2016

Assari, S., & Dejman, M. (2016). Heterogeneity of the link between depression and self-esteem based on race. Caspian Journal of Neurological Sciences, 2(5), 7-21.

Background: Although the association between major depressive disorder (MDD) and low self-esteem is well established, we do not know if race and ethnicity modify the magnitude of this link. Objectives: Using a nationally representative sample of adults in the United States, we explored whether or not race alters the association between MDD and self-esteem. Materials and Methods: Data came from the National Survey of American Life (NSAL), a nationally representative household survey with 3,570 African Americans (Blacks) and 891 Non-Hispanic Whites. Low self-esteem (Rosenberg Self-Esteem Scale) was the dependent variable, MDD (Composite International Diagnostic Interview) was the independent variables, gender, age and educational level were controls, and race was the focal moderator. Logistic regressions were used for data analysis. Results: In the pooled sample, MDD and low self-esteem showed reciprocal associations, above and beyond all covariates. Our model showed significant interaction between race and MDD, suggesting a stronger association between MDD and self-esteem among Blacks compared to Whites. We could find such interactions among men but not women. Conclusion: Depression and low self-esteem are more strongly linked among Blacks than Whites, particularly among men. It is not clear whether depression leaves a larger scar on self-esteem for Blacks or that Blacks are more vulnerable to the effect of low self-esteem on depression.

Adams, G. C., Balbuena, L., Meng, X. F., & Asmundson G. J. G. (2016). When social anxiety and depression go together: A population study of comorbidity and associated consequences. Journal of Affective Disorders, 206, 48-54.

Background:  Despite several studies suggesting higher depression severity and dysfunction occurring in individuals with major depressive disorder (MDD) comorbid with social anxiety disorder (SAD), a clear understanding of the specific risks associated with this comorbidity is lacking. In this study we compared the disease characteristics and level of disability of individuals with MDD-SAD with other comorbidities between depression and anxiety. Methods: Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N=20,013) were used. Individuals were divided in four groups comparing MDD-SAD with MDD alone, as well as other comorbidities between MDD and one anxiety (MDD-1ANX) or more than two anxiety disorders (MDD≥2ANX), with respect to several clinical, demographic, and functional characteristics. Results:  MDD-SAD comorbidity in the general population occurred in younger people, particularly men, and seemed to have an earlier onset of MDD. Occupational and social dysfunction was similar between individuals with MDD-SAD and those with MDD-1ANX. However, individuals with MDD≥2ANX had significantly higher severity as measured by suicidality as well as substance abuse and social and occupational dysfunction. SAD was the most prevalent comorbid anxiety in this group. Limitations: The findings of this study were derived from the cross-sectional data. Conclusion: Our results suggest that the particular risks associated with MDD-SAD are the early onset and likelihood of additional anxiety, leading to higher severity and disability levels. Clinicians should increase the screening and treatment of SAD and other anxiety disorders in individuals with MDD given the higher associated health risk and functional impairment.

Anderson, R. E., Geier, T. J., & Cahill, S. P. (2016). Epidemiological associations between posttraumatic stress disorder and incarceration in the National Survey of American Life. Criminal Behaviour and Mental Health, 26(2), 110-123.

Background: In spite of an elevated prevalence of trauma histories among prisoners, there has been little research examining the relationship between incarceration and posttraumatic stress disorder (PTSD); this is especially true for Black Americans. Aims: To examine relationships between PTSD and incarceration in a nationally representative sample of Black Americans. Methods: We conducted analysis of data from the National Survey of American Life sample of 5008 Black American adults in the USA. Multivariate logistic regression analyses controlling for demographic factors including age, gender, home region and education were conducted to examine whether incarceration status was independently associated with PTSD. Results: Incarceration was significantly associated with trauma exposure, PTSD in the 12 months prior to interview and lifetime PTSD, even while controlling for demographic covariates. Conclusions and implications for practice: Incarceration, trauma exposure and PTSD share a significant number of risk factors and co-vary frequently in some populations, including the one of Black Americans investigated in this study. Interventions that can reduce shared risk factors for incarceration and PTSD and/or facilitate successful treatment of the established condition have the potential to make a large positive impact among incarcerated and formerly incarcerated people.

Assari, S., & Moazen Zadeh, E. (2016). Ethnic variation in the cross-sectional association between domains of depressive symptoms and clinical depression. Frontiers in Psychiatry, 7, 53.

