Valire Carr Copeland

Mental Health Treatment Seeking Among Older Adults with Depression: The Impact of Stigma and Race

OBJECTIVE Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment-seeking attitudes and behaviors among older adults with depression. METHOD Random digit dialing was utilized to identify a representative sample of 248 African American and white older adults (older than 60 years) with depression (symptoms assessed by the Patient Health Questionnaire-9). Telephone-based surveys were conducted to assess their treatment-seeking attitudes and behaviors and the factors that impacted these behaviors. RESULTS Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in or did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their white counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment. CONCLUSION Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.

Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults

Objective: Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services. Method: A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data. Results: Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans; (2) Barriers to Seeking Treatment for Older African-Americans; and (3) Cultural Coping Strategies for Depressed African-American Older Adults. Conclusion: Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors, which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.

Does marijuana use serve as a gateway to cigarette use for high-risk African-American youth?

Background/Objectives: The purpose of this investigation was to test whether the gateway hypothesis of drug initiation sequencing applies equally well to high-risk African-American and Caucasian youth. Methods: The study sample (N = 618, mean age = 15.5, SD = 1.2) represented the population of residents in the Missouri Division of Youth Services (DYS) who had initiated marijuana and nicotine use. Results: As hypothesized, African-American youth were significantly more likely to initiate marijuana use before cigarette use. Over one-third of African Americans reported initiating marijuana before cigarettes (37.9%), compared to less than one-quarter of youth in the other ethnic groups (Caucasian = 17.3%, Latino/Latina = 21.7%, Biracial/Other = 20.8%). Further, multinomial simulation and logistic regression models revealed that African-American youth were significantly more likely than other ethnic groups to initiate marijuana before cigarettes (Adjusted OR = 3.53, CI = 1.92–6.46). Conclusions/Scientific Significance: Findings suggest that the hypothesized gateway sequence may not apply equally well to African-Americans, and that prevention efforts based on this theory may need to be amended for these youth.

Child and Mother Client Satisfaction Questionnaire Scores regarding Mental Health Services: Race, Age, and Gender Correlates.

This study used the Client Satisfaction Questionnaire (CSQ-8) to examine the level of consumer satisfaction with children’s (ages 8 to 17 years) outpatient mental health services. Analyses were completed using both individual satisfaction items and a summed scale score. The CSQ scale had satisfactory internal consistency reliability for both mothers (alpha = .96) and children (alpha = .93). Parents’ratings of satisfaction with their child’s treatment were not uniformly consistent with those of the child who was in treatment. Mothers’and children’s ratings were significantly, but only moderately, related. We also found that a child’s satisfaction with outpatient services, relative to that of the parent, may depend on the child’s gender, race, and age. These findings suggest that children’s satisfaction with mental health treatment was complexly determined and should not be inferred from their mothers’degree of satisfaction.

Barriers to Mental Health Treatment Services for Low-Income African American Women Whose Children Receive Behavioral Health Services: An Ethnographic Investigation

Despite the prevalence of mental illness among low-income African American women, only a limited number seek and/or accept help from mental health service delivery systems. A qualitative analysis of 64 ethnographic interviews of low-income African American women whose children receive behavioral health services was completed to assess what barriers to care were reported for the women themselves. These African American women were interviewed as part of a larger study seeking to determine why mothers seek mental health treatment for their children, but not themselves, after many of the women (n = 32) met the baseline criteria for anxiety and/or depression. Our finding revealed that (1) the fear of losing their children, (2) economic stressors, (3) role strain, (4) perceptions of the system, and (5) violence and survival are key factors to consider when engaging low-income African American women in mental health treatment services. These factors have a negative influence on help seeking that should be considered for eliminating disparities in access to and utilization of mental health services.

Monitoring and Enforcing Cultural Competence in Medicaid Managed Behavioral Health Care

In recent years cultural competence has expanded beyond language provisions to include understanding and factoring into services provision the cultural perspectives clients may have that are different from the majority culture. The federal government requires state Medicaid programs to offer culturally competent services, but little is known about how states implement such mandates and monitor and enforce them. We reviewed the origins and implications of cultural competence mandates and conducted a brief case study of 5 states to learn about the implementation of cultural competence provisions in behavioral managed care contracts. We found that states and managed behavioral health organizations (MBHOs) vary in their definitions and implementation of standards to ensure mental health care access for vulnerable populations. Although states had a variety of oversight mechanisms, varying contractual requirements ranging from optional to required, vague contract language, no existing standardized indicators or definitions, and scant data on the cultural characteristics of the populations enrolled in Medicaid managed care hamper monitoring and enforcement of cultural competence by states. Implications for MBHOs, states, and the federal government, as well as services researchers, follow.

Patient satisfaction: African American women's views of the patient-doctor relationship.

Abstract African American women are less likely than other groups of women to use health care services despite an equal or greater need. In particular, they may rely more frequently on informal sources of health care advice, such as family members and/or social support networks. Very little is known about how African American women view the health care system because few studies have investigated the impact of race and gender on patient satisfaction. To address this gap, we analyzed transcripts of focus groups conducted with African American women about their attitudes toward health care, especially their expectations and experiences of the doctor-patient relationship. African American (AA) women in this study reported preferences for doctors who did not rush them through their appointments, who explained what was happening during the examination, who respected their need for self-determination, and who had a holistic focus on the patient. During this period of rapid change in the health care system, such information about how individuals of diverse backgrounds perceive the health care system is critical to ensure broad access and reduce disparities in utilization.

Pilot testing of a question prompt sheet to encourage family caregivers of cancer patients and physicians to discuss end-of-life issues.

Family members of patients with advanced illness have many questions. Unfortunately, several barriers prevent caregivers from discussing their questions with the physicians caring for the patient. Although question prompt sheets can be helpful in overcoming barriers to communication, few have been developed for family caregivers. The goal of this study, therefore, was to develop and test the acceptability and feasibility of a short question prompt sheet designed to encourage discussions about end-of-life concerns in an outpatient palliative care clinic. Our results demonstrated that caregivers wanted to discuss a variety of questions, primarily questions about medications, symptoms, support services, and what to expect. All caregivers thought that the question prompt sheets was easy to understand and felt comfortable completing it in clinic and the majority reported that the question prompt sheets made it easier for them to ask questions.

Reconceptualizing access: a cultural competence approach to improving the mental health of African American women.

SUMMARY Despite the prevalence of mental illness among African American women, only a limited number of them seek or accept help from mental health service delivery systems. An extensive review of the literature revealed that (1) racism and discrimination, (2) socioeconomic status, (3) stress and well being, and (4) housing and neighborhood conditions must be considered in an assessment of the mental health status of African American women. These factors negatively affect their mental health and should be addressed in eliminating disparities in access to and utilization of mental health services. We recommend a process by which mental health providers reconceptualize access to mental health services using a socio-cultural framework. The knowledge gained in this process will result in increased provider cultural competence. This developmental process would be facilitated by the use of a socio-cultural conceptual model for treatment engagement. The model takes into consideration the barriers to mental health treatment services that, in part, have to be eliminated by mental health providers in order to decrease disparities and enhance both access to and utilization of mental health services by African American women.

Implications of type 2 diabetes on adolescent reproductive health risk: an expert model.

Purpose The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D). Methods Using a mental model approach, a panel of experts— representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health—was convened to discuss reproductive health issues for female adolescents with T2D. Results Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one’s lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management. Conclusions Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D.