Ahmed, A. O., Green, B. A., McCloskey, M. S., & Berman, M. E. (2010). Latent structure of intermittent explosive disorder in an epidemiological sample. Journal of Psychiatry Research. 44(10): 663-672.

Intermittent explosive disorder (IED) is characterized by distinct periods of impulsive aggression marked by assaultive acts or destruction of property. However, impulsive ggression is also a feature of other disorders, all of which are viewed in diagnostic nomenclature as qualitatively distinct from IED. This state of affairs is problematic for categorical models unless it is demonstrated empirically that IED-related impulsive aggression is qualitatively distinct from impulsive aggression observable in other axis I and II disorders. The current study addresses this question using taxometric methods to examine the latent structure of IED. Participants were respondents on the Collaborative Psychiatric Epidemiological Surveys, which obtained data on a range of disorders including intermittent explosive disorder (N = 20,013) and a range of psychological variables. Indicator variables used were drawn from the survey items and submitted to select taxometric methods (MAMBAC and MAXEIG) to determine the relative fits of a taxonic versus dimensional model. The results of taxometric analyses provided support for a taxonic, rather than dimensional, structure for IED symptoms in the epidemiological sample. Taxon group membership was associated with treatment seeking, family history of anger attacks, lower age of onset of anger attacks, and male biological sex, providing strong support for the validity of the IED taxon.

Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C., Takeuchi, D., Jackson, J.S., Meng, X. (2008) Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States. Psychiatric Services, 59: 1264 - 1272.

OBJECTIVE: Prior research on racial and ethnic disparities in depression treatment has been limited by the scarcity of national samples that include an array of diagnostic and quality indicators and substantial numbers of non-English-speaking individuals from minority groups. Using nationally representative data for 8,762 persons, the authors evaluated differences in access to and quality of depression treatments between patients in racial-ethnic minority groups and non-Latino white patients. METHODS: Access to mental health care was assessed by past-year receipt of any mental health treatment. Adequate treatment for acute depression was defined as four or more specialty or general health provider visits in the past year plus antidepressant use for 30 days or more or eight or more specialty mental health provider visits lasting at least 30 minutes, with no antidepressant use. RESULTS: For persons with past-year depressive disorder, 63.7% of Latinos, 68.7% of Asians, and 58.8% of African Americans, compared with 40.2% of non-Latino whites, did not access any past-year mental health treatment (significantly different at p<.001). Disparities in the likelihood of both having access to and receiving adequate care for depression were significantly different for Asians and African Americans in contrast to non-Latino whites. CONCLUSIONS: Simply relying on present health care systems without consideration of the unique barriers to quality care that ethnic and racial minority populations face is unlikely to affect the pattern of disparities observed. Populations reluctant to visit a clinic for depression care may have correctly anticipated the limited quality of usual care.

Borooah, V. K. (2010). Gender differences in the incidence of depression and anxiety: Econometric evidence from the USA. Journal of Happiness Studies. 11(6): 663-682.

Using data from the Collaborative Psychiatric Epidemiology Surveys (CPES) for the United States for the period 2001–2003, this paper addresses a vexed question relating to inter-gender differences in depression rates, namely how much of the observed difference in depression rates between men and women may be explained by differences between them in their exposure, and how much may be explained by differences between them in their response, to depression-inducing factors. The contribution of this paper is to propose a method for disentangling these two influences and to apply it to US data. The central conclusion of the paper was differences between men and women in rates of depression and anxiety were largely to be explained by differences in their responses to depression-inducing factors: the percentage contribution of inter-gender response differences to explaining the overall difference in inter-gender probabilities of being depressed was 93 percent for ‘‘sad, empty type depression’’; 92 percent for ‘‘very discouraged’’ type depression; and 69 percent for ‘‘loss of interest’’ type depression.

Broman, C., Neighbors, H.W., Delva, J., Torres, M., Jackson, J.S. (2008). Prevalence of DSM-IV Substance Use Disorders Among African Americans and Caribbean Blacks in the National Study of American Life. American Journal of Public Health, 98:1107-1114.

Objectives. We sought to estimate the prevalence of substance disorders for African Americans and Caribbean Blacks in the United States using data from the National Survey of American Life. Methods. A national household probability sample of noninstitutionalized African Americans (n=3570) and Caribbean Blacks (n=1621) was obtained between February 2001 and June 2003 using a slightly modified version of the Composite International Diagnostic Interview. Results. Overall differences in prevalence of substance disorders between the ethnic groups were not significant. Prevalence rates of substance disorders among African Americans exceeded that of Caribbean Blacks among women, those aged 45 to 59 years, and those who were divorced. African Americans in major metropolitan areas had higher prevalence rates, and those in the South had lower ones, compared with those living in other areas. Overall, first-generation Caribbean Blacks were significantly less likely, but second-generation more likely, than were African Americans to meet criteria for overall substance disorders. Conclusions. Failure to distinguish between African Americans and Caribbean Blacks masks important differences in substance use patterns among the Black population in the United States.

Broman, C. L., Torres, M., Canady, R. B., Neighbors, H. W., & Jackson, J. S. (2010). Race and ethnic self-identification influences on physical and mental health statuses among blacks. Race and Social Problems. 2(2): 81-91.

We examine if commonly used distress measures, rates of psychiatric disorders, and chronic health conditions are affected by alternate measures of race-ethnicity for African Americans and Caribbean blacks. We examined two alternative self-identification measures to investigate if their influence might differ. A study on national household probability sample of non-institutionalized African Americans (n = 3,570) and blacks from Caribbean countries, who now live in the United States (n = 1,621), was conducted between February 2001 and June 2003, using a slightly modified version of the Composite International Diagnostic Interview. The method used to measure black race and ethnicity has influence on physical and mental health outcomes. The distributions of depressive symptoms are not affected, while the distributions of DSM IV disorders and chronic health conditions vary by race and ethnic self-identifications among the African American and Caribbean black populations. There are serious implications of using alternate measures of race-ethnicity on the distribution of physical and mental health morbidity among African Americans and Caribbean blacks. The conceptualization and assessment of race-ethnicity should be carefully considered when studying mental and physical health statuses and service needs in the American black population.

Bryant, C., Taylor, R.J., Lincoln, K.D., Chatters, L.M., & Jackson, J.S. (2008) Marital Satisfaction Among African Americans and Black Caribbeans: Findings From the National Survey of American Life . Family Relations, 57(2):113-266.

This study examines the correlates of marital satisfaction using data from a national probability sample of African Americans (N = 962) and Black Caribbeans (N = 560). Findings reveal differences between African Americans and Black Caribbeans, and men and women within those groups, in the predictors of marital satisfaction. Black Caribbean women reported overall higher levels of marital satisfaction than African American women. The findings amply demonstrate the significance of ethnic diversity within the Black population in the United States. Difficulties with finances (budgeting, credit issues, and debt management) are one of the key issues that generate conflict in marriages; stress generated as a result of financial problems can lower marital satisfaction. Because these issues are salient for couples at any given time in the family life cycle, counseling at critical points in the marriage (birth of children, launching of children from home, and retirement) may be helpful.

Chae, D.H., Lincoln, K.D., Adler, N.E., Syme, S.L. (2010). Do major experiences of racial discrimination predict cardiovascular health outcomes among African American men? The moderating role of negative attitudes towards Blacks. Social Science and Medicine. 71(6): 1182–1188.

Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001–2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive racial group identity may help to improve cardiovascular health among African American men.

Chatterji, P., Alegría, M., & Takeuchi, D. (2009). Racial/ethnic differences in the effects of psychiatric disorders on employment. Atlantic Economic Journal. 37(3): 243-257. PMCID: PMC2773508

Prior research on the disability burden of mental disorders has focused on the non-Latino white population, despite the growing size and importance of racial/ethnic minorities in the labor market and in the US population as a whole. This paper is one of the first to test for racial/ethnic differences in the effects of mental disorder on employment outcomes with data from the National Institute of Mental Health (NIMH) Collaborative Psychiatric Epidemiological Studies (CPES). We find that recent psychiatric disorder is associated with a reduction in the likelihood of employment for men of all racial/ethnic groups relative to non-Latino whites with the possible exception of Caribbeans. These findings are driven by the effects of anxiety and affective disorders. For females, only affective disorders appear to detract from employment overall. Much larger negative effects are found for Latino women with anxiety disorders.

Chatters, L. M., Mattis, J. S., Woodward, A. T., Taylor, R. J., Neighbors, H. W., & Grayman, N. A. (2011). Use of ministers for a serious personal problem among African Americans. American Journal of Orthopsychiatry. 81(1): 118-127.

This study examined use of ministers for assistance with a serious personal problem within a nationally representative sample of African Americans (National Survey of American Life—2001–2003). Different perspectives on the use of ministers—social stratification, religious socialization, and problem-oriented approach—were proposed and tested
using logistic regression analyses with demographic, religious involvement, and problem type factors as predictors. Study findings supported religious socialization and problem oriented explanations indicating that persons who are heavily invested in religious pursuits and organizations (i.e., women, frequent attenders) are more likely than their counterparts to use ministerial assistance. Contrary to expectations from the social stratification perspective, positive income and education effects indicated that higher status individuals were more likely to report use of ministers. Finally, problems involving bereavement are especially suited for assistance from ministers owing to their inherent nature (e.g., questions of ultimate meaning) and the extensive array of ministerial support and church resources that are available to address the issue.

Chatters, L.M., Taylor, R.J., Bullard, K.M., Jackson, J.S. (2008) Race and Ethnic Differences in Religious Involvement: African Americans, Caribbean Blacks and Non-Hispanic Whites. Ethnic and Racial Studies. DOI: 10.1080/01419870802334531

This study examined differences in religious participation and spirituality among African Americans, Caribbean blacks (black Caribbeans) and non-Hispanic whites. Data are taken from the National Survey of American Life, a nationally representative study of African Americans, black Caribbeans and non-Hispanic whites. Selected measures of organizational, non-organizational and subjective religious participation were examined. African American and Caribbean blacks were largely similar in their reports of religious involvement; both groups generally indicated higher levels of religious participation than non-Hispanic whites. African Americans were more likely than black Caribbeans to be official members of their places of worship, engage in activities (choirs, church clubs) at their place of worship and request prayer from others. Black Caribbeans reported reading religious materials more frequently than African Americans. The discussion notes the importance of examining ethnic differences within the black American population of the United States.