Background: The degree by which depressive symptoms and clinical depression reflect each other may vary across populations. The present study compared Blacks and Whites for the magnitude of the cross-sectional associations between various domains of depressive symptoms and endorsement of clinical disorders of depression. Methods: Data came from the National Survey of American Life (NSAL), 2001–2003. We included 3,570 Black (African Americans), and 891 Non-Hispanic Whites. Predictors were positive affect, negative affect, and interpersonal problems measured using the 12-item Center for Epidemiologic Studies Depression Scale (CES-D). Outcomes were lifetime MDD, lifetime MDE, 12 month MDE, 30 days MDE, and 30 days MDDH based on the Composite International Diagnostic Interview (CIDI). Logistic regression models were applied in the pooled sample, as well as Blacks and Whites. Results: Regarding CES-D, Blacks had lower total scores, positive affect, negative affect, and interpersonal problems compared to Whites (p < 0.05 for all comparisons). Blacks also had lower odds of meeting criteria for lifetime MDD and MDE, 12 month MDE, and 30 days MDE and MDDH (p < 0.05 for all comparisons). For most depressive diagnoses, ethnicity showed a positive and significant interaction with the negative affect and interpersonal domains, suggesting stronger associations for Blacks compared to Whites. CES-D total and CES-D positive affect did not interact with ethnicity on CIDI based diagnoses. Conclusion: Stronger associations between multiple domains of depressive symptoms and clinical MDD may be due to higher severity of depression among Blacks, when they endorse the disorder. This finding may explain some of previously observed ethnic differences in social, psychological, and medical correlates of depressive symptoms and clinical depression in the general population as well as clinical settings.

DeVylder, J. E., & Kelleher, I. (2016). Clinical significance of psychotic experiences in the context of sleep disturbance or substance use. Psychological Medicine, 46(8), 1761-1767.

Background: Psychotic experiences (PE) are commonly reported in the general population, where they are associated with elevated clinical need and functional impairment. Research studies typically exclude PE that occur in the context of sleep or substance use (PE-SS), based on the assumption that they are normative within these contexts. This is the first study to formally test clinical and functional outcomes associated with PE that occur in the context of sleep or substance use. Method: Data from the Collaborative Psychiatric Epidemiology Surveys (n = 11 776) were used to assess the associations between both PE and PE-SS and a broad range of outcomes, including psychiatric co-morbidity, suicidal behavior, mental health treatment utilization and World Health Organization (WHO) domains of function, using logistic regression analyses. Lifetime PE and PE-SS were mutually exclusive categories, assessed using the WHO Composite International Diagnostic Interview psychosis screen.  Results: PE were associated with all 10 clinical and functional outcomes. Similarly, respondents reporting PE-SS had greater clinical need and impaired function relative to controls, which was significant for seven of the 10 outcome variables. When directly compared, the PE and PE-SS groups differed only in their associations with role function (greater impairment for PE) and self-care (greater impairment for PE-SS). Conclusions: PE-SS were associated with a broad range of clinical and functional outcomes in this large general population sample. These associations were similar to those found for PE. Future studies should investigate relative differences between sleep- and substance-induced PE.

Erving, C. L. (In press). Ethnic and nativity differences in the social support-physical health association among black Americans. Journal of Immigrant and Minority Health.

Despite an abundant literature on social support and health, relatively less is known about how support and its impact on physical health vary within the Black population. Using the National Survey of American Life (NSAL), this paper examines which sources and types of support are associated with physical health among African Americans, U.S.-born Caribbean Blacks and foreign-born Caribbean Blacks. The results showed that for U.S.-born Caribbean Blacks, being married was especially beneficial to health. Closeness to family was associated with better health while negative interactions with family members was associated with worse health for African Americans and foreign-born Caribbean Blacks. Different sources of instrumental support affected all three groups. Overall, the findings reveal that, among Black Americans, the association between social support and physical health is contingent upon ethnicity, nativity, and the ways in which social support and health are operationalized.

 

Hudson, D. L., Neighbors, H. W., Geronimus, A. T., & Jackson, J. S. (2016). Racial discrimination, John Henryism, and depression among African Americans. Journal of Black Psychology, 42(3), 221-243.

Evidence from previous studies indicates that racial discrimination is significantly associated with depression and that African Americans with higher levels of socioeconomic status (SES) report greater exposure to racial discrimination compared to those with lower SES levels. Coping strategies could alter the relationship between racial discrimination and depression among African Americans. This study first examined whether greater levels of SES were associated with increased reports of racial discrimination and ratings of John Henryism, a measure of high-effort coping, among African Americans. Second, we examined whether high-effort coping moderated the relationship between racial discrimination and depression. Data were drawn from the National Survey of American Life Reinterview (n = 2,137). Analyses indicated that greater levels of education were positively associated with racial discrimination (p < .001) and increased levels of racial discrimination were positively related to depression (p < .001), controlling for all sociodemographic factors. Greater levels of John Henryism were associated with increased odds of depression but there was no evidence to suggest that the relationship between discrimination and depression was altered by the effects of John Henryism.

