of child behavior problems, and length of treatment delay from intake to first scheduled treatment session were compared for families who did and did not attend their first treatment session. Parents who never attended their child's first treatment session were more likely to live with more than four adults and children ( p = .007) and have more depressive symptoms ( p = .003). Median length of treatment delay was 80 days (IQR = 55) for those who attended and 85 days (IQR = 67.5) for those who did not attend their child's first treatment session ( p = .142). Three themes emerged from caregiver interviews: (a) expectations about the treatment, (b) delays in getting help, and (c) ambivalence about research participation. Findings suggest the need to develop better strategies for addressing risk factors early in the treatment process and reducing the length of time families with adverse psychosocial circumstances must wait for child mental health treatment. [ABSTRACT FROM AUTHOR]

Objective: The study examined the impact of a peer navigator program (PNP) developed by a community-based participatory research team and used with a group of African Americans with serious mental illness who were homeless.Methods: Sixty-seven research participants were randomly assigned to receive PNP or treatment as usual (control) for one year. Data on general health and mental health, recovery, and quality of life were collected at baseline and at four, eight, and 12 months.Results: Findings from group × trial analyses of variance of omnibus measures of the four constructs showed significant impact over the year for participants in PNP compared with those in the control group, with analyses showing small to moderate effect sizes: general health status (η2=.24), psychological experience of physical health (η2=.42), recovery (η2=.36), and quality of life (η2=.14). These differences emerged even though both groups showed significant reductions in homelessness and increases in insurance coverage.Conclusions: Implications for improving in-the-field health care for this population are discussed. Whether these results occurred because navigators were peers per se needs to be examined in future research. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the impact of everyday discrimination (both racial and non-racial) on the mental health of older African Americans.Methods: This analysis is based on the older African American subsample of the National Survey of American Life (NSAL) (n = 773). We examined the associations between everyday discrimination and both general distress and psychiatric disorders as measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Six dependent variables were examined: lifetime mood disorders, lifetime anxiety disorders, any lifetime disorder, number of lifetime disorders, depressive symptoms as measured by the 12-item Center for Epidemiological Scale of Depression (CES-D), and serious psychological distress as measured by the Kessler 6 (K6).Results: Overall, racial and non-racial everyday discrimination were consistently associated with worse mental health for older African Americans. Older African Americans who experienced higher levels of overall everyday discrimination had higher odds of any psychiatric disorder, any lifetime mood disorder, any lifetime anxiety disorder, and more lifetime DSM-IV disorders, in addition to elevated levels of depressive symptoms and serious psychological distress. These findings were similar for both racial discrimination and non-racial discrimination.Conclusions: This study documents the harmful association of not only racial discrimination, but also non-racial (and overall) discrimination with the mental health of older African Americans. Specifically, discrimination is negatively associated with mood and anxiety disorders as well as depressive symptoms and psychological distress. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

African American neighborhoods have been historically targeted for urban renewal projects, which impact social composition and resident's health. The Hill District in Pittsburgh, PA is such a neighborhood. This research sought to investigate the extent to which social networks and perceived neighborhood social cohesion and safety were associated with psychological distress among residents in an African American neighborhood undergoing urban renewal, before the implementation of major neighborhood changes. Findings revealed a modest, significant inverse association between social network size and psychological distress (β = −0.006, p < .01), even after controlling for age, employment, education, and income. Perceived neighborhood safety predicted decreased psychological distress (β = −1.438, p < .01), but not social cohesion, which is consistent with past research. Findings suggest that social networks protect against psychological distress, but neighborhood perceptions are also paramount. [ABSTRACT FROM AUTHOR]