Chatters, L.M., Taylor, R.J., Bullard, K.M., Jackson, J.S. (2008) Spirituality and Subjective Religiosity Among African Americans, Caribbean Blacks, and Non-Hispanic Whites. Journal of Scientific Study of Religion. 47(4):725–737.

Patterns and correlates of self-perceptions of spirituality and subjective religiosity are examined using data from the National Survey of American Life, a nationally representative study of African Americans, Caribbean blacks, and non-Hispanic whites. Demographic and denominational correlates of patterns of subjective religiosity and spirituality (i.e., religious only, spiritual only, both religious/spiritual, and neither religious/spiritual) are examined. In addition, the study of African Americans and Caribbean blacks permits the investigation of possible ethnic variation in the meaning and conceptual significance of these constructs within the U.S. black population. African Americans and Caribbean blacks are more likely than non-Hispanic whites to indicate that they are “both religious and spiritual” and less likely to indicate that they are “spiritual only” or “neither spiritual nor
religious.” Demographic and denominational differences in the patterns of spirituality and subjective religiosity are also indicated. Study findings are discussed in relation to prior research in this field and conceptual and methodological issues deserving further study are noted.

Chatters, L.M., Taylor, R.J., Bullard, K.M., Woodward, A.T., Neighbors, H.W., Jackson, J.S. (2008) Religious Participation and DSM-IV Disorders Among Older African Americans: Findings from the NSAL. American Journal of Geriatric Psychiatry. 16(12): 957-965.

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 lifetimemood 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.

Chatters, L., Taylor, R.J., Lincoln, K., Jackson, J.S. (2008). Religious Coping Among African Americans, Caribbean Blacks and Non-Hispanic Whites. Journal of Community Psychology, 36(3):371-386.

This study examined demographic predictors of attitudes regarding religious coping (i.e., prayer during stressful times and look to God for support, strength and guidance) within a national sample of African Americans, Caribbean Blacks, and non-Hispanic Whites (National Survey of American Life). The findings demonstrate significant Black- White differences in attitudes regarding religious coping with higher endorsements of religious coping among African Americans and Black Caribbeans (Caribbean Blacks). Comparisons of African Americans and Black Caribbeans revealed both similar and divergent patterns of demographic effects. For both African Americans and Black Caribbeans, women were more likely to utilize religious coping than men and married respondents were more likely than never married respondents to report utilizing prayer when dealing with a stressful situation. Further, for both groups, higher levels of education were associated with lower endorsements of the importance of prayer in dealing with stressful situations. Among African Americans only, Southerners were more likely than respondents who resided in other regions to endorse religious coping. Among Black Caribbeans, those who emigrated from Haiti were more likely than Jamaicans to utilize religious coping when dealing with a stressful episode.

Chatters, L.M., Taylor, R.J., Jackson, J.S. (2009) Correlates of Spirituality Among African Americans and Caribbean Blacks in the United States:  Findings from the National Survey of American Life. Journal of Black Psychology. 35(3): 317-342. DOI:10.1177/0095798408329947

The present study examined differences in reports of spirituality among African Americans, Caribbean Blacks (Black Caribbeans), and non-Hispanic Whites using data from the National Survey of American Life. Bivariate analyses indicated that African Americans were most likely to endorse statements regarding the importance of spirituality in their lives ("How important is spirituality in your life?") and self-assessments of spirituality ("How spiritual would you say you are?"), followed by Caribbean Blacks and non-Hispanic Whites. Regression analyses indicated that African Americans and Caribbean Blacks had significantly higher levels of spirituality than did non-Hispanic Whites. However, there were no significant differences in spirituality between African Americans and Caribbean Blacks. Separate regression analyses for African Americans and Caribbean Blacks indicated distinctive patterns of sociodemographic and denominational correlates of spiritual sentiments. Findings are discussed in relation to available survey and ethnographic data on self-assessments of spirituality.

Eaton, W. W., Martins, S. S., Nestadt, G., Bienvenu, O. J., Clarke, D., & Alexandre, P. (2008). The burden of mental disorders. Epidemiologic Reviews. 30(1): 1-14. PMCID: PMC2683377

In the last decade, there has been an increase in interest in the burden of chronic and disabling health conditions that are not necessarily fatal, such as the mental disorders. This review systematically summarizes data on the burden associated with 11 major mental disorders of adults. The measures of burden include estimates of prevalence, mortality associated with the disorders, disabilities and impairments related to the disorders, and costs. This review expands the range of mental disorders considered in a report on the global burden of disease, updates the literature, presents information on the range and depth of sources of information on burden, and adds estimates of costs. The purpose is to provide an accessible guide to the burden of mental disorders, especially for researchers and policy makers who may not be familiar with this subfield of epidemiology.

Fortuna, L. R., Alegría, M., & Gao, S. (2010). Retention in depression treatment among ethnic and racial minority groups in the United States. Depression and Anxiety. 27(5): 485-494.

Background: Premature discontinuation of psychiatric treatment among ethnic–racial minorities is a persistent concern. Previous research on identifying factors associated with ethnic–racial disparities in depression treatment has been limited by the scarcity of national samples with adequate representation of minority groups and especially non-English speakers. In this article, we aim to identify variations in the likelihood of retention in depression treatment among ethnic–racial minority groups in the United States as compared to non-Latino whites. Second, we aim to identify the factors that are related to treatment retention. Methods: We use data from the Collaborative Psychiatric Epidemiology Surveys to examine differences and correlates of depression treatment retention among a representative sample (n5564) of non-Latino whites, Latinos, African-American, and Asian espondents with last 12-month depressive disorder and who report receiving formal mental health treatment in the last year. We define retention as attending at least four visits or remaining in treatment during a 12-month period. Results: Being seen by a mental health specialist as opposed to being seen by a generalist and having received medication are correlates of treatment retention for the entire sample. However, after adjusting for demographics, clinical factors including number of co-occurring psychiatric disorders and level of disability, African-Americans are significantly less likely to be retained in depression treatment as compared to non-Latino whites. Conclusions: Availability of specialized mental health services or comparable treatment within primary care could improve treatment retention. Low retention suggests persistent problems in the delivery of depression treatment for African-Americans.

Finlayson, T.L., Williams, D.R., Siefert, K.,  Jackson, J.S., Nowjack-Raymer, R. (2010). Oral Health Disparities and Psychosocial Correlates of Self-Rated Oral Health in the NSAL. Am J Public Health. 100:S246-S255.

Objectives. We sought to better understand the determinants of oral health disparities by examining individual-level psychosocial stressors and resources and self-rated oral health in nationally representative samples of Black American, Caribbean Black, and non-Hispanic White adults. Methods. We conducted logistic regression analyses on fair or poor versus better oral health using data from the National Survey of American Life (n = 6082). Results. There were no significant racial differences. Overall, 28% of adults reported having fair or poor oral health. Adults with lower income and less than a high school education were each about 1.5 times as likely as other adults to report fair or poor oral health. Higher levels of chronic stress, depressive symptoms, and material hardship were associated with fair or poor oral health. Adults living near more neighborhood resources were less likely to report fair or poor oral health. Higher levels of self-esteem and mastery were protective, and more-religious adults were also less likely to report fair or poor oral health. Conclusions. Social gradients in self-rated oral health were found, and they have implications for developing interventions to address oral health disparities.

Ford, B. C., Bullard, K. M., Taylor, R. J., Toler, A. K., Neighbors, H. W. & Jackson, J. S. (2007). Lifetime and 12-month Prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Among Older African Americans: Findings From the National Survey of American Life. American Journal of Geriatric Psychiatry, 15:652-659.

The purpose of this study was to estimate lifetime and 12-month prevalence of 13 psychiatric disorders for older African Americans. Methods: Data are from the older African American subsample of the National Survey of American Life. Selected measures of lifetime and 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder (PTSD), major depressive disorder, dysthymia, bipolar I and II disorders, alcohol abuse/dependence, and drug abuse/dependence). Twenty-three percent of older African Americans reported at least one lifetime disorder and 8.54% reported at least one 12-month disorder. Alcohol abuse, PTSD, and major depression were the most prevalent lifetime disorders. The most prevalent 12-month disorders were PTSD, major depression, and social phobia. Age, sex, education, and region were significantly associated with the odds of having a lifetime disorder. This is the first study of prevalence rates of serious mental disorders for older African Americans based on a national sample. Demographic correlates of the prevalence of disorders are discussed with an emphasis on age and regional differences.

Gavin, A. R., Chae, D. H., & Takeuchi, D. (2009). Association between family structure in childhood and lifetime depressive disorder in adulthood among a nationally representative sample of blacks. General Hospital Psychiatry. 31(5): 484-493. PMCID: PMC2765913

Objective: This study investigated whether there were associations between family structure in childhood and lifetime prevalence of major depressive disorder in adulthood in a representative national sample of 4918 Blacks in the United States. We explored whether the associations between family structure and depressive disorder differed based on four types of family structure: (1) the presence of both biological parents; (2) one biological parent and a nonbiological parent; (3) one biological parent and (4) neither biological parent. Method: The data used were from the National Survey of American Life. Results: In the adjusted analysis, among all respondents, higher odds of major depressive disorder in adulthood were associated with growing up with one biological parent and a nonbiological parent compared to those who grew up with both biological parents. In the analysis stratified by gender, only women who lived with one biological parent and a nonbiological parent during childhood had an increased risk of depressive disorder in adulthood.
Conclusions: Growing up in a household with one biological parent and a nonbiological parent was positively associated with depressive disorder in adulthood among Black women. Future studies should continue to explore the pathways linking family structure in childhood to the long-term consequences of depressive disorder.