Lacey, K. K., West, C. M., Matusko, N., & Jackson, J. S. (2016). Prevalence and factors associated with severe intimate partner violence among U.S. women: A comparison of African American and Caribbean blacks. Violence Against Women, 22(6), 651-670.

This study explored prevalence rates and factors associated with lifetime severe physical intimate partner violence among U.S. Black women. Data from the National Survey of American Life were examined. Rates of severe physical intimate partner violence were higher among African American women compared with U.S. Caribbean Black women. Risk factors associated with reported abuse were similar to those found in earlier studies but differed by ethnic backgrounds. Demographic, resource, and situational factors were associated with severe physical intimate partner violence among U.S. Black women in general but made unique contributions by ethnic group. Implications and suggestions for future studies were discussed.

LeCook, B., Kim, G., Morgan, K. L., Chen, C.-N., Nillni, A., & Alegría, M. (2016). Measuring geographic “hot spots” of racial/ethnic disparities: An application to mental health care. Journal of Health Care for the Poor and Underserved, 27(2), 663-684.

This article identifies geographic “hot spots” of racial/ ethnic disparities in mental health care access. Using data from the 2001– 2003 Collaborative Psychiatric Epidemiology Surveys (CPES), we identified metropolitan statistical areas(MSAs) with the largest mental health care access disparities (“hot spots”) as well as areas without disparities (“cold spots”).  Racial/ethnic disparities were identified after adjustment for clinical need. Richmond, Virginia and Columbus, Georgia were found to be hot spots for Black-White disparities, regardless of method used. Fresno, California and Dallas, Texas were ranked as having the highest Latino- White disparities and Riverside, California and Houston, Texas consistently ranked high in Asian- White mental health care disparities across different methods. We
recommend that institutions and government agencies in these “hot spot” areas work together to address key mechanisms underlying these disparities. We discuss the potential and limitations of these methods as tools for understanding health care disparities in other contexts.

Marshall-Fabien, G. L., & Miller, D. B. (2016). Exploring ethnic variation in the relationship between stress, social networks, and depressive symptoms among older black Americans. Journal of Black Psychology, 42(1), 54-72.

The relationship between different types of stressors and depressive symptoms among older Black populations is poorly understood. Even less is known about the social networks that might buffer different stressors on individuals within Black ethnic groups. The purpose of this study was to examine whether there are differences in the relationship between stress and social networks on depressive symptoms by ethnic group while ethnicity functioned as a proxy for culture. Data were drawn from the National Survey of American Life, which includes older African Americans (N = 837) and Caribbean Blacks (N = 271). In this survey, the measures of stress were perceived discrimination and material hardship; measures of social networks were social support and social connectedness. The association between perceived discrimination and depressive symptoms was significant for both groups while the association between material hardship and depressive symptoms was only significant for older African Americans. Results also indicate that compared with African Americans, Caribbean Blacks derived greater protective effects against depression from social support and social connectedness in late life.

Mereish, E. H., N’cho, H. S., Green, C. E., Jernigan, M. M., & Helms, J. E., (2016). Discrimination and depressive symptoms among black American men: Moderated-mediation effects of ethnicity and self-esteem. Behavioral Medicine, 42(3), 190-196.

Discrimination is related to depression and poor self-esteem among Black men. Poorer self-esteem is also associated with depression. However, there is limited research identifying how self-esteem may mediate the associations between discrimination and depressive symptoms for disparate ethnic groups of Black men. The purpose of this study was to examine ethnic groups as a moderator of the mediating effects of self-esteem on the relationship between discrimination and depressive symptoms among a nationally representative sample of African American (n = 1201) and Afro-Caribbean American men (n = 545) in the National Survey of American Life. Due to cultural socialization differences, we hypothesized that self-esteem would mediate the associations between discrimination and depressive symptoms only for African American men, but not Afro-Caribbean American men. Moderated-mediation regression analyses indicated that the conditional indirect effects of discrimination on depressive symptoms through self-esteem were significant for African American men, but not for Afro-Caribbean men. Our results highlight important ethnic differences among Black men.

 

Molina, K. M., & James, D. (2016). Discrimination, internalized racism, and depression: A comparative study of African American and Afro-Caribbean adults in the US. Group Processes and Intergroup Relations, 19(4), 439-461.

