Richard L. Hough

Post-traumatic stress disorder in Hispanic Vietnam veterans. Clinical phenomenology and sociocultural characteristics.

The complex symptomatology of Hispanic Vietnam veterans receiving treatment for post-traumatic stress disorders (PTSD) was explored with the National Institute of Mental Health Diagnostic Interview Schedule, a structured diagnostic interview that yields current and lifetime operational diagnoses (e.g., DSM-III). Social networks and level of acculturation of these veterans were also examined and compared to those of a “control” group and a sample of veterans with DSM-III schizophrenic disorder (both samples included only Hispanic veterans from the Vietnam and post-Vietnam eras). All subjects reported heavy combat stress and met DSM-III criteria for PTSD. Most were very symptomatic and had significant social impairment. PTSD was rarely seen as a discrete entity but appeared instead mixed with symptom clusters cutting across various DSM-III diagnoses. Social networks of PTSD veterans were intermediate in size, frequency of contact with network members, and network density to those of the comparison groups. A distinctive feature of the PTSD group was the high proportion of negative relationships with close family members, especially spouses. “Highly” symptomatic PTSD veterans reported significantly smaller networks, fewer contacts outside the close family circle, and more negative emotionality directed toward family members than “minimally” symptomatic veterans. While all Hispanic groups studied were not significantly different in level of acculturation, PTSD veterans appeared more alienated from their cultural heritage than the other groups. The severe and polymorphous psychopathology found among these veterans suggests that “rap” groups alone may not constitute an adequate therapeutic approach and that more formal psychiatric therapies should be additionally considered in the management of Vietnam-linked PTSD.

Parental Beliefs About the Causes of Child Problems: Exploring Racial/Ethnic Patterns

OBJECTIVEnTo examine racial/ethnic patterns of parental beliefs about etiological explanations for youth problems.nnnMETHODnThe parents of 1338 youths with identified mental health problems were asked about their beliefs about the causes for their childrens problems from a questionnaire with 11 etiological categories.nnnRESULTSnParents of African American, Asian/Pacific Islander American, and Latino youths were generally less likely than parents of non-Hispanic whites to endorse etiologies consistent with biopsychosocial beliefs about mental illness. Some racial/ethnic differences were evident for sociological causes, but none existed for spiritual or nature disharmony etiologies. Analyses controlling for factors including child symptomatology produced fewer significant racial/ethnic differences but a similar pattern of results.nnnCONCLUSIONSnRacial/ethnic differences in parental beliefs about the causes of child problems exist in an at-risk sample, and implications for the help-seeking, utilization, and effectiveness of biopsychosocially oriented mental health services for diverse populations are discussed.

Why Bother with Beliefs? Examining Relationships between Race/Ethnicity, Parental Beliefs about Causes of Child Problems, and Mental Health Service Use.

In this study, the authors examined the role of parental beliefs about the causes of child problems in predicting later mental health service use in a large, diverse population of at-risk youths. Study hypotheses were that parental beliefs consistent with biopsychosocial causes would be associated with later mental health service use; sociological, spiritual, or nature disharmony etiologies would be negatively associated with service use; and beliefs would partially mediate the relationship between race/ethnicity and service use. Of the 5 biopsychosocial beliefs, 2 were positively related to later mental health service use. Unexpectedly, of the 6 parental beliefs related to sociological, spiritual, or nature disharmony etiologies, only 1 was negatively associated with later service use patterns. Parental endorsement of etiologies relating to physical causes, relational issues, trauma, and prejudice was found to partially mediate the relationship between race/ethnicity and service use for Asian/Pacific Islander American and Latino youths. ((c) 2005 APA, all rights reserved).

Racial and Ethnic Variations in Mental Health Care Utilization Among Children in Foster Care

Although children placed in foster care have an elevated need for mental health services, little is known about the extent to which their needs are met and the factors associated with their utilization of such services. In this study we examined racial and ethnic differences in caregiver-reported mental health service utilization rates among a sample of 659 youth ages 2-17 years in foster care. Results indicate that White American youth were significantly more likely to receive services compared to African American and Latino youth, even when the effects of possible confounding variables were controlled. Possible explanations and implications for racial and ethnic disparities in service utilization are discussed.