Gavin, A. R., Rue, T., & Takeuchi, D. (2010). Racial/ethnic differences in the association between obesity and major depressive disorder: Findings from the Comprehensive Psychiatric Epidemiology Surveys. Public Health Reports. 125(5): 698-708. PMCID: PMC2925006

Objectives. This study examined whether the association between obesity and 12-month prevalence of major depressive disorder (MDD) varied according to racial/ethnic status and nativity in representative national samples of black, Latino, Asian, and non-Hispanic white people. Methods. We used data from the Comprehensive Psychiatric Epidemiology Surveys. Results. In analyses by gender, obesity was associated with an elevated risk of MDD among non-Hispanic white women (adjusted odds ratio [AOR] =1.73; 95% confidence interval [CI] 1.27, 2.35; p50.001). Formal test for interaction revealed significant variation by race present between non-Hispanic white women and black, Latin, and Asian women. No significant differences were evident among men. In analyses by nativity, the association between obesity and MDD was significant among U.S.-born non-Hispanic white women (AOR51.62; 95% CI 1.16, 2.27; p50.001) and U.S.-born black women (AOR51.29; 95% CI 1.01, 1.66; p50.041). Significant interactions were present among U.S.-born white and black women, Latin women, and Asian women. No significant interactions were evident among foreign-born women. Similarly, no significant differences were present among native-born or foreign-born men. Conclusions. The findings suggest that the association between obesity and MDD varies according to racial/ethnic status and nativity. Understanding the link between obesity and depression may be imperative to designing interventions to address body weight maintenance and reduction strategies among women.

Gavin, A.R., Walton, E., Chae, D.H., Alegria, M., Jackson, J.S., Takeuchi, D. (2009) The Associations Between Socioeconomic Status and Major Depressive Disorder among Blacks, Latinos, Asians, and non-Hispanic Whites: Findings from the Collaborative Psychiatric Epidemiology Studies. Psychological Medicine. 22:1-11.

Background This study examined whether there were associations between individual measures of socio-economic status (SES) and the 12-month prevalence of major depressive disorder (MDD) in representative samples of Blacks, Latinos, Asians and Whites in the USA. Method The data used were from the Collaborative Psychiatric Epidemiology Studies (CPES). Results There was an association between household income and MDD among Whites. However, the association was not statistically significant. Statistically significant associations were present between educational attainment and MDD among Whites. Among both Whites and Latinos, being out of the labor force was significantly associated with MDD. In analyses by nativity, being out of the labor force was significantly associated with MDD among US-born and foreign-born Latinos. Conclusions Significant associations between various measures of SES and MDD were consistently observed among White and, in some cases, Latino populations. Future studies should continue to examine sociopsychological factors related to SES that increase the risk of MDD among people from racial-ethnic communities.

Griffith, D. M., Johnson, J. L., Zhang, R., Neighbors, H. W., & Jackson, J. S. (2011). Ethnicity, nativity and the health of American blacks.  Journal of Health Care for the Poor and Underserved. 22(1): 142-156.

There have been few empirical studies of ethnic differences in health within the American Black population. Logistic regressions were used to examine the relationships among ethnicity, nativity, depressive symptoms, and physical health in the two largest ethnic groups of American Blacks, African Americans and Caribbean Blacks. The data were from
the National Survey of American Life, a national household survey representative of the non-institutionalized U.S. Black population. We found that African Americans, U.S.-born Caribbean Blacks, and Caribbean-born Blacks had significantly different self-ratings of their health and self-reports of being diagnosed with a chronic physical health condition:
Caribbean-born Blacks had the best health outcomes and U.S.-born Caribbean Blacks had the worst. This finding remained significant even after considering self-reported depressive symptoms. This study highlights the importance of considering ethnic diversity, nativity and immigration as independent sources of variation in health status within the American Black population.

González, H. M., Croghan, T., West, B., Williams, D., Nesse, R., Tarraf, W., Taylor, R., Hinton, L., Neighbors, H., Jackson, J. (2008) Antidepressant Use in Black and White Populations in the United States. Psychiatric Services.; 59: p. 1131-1138.

Objective: The study objective was to estimate the prevalence and correlates of antidepressant use by black and white Americans. Methods: Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) were analyzed to calculate nationally representative estimates of pastyear antidepressant use by black and white Americans ages 18 years
and older (N=9,723). Results: Among individuals with depressive and anxiety disorders in the past year (N=516), black respondents (14.6%) had significantly lower (p<.001) antidepressant use than white respondents (32.4%). Depression severity was significantly associated with higher antidepressant use for white but not for black respondents.
Psychiatric disorders and vascular disease significantly increased the odds of past-year antidepressant use. The increased prevalence of antidepressant use associated with vascular disease was independent of diagnosable psychiatric disorders. Among respondents not meeting criteria for depressive and anxiety disorders in the past year, lifetime depressive and anxiety disorders and vascular disease significantly increased the odds of antidepressant use. Conclusions: Few white and fewer black Americans with depressive and anxiety disorders received antidepressant treatment. Higher depression severity was associated with more antidepressant use for white but not for black respondents. Antidepressant use was associated with medical conditions related to vascular disease, and these medical conditions were independent of coexisting psychiatric conditions. The results also indicate that many antidepressants are used for maintenance pharmacotherapy for depressive and anxiety disorders as well as common medical conditions associated with vascular disease.

González, H. M., Tarraf, W., Whitfield, K. E., & Vega, W. A. (2010). The epidemiology of major depression and ethnicity in the United States. Journal of Psychiatric Research. 44(15): 1043-1051.

Objectives: To determine the prevalence, age of onset, severity, associated disability, and treatment of major depression among United States ethnic groups, national survey data were analyzed. Methods: National probability samples of US household residents aged 18-years and older (n¼ 14,710) participated. The main outcomes were past-year and lifetime major depression (World Mental Health Composite International Diagnostic Interview). Major depression prevalence estimates, age of onset, severity, associated disability, and disaggregated treatment use (pharmacotherapy and psychotherapy) and treatment guideline concordant use were examined by ethnicity. Results: The prevalence of major depression was higher among US-born ethnic groups compared to foreign-born groups, but not among older adults.  African Americans and Mexicans had significantly higher depression chronicity and significantly lower depression care use and guideline concordant use than Whites. Discussion: We provide concise and detailed guidance for better  understanding the distribution of major depression and related mental healthcare inequalities and related morbidity. Inequalities in depression care primarily affecting Mexican Americans and African Americans may relate to excesses in major depression disease burden.

González, H.M., Vega, W., Williams, D.R., West, B.T., Tarraf, W., Neighbors, H.W. (2010) Depression care in the United States: Too little for too few. Archives of General Psychiatry. 67:37-46.

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. 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. 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.

González, H. M., Whitfield, K. E., West, B. T., Williams, D. R., Lichtenberg, P. A. & Jackson, J. S. (2007). Modified-Symbol Digit Modalities Test for African Americans, Caribbean Black Americans, and Non-Latino Whites: Nationally Representative Normative Data from the National Survey of American Life. Archives of Clinical Neuropsychology, 22(5): 605-613. DOI: 10.1016/j.acn.2007.04.002

Normative neuropsychological data for U.S. racial/ethnic minorities are limited. Extant norms are based on small, regional groups that may not be nationally representative. The objectives of this study were to (1) provide norms for a modified Symbol Digit Modalities Test (M-SDMT) based on a nationally representative sample of African Americans, Caribbean Blacks, and non-Latino Whites (NLW) living in areas with large populations of Blacks; and (2) determine significant correlates of M-SDMT performance. The M-SDMT was administered to a subset of respondents from the National Survey of American Life in standard face-to-face interviews. M-SDMT performance was influenced by race/ethnicity, age, education, and gender. African Americans and NLW groups had similar M-SDMT performances, which differed from Caribbean Blacks. The Black ethnic differences in M-SDMT were not explained by the sociodemographic factors considered in this study. Unlike previous work, this study supports the consideration of Black ethnicity when evaluating Black neuropsychological test performance.

Hammond, W. P., Mohottige, D., Chantala, K., Hastings, J. F., Neighbors, H. W., & Snowden, L. (2011). Determinants of usual source of care disparities among African American and Caribbean black men: Findings from the National Survey of American Life. Journal of Health Care for the Poor and Underserved. 22(1): 157–175. PMCID: PMC3062470

Purpose. The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n5551) and Caribbean Black
men (n51,217). Methods. We used the 2001–2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses. Results. Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men. Conclusions. Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men.

Hastings, J. F., & Snowden, L. R. (2009). Increasing body weight and the transition from welfare to work: Findings from the National Survey of American Life. Ethnicity and Disease. 19(1): 13-17.

Objective: Few studies focus on employment outcomes for overweight and obese low income women. We describe the relationship between body mass index and employment status among African American, Caribbean Black and White women who receive assistance through the Temporary Assistance for Needy Family program. Methods: This was a secondary analysis of data from the National Survey of American Life dataset. We analyzed a sample of 1039 community-dwelling adult women who reported that they received public assistance. Results: African Americans and whites reported the highest rates of obesity, 45% and 48%, respectively. Logistic regression analyses for the entire sample revealed that being overweight or obese did not significantly predict employment status, controlling for known covariates. This aggregate effect concealed ethnic differences. African American women who were overweight (OR 1.60, P,.05) and Caribbean Black women who were obese (OR 3.41, P,.05) were more likely to be employed, but overweight White women (OR .09, P,.01) were less likely to be employed. Conclusion: Overweight was as an employment barrier only to White women. By contrast, overweight African American women and obese Caribbean Black women were more likely than were women of a normal weight to be employed.

Heeringa, S.; Wagner, J.; Torres, M.; Duan, N.H.; Adams, T.; and Berglund, P. Sample Designs and Sampling Methods for the Collaborative Psychiatric Epidemiology Studies (CPES). (2004) International Journal of Methods in Psychiatric Research, 13: 221-240.

This paper provides an overview of the probability sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES): the National Comorbidity Survey Replication (NCS-R), the National Study of American Life (NSAL) and the National Latino and Asian American Study of Mental Health (NLAAS). The multi-stage sample design and respondent selection procedures used in these three studies are based on the University of Michigan Survey Research Center's National Sample designs and operations. The paper begins with a general overview of these designs and procedures and then turns to a more detailed discussion of the adaptation of these general methods to the three specific study designs. The detailed discussions of the individual study samples focus on design characteristics and Outcomes that are important to analysts of the CPES data sets and to researchers and statisticians who are planning future studies. The paper describes how the expected Survey cost and error Structure for each of these surveys influenced the original design of the samples and how actual field experience led to changes and adaptations to arrive at the final samples of each Survey population.

Hickman, N. J., Delucchi, K. L., & Prochaska, J. J. (2010). A population-based examination of cigarette smoking and mental illness in black Americans. Nicotine & Tobacco Research. 12(11): 1125-1132.