Emerging research suggests that both perceptions of discrimination and internalized racism (i.e., endorsement of negative stereotypes of one’s racial group) are associated with poor mental health. Yet, no studies to date have examined their effects on mental health with racial/ethnic minorities in the US in a single study. The present study examined: (a) the direct effects of everyday discrimination and internalized racism on risk of DSM-IV criteria of past-year major depressive disorder (MDD); (b) the interactive effects of everyday discrimination and internalized racism on risk of past-year MDD; and (c) the indirect effect of everyday discrimination on risk of past-year MDD via internalized racism. Further, we examined whether these associations differed by ethnic group membership. We utilized nationally representative data of Afro-Caribbean (N = 1,418) and African American (N = 3,570) adults from the National Survey of American Life. Results revealed that experiencing discrimination was associated with increased odds of past-year MDD among the total sample. Moreover, for Afro-Caribbeans, but not African Americans, internalized racism was associated with decreased odds of meeting criteria for past-year MDD. We did not find an interaction effect for everyday discrimination by internalized racism, nor an indirect effect of discrimination on risk of past-year MDD through internalized racism. Collectively, our findings suggest a need to investigate other potential mechanisms by which discrimination impacts mental health, and examine further the underlying factors of internalized racism as a potential self-protective strategy. Lastly, our findings point to the need for research that draws attention to the heterogeneity within the U.S. Black population.

 

Mouzon, D. M., Taylor, R. J., Nguyen, A. W., & Chatters, L. M. (2016). Serious psychological distress among African Americans: Findings from the National Survey of American Life. Journal of Community Psychology, 44(6), 765-780.

Despite their low social standing, there remains a paucity of research on psychological distress among African Americans. We use data from the 2001–2003 National Survey of American Life to explore a wide array of social and economic predictors of psychological distress among African American adults aged 18 years and older, including previous incarceration, history of welfare receipt, and having a family member who is either currently incarcerated or homeless. Younger age, lower income, lower educational attainment, and lower self-rated health and childhood health are associated with higher levels of psychological distress among African Americans. We also find a strong association between higher levels of material hardship, previous incarceration history, and the presence of a family member who is either incarcerated or homeless and higher levels of psychological distress. The findings highlight the importance of considering unique types of social disadvantage experienced by African Americans living in a highly stratified society.

 

Nobles, C. J., Valentine, S. E., Borba, C. P. C., Gerber, M. W., Shtasel, D. L., & Marques, L. (2016). Black-white disparities in the association between posttraumatic stress disorder and chronic illness. Journal of Psychosomatic Research, 85, 19-25. PMCID: PMC4879687

Objective: Non-Latino blacks experience a higher proportion of chronic illness and associated disabilities than non-Latino whites. Posttraumatic stress disorder (PTSD) is associated with a greater risk of chronic illness, although few studies have investigated whether the interaction of PTSD with racial disparities may lead to a greater risk of chronic illness among blacks with PTSD than among whites with PTSD. Methods: We evaluated data from the population-based National Survey of American Life and the National Comorbidity Survey Replication to investigate the association between race, lifetime PTSD and self-reported chronic illness. Weighted linear and Poisson regression models assessed differences in the magnitude of association between PTSD and chronic illness by race on both the additive and multiplicative scales. Results: The magnitude of the association between lifetime PTSD and diabetes was greater among blacks (RD 0.07, 95% CI 0.02, 0.11; RR 1.9, 95% CI 1.4, 2.5) than whites (RD 0.004, 95% CI − 0.02, 0.03; RR 1.2, 95% CI 0.7, 1.9) on the additive (p = 0.017) scale. The magnitude of the association between lifetime PTSD and heart disease was greater among blacks (RD 0.09, 95% CI 0.05, 0.13) than whites (RD 0.04, 95% CI 0.01, 0.07) on the additive scale at a level approaching significance (p = 0.051). Conclusion: A lifetime history of PTSD was associated with a significantly greater risk of diabetes among blacks as compared to whites. These findings suggest that continuous exposure to racial inequalities may be associated with a greater risk of PTSD-related health sequela.

