Sirry Alang

Police Brutality and Black Health: Setting the Agenda for Public Health Scholars

We investigated links between police brutality and poor health outcomes among Blacks and identified five intersecting pathways: (1) fatal injuries that increase population-specific mortality rates; (2) adverse physiological responses that increase morbidity; (3) racist public reactions that cause stress; (4) arrests, incarcerations, and legal, medical, and funeral bills that cause financial strain; and (5) integrated oppressive structures that cause systematic disempowerment. Public health scholars should champion efforts to implement surveillance of police brutality and press funders to support research to understand the experiences of people faced with police brutality. We must ask whether our own research, teaching, and service are intentionally antiracist and challenge the institutions we work in to ask the same. To reduce racial health inequities, public health scholars must rigorously explore the relationship between police brutality and health, and advocate policies that address racist oppression.

Postpartum Depression in an Online Community of Lesbian Mothers: Implications for Clinical Practice

A growing number of lesbians are choosing to conceive and raise children. Online communities for lesbian mothers are increasingly popular and discussion forums specific to postpartum depression (PPD) are emerging. Online ethnography (netnography) and content analysis were employed to assess the role of an online forum in PPD and to investigate how the shared experiences of lesbian birth mothers with PPD might inform clinical practice. Disclosure, coping, treatment-seeking, medications, perseverance, and comorbid conditions emerged as themes that characterize online messages and participant experiences. Findings have implications for assessing risks of PPD and for increasing help-seeking behavior among lesbian mothers.

“Black folk don't get no severe depression”: Meanings and expressions of depression in a predominantly black urban neighborhood in Midwestern United States

Discrepancies exist between how some Black populations perceive depression and how depression is conceptualized within research and clinical settings. Based on a 12-month ethnography of mental health in a predominantly Black disadvantaged urban neighborhood in Midwestern United States, the current study identifies meanings and common ways of expressing depression among African Americans. Depression was often considered a sign of weakness rather than a health problem that might need medical attention. Associated emotions like sadness and hopelessness were inconsistent with notions of strength. Common indicators of depression included classic symptoms such as hopelessness, loss of sleep, and feeling worthless. However, expressions of depression such as anger, agitation, violent behavior, and a frantic search for social interaction that are inconsistent with DSM-V criteria were also common. These findings have implications for the clinical assessment of depression and for the measurement of depression in community surveys. In addition, the context and meaning of symptoms play an important role in determining whether experiences are indicative of depression. This paper underscores that the provision of patient-centered mental health care requires a better understanding of the conceptualization of disorders within specific contexts.

Disability, Health Insurance, and Psychological Distress among US Adults An Application of the Stress Process

Structural resources, including access to health insurance, are understudied in relation to the stress process. Disability increases the likelihood of mental health problems, but health insurance may moderate this relationship. We explore health insurance coverage as a moderator of the relationship between disability and psychological distress. A pooled sample from 2008 to 2010 (N = 57,958) was obtained from the Integrated Health Interview Series. Chow tests were performed to assess insurance group differences in the association between disability and distress. Results indicated higher levels of distress associated with disability among uninsured adults compared with their peers with public or private insurance. The strength of the relationship between disability and distress was weaker for persons with public compared with private insurance. As the Affordable Care Act is implemented, decision makers should be aware of the potential for insurance coverage, especially public, to ameliorate secondary conditions such as psychological distress among persons who report a physical disability.

The Meaning and Predictive Value of Self-rated Mental Health among Persons with a Mental Health Problem:

Self-rated health is a valid measure of health that predicts quality of life, morbidity, and mortality. Its predictive value reflects a conceptualization of health that goes beyond a traditional medical model. However, less is known about self-rated mental health (SRMH). Using data from the Medical Expenditure Panel Survey (N = 2,547), we examine how rating your mental health as good—despite meeting criteria for a mental health problem—predicts outcomes. We found that 62% of people with a mental health problem rated their mental health positively. Persons who rated their mental health as good (compared to poor) had 30% lower odds of having a mental health problem at follow-up. Even without treatment, persons with a mental health problem did better if they perceived their mental health positively. SRMH might comprise information beyond the experience of symptoms. Understanding the unobserved information individuals incorporate into SRMH will help us improve screening and treatment interventions.