Introduction: This study examines the relation between tobacco use and cessation with lifetime and past year mental illness in a nationally representative sample of Blacks. Methods: This cross-sectional study analyzed nationally representative data from 3,411 adult Blacks participating in the 2001–2003 National Survey of American Life. Smoking prevalence and quit rates according to lifetime and past year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders were assessed by a modified version of the Composite International Diagnostic Interview. Results: Compared with those without mental illness, respondents with a lifetime, past year, or past month mental illness had a higher smoking prevalence (20.6%, 35.6%, 36.0%, and 45.4%, respectively) and lower quit rate (40.5%, 31.2%, and 26.2%, respectively). The odds of being a current smoker among Blacks with mental illness in their lifetime, past year, and past month, after adjusting for age, gender, education, poverty, and marital status were 1.76 (95% CI = 1.39–2.22), 1.57 (95% CI = 1.22–2.03), and 2.20 (95% CI = 1.56–3.12), respectively. Mental illness also was associated with heavier smoking. Blacks with past year mental illness represented 18.1% of the sample, yet consumed 23.9% of cigarettes smoked by Black smokers. Past year (odds ratio [OR] = 0.72, 95% CI = 0.53–0.97) and past month (OR = 0.54, 95% CI = 0.29–0.98) mental illness were associated with a lower odds of quitting for at least 1 year. Conclusions: Findings indicate that mental illness is significantly associated with tobacco use in Blacks. Tobacco cessation interventions that address mental illness as a barrier to cessation are needed.

Himle, J.A., Baser, R., Taylor, R.J., Campbell, R. D., & Jackson, J.S. (2009).  Anxiety disorders among African Americans, Blacks of Caribbean Descent and Non-Hispanic Whites in the United States.  Journal of Anxiety Disorders. 23(5): 578-590.

The central aim of this study is to estimate prevalence, ages of onset, severity, and associated disability of anxiety disorders among African Americans, Caribbean Blacks, and non-Hispanic whites in the U.S. Results indicated that whites were at elevated risk for generalized anxiety disorder, panic disorder, and social anxiety compared to Caribbean Blacks and African Americans. Black respondents were more likely to meet criteria for PTSD. When African American and Caribbean Black respondents met criteria for an anxiety disorder, they experienced higher levels of overall mental illness severity and functional impairment compared to whites. White respondents were at greater risk to develop generalized anxiety, social anxiety, and panic disorders late in life. Risk of developing PTSD endured throughout the life course for blacks whereas whites rarely developed PTSD after young adulthood. These results can be used to inform targeted interventions to prevent or remediate anxiety disorders among these diverse groups.

Himle , J.A., Muroff, J.R., Taylor, R.J., Baser, R.E., Abelson, J.M., Hanna, G.L., Abelson, J.L., Jackson, J.S. (2008) Obsessive-compulsive disorder among African Americans and blacks of Caribbean descent: results from the national survey of American life. Depression and Anxiety, 0:1-13.

Background: There is limited research regarding the nature and prevalence of obsessive-compulsive disorder (OCD) among various racial and ethnic subpopulations
within the United States, including African Americans and blacks of Caribbean descent. Although heterogeneity within the black population in the United States has largely been ignored, notable differences exist between blacks of Caribbean descent and African Americans with respect to ethnicity, national heritage, and living circumstances. This is the first comprehensive examination of OCD among African Americans and blacks of Caribbean descent. Methods: Data from the National Survey of American Life, a national household probability sample of African Americans and Caribbean blacks in the United States, were used to examine rates of OCD among these groups. Results: Lifetime and 12- month OCD prevalence estimates were very similar for African Americans and Caribbean blacks. Persistence of OCD and rates of co-occurring psychiatric disorders were very high and also similar between African American and Caribbean black respondents. Both groups had high levels of overall mental illness severity and functional impairment. Use of services was low for both groups, particularly in specialty mental health settings. Use of anti-obsessional medications was also rare, especially among the Caribbean black OCD population. Conclusions: OCD among African Americans and Caribbean blacks is very persistent, often accompanied by other psychiatric disorders, and is associated with high overall
mental illness severity and functional impairment. It is also likely that very few blacks in the United States with OCD are receiving evidence-based treatment and thus considerable effort is needed to bring treatment to these groups.

Jackson, J.S. & Antonucci, T.C. (2005). Physical and mental health consequences of aging-in-place and aging-out-of-place among black Caribbean immigrants. Research in Human Development, 2(4), 229-244.

Our purpose in this article was to examine the influences of age group, timing of immigration, and race/ethnicity on self-reported health, self-esteem, and serious mental disorders among Black Caribbean immigrants to the United States. Analyses of the recently collected National Survey of American Life (Jackson et al., 2004) revealed that immigrants have better self-reported physical health and mental health than nonimmigrant ancestry group members. Age group, however, moderates and complicates this relationship. Black Caribbeans who immigrated more recently tend to have better self-reported health; older, more recent immigrants have lower self reported health than those who are older and have lived longer in the United States. Similar results were found for the prevalence rates of reported any lifetime or 12 month Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) mental disorders.

Jackson, P. B., & Cummings, J. (2011). Health disparities and the black middle class: Overview, empirical findings, and research agenda. In Pescosolido, B. A., Martin, J. K., McLeod, J. D., & Rogers, A. (Eds.), Handbook of the sociology of health, illness, and healing: A blueprint for the 21st century (pp. 383-410). New York, NY: Springer.

Health disparities may follow along a series of “…events signified by a difference in (1) environment, (2) access to, utilization of, and quality of care, (3) health status, or (4) a particular health outcome that deserves scrutiny”. This chapter focuses on three types of health disparities assessed by evaluating the gap in health status or a given health outcome. First, we describe Black–White differences across health and refer to these patterns as general health disparities. Second, we present some research demonstrating the standard SES-health gradient where those at the top of the economic hierarchy are in much better health than those at the bottom of the economic hierarchy. We focus specifically on the health of African Americans since our ultimate goal is to better understand differences within this population. Third, we emphasize a more recent disparity highlighted by some health scholars – that of a paradox among the Black middle class. These inequalities are surprising (and hence referred to as paradoxical) because the patterns are counter-intuitive to the SES-health gradient.

Jackson, J. S., Forsythe-Brown, I. , and Govia, I.O. (2007). Age Cohort, Ancestry, and Immigrant Generation Influences in Family Relations and Psychological Well-Being among Black Caribbean Family Members. Journal of Social Issues, 63(4):729-743.

Immigration is contributing to the U.S. population becoming increasingly ethnically diverse. This article examines the role of family relations and well-being among different generations of Black Caribbean immigrants. Family disruptions, such as migration, can have complex effects on the support networks and emotional well-being of family members. Data from a recently completed national study of American Blacks in the United States, however, reveal significant similarities across ancestry and immigrant status in family contact, solidarity and well-being. It is concluded that intrafamilial relations may serve to overcome barriers of geographical distance in providing comparable levels of contact, solidarity, and well-being for both U.S.-born and immigrant Black Caribbean family members of different generations. Because of the increasing numbers of immigrant elders, these sources of family support will become increasingly more important in bridging the gaps between government resources and needed assistance in an aging society.

Jackson, J. S., Neighbors, H. W., Torres, M., Martin, L.A., Williams, David R., and Baser, R. (2007). Use of Mental Health Services and Subjective Satisfaction With Treatment Among Black Caribbean Immigrants: Results From the National Survey of American Life. American Journal of Public Health, 97(1): 60-67.

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.

Jackson, J. S., Neighbors, H. W., Nesse, R. M., Trierweiler, S. J., & Torres, M. (2004).  Methodological innovations in the National Survey of American Life.   International Journal of Methods in Psychiatric Research, 13(4), 289-298.

This paper provides an overview of the conceptualization and methods used in the National Survey of American Life (NSAL).  The objectives of the NSAL are to investigate the nature, severity, and impairment of mental disorders among national samples of the black and non-Hispanic white (n=1,006) populations in the US, including African American (n=3,570), and Afro-Caribbean (n=1,623) immigrant and second and older generation, populations.  National and multi-stage probability methods were used in generating the samples and race/ethnic matching of interviewers and respondents were employed in the largely face-to-face interview, lasting on average of 2 hours and 20 minutes.  Two methodological approaches are described for addressing sampling coverage of individuals attached to, but not residing in, selected households at the time of the study.  The paper also describes two approaches used to address concerns about the interpretations of standard symptom probe information in assessing serious mental disorders.  This included a clinical reappraisal study designed to ascertain differences in symptom responding and ascertainment of cases (n=677) in a subset of the same NSAL respondents.  Finally, an abbreviated, novel method for estimating the prevalence of mental disorders in first degree family members is described and the preliminary results from this approach are reported.

Jackson, J. S., Torres, M., Caldwell, C. H., Neighbors, H. W., Nesse, R. M., Taylor, R. J., Trierweiler, S. J. & Williams, D. R. (2004).  The National Survey of American Life: A study of racial, ethnic, and cultural influences on mental disorders and mental health.  International Journal of Methods in Psychiatric Research, 13(4), 196-207.

The objectives of the National Survey of American Life (NSAL) are to investigate the nature, severity, and impairment of mental disorders among national samples of the samples of the black and non-Hispanic white (n=1,006) populations in the U.S.  Special emphasis in the study is given to the nature of race and ethnicity within the black population by selecting and interviewing national samples of African-American (n=3,570), and Afro-Caribbean (n=1,623) immigrant and second and older generation populations.  National multi-stage probability methods were used in generating the samples and race/ethnic matching of interviewers and respondents were use in the largely face-to-face interview, which lasted on average 2 hours and 20 minutes.  The Diagnostic and Statistical Manual (DSM) IV World Mental Health Composite Interview (WHO-CIDI) was used to assess a wide range of serious mental disorders, potential risk and resilience factors, and help seeking and service use patterns.  This paper provides an overview of the design of the NSAL, sample selection procedures, recruitment and training of the national interviewing team, and some of the special problems faced in interviewing ethnically and racially diverse national samples.   Unique features of sample design, including special screening and listing procedures, interviewer training and supervision, and response rate outcomes are described.