 

Nguyen, A. W., Chatters, L. M., Taylor, R. J., & Mouzon, D. M. (2016). Social support from family and friends and subjective well-being of older African Americans. Journal of Happiness Studies, 17(3), 959-979. PMCID: PMC4869534

This study examines the impact of informal social support from family and friends on the well-being of older African Americans. Analyses are based on a nationally representative sample of older African Americans from the National Survey of American Life (n = 837). Three measures of well-being are examined: life satisfaction, happiness and self-esteem. The social support variables include frequency of contact with family and friends, subjective closeness with family and friends, and negative interactions with family. Results indicate that family contact is positively correlated with life satisfaction. Subjective closeness with family is associated with life satisfaction and happiness and both subjective closeness with friends and negative interaction with family are associated with happiness and self-esteem. There are also significant interactions between family closeness and family contact for life satisfaction, as well as friendship closeness and negative interaction with family for happiness. Overall, our study finds that family and friend relationships make unique contributions to the well-being of older African Americans. Qualitative aspects of family and friend support networks (i.e., subjective closeness, negative interactions) are more important than are structural aspects (i.e., frequency of contact). Our analysis verify that relationships with family members can both enhance and be detrimental to well-being. The findings are discussed in relation to prior research on social support and negative interaction and their unique associations with well-being among older African Americans.

 

Oh, H., Cogburn, C. D., Anglin, D., Lukens, E., & DyVylder, J. (2016). Major discriminatory events and risk for psychotic experiences among black Americans. American Journal of Orthopsychiatry, 86(3), 277-285.

Racism is a multidimensional construct that impacts risk for psychosis through various complex pathways. Previous research has yet to fully explore how major racial discriminatory events contribute to risk for psychotic experiences in the general population. We examined the National Survey of American Life to analyze the effects of 9 major racial discriminatory events on lifetime psychotic experiences among Black Americans. By examining each event separately, we found that police discrimination was associated with increased risk for lifetime psychotic experiences after adjusting for demographic variables, socioeconomic status, and co-occurring psychological or social problems. Being denied a promotion, being a victim of police abuse, and being discouraged from pursuing education were associated with lifetime visual hallucinations, and being discouraged from pursuing education was also associated with lifetime delusional ideation. None of the events were associated with lifetime auditory hallucinations. As a count of events, experiencing a greater range of major racial discriminatory events was associated with higher risk, particularly for lifetime visual hallucinations. Our findings point to the need for early detection and intervention efforts in community settings and multilevel efforts to eliminate racial discrimination.

 

Torres, E. R., Sampselle, C. M., Ronis, D. L., Neighbors, H. W., & Gretebeck, K. A. (2016). Gardening/yard work and depressive symptoms in African Americans. Archives of Psychiatric Nursing, 30(2), 155-161. PMCID: PMC4799838

Background: The purpose of this study was to examine the frequency of gardening/yard work in relation to depressive symptoms in African-Americans while controlling for biological and social factors. Methods: A secondary analysis was performed on the National Survey of American Life (n=2,903) using logistic regression for complex samples. Gardening/yard work was measured by self-reported frequency. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Results: Biological and social factors, not gardening/yard work, were associated with depressive symptoms. Conclusions: Biological and social factors may need to be addressed before the association between gardening/yard work and depressive symptoms can be determined.

 

Uzogara, E. E., & Jackson, J. S. (2016). Perceived skin tone discrimination across contexts: African American women’s reports. Race and Social Problems, 8(2), 147-159.

There is a void in empirical research that examines African American women’s self-reported skin tone discrimination from out-groups (e.g., whites) and in-groups (blacks). We analyzed data of women from diverse socioeconomic backgrounds in the nationally representative National Survey of American Life (N = 1653). Light-skinned women reported less out-group colorism, and light-, medium-, and dark-skinned women with higher self-mastery perceived lower out-group colorism. Medium-skinned women perceived less in-group colorism, while dark-skinned women perceived more in-group and out-group colorism than counterparts. Implications for intergroup and intragroup race relations as well as well-being are discussed.

 

Williams, S. L., & Cabrera-Nguyen, E. P. (2016). Impact of lifetime evaluated need on mental health service use among African American emerging adults. Cultural Diversity and Ethnic Minority Psychology, 22(2), 205-214. PMCID: PMC4595164

OBJECTIVE: This study investigated the association between evaluated need and mental health service use among African-American emerging adults, when controlling for other predictor variables. METHOD:  Secondary analysis of data from the National Survey of American Life (2001-2003) was conducted. A nationally representative sample of African-American emerging adults, ages 18 to 29 years (N = 806), was assessed with the Composite International Diagnostic Interview. The sample included females and males with a mean age of 23 years. Evaluated need was determined by endorsement of mood, anxiety, substance use, or impulse control diagnoses. Respondents who reported ever voluntarily using mental health or general medical services to address these problems were considered to have used services. RESULTS:  Forty-seven percent of the sample demonstrated an evaluated need for services, whereas a quarter of the sample used services in their lifetime. Respondents who were females, had received religious/spiritual support, and who had an evaluated need for services were significantly more likely to have used services in their lifetime compared with males, those who had not received religious/spiritual support, and those without a need for services. CONCLUSIONS: Literature indicates that evaluated need is a strong predictor of mental health service use, yet research examining its impact on service use among African American emerging adults is limited. This study found that along with having an evaluated need, this population was more likely to use services when supported by a religious/spiritual leader. Mental health outreach and education that incorporates the informal support systems identified by African American emerging adults, particularly males, is needed.

