Amanda Toler Woodward

Religious Participation and DSM-IV Disorders Among Older African Americans: Findings From the National Survey of American Life

OBJECTIVES This study examined the religious correlates of psychiatric disorders. DESIGN The analysis is based on the National Survey of American Life (NSAL). The African American sample of the NSAL is a national representative sample of households with at least one African American adult 18 years or over. This study uses the older African American subsample (N = 837). METHODS Religious correlates of selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress, major depressive disorder, dysthymia, bipolar I & II disorders, alcohol abuse/dependence, and drug abuse/dependence) were examined. PARTICIPANTS Data from 837 African Americans aged 55 years or older are used in this analysis. MEASUREMENT The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess mental disorders. Measures of functional status (i.e., mobility and self-care) were assessed using the World Health Organization Disability Assessment Schedule-Second Version. Measures of organizational, nonorganizational and subjective religious involvement, number of doctor diagnosed physical health conditions, and demographic factors were assessed. RESULTS Multivariate analysis found that religious service attendance was significantly and inversely associated with the odds of having a lifetime mood disorder. CONCLUSIONS This is the first study to investigate the relationship between religious participation and serious mental disorders among a national sample of older African Americans. The inverse relationship between religious service attendance and mood disorders is discussed. Implications for mental health treatment underscore the importance of assessing religious orientations to render more culturally sensitive care.

Social Support from Church and Family Members and Depressive Symptoms Among Older African Americans

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.

Use of Professional and Informal Support by African Americans and Caribbean Blacks With Mental Disorders

OBJECTIVES This study investigated the use of professional services and informal support among African Americans and Caribbean blacks with a lifetime mood, anxiety, or substance use disorder. METHODS Data were from the National Survey of American Life. Multinomial logistic regression was used to test the utilization of professional services only, informal support only, both, or neither. Analyses controlled for sociodemographic characteristics, disorder-related variables, and family network variables. RESULTS The analytic sample included 1,096 African Americans and 372 Caribbean blacks. Forty-one percent used both professional services and informal support, 14% relied on professional services only, 23% used informal support only, and 22% did not seek help. There were no significant differences in help seeking between African Americans and Caribbean blacks. Having co-occurring mental and substance use disorders, having a severe disorder in the past 12 months, having more people in the informal helper network, and being female increased the likelihood of using professional services and informal supports. When men sought help, they were more likely to rely on informal helpers. Marital status, age, and socioeconomic status were also significantly related to help seeking. CONCLUSIONS The significant proportion of black Americans with a mental disorder who relied on informal support alone, professional services alone, or no help at all suggests potential unmet need in this group. However, the reliance on informal support also may be evidence of a strong protective role that informal networks play in the lives of African Americans and Caribbean blacks.

Mental health service use among older African Americans: The national survey of american life

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.

Prevalence and burden of general medical conditions among adults with bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

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 subsample 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.

Prevalence of lifetime DSM-IV affective disorders among older African Americans, Black Caribbeans, Latinos, Asians and Non-Hispanic White people

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.

Major Depressive Disorder Among Older African Americans, Caribbean Blacks, And Non‐Hispanic Whites: Secondary Analysis Of The National Survey Of American Life

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.

Emotional support, negative interaction and DSM IV lifetime disorders among older African Americans: findings from the national survey of American life (NSAL)

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.

Use of Professional and Informal Support by Black Men with Mental Disorders.

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.

Demographic Correlates of DSM-IV Major Depressive Disorder among Older African Americans, Black Caribbeans, and Non-Hispanic Whites: Results from the National Survey of American Life

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.