Jimenez, D. E., Alegría, M., Chen, C-N., Chan, D., & Laderman, M. (2010). Prevalence of psychiatric illnesses in older ethnic minority adults. Journal of the American Geriatrics Society. 58(2): 256-264. PMCID: PMC2854540

To compare lifetime and 12-month prevalence of psychiatric disorders in a nationally representative sample of older Latino, Asian, African-American, and Afro-Caribbean adults with that of older non-Latino white adults. DESIGN: Cross-sectional study conducted in 2001 through 2004. SETTING: Urban and rural households in the contiguous United States.
PARTICIPANTS: Two thousand three hundred seventy five community-dwelling residents aged 60 and older living in noninstitutional settings. Data are from the National Institutes of Mental Health Collaborative Psychiatric Epidemiological Studies. METHODS: The World Mental Health Composite International Diagnostic Interview assessed lifetime and 12-month psychiatric disorders. Bayesian estimates compared psychiatric disorder prevalence rates of ethnic and racial groups. RESULTS: Older non-Latino whites exhibited a greater prevalence on several lifetime diagnoses than older Asian, African-American, and Afro-Caribbean respondents. Older Latinos did not differ from older non-Latino whites on any lifetime diagnosis and had higher 12-month rates of any depressive disorder. No differences were observed in the 12-month diagnoses between older non-Latino whites and the other racial and ethnic minority groups.  Older immigrant Latinos had higher lifetime rates of dysthymia and generalized anxiety disorder (GAD) than U.S.-born Latinos. Older immigrant Asians had higher lifetime rates of GAD than U.S.-born Asians. Older immigrant Latinos had higher 12-month rates of dysthymia than older U.S.-born Latinos. CONCLUSION: Caution should be taken when generalizing the protective effects of ethnicity into old age. Older Asians and African-Americans exhibited lower prevalence rates of some psychiatric disorders, whereas older Latinos exhibited rates equal to those of older non-Latino whites. Also, the protective effect of nativity seems to vary according to age, psychiatric disorder, and ethnicity.

Joe, S., Baser, R, Breeden, G., Neighbors, H.W. & Jackson, J.S. (2006).  Prevalence of and Risk Factors for Lifetime Suicide Attempts Among Blacks in the United States.  Journal of the American Medical Association, 296:2112-2123.

Context  Lack of data on the lifetime prevalence and age at onset of suicide ideation, plans, and attempts among blacks in the United States limits the creation and evaluation of interventions to reduce suicide among black Americans. Objective  To examine the prevalence and correlates of suicide ideation, planning, and attempts across 2 ethnic classifications of blacks in a nationally representative sample. Design, Setting, and Participants  Data are from the National Survey of American Life, a national household probability sample of 5181 black respondents aged 18 years and older, conducted between February 2001 and June 2003, using a slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. Bivariate and survival analyses were used to delineate patterns and correlates of nonfatal suicidal behavior. Main Outcome Measures  Self-reports of lifetime suicide ideation, planning, and attempts. Results  Survey respondents, categorized as African Americans and Caribbean Americans, reported lifetime prevalence of 11.7% for suicide ideation and 4.1% for attempts. Among the respondents who reported ideation, 34.6% transitioned to making a plan and only 21% made an unplanned attempt. Among 4 ethnic-sex groups, the 7.5% lifetime prevalence for attempts among Caribbean black men was the highest among black Americans. The greatest risk of progressing to suicide planning or attempt among ideators occurred within the first year after ideation onset. Blacks at higher risk for suicide attempts were in younger birth cohorts, less educated, Midwest residents, and had 1 or more Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders. Conclusions  This study documents the burden of nonfatal suicidality among US blacks, notably Caribbean black men, and individuals making planned attempts. Advancing research on the transition from suicide planning to attempt is vital to the efficacy of health care professionals' ability to screen blacks at risk for suicide.

Joe, S., Baser, R., Neighbors, H.W., Caldwell, C., & Jackson, J.S. (2009) 12-Month and Lifetime Prevalence of Suicide Attempts Among Black Adolescents in the National Survey of American Life. Journal of American Academy of Child and Adolescent Psychiatry, 48(2): 272-283.

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.

Keith, V.M., Lincoln, K.D., Taylor, R.J., Jackson, J.S. (2010) Discriminatory Experiences and Depressive Symptoms among African American Women: Do Skin Tone and Mastery Matter? Sex Roles. Vol 62(1-2):48-59.

We apply structural equation modeling techniques to data from the National Survey of American Life to investigate the relationship between perceived discrimination and depressive symptoms among African American women ages 18–98 years (N=2,299). In addition, we evaluate whether or not personal mastery accounts for the intensity of African American women’s psychological response to discrimination and whether or not exposure to discrimination varies by skin complexion. Findings reveal that discrimination is a major threat to African American women’s mental health. They are vulnerable to discrimination, in part, because discrimination undermines their beliefs in mastery making them less psychologically resilient. Experiences of discrimination do not differ by complexion. We conclude that complexion does not matter, but mastery does.

Le Cook, B., Carson, N., & Alegría, M. (2010). Assessing racial/ethnic differences in the social consequences of early-onset psychiatric disorder. Journal of Health Care for the Poor and Underserved. 21(2, suppl.): 49-66.

Individuals with early onset of psychiatric disorder have worse social outcomes than individuals with adult onset. It is unknown whether this association varies by racial/ethnic group. Identifying groups at risk for poor social outcomes is important for improving clinical and policy interventions. We compared unemployment, high school dropout, arrest, and welfare participation by race/ethnicity and time of onset using a nationally representative sample of Whites, Blacks, Asians, and Latinos with lifetime psychiatric disorder. Early onset was associated with worse social outcomes than adult onset. Significant Black-White and Latino-White differences in social outcomes were identified. The association between early onset and negative social outcomes was similar across Whites, Latinos, and Blacks. For Asians, the association between unemployment and early onset was opposite that of Whites. Increasing early detection and treatment of psychiatric illness should be prioritized. Further study will clarify the association between onset and social outcomes among sub-ethnic populations.

Levin, J., Taylor, R. J., & Chatters, L. M. (2011). Prevalence and sociodemographic correlates of spiritual healer use: Findings from the National Survey of American Life. Complementary Therapies in Medicine,19(2), 63-70.

Objectives: This study investigates sociodemographic and health-related correlates of use of a spiritual healer for medical help. A large national, multiracial—multiethnic data source permits a more comprehensive investigation than was possible in previous studies. It also enables a closer focus on socioeconomic disadvantage and health need as determinants of utilization. Design and setting: Respondents are from the National Survey of American Life: Coping with Stress in the 21st Century (NSAL), a nationally representative multi-stage area-probability survey of U.S. adult African Americans, Caribbean Blacks, and non-Hispanic Whites conducted from 2001 to 2003. The sample contains 6082 adults aged 18 and over. Main outcome measures: NSAL respondents were surveyed about lifetime use of alternative providers for medical care or advice. Response categories included two types of spiritual healers:faith healers and psychics. These outcomes were logistically regressed, separately, onto 10 sociodemographic or health-related indicators: race/ethnicity, age, gender, marital status, education, household income, region, medical care use, insurance coverage, and self-rated health. Results: Lifetime utilization of a faith healer is more prevalent among respondents in good health and less prevalent among Caribbean Blacks and never married persons. Users of a psychic healer are more likely to be educated, residents of the Northeast or West, and previously married, and less likely to report excellent health. Conclusions: Use a spiritual healer is not due, on average, to poor education, marginal racial/ethnic or socioeconomic status, dire health straits, or lack of other healthcare options. To some extent, the opposite appears to be true. Use of a spiritual healer is not associated with fewer social and personal resources or limitations in health or healthcare.

Lincoln, K.D., Chae. (2010). Stress, Marital Satisfaction, and Psychological Distress Among African Americans. Journal of Family Issues. 31(8): 1081–1105.

This study examines relationships among financial strain, unfair treatment, and martial satisfaction among African Americans. Using data from the National Survey of American Life, findings indicated that social stressors that occur inside of the home (i.e., financial strain) as well as those experienced outside of the home (i.e., unfair treatment) have negative consequences for marital quality and psychological distress. Furthermore, the combination of experiencing unfair treatment and financial strain has particularly deleterious mental health consequences for married African Americans. Results also highlight the protective effect of marital satisfaction on psychological distress as well as its potential to buffer the negative effects of unfair treatment and financial strain on psychological distress. Implications for policy to improve marital quality and promote the mental health of African Americans are discussed.

Lincoln, K.D., Taylor, R.J., Bullard, K.M., Chatters, L.M., Woodward, A.T., Himle, J.A., Jackson, J.S. (2010) Emotional Support, Negative Interaction and DSM IV Lifetime Disorders among Older African Americans: Findings from the National Survey of American Life (NSAL). International Journal of Geriatric Psychiatry. PMID: 20157904.

OBJECTIVES: 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. DESIGN: The analyses utilized the National Survey of American Life. METHODS: Logistic regression and negative binomial regression analyses were used to examine the effect of emotional support and negative interaction with family members on the prevalence of lifetime DSM-IV mood and anxiety disorders. PARTICIPANTS: Data from 786 African Americans aged 55 years and older were used. MEASUREMENT: The DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to assess mental disorders. Three dependent variables were investigated: the prevalence of lifetime mood disorders, the prevalence of lifetime anxiety. RESULTS: Multivariate analysis found that emotional support was not associated with any of the three dependent variables. Negative interaction was significantly and positively associated with the odds of having a lifetime mood disorder, a lifetime anxiety disorder and the number of lifetime mood and anxiety disorders. CONCLUSIONS: This is the first study to investigate the relationships among emotional support, negative interaction with family members and psychiatric disorders among older African Americans. Negative interaction was a risk factor for mood and anxiety disorders among older African Americans, whereas emotional support was not significant.

Lincoln, K.D., Taylor, R. J., Chatters, L., Jackson, J. S. Profiles of Depressive Symptoms among African Americans and Caribbean Blacks. Social Science and Medicine, 65:200-213.

Abstract Latent profile analysis was used to summarize profiles of depressive symptoms among a nationally representative sample of US-born and Caribbean-born Blacks. Analyses are based on the responses of 4915 African Americans and Caribbean Blacks from the National Survey of American Life. A high symptoms and a low symptoms class were identified. Age, gender, negative interaction within the individual's social network (e.g., conflict, demands, criticism) and racial discrimination were associated with depressive symptoms in the low symptoms class, whereas socioeconomic status, gender, emotional support and negative interaction were associated with depressive symptoms in the high symptoms class. The findings demonstrate the heterogeneity within the Black population in the USA and the distinct sociodemographic, family network and stress correlates of depressive symptoms for each latent class.

Lincoln, K.D, Taylor, R.J., & Jackson, J.S. (2008) Romantic Relationships Among Unmarried African Americans and Caribbean Blacks: Findings From the National Survey of American Life. Family Relations, 57 (2): 254-266 .