Harnois, C. E. (2013). Further re-modeling with multiracial feminism: Highlighting interactive effects of race, ethnicity, age, and gender. In C. E. Harnois (Ed.), Feminist Measures in Survey Research (pp. 81-104). Thousand Oaks, CA: Sage.

In the previous chapter I argued that multiracial feminism offers a fruitful yet underused theoretical perspective from which to analyze sexism and gender discrimination. While previous research on sexism has yielded valuable information, I suggested that, by focusing primarily on gender, scholars had obscured how other social statuses—such as age, race, ethnicity, and class—interacted with gender to shape women's experiences. Using data from the General Social Survey (GSS), I showed how even with minimal measures of sexism, a multiracial feminist approach could highlight important commonalities and differences among women. In this chapter, I hope to show how a multiracial feminist approach can similarly inform survey research on racial discrimination. Just as survey research on sexism and gender discrimination has focused primarily on one dimension of inequality (gender), so too has research on racial discrimination (race). While attention to race is clearly important for analyzing racial discrimination, a multiracial feminist perspective highlights how racial inequalities work with and through other systems of inequality to shape the experiences of all individuals. While not discounting the importance of previous work, I hope to bring attention to the potential contributions of an interdisciplinary multiracial feminist or “intersectional” approach for this area of research.

Building on the insights presented in the previous two chapters, this chapter focuses on issues of measurement bias and universalizing models in survey research on racial discrimination. Whereas the previous chapter analyzed data from a general social survey to highlight experiences of discrimination, this chapter draws on data from a more particular survey: the 2001 to 2003 National Survey of American Life (NSAL): Coping With Stress in the 21st Century. While the General Social Survey is designed to understand a range of social issues, the NSAL is designed specifically to “gather data about the physical, emotional, mental, structural, and economic conditions of black Americans” (http://www.rcgd.isr.umich.edu/prba/nsal). In addition, where as the previous chapter developed an intersectional approach to analyzing the predictors of workplace sexism and discrimination more generally this chapter demonstrates how an intersectional approach can illuminate some of the consequences of discrimination. Like research on feminism and sexism, survey research on racial and ethnic discrimination can be classified into three broad groups: studies that analyze data from large general social surveys, studies that use data from surveys that are more focused yet still include large samples, and studies that use smaller surveys designed to understand a particular phenomenon in a particular context. In this chapter, I demonstrate how a multiracial feminist approach can inform survey research that falls within the second category: the NSAL is focused rather than general, yet it includes a large and diverse sample of respondents.

Henderson, A. K. (In press). The long arm of religion: Childhood adversity, religion, and self-perception among black Americans. Journal for the Scientific Study of Religion.

Significant associations between childhood adversity and adult mental health have been documented in epidemiological and social science research. However, there is a dearth of research examining this relationship among black Americans, as well as into what cultural institutions and practices may help individuals in dealing with childhood adversity. This study suggests that religion may be an important resource for black Americans in the face of early-life socioeconomic and health disadvantage. Using data from the National Survey of American Life, a nationally representative sample of both African Americans and black Caribbeans (n = 5,191), this study outlines a series of arguments linking childhood adversity, religiosity, and self-perception among black Americans. The results suggest some support for religious involvement in moderating—or buffering—the harmful effects of childhood adversity on the self-esteem and mastery among black Americans, specifically religious service attendance and religious coping. In addition, the results reveal that religion may also amplify the deleterious effects of childhood disadvantage on adult mental health. Study limitations are identified and several promising directions for future research are discussed.

 

James, D. (In press). Internalized racism and past-year major depressive disorder among African-Americans: The role of ethnic identity and self-esteem. Journal of Racial and Ethnic Health Disparities.