Access to care for children with emotional/behavioral difficulties

Emotional/behavioral difficulties (EBDs) are increasingly diagnosed in children, constituting some of the most common chronic childhood conditions. Left untreated, EBDs pose long-term individual and population-level consequences. There is a growing evidence of disparities in EBD prevalence by various demographic characteristics. This article builds on this research by examining disparities in access to medical care for children with EBD. From 2008 to 2011, using data from the US National Health Interview Survey (N = 31,631) on sample children aged 4–17, we investigate (1) whether having EBD affects access to care (modeled as delayed care due to cost and difficulty making an appointment) and (2) the role demographic characteristics, health insurance coverage, and frequency of service use play in access to care for children with EBD. Results indicate that children with EBD experience issues in accessing care at more than twice the rate of children without EBD, even though they are less likely to be uninsured than their counterparts without EBD. In multivariable models, children with EBD are still more likely to experience delayed care due to cost and difficulty making a timely appointment, even after adjusting for frequency of health service use, insurance coverage, and demographic characteristics.

Pathways to Mental Health Services and Perceptions about the Effectiveness of Treatment

The gap between need and effective treatment for mental health problems continues to be a challenge for researchers and policymakers. Much of the attention has been on differences in treatment rates, with insufficient attention to variation in pathways that people take into treatment. Individuals may choose to seek help but may also be substantially influenced by others or coerced into care. The chances of each type of pathway are influenced by social characteristics and may shape perceptions of effectiveness of care. This paper investigates variation in pathways into care and perceived effectiveness of care. We also examine whether choice or coercion into care are associated with whether individuals perceive care as effective and if severity of illness moderates this relationship. We use data from the 2010–2014 National Survey on Drug Use and Health (N = 10,020). Persons who independently sought mental health care were more likely to rate treatment as effective compared to persons ordered into care. Among people with severe mental illnesses, the probability of rating treatment as effective is lowest among those who were ordered into care. Entry into mental health care is not sufficient for closing the treatment gap if coerced care leads to poorer quality outcomes.

Contrasting depression among African Americans and major depressive disorder in the DSM-V

Purpose The purpose of this paper is to identify symptoms that constitute a shared cultural model of depression among African Americans and to compare these accounts with criteria for major depressive disorder (MDD) in the 5th edition of the Diagnostic Statistical Manual of mental disorders (DSM-V). Design/methodology/approach Data were collected in a disproportionately Black urban neighborhood in the USA and analyzed using cultural consensus analysis (CCA). In total, 34 African Americans participated in a free-listing exercise to elicit common indicators of depression in the same community. Another 40 key informants completed a survey to rate how common each indicator was in the same community. Factor analysis was performed, factor loadings were used to weight the responses of each informant in the survey and then aggregated to determine the most significant indicators or components of the shared model depression. Findings Indicators of depression included classic symptoms in the DSM-V such as sadness and lack of motivation. However, other indicators that are inconsistent with symptoms of MDD in the DSM-V such as paranoia and rage were common and constituted a shared model of depression in the sample. Research limitations/implications Some symptoms common among African Americans that are not in the DSM-V or on research instruments developed based on the DSM could be overlooked in epidemiological surveys and in clinical assessments of depression. Practical implications The provision of mental health care might benefit from a better understanding of how contextual factors shape expressions of distress among African Americans. Originality/value This study identify culturally salient symptoms of depression among African Americans independent of clinically defined criteria.

HIV testing history among young adults: The roles of sex, race, and sexual orientation

ABSTRACT One in five new HIV diagnoses in the United States is among persons younger than 25 years old. Routine testing is a crucial prevention strategy. We assessed the relationships between sex, race, sexual orientation, and HIV testing among young adults. Odds of affirmative testing history were higher among women than men, and among Latino gay/bisexual men than their White counterparts. Among straight men, odds of having tested were greatest among Blacks. Mechanisms through which race/ethnicity affect HIV vulnerability among young gay/bisexual men of color need to be explored, especially as these populations are more likely to have affirmative testing histories, yet are disproportionately impacted.