This study investigated the correlates of relationship satisfaction, marriage expectations, and relationship longevity among unmarried African American and Black Caribbean (Caribbean Black) adults who are in a romantic relationship. The study used data from the National Survey of American Life, a national representative sample of African Americans and Caribbean Blacks in the United States. The findings indicated that the correlates of relationship satisfaction, expectations of marriage, and relationship longevity were different for African Americans and Black Caribbeans. For Black Caribbeans, indicators of socioeconomic status were particularly important correlates of relationship satisfaction. For African Americans, indicators of parental status were important for relationship longevity. Policy and practice implications for nonmarital unions are discussed.

Lo, C. C. & Cheng, T. C. (2011). Racial/ethnic differences in access to substance abuse treatment. Journal of Health Care for the Poor and Underserved, 22(2), 621-637.

A secondary dataset, Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003, was employed to examine racial/ethnic differences in access to specialty and non-specialty substance abuse treatment (compared with no access to treatment). The study found that non-Hispanic White Americans were (1) likelier than members of all racial/ethnic minority groups (other than Hispanics) to address substance abuse by accessing care through specialty addiction-treatment facilities, and were (2) also less likely to access substance abuse care through non-specialty facilities. Because non-specialty facilities may have
staffs whose professional training does not target treating chronic, bio-psycho-social illness such as substance abuse, our results imply that treatment facilities deemed non-specialty may need to enhance staff training, in order to ensure individuals are properly screened for substance use conditions and are referred for or provided with effective counseling and medications as appropriate.

Mackenzie, C. S., Pagura, J., & Sareen, J. (2010). Correlates of perceived need for and use of mental health services by older adults in the Collaborative Psychiatric Epidemiology Surveys. American Journal of Geriatric Psychiatry. 18(12): 1103-1115.

Objectives: Older adults are especially unlikely to seek mental health services, but little is known about whether their perceptions of need for help contribute to this problem. The objectives of this study were to compare perceived need across the lifespan and to examine sociodemographic and mental health correlates of whether older adults sought professional help, perceived the need for help without seeking it, and sought help from specialty mental health professionals. Methods: The authors examined help-seeking and perceived need with the Collaborative Psychiatric Epidemiology Surveys, focusing on 3,017 adults aged 55 years and older. Logistic regressions predicted help-seeking and perceived need from sociodemographic factors, past-year psychiatric disorders, and past-year suicidal behaviors. Individuals who perceived the need for help without receiving it also reported barriers to help-seeking. Results: Levels of perceived need were highest among 25-44 year olds and lowest among adults aged 65 years and older. Among older adults with psychiatric disorders, 47.1% did not perceive a need for professional help. Diagnoses and suicidal behaviors were strong predictors of whether individuals perceived need, whereas among those who perceived the need for help, only older age was positively associated with help-seeking. Few factors clearly distinguished those who did and did not seek help from specialty mental health professionals with the exception of having three or more psychiatric diagnoses. Finally, the most common barrier to help-seeking was a desire to handle problems on one’s own. Conclusions: A lack of perceived need for mental health services and self-sufficiency beliefs are significant barriers to older adults’ use of mental health services.

Nazroo, J., Jackson, J. S., Karlsen, S. & Torres, M. (2007). The Black Diaspora and Health Inequalities in the US and England: Does Where you go and how you get There Make a Difference? Sociology of Health and Illness, doi: 10.1111/j.1467-9566.2007.01043.x.

The relatively poor health of Black American people in the US and Black Caribbean people in England is a consistent finding in the health inequalities literature. Indeed, there are many similarities between the health, social, economic and demographic profiles of these two groups. However, there is evidence that Caribbean people in the US are faring considerably better. This paper explores differences in the social and economic position of Black American, Black Caribbean and white people in the US and Black Caribbean and white people in England, how these relate to ethnic inequalities in health, and may be underpinned by differences in patterns and contexts of migration. We use similar surveys from the US and England to explore these questions. The US data were drawn from the National Survey of American Life and the English data were drawn from the Health Survey for England and a follow up study. Findings show the advantaged health position of Caribbean American people in comparison with both Caribbean people in England and Black American people. Multivariate analyses indicate that these differences, and the differences in health between Black and white people in the two countries, are a consequence of social and economic inequalities.

Neighbors, Harold W. ; Caldwell, Cleopatra; Williams, David R.; Nesse, Randolph; Taylor, Robert Joseph; Bullard, Kai McKeever; Torres, Myriam; Jackson, James S. (2007).  Race, Ethnicity, and the Use of Services for Mental Disorders: Results From the National Survey of American Life.  Arch Gen Psychiatry, 64:485-494.

Context  Little is known about differences in the unmet need for mental health service use between African Americans and Caribbean blacks. Objective  To extend the National Survey of Black Americans by examining 12-month mental health service use for African Americans and Caribbean blacks from the recently completed National Survey of American Life. Design and Setting  National household probability samples of noninstitutionalized African Americans and Caribbean blacks (blacks from Caribbean area countries now living in the United States) conducted between February 2001 and June 2003, using a slightly modified World Mental Health version of the World Health Organization's Composite International Diagnostic Interview. Participants  A total of 3570 African Americans and 1621 Caribbean blacks 18 years and older (N = 5191). Main Outcome Measures  Proportion of respondents with 12-month DSM-IV disorders who sought help in the specialty mental health, general medical, human service, and complementary-alternative medicine treatment sectors. The percentage receiving minimally adequate treatment was also assessed. Results  Overall, 10.1% of respondents used some form of mental heath care services in the past year. Use of services was much higher among those who met criteria for a 12-month DSM-IV disorder (31.9%) than among those who did not (5.4%). Forty-nine percent of respondents with serious mental illness used services, whereas 39.3% had contact with mental health care specialists. The youngest and oldest age groups were least likely to obtain any services. Among African Americans, women were more likely than men to use general medical care and services from any sector. Respondents with the most years of education showed the highest use of services. Conclusions  The underuse of mental health services among black Americans remains a serious concern. Educational interventions that focus on both consumers and mental health care professionals are needed.

Neighbors, H. W., Njai, R. & Jackson, J. S. (2007). Race, Ethnicity, John Henryism, and Depressive Symptoms: The National Survey of American Life Adult Re-Interview. Research in Human Development, 4(1-2):71-89.

We used data from the adult reinterview portion of the National Survey of American Life (Jackson, Torres, et al., 2004) to investigate the relationships of John Henryism
Active Coping Scale (James, Hartnett, & Kalsbeek, 1983), Social Dominance, and Stratification Beliefs to depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (Radloff, 1977). Social Dominance and Stratification Beliefs were identified from a factor analysis. The results indicate significant interaction effects for John Henryism and American Values for White Americans and Caribbean Blacks but not for African Americans. We found a strong positive effect between John Henryism and depressive symptoms for Whites with high levels of Stratification Beliefs. For Whites with low Stratification Beliefs, depressive symptoms remained constant as John Henryism increased. Among Caribbean Blacks, John Henryism showed a significant interaction with Social Dominance. Among Caribbean Blacks, there was a linear positive relationship between John Henryism and depressive symptoms for all levels of Social Dominance except for those with the highest endorsement for which there was no linear relationship. We discuss the findings within the context of psychosocial risk and protective factors and the need for more research on cultural processes, acculturation, and mental health.

Neighbors, H.W.,  Woodward, A.T., Bullard, K.M., Ford, B.C., Taylor, R.J., Jackson, J.S. (2008) Mental Health Service Use Among Older African Americans.  American Journal of Geriatric Psychiatry. 16(12): 948-956.

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.

Pagoto, S. L., Curtin, C., Lemon, S. C., Bandini, L. G., Schneider, K. L., Bodenlos, J. S., & Ma, Y. (2009). Association between adult attention deficit/ hyperactivity disorder and obesity in the US population. Obesity. 17(3): 539-544.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects ~2.9–4.7% of US adults. Studies have revealed high rates of ADHD (26–61%) in patients seeking weight loss treatment suggesting an association between ADHD and obesity. The objective of the present study was to test the association between ADHD and overweight and obesity in the US population. Cross-sectional data from the Collaborative Psychiatric Epidemiology Surveys were used. Participants were 6,735 US residents (63.9% white; 51.6% female) aged 18–44 years. A retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD were administered. Diagnosis was defined by three categories: never met diagnostic criteria, met full childhood criteria with no current symptoms, and met full childhood criteria with current symptoms. The prevalence of overweight and obesity was 33.9 and 29.4%, respectively, among adults with ADHD, and 28.8 and 21.6%, respectively, among persons with no history of ADHD. Adult ADHD was associated with greater likelihood of overweight, (odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.05, 2.38) and obesity (OR = 1.81; 95% CI = 1.14, 2.64). Results were similar when adjusting for demographic characteristics and depression. Mediation analyses suggest that binge eating disorder (BED), but not depression, partially mediates the associations between ADHD and both overweight and obesity. Results suggest that adult ADHD is associated with overweight and obesity.

Pennell, B.; Bowers, A.; Carr, D.; Chardoul, S.; Cheun, G.; Dinkelmann, K.; Gebler, N.; Hansen, S. E.; Pennell, S.; Torres, M. (2004). The development and implementation of the NCSR, the NSAL and the NLASS. International Journal of Methods in Psychiatric Research, 13:241-269. 

This paper provides an overview of the development and implementation of the Collaborative Psychiatric Epidemiology Surveys (CPES): the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL), and the National Latino and Asian American Study (NLAAS). The paper describes the instrument development and testing phases, the development of training and other project materials, interviewer recruitment and training activities, and data collection procedures and outcomes. The last section offers recommendations for other researchers who undertake similar studies and who might benefit from the experiences learned in the development and operation of NCS-R, NSAL, and NLAAS.

Perron, B.E., Alexander-Eitzman, B., Watkins, D., Taylor, R.J., Baser, R., Neighbors, H.W., Jackson, J.S. (2009). Ethnic Differences in delays to treatment for substance use disorders: African Americans, Black Caribbeans, Non-Hispanic Whites. Journal of Psychoactive Drugs. 41(4):369-377.