Although a large body of research focuses on discrimination as a risk for depression among African-Americans, only a dearth of research focuses on internalized racism (i.e., endorsement of negative stereotypes of one’s racial group) as a risk factor. In addition, no studies have yet to examine mediators and/or moderators of the relationship between internalized racism and depression. To this end, the present study examined the mediating and moderating roles of (a) self-esteem and (b) ethnic identity on the relationship between internalized racism and past-year major depressive disorder (MDD), in a nationally representative sample of African-American adults (N = 3570) from the National Survey of American Life. Results from this study revealed an indirect association between internalized racism and past-year MDD via self-esteem, but no indirect relationship via ethnic identity. Further, results show that both self-esteem and ethnic identity individually moderate the relationship between internalized racism and past-year MDD. Collectively, these findings suggest a need to further investigate mechanisms through which internalized racism impacts mental health and factors that strengthen and/or weaken the association between internalized racism and depression.

 

Lacey, K. K., Jackson, J. S., & Matusko, N. (2016). Racial and ethnic influences on mental health and substance use disorders: The case of Caribbean blacks. In Y. F. Thomas & L. N. Price (Eds.), Drug use trajectories among minority youth (pp. 331-346).  Dordrecht, Netherlands: Springer.

(No abstract available.)

 

Was in press, and now is published:

Nguyen, A. W., Chatters, L. M., Taylor, R. J., Levine, D. S., & Himle, J. A. (2016). Family, friends, and 12-month PTSD among African Americans. Social Psychiatry and Psychiatric Epidemiology, 51(8), 1149-1157.

 

Nobles, C. J., Valentine, S. E., Gerber, M. W., Shtasel, D. L., & Marques, L. (In press). Predictors of treatment utilization and unmet treatment need among individuals with posttraumatic stress disorder from a national sample. General Hospital Psychiatry.

Objective: Posttraumatic stress disorder (PTSD) is a chronic psychiatric condition associated with significant disability that often remains untreated. Sociodemographic and family-level factors may serve as predictors of unmet treatment need, identifying groups that would most benefit from policies aimed at increasing access to the mental healthcare system. Method: Data from the nationally-representative Collaborative Psychiatric Epidemiologic Surveys was used to identify predictors of mental health treatment utilization, both with a mental health specialist and with a general health practitioner, and self-reported unmet treatment need among individuals who endorsed past-year PTSD. We defined unmet treatment need as self-reporting a mental health problem and not accessing mental health care in the general or specialty mental health care system. Results: Among 600 participants, predictors of unmet treatment need included being non-Latino black (OR 2.11, 95% CI 1.25–3.54), having a high school education versus some college (OR 2.45, 95% CI 1.34–4.48), and being employed or unemployed verses not being in the workforce (OR 1.74, 95% CI 1.00–3.02 and OR 4.95, 95% CI 1.60–15.34, respectively). Recursive partitioning identified younger age and being married as predictors of low treatment utilization. Conclusions: Future research should elucidate barriers to accessing treatment among those with PTSD in these underserved groups.

 

Oh, H. Y., Koyanagi, A., Singh, F., & DeVylder, J. (2016). Is smoking tobacco associated with psychotic experiences across racial categories in the United States? Findings from the Collaborative Psychiatric Epidemiological Surveys. Psychiatry Research, 246, 58-61.

Smoking tobacco has been associated with psychosis, though research has yet to fully examine the extent to which this association reaches into the sub-threshold range of the psychosis continuum within the US, and whether this association persists after accounting for co-occurring disorders. We analyzed data from three large racially-diverse surveys of the US population and found that current smokers were more likely to report a lifetime psychotic experience when compared with never smokers after adjusting for socio-demographics. But after controlling for anxiety, mood, and substance use disorders, these effects only remained strong and statistically significant for Asian-Americans.

 

Parker, L. J., Benjamin, T., Archibald, P., & Thorpe, R. J. (In press). The association between marijuana usage and discrimination among adult black men. American Journal of Men’s Health.

Black men may use marijuana as an externalizing coping mechanism to handle the chronic stress of discrimination. The aim of the study was to examine the relationship between everyday and major discrimination and marijuana use among a national sample of Black men. Using the National Survey of American Life, logistic regression analyses was used to determine the association between recent marijuana use and everyday discrimination, major discrimination, and a fully adjusted model that include everyday and major discrimination among adult Black men (n = 1,833). Additionally, a multinomial logistic regression was used to examine the association between the frequency of marijuana usage and everyday discrimination and major discrimination among men who used marijuana in the past year. Everyday discrimination was not associated with marijuana use. In the fully adjusted model, men who experienced major discrimination had a higher odds of marijuana use (OR: 1.19, 95% CI [1.05, 1.34]), than those who did not control for everyday discrimination and covariates of interest. Among recent marijuana users, men who used almost every day had a decreased risks for major discrimination (RRR: 0.72, 95% CI [0.56, 0.92]), compared with men who used less than once a month. The findings suggest that recent marijuana use among Black men is associated with experiences of major discrimination. Interestingly, men who used almost every day had a decreased risk for major discrimination. Marijuana may be used as a coping mechanism.

