Harold W. Neighbors

Racial/Ethnic Discrimination and Health: Findings From Community Studies

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health.

Depression care in the United States: too little for too few.

OBJECTIVE To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States. DESIGN Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care. SETTING The 48 coterminous United States. PARTICIPANTS Household residents 18 years and older (N = 15 762) participated in the study. MAIN OUTCOME MEASURES Past-year depression pharmacotherapy and psychotherapy using American Psychiatric Association guideline-concordant therapies. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode. RESULTS Mexican American and African American individuals meeting 12-month major depression criteria consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies despite depression severity ratings not significantly differing between ethnic/racial groups. All groups reported higher use of any past-year psychotherapy and guideline-concordant psychotherapy compared with pharmacotherapy; however, Caribbean black and African American individuals reported the highest proportions of this use. CONCLUSIONS Few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report underscores the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States.

“Being black and feeling blue”: the mental health consequences of racial discrimination

Abstract The association between racial discrimination and mental health was examined using Wave 2 (1987–1988) and Wave 3 (1988–1989) panel data from the National Survey of Black Americans (NSBA). Mental health status was assessed by psychological distress and depression. In cross-sectional analyses, the perception of racial discrimination was related to high levels of psychological distress at Waves 2 and 3. Experiencing racial discrimination was marginally related to a high likelihood of depression at Wave 2. In longitudinal analyses, reports of racial discrimination at Wave 2 were associated with high levels of psychological distress at Wave 3. High psychological distress or depression at Wave 2 was not associated with reports of racial discrimination at Wave 3—indicating that poor mental health did not predict subjective reports (perceptions) of discrimination. The Discussion focused on possible directions for a more comprehensive program of research on mental health, stress, and experiences of racially based discrimination.

The African American Minister as a Source of Help for Serious Personal Crises: Bridge or Barrier to Mental Health Care?

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

The Experience of Symptoms of Depression in Men vs Women: Analysis of the National Comorbidity Survey Replication

IMPORTANCE When men are depressed they may experience symptoms that are different than what is included in the current diagnostic criteria. OBJECTIVE To explore whether sex disparities in depression rates disappear when alternative symptoms are considered in the place of, or in addition to, more conventional depression symptoms. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOMES AND MEASURES: Using data from the National Comorbidity Survey Replication, a nationally represented mental health survey, we evaluated sex differences in symptom endorsement in 2 new scales that included alternative depression symptoms. We analyzed sex differences in symptom endorsement using 2-sided, design-based, .05-level t tests and multivariate logistic regression to identify predictors of depression. RESULTS; Men reported higher rates of anger attacks/aggression, substance abuse, and risk taking compared with women. Analyses using the scale that included alternative, male-type symptoms of depression found that a higher proportion of men (26.3%) than women (21.9%) (P = .007) met criteria for depression. Analyses using the scale that included alternative and traditional depression symptoms found that men and women met criteria for depression in equal proportions: 30.6% of men and 33.3% of women (P = .57). CONCLUSIONS AND RELEVANCE When alternative and traditional symptoms are combined, sex disparities in the prevalence of depression are eliminated. Further study is needed to clarify which symptoms truly describe mens experiences of depression.

Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans.

Schizophrenia is diagnosed more frequently among African Americans while mood disorders are identified more often among whites. Such findings have raised serious questions about the accuracy of clinical judgment. This article analyzes data on 665 African American and white psychiatric inpatients using a semi-structured diagnostic instrument. The paper explores the relationship of patient race to schizophrenia, schizoaffective disorder, major depression, and bipolar disorder. The paper also explores the extent to which patient race is related to the manner in which clinicians link individual symptoms to diagnoses. Results indicate some significant race differences in diagnosis remain even when a semi-structured instrument and DSM criteria are used, whites, were more likely than African Americans to receive a diagnosis of bipolar disorder and less likely to be diagnosed with schizophrenia. There were no race differences in major depression. Some patterns of symptom attribution differed by race. The results are consistent with previous sociological research showing that patient race is related to diagnosis even when standardized diagnostic criteria are used. These findings underscore the importance of clinical judgment within the context of cross-race and cross-ethnic diagnosis. Clinical training programs must reduce ethnocentric bias by teaching the appropriate use of the socio-cultural information necessary to employ DSM-IVs Cultural Formulation.

Use of mental health services and subjective satisfaction with treatment among Black Caribbean immigrants: Results from the National Survey of American Life

OBJECTIVES We examined the use rates and correlates of formal psychiatric services among the US-born and immigrant Caribbean Black population. METHODS We compared overall mental health service use in samples of Caribbean Blacks and African Americans and examined the within-sample ethnic variation among Caribbean Blacks, including for ethnic origin (Spanish Caribbean, Haiti, and English Caribbean), nativity status (those born in or outside the United States), number of years spent living in the United States, age at the time of immigration, and generational status. RESULTS African Americans and Caribbean Blacks used formal mental health care services at relatively low rates. Among Caribbean Blacks, generational status and nativity showed the greatest effects on rates of reported use, satisfaction, and perceived helpfulness. Of those study participants who met the criteria for disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, about one third used formal mental health care services. The US-born subjects were more likely to receive care than were first-generation immigrants. CONCLUSIONS Our study underscores the importance of ethnicity, immigration, and migration-related factors, within racial categorization, as it pertains to the use of mental health services in the United States. Our findings suggest that timing of migration and generational status of Caribbean Black immigrants and ancestry groups contribute to important differences in rates and sources of use, relative satisfaction, and perception of helpfulness, with regard to formal mental health services.

12-month and lifetime prevalence of suicide attempts among black adolescents in the National Survey of American Life.

OBJECTIVE Provide nationally representative data on the prevalence and psychiatric correlates of suicidal ideation and attempts among African American and Caribbean black adolescents in the United States. METHOD Data on nonfatal suicidal behavior among 1,170 African American and Caribbean black adolescents aged 13 to 17 years are from the National Survey of American Life-Adolescent, a nationally representative household survey of adults with an attached adolescent sample conducted between February 2001 and June 2003. RESULTS Nationwide black adolescents reported having a lifetime prevalence of 7.5% for suicidal ideation and 2.7% for attempts. The 12-month prevalence of suicidal ideation and attempt was 3.2% and 1.4%, respectively. Among all respondents, 4% of black American adolescents and 7% of female subjects were projected to attempt suicide by age 17 years. African American adolescents were approximately five times more likely than Caribbean black adolescents to attempt suicide. Almost half of the National Survey of American Life-Adolescent respondents who reported a suicide attempt had never met criteria for any of the DSM-IV disorders by the time of their attempts. CONCLUSIONS Clinicians should be trained to screen for suicidal behavior, even among those without DSM-IV disorders, when treating black adolescents, particularly female subjects. In addition, preventive efforts should consider ethnic differences in suicide risk and targeting nonclinical settings.

Sex differences in professional help seeking among adult black Americans

This paper provides baseline data on sex differences in the use of professional help for serious personal problems in a nationally representative sample of adult black Americans. Bivariate analyses revealed that women had higher levels of psychological distress and were significantly more likely to seek professional help than were men. They were also more likely to utilize physicians and social service agencies. The relationship of gender to these help resources remained significant even when the effects of problem severity and differential problem definition were taken into account. Controlling for income, however, eliminated the sex difference for social services use but not for physician use.

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.