Objectives: The current study explores the potential mediating role of internalized racism in the relationship between racist experiences and anxiety symptomology in a Black American sample.Method: One hundred and 73 Black American participants, between 18 and 62 years of age, completed a questionnaire packet containing measures of anxious arousal and stress symptoms, internalized racism, and experiences of racist events.Results: Results indicated that internalized racism mediated the relationship between past-year frequency of racist events and anxious arousal as well as past-year frequency of racist events and stress symptoms.Conclusions: Internalized racism may be 1 mechanism that underlies the relationship between racism and anxious symptomology for Black Americans. These preliminary findings suggest that internalized racism may be an avenue through which clinicians can target the anxiety elicited by racist experiences. The clinical implications of these findings and future research directions are discussed. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Given the high prevalence of End Stage Renal Disease (ESRD) among African Americans, this article will explore the significance of faith, spirituality, and coping in the management of mental health concerns with African Americans receiving hemodialysis. The findings of the study from which this article is drawn point to the identification and use of spiritual assessment tools as a guide for clinical social work practice. Spiritual assessments may help identify the strengths of spirituality in the development of positive coping skills in patients diagnosed with chronic or end stage illness within populations for whom spirituality may be a significant factor. [ABSTRACT FROM AUTHOR]

Resource-poor social environments predict poor health, but the mechanisms and processes linking the social environment to psychological health and well-being remain unclear. This study explored psychosocial mediators of the association between the social environment and mental health in African American adults. African American men and women (n = 1467) completed questionnaires on the social environment, psychosocial factors (stress, depressive symptoms, and racial discrimination), and mental health. Multiple-mediator models were used to assess direct and indirect effects of the social environment on mental health. Low social status in the community (p < .001) and U.S. (p < .001) and low social support (p < .001) were associated with poor mental health. Psychosocial factors significantly jointly mediated the relationship between the social environment and mental health in multiple-mediator models. Low social status and social support were associated with greater perceived stress, depressive symptoms, and perceived racial discrimination, which were associated with poor mental health. Results suggest the relationship between the social environment and mental health is mediated by psychosocial factors and revealed potential mechanisms through which social status and social support influence the mental health of African American men and women. Findings from this study provide insight into the differential effects of stress, depression and discrimination on mental health. Ecological approaches that aim to improve the social environment and psychosocial mediators may enhance health-related quality of life and reduce health disparities in African Americans. [ABSTRACT FROM AUTHOR]

Racist police brutality has been systemic in Prince George's County, Maryland. The victims include African Americans, the mentally challenged, and immigrant populations, creating a complex and uneven public health impact. Three threads characterize the social movements and intervention since 1970. First, a significant demographic shift occurred as African Americans became the majority population in the late 1980s when the first Black county executive was elected in 1994. Despite the change in political leadership, police brutality remained rampant. Lower-income households located close to the District of Columbia and "inside the beltway" experienced the most police brutality. In 2001, The Washington Post revealed that between 1990 and 2000, Prince George's police shot and killed more citizens per officer than any of the 50 largest city and county law enforcement agencies in the country, 84 % of whom were black. Of the 147 persons shot during the 1990s, 12 were mentally and/or emotionally disturbed; 6 of these shootings were fatal. Second, resistance to police brutality emerged in a variety of political formations throughout the period, especially in the late 1990s. Sustained community pressure prompted the Department of Justice (DOJ) to open a civil rights investigation of the police department in November 2000. To avoid a potential federal lawsuit, the county leadership negotiated a memorandum of agreement (MOA) with the DOJ to enact policy reforms, part of which called for supplementing the departmental mobile crisis team, comprised of mental health care professionals, to respond to all cases involving mentally challenged citizens. Third, the incomplete process of change subsequent to the ending of DOJ oversight suggests a continued challenge to social movements opposing police brutality. This study focuses on the effectiveness of the MOA along with the activism of the People's Coalition for Police Accountability (PCPA) in reforming a culture of police brutality. The intensive oversight by the DOJ, combined with engaged resident activism, reduced the incidences of police brutality during the period 2004-2013. Since the termination of DOJ oversight, disturbing developments suggest the need for continued and sustained activism. Since 2010, county police officers have fatally shot 21 people, several in questionable circumstances. At the same time, the Prince George's Police Department has received more tactical military weaponry than any other jurisdiction in the state of Maryland under the 1033 program of the National Defense Authorization Act. [ABSTRACT FROM AUTHOR]