Prior research has shown that minority groups experience greater levels of disability associated with psychiatric and substance use conditions due to barriers to treatment. Treatment delays are an important part of the overall problem of service utilization and access to treatment, yet little work has been done to understand the factors associated with treatment delays among ethnic minorities. This study compares African Americans, Caribbean Blacks and non-Hispanic Whites regarding their probability of making treatment contacts over time, using a combined sample of African Americans and Caribbean Blacks from the National Survey of American Life (NSAL) and non-Hispanic Whites from the National Comorbidity Survey-Replication (NCS-R). Alcohol and other drug use disorders (abuse and dependence) were assessed using the World Mental Health Composite International Diagnostic Interview. Cumulative lifetime probability curves were used to examine race differences in treatment contact. Cox regression analysis was used to test the association between race and treatment groups while controlling for other potential confounding variables. Significant delays in making treatment contact were observed across all disorders. However, no evidence of delays was found for racial differences. In the multivariate analysis, race was not significantly associated with delays. However, comorbid anxiety disorders were found to be a consistent factor associated with a faster time to treatment.

Pilver, C. E., Kasl, S., Desai, R., & Levy, B. R. (2011). Exposure to American culture is associated with premenstrual dysphoric disorder among ethnic minority women. Journal of Affective Disorders. 130(1-2): 334-341.

Background: Ethnic minorities in America will achieve majority by 2042, and due to their younger age distribution, will represent the largest proportion of women at risk for premenstrual dysphoric disorder (PMDD). Research has not addressed ethnic minority women's vulnerabilities to PMDD. The objective of this study was to examine the relationship
between acculturation and PMDD. Methods: An analysis of acculturation and PMDD among 3856 English-speaking, premenopausal Asian, Latina, and Black women from the National Latino and Asian American Survey and the National Survey of American Life was performed. Results: The lifetime prevalence of PMDD was 3.3%. Nativity status, duration of residence, and age at immigration were significantly associated with PMDD. Foreign-born women (OR=0.38; 95% confidence interval (CI)=0.21–0.68) and immigrants arriving to the US after age six (OR=0.33, 95% CI=0.18, 0.62) were less likely to have PMDD, compared to US-born women, and US-born women/immigrants who arrived before age six, respectively. The likelihood of PMDD increased as the duration of residence in the US lengthened. Limitations: The diagnosis of PMDD was provisional due to retrospective symptom reporting. Statements of causality could not be made because the study was cross-sectional. Conclusions: A substantial percentage of ethnic minority women suffer from PMDD in their lifetimes. Exposure to American culture appeared to elevate ethnic minority women's likelihood for PMDD. The stressors that are associated with ethnic minority life in America— discrimination, poverty, pressures to assimilate, etc.—may contribute to ethnic minority women's vulnerability to PMDD, and clinicians should be sensitive to the special risks in this population.

Rodebaugh, T. L. (2009). Social phobia and perceived friendship quality. Journal of Anxiety Disorders. 23(7): 872-878.

Although it is clear that people with social phobia have interpersonal impairment, evidence that social phobia (as opposed to other mental disorders) affects friendship in particular is lacking. Two large epidemiological datasets were used to test whether diagnosis of social phobia is related to perceived friendship quality above and beyond perceived family relationship quality, diagnosis of other mental disorders, and a variety of demographic variables. After Bonferroni correction, social phobia was the only diagnosis related to perceived friendship quality above and beyond other factors, such that people with social phobia reported more impaired friendship quality. Social phobia’s effect was similar in magnitude to demographic characteristics in both samples. The current study demonstrates that social phobia is specifically related to perceived friendship quality, suggesting that this aspect of social phobia’s effects is worthy of further study.

Rosen-Reynoso, M., Alegría, M., Chen, C-N., Laderman, M., & Roberts, R. (2011). The relationship between obesity and psychiatric disorders across ethnic and racial minority groups in the United States. Eating Behaviors. 12(1): 1-8.

Context: Epidemiologic studies of obesity have not examined the prevalence and relationship of mental health conditions with obesity for diverse ethnic and racial populations in the United States. Objective: (1) To assess whether obesity was associated with diverse psychiatric diagnoses across a representative sample of non-Latino whites, Latinos, Asians, African-Americans, and Afro-Caribbeans; and (2) to test whether physical health status, smoking,  sociodemographic characteristics, and psychiatric comorbidities mediate any of the observed associations. Design: Our analyses used pooled data from the NIMH Collaborative Psychiatric Epidemiology Surveys (CPES). Analyses tested the association between obesity and psychiatric disorders in a diverse sample of Americans (N=13,837), while adjusting for factors such as other disorders, age, gender, socioeconomic status, smoking and physical health status (as measured by chronic conditions and WHO-DAS scores) in different models. Results: The relationship between obesity and last-year psychiatric disorders varied by ethnicity/race. The likelihood of having mood or anxiety disorder was positively associated with obesity for certain racial/ethnic groups, but was moderated by differences in physical health status. Substance-use disorders were associated with decreased odds for obesity in African-Americans. Conclusions: The role of physical health status (as measured by chronic conditions and WHO-DAS scores) dramatically changes the pattern of associations between obesity and psychiatric disorders, suggesting the important role it plays in explaining differential patterns of association across racial and ethnic groups.

Scott, T., Matsuyama, R., & Mezuk, B. (2011). The relationship between treatment settings and diagnostic attributions of depression among African Americans. General Hospital Psychiatry. 33(1): 66-74.

Objective: To explore the relationship between treatment setting characteristics and diagnostic attributions of depression among community dwelling African Americans. Methods: Data come from the National Survey of American Life, a nationally representative sample of African Americans and Caribbean Blacks. Major Depression (MD) was assessed using the Composite International Diagnostic Inventory. Participants were categorized into four diagnostic groups: never MD, MD never attributed to physical health problems (i.e., affective depression), MD sometimes attributed to physical health problems (i.e., complicated depression), and MD always attributed to physical health problems (i.e., physical depression). Multinomial regression was used for assessment. Results: Among 441 participants, 66.4% were classified as affective depression, 17.8% as complicated depression and 15.8% as physical depression. Seeking treatment from a mental health professional was associated with increased likelihood of being in the complicated depression group [adjusted odds ratio (AOR): 5.52; 95% confidence interval (CI): 2.28–13.36]. Seeking treatment from a family doctor was associated with physical depression (AOR: 2.93; 95% CI: 1.18–7.26). Seeking care from three or more different health care providers was associated with complicated depression (AOR: 1.99; 95% CI: 1.17–3.40). Conclusion: Results suggest that encounters with health care providers influence the diagnostic attribution of depression in a systematic manner.

Seaton, E.K., Caldwell, C.H., Sellers, R.M., & Jackson, J.S. (2010). Developmental characteristics of African American and Caribbean Black adolescents’ attributions regarding discrimination. Journal of Research on Adolescents. 1-15.

The present study examined discrimination attributions in the psychological well-being of Black adolescents. Findings are based on a representative sample of 810 African American and 360 Caribbean Black youth, aged 13–17, who participated in the National Survey of American Life. Youth completed measures of perceived discrimination, discrimination attributions, depressive symptoms, self-esteem, and life satisfaction. Approximately half the youth attributed discrimination to race/ethnicity (43%), followed by age (17%), physical appearance (16.5%), and gender (7.5%), and there were no ethnic, gender, or age differences regarding discrimination attributions. Key findings suggest that the association between perceived discrimination and psychological well-being did not vary according to discrimination attribution, which implies that discrimination is harmful for Black youth regardless of the attribution.

Snowden, L. R., Hastings, J. F., & Alvidrez, J. (2009). Overrepresentation of black Americans in psychiatric inpatient care. Psychiatric Services. 60(6): 779-785.

Objective: Numerous studies have documented overrepresentation of the black population in psychiatric inpatient settings, but none have included certain important covariates or examined heterogeneity within the black population. After controlling for key social, demographic, and clinical factors, the investigators sought to determine whether blacks are overrepresented in inpatient psychiatric settings; they examined differences within the black population by separately examining the prevalence of inpatient treatment of African Americans and U.S.- and foreign-born Caribbean blacks. Methods: Secondary analysis was performed on data from two population-based household surveys, the National Survey of American Life (NSAL) and the National Comorbidity Survey Replication (NCS-R), which provided a population-based sample of 9,371 community-dwelling adults, including 3,570 African Americans, 1,621 blacks of Caribbean descent, and 4,180 non-Hispanic whites. Using logistic regression, the investigators estimated self-reported lifetime psychiatric hospitalization as a function of racial-ethnic background after controlling for sociodemographic differences and differences in lifetime counseling or therapy and psychiatric diagnosis. Results: With controls for demographic and clinical factors, both African Americans (odds ratio [OR]=2.52, 95% confidence interval [CI]=1.91–3.33) and Caribbean blacks (OR=2.74, CI=1.98–3.82) had higher odds than whites of having a psychiatric hospitalization in their lifetime. U.S.-born Caribbean blacks had much higher odds of hospitalization (OR=5.47, CI=3.60–8.32) than whites, whereas the likelihood of hospitalization of foreign-born Caribbean blacks did not differ from that of whites (OR=.96, CI=.51–1.82). Conclusions: Disparities between blacks and whites in the prevalence of psychiatric inpatient treatment appear to be persistent, but global comparisons mask important heterogeneity within the black population.

Soto, J. A., Dawson-Andoh, N. A., & BeLue, R. (2011). The relationship between perceived discrimination and generalized anxiety disorder among African Americans, Afro Caribbeans, and non-Hispanic whites. Journal of Anxiety Disorders. 25(2): 258-265.

The present study examined the relationship between frequency of race based and non-race based discrimination experiences and Generalized Anxiety Disorder (GAD) in a sample of 3570 African Americans, 1438 Afro Caribbeans, and 891 non-Hispanic Whites from the National Survey of American Life (NSAL). Because GAD and the experience of racial discrimination are both associated with symptoms of worry and tension, we expected race based discrimination to predict GAD prevalence for African Americans, but not other groups. We did not expect non-race based discrimination to predict GAD. Results showed that while more frequent experiences of non-race based discrimination predicted GAD for all groups, experiencing race based discrimination was associated with significantly higher odds of endorsing lifetime GAD for African Americans only. Results are interpreted in light of the different contexts that these three ethnic groups represent relative to their history within the United States as well as their present day circumstances.

Taylor, J., Caldwell, C. H., Baser, R. E., Faison, N., & Jackson, J. S. (2007). Prevalence of eating disorders among Blacks in the NSAL. International Journal of Eating Disorders , 40 , S10–S14.