Racial/Ethnic Differences in the Use of Psychotropic Medication in High-Risk Children and Adolescents

OBJECTIVESnTo investigate rates of psychotropic medication use by youths served in public service sectors as a function of race/ethnicity.nnnMETHODnLogistic regression models were used to examine racial/ethnic differences in caregiver report of psychotropic medication use for a random stratified sample of 1,342 children who were served in public service sectors during the second half of fiscal year 1996-97.nnnRESULTSnRace/ethnicity predicted caregiver report of past-year and lifetime psychotropic medication use when all other factors were held constant. Specifically, caregivers of African-American and Latino children were less likely to report past-year use compared to white children; caregivers of Latino children and others were less likely to report lifetime use. Additional factors predictive of medication use in regression models included younger age, male gender, higher household income, insurance type, active to mental health sector at time of enumeration into the study, impairment and diagnosis of mood, and anxiety or attentional disorder.nnnCONCLUSIONSnRacial/ethnic differences in use of psychotropic medication occur in children served in public service sectors and need to be considered in clinical diagnosis and treatment.

Comparing DISC-IV and Clinician Diagnoses Among Youths Receiving Public Mental Health Services

OBJECTIVESnTo compare the prevalence and agreement of diagnoses based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) and clinician assignment for youths receiving public mental health services between 1996 and 1997 and to examine potential predictors of diagnostic agreement.nnnMETHODnParticipants included 240 youths aged 6-18 years. Past-year prevalence rates and kappa statistics were calculated for four diagnostic categories: anxiety, mood, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBD). Potential predictors of diagnostic agreement were examined with logistic regression analysis.nnnRESULTSnThe prevalence of ADHD, DBD, and anxiety disorders was significantly higher based on the DISC-IV, while the prevalence of mood disorders was significantly higher based on clinician assignment. Diagnostic agreement was poor overall. The kappa values ranged from -0.04 for anxiety disorders to 0.22 for ADHD. Significant predictors of agreement varied by diagnosis and included symptom severity, comorbidity, youth age and gender, and school-based problem identification.nnnCONCLUSIONSnConsistent with previous findings of poor diagnostic agreement between structured interviews and clinicians, these results call for a better understanding of factors affecting diagnostic assignment across different methods. This is especially important if researchers continue to use structured interviews to determine prevalence, establish diagnosis-based treatment guidelines, and disseminate evidence-based treatments to community mental health settings.

Understanding Racial/Ethnic Disparities in Youth Mental Health Services Do Disparities Vary by Problem Type?

The authors examined racial/ethnic disparities in mental health service use based on problem type (internalizing/externalizing). A diverse sample of youth in contact with public sectors of care and their families provided reports of youths symptoms and functional impairment during an initial interview. Specialty and school-based mental health service use during the subsequent 2 years was assessed prospectively. Greater disparities in mental health service receipt were evident for internalizing problems, with non-Hispanic White youth more likely to receive services in response to internalizing symptoms than minority youth. Fewer disparities in rates of unmet need emerged for externalizing problems, but minority youth were more likely to have need for externalizing problems met and African American youth were particularly likely to receive services in response to such problems. Findings highlight the importance of considering problem type when examining racial disparities in mental health services and underscore concerns about the responsiveness of mental health services for minority youth with internalizing disorders.

Measures and Predictors of Community-Based Employment and Earnings of Persons With Schizophrenia in a Multisite Study

OBJECTIVEnData from a national study of persons with schizophrenia-related disorders were examined to determine clinical factors and labor-market conditions related to employment outcomes.nnnMETHODSnData were obtained from the U.S. Schizophrenia Care and Assessment Program, a naturalistic study of more than 2,300 persons from organized care systems in six U.S. regions. Data were collected via surveys and from medical records and clinical assessments at baseline and for three years. Outcome measures included any community-based (nonsheltered) employment, 40 or more hours of work in the past month, employment at or above the federal minimum wage, days and hours of work, and earnings. Bivariate and multiple regression analyses of data from more than 7,000 assessments tested relationships between outcomes and sociodemographic, clinical, and local labor market characteristics.nnnRESULTSnThe employment rate was 17.2%; only 57.1% of participants who worked reported 40 or more hours of past-month employment. The mean hourly wage was

Factors Affecting the Probability of Use of General and Medical Health and Social/community Services for Mexican Americans and Non-hispanic Whites

7.05, and mean monthly earnings were

Multi-Sector Complexity of Systems of Care for Youth With Mental Health Needs

494.20. Employment rates and number of hours worked were substantially below those found in household surveys or in baseline data from trials of employment programs but substantially higher than those found in a recent large clinical trial. Strong positive relationships were found between clinical factors and work outcomes, but evidence of a relationship between local unemployment rates and outcomes was weak.nnnCONCLUSIONSnWork attachment and earnings were substantially lower than in previous survey data, not very sensitive to labor market conditions, and strongly related to clinical status.