Objective: To provide information on the characteristics of eating disorders based on nationally representative samples of African American and Caribbean Black adults and adolescents. Method: Conducted between 2001 and 2003 the National Survey of American Life (NSAL) interviewed adults ( n 5 5,191) and adolescents ( n 5 1,170) in their homes. Professionally trained interviewers used the WMH Composite International Diagnostic Interview (WMH-CIDIWHO Organization 2004-modified) to assess DSM-IV TR eating disorders. Results: Anorexia was the rarest eating disorder among African American adults and adolescents, with age of onset for adults in mid adolescence. No 12-month case of anorexia was found among Caribbean Black adults. Binge eating was the most prevalent eating disorder among adults and adolescents. Persistence of disorders was lowest for anorexia and highest for binge eating disorder among adults. Conclusion: Prevalence of eating disorders within the U.S. Black population varies by type of disorder, age cohort, gender, and ethnic group among adults, and by type of disorder among adolescents. Clinicians need preparation and training to recognize and treat eating disorders in ethnically-diverse patient populations. VV C 2007 by Wiley Periodicals, Inc. Keywords: eating disorders; Blacks; prevalence; age of onset; gender differences.

Taylor, R.J., Chatters, L.M., Bullard, K.M., Wallace, J.M., Jr., Jackson, J.S. (2009) Organizational Religious Behavior among Older African Americans: Findings from the NSAL. Research on Aging. Mar 2009; vol. 0: pp. 0164027509333453v1.

The authors used data from the older African American subsample of the National Survey of American Life (n = 837) to examine the sociodemographic and denominational correlates of organizational religious involvement among older African Americans. Six measures of organizational religious participation were used, including two measures of time allocation for organized religious pursuits. Significant gender, regional, marital status, and denominational differences in organizational religiosity were found. Of particular note, although older Black women generally displayed higher levels of religious participation, older Black men spent more hours per week in other activities at their places of worship. The findings are discussed in relation to prior work in the area of religious involvement among older adults. New directions for research on religious time allocation are outlined.

Taylor, R. J.; Chatters, L.; Jackson, J. S. Religious and Spiritual Involvement among Older African Americans, Caribbean Blacks, and Whites. Journal of Gerontology: Social Sciences, 62B: S238-S250.

The purpose of this study was to examine similarities and differences in religious involvement among three groups of older adults—African Americans, Caribbean Blacks and non-Hispanic Whites. Data are taken from the National Survey of American Life, a nationally representative household study of African Americans and Caribbean Blacks with a national sample of non-Hispanic Whites who reside in areas (census tracks and block groups) at least 10% African American. Demographic correlates of 16 measures of organizational, nonorganizational, subjective religiosity, as well as religious coping and spirituality were examined. The findings indicate that older African Americans and Caribbean Blacks report higher levels of religious participation, religious coping and spirituality than older Whites. Few significant differences between older African Americans and older Caribbean Blacks were observed. Gender, age, marital status, income, education, marital status and region all exhibited significant influences on religious participation and spirituality. Racial groups within the older population present distinctive profiles of religious participation and spirituality. The demographic correlates of religious involvement and spirituality were consistent across a variety of diverse dimensions and measures.

Taylor, R. J.; Chatters, L.; Jackson, J. S. Religious Participation Among Older Black Caribbeans in the United States. Journal of Gerontology: Social Sciences, 62B.

Objectives. The purpose of this study was to examine the correlates of religious participation among older Black Caribbeans. Methods. Data from the older Black Caribbean subsample of the National Survey of American Life were used to examine selected measures of organizational, nonorganizational, and subjective religious participation. Results. The findings indicated important demographic differences in the correlates of religious participation among older Black Caribbeans. In particular, gender, marital status, income, immigration status, and denomination were associated with religious participation. Discussion. We discuss study findings in relation to available ethnographic data on Black Caribbeans and prior survey research on religious participation among older African Americans. Although there were several similarities to the research on older African Americans and religious involvement (e.g., marital status, gender, denomination), noted departures from prior research findings (e.g., income effects) may indicate the influence of ethnic group membership and the importance of the immigration experience in shaping distinctive life experiences for older Black Caribbeans.

Williams, D.R.; Gonzalez, H.M.; Neighbors, H.W.; Nesse, R.; Abelson, J.M.;Sweetman, J.; Jackson, J.S. (2007). Prevalence and Distribution of Major Depressive Disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites: Results From the National Survey of American Life. Archives of General Psychiatry, 64:305-315.

Context: Little is known about the relationship between race/ethnicity and depression among US blacks. Objective: To estimate the prevalence, persistence, treatment, and disability of depression in African Americans, Caribbean blacks, and non-Hispanic whites in the National Survey of American Life. Design: A slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. Setting: National household probability samples of non- institutionalized African Americans, Caribbean blacks, and non-Hispanic whites in the United States conducted between February 2, 2001, and June 30, 2003. Participants: A total of 3570 African Americans, 1621 Caribbean blacks, and 891 non-Hispanic whites aged 18 years and older (N=6082). Main Outcome Measures: Lifetime and 12-month diagnoses of DSM-IV major depressive disorder (MDD), 12-month mental health services use, and MDD disability as quantified using the Sheehan Disability Scale and the World Health Organization’s Disability Assessment Schedule II. Results: Lifetime MDD prevalence estimates were highest for whites (17.9%), followed by Caribbean blacks (12.9%) and African Americans (10.4%); however, 12month MDD estimates across groups were similar. The chronicity of MDD was higher for both black groups (56.5% for African Americans and 56.0% for Caribbean blacks) than for whites (38.6%). Fewer than half of the African Americans (45.0%) and fewer than a quarter (24.3%) of the Caribbean blacks who met the criteria received any form of MDD therapy. In addition, relative to whites, both black groups were more likely to rate their MDD as severe or very severe and more disabling. Conclusions: When MDD affects African Americans and Caribbean blacks, it is usually untreated and is more severe and disabling compared with that in non-Hispanic whites. The burden of mental disorders, especially depressive disorders, may be higher among US blacks than in US whites.

Williams, D.R., Haile, R, Gonzalez, H.M., Neighbors, H.W., Baser, R. (2007) The Mental Health of Black Caribbean Immigrants: Results from the National Survey of American Life. American Journal of Public Health, 97(1): 52-59.

Objectives. We examined the prevalence of psychiatric disorders among Black Caribbean immigrant (“Caribbean Black”) and African American populations and the correlates of psychiatric disorders among the Caribbean Black population. Methods. We conducted descriptive and age-adjusted analyses of the data from the National Survey of American Life—an in-person household mental health survey of noninstitutionalized US Blacks. We assessed psychiatric disorders as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria with the Composite International Diagnostic Interview. Results. Compared with African American men, Caribbean Black men had higher risks for 12-month rates of psychiatric disorders. Caribbean Black women had lower odds for 12-month and lifetime psychiatric disorders compared with African American women. Risks varied by ethnicity, immigration history, and generation status within the Caribbean sample. First-generation Caribbean Blacks had lower rates of psychiatric disorders compared with second- or third-generation Caribbean Blacks, and, compared with first-generation Carribbean Blacks, third-generation Caribbean Blacks had markedly elevated rates of psychiatric disorders. Conclusions. Mental health risks were associated with ethnic diversity within the US Black population. Increased exposure to minority status in the United States was associated with higher risks for psychiatric disorders among Black Caribbean immigrants, which possibly reflects increased societal stress and downward social mobility associated with being Black in America.

Woodward, A.T., Bullard, K.M., Taylor, R.J., Chatters, L.M., Baser, R.E., Perron, B.E., Jackson, J.S. (2009) Complementary and Alternative Medicine for Mental Disorders Among African Americans, Black Caribbeans, and Whites. Psychiatric Services, 60: 1342-1349.

Objectives: This study examined racial and ethnic differences in the use of complementary and alternative medicine (CAM) for the treatment of mental and substance use disorders. Methods: Data were from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R). The analytic sample included 631 African Americans and 245 black Caribbeans from the NSAL and 1,393 non-Hispanic whites from the NCS-R who met criteria for a mood, anxiety, or substance use disorder in the past 12 months. Logistic regression was used to examine racial and ethnic differences in the use of any CAM and in the use of CAM only versus the use of CAM plus services in another
treatment sector. Results: Thirty-four percent of respondents used some form of CAM. Whites were more likely than blacks to use any CAM, although there was no racial or ethnic difference in CAM use only versus CAM use plus traditional services. A higher proportion of blacks than whites used prayer and other spiritual practices. Among those with a
mood disorder, black Caribbeans were less likely than African Americans to use any CAM. Conclusions: Findings of this study were similar to those of previous studies that examined physical illness in relation to CAM use in terms of its overall prevalence, the predominant use of CAM in conjunction with traditional service providers, and racial and
ethnic differences in the use of CAM. The use of prayer was a major factor in differences between blacks and whites in CAM use; however, there were also differences among black Americans that warrant further research.

Woodward, A. T., Chatters, L. M., Taylor, R. J., Neighbors, H. W., & Jackson, J. S. (2010). Differences in professional and informal help seeking among older African Americans, black Caribbeans, and non-Hispanic whites.  Journal of the Society for Social Work and Research. 1(3): 124-139.

This study uses a national probability sample of older adults to examine racial and ethnic differences in the use of professional services and informal support for a stressful personal problem. Using data from the National Survey of American Life, this study focuses on African Americans, Black Caribbeans, and Whites 55 years and older who experienced a personal problem that caused them significant distress (N=862). Multinomial logistic regression is used to estimate the association of race with the use of professional services only, informal support only, both professional services and informal support, or no help at all, while controlling for demographic and socioeconomic variables, characteristics of the informal support network, the type of problem experienced, and experiences of racial discrimination. Examining the use of professional services and informal support provides a more complete picture of racial and ethnic differences of help-seeking behaviors among older adults, and the factors associated with the sources from which these adults request help. Most respondents use informal support alone or in combination with professional services. Black Caribbeans are more likely than African Americans to rely on informal support only, whereas African Americans are more likely than Whites to not receive any help. However, these findings are accounted for by differences in social support and experiences of discrimination.

Woodward, A.T., Taylor, R.J., Bullard, K.M., Neighbors, H.W., Chatters, L.M., Jackson, J.S. (2008) Use of Professional and Informal Support by African Americans and Caribbean Blacks with Mental Disorders. Psychiatric Services. 59(11):1292-1298.

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 ocioeconomic 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.