 

Parker, L. J., Kinlock, B. L., Chisolm, D., Furr-Holden, D., & Thorpe Jr., R. J. (2016). Association between any major discrimination and current cigarette smoking among adult African American men. Journal of Substance Use and Misuse, 51(12), 1593-1599.

Background: Findings from previous research has demonstrated a positive relationship between interpersonal discrimination and cigarette smoking. Cigarette smoking is proposed to be an externalizing coping mechanism used to alleviate discrimination. At the national level, it is unclear if discrimination is associated with cigarette smoking among African American men. Objective: The aim of the study was to examine the association between discrimination and cigarette smoking among a national sample of African American men. Methods: Using data from the National Survey of American Life (n = 1,271), multivariable logistic regression was used to examine the relationship between discrimination and cigarette smoking. Results: Thirty-two percent of the men were current smokers. Controlling for everyday discrimination, major discrimination, major stress, depressive symptoms, age, being married, household income, and education, African American men who experienced major discrimination had a higher odd of being a current smoking (odds ratio: 1.11, 95% confidence interval: 1.02–1.21) than African American men who did not experience major discrimination. Conclusion/Importance: Findings suggest that African American men may use cigarette smoking as a mechanism to alleviate the experiences of discrimination. Future studies should continue to examine factors associated with African American men's smoking behavior in efforts to inform culturally relevant interventions.

 

Adolescent paper:

Rose, T., Finigan-Carr, N., & Joe, S. (In press).  Organized religious involvement and mental health among Caribbean black adolescents. Child and Adolescent Social Work Journal.

Though religion has been related to better mental health, the aspects of organized religious life most salient for the mental health of Caribbean Black adolescents in the US, beyond religious service attendance, has been understudied. This research utilized a sub-sample of Caribbean Black adolescents from the NSAL-A, a nationally representative U.S. dataset, to examine (1) the prevalence of organized religious involvement (e.g., participation in religious service activities, choice to attend religious services) and (2) the relationship between organized religious involvement and mental health. Results showed that 62 % of Caribbean Black adolescents attend religious services regularly (at least a few times a month) and 49 % or more attend religious services or participate in religious activities (e.g., youth groups) by choice. Additionally, various aspects of organized religious involvement were positively related to coping and self-esteem, and negatively related to depressive symptoms. Religious service attendance was not related to any of the mental health indicators. Study results can inform the development of individual and group level interventions targeted at supporting the mental health of Caribbean Black adolescents.

 

Rosenstrom, T., & Jokela, M. (In press). Reconsidering the definition of major depression based on Collaborative Psychiatric Epidemiology Surveys. Journal of Affective Disorders.

Background: Diagnostic definitions for depressive disorders remain a debated topic, despite their central role in clinical practice and research. We use both recent evidence and nationally representative data to derive an empirically-based modification of DSM-IV/−5 Major Depressive Disorder (MDD). Method: A modified MDD diagnosis was derived by analyzing data from Collaborative Psychiatric Epidemiology Surveys, a multistage probability sample of adults (n = 20 013; age ≥ 18 years) in coterminous USA, Alaska and Hawaii. The old and the newly suggested MDD definitions were compared for their associated disability (WHO Disability Assessment Schedule and number of disability days in past month), suicide attempt, and other covariates. Results: Our data-driven definition for major depression was “lack of interest to all or most things” plus four other symptoms from the set {weight gain, weight loss, insomnia, psychomotor retardation, fatigue, feelings of worthlessness, diminished ability to think/concentrate, suicidal ideation/attempt}. The new definition captured all the disability implied by MDD and excluded cases that showed no greater disability than the general population nor increased risk of suicide attempts. The lifetime prevalence of the new diagnosis was 14.7% (95% CI = 14–15.4%) of the population, slightly less than for the old definition (16.4%; CI = 15.4–17.3%). Limitations: Only conservative modifications of MDD could be studied, because of restrictions in the symptom data. Conclusions: With only small adjusting, the new definition for major depression may be more clinically relevant than the old one, and could serve as a conservative replacement for the old definition.

 

Sullivan, J. M., & Winburn, J. (2016). The role of discrimination in shaping the presence and strength of linked fate. In J. M. Sullivan & W. E. Cross (Eds.), Meaning-making, internalized racism, and African American identity (pp. 309-328). Albany, NY: SUNY Press.

(No abstract available.)

 

Taylor, R. J., Miller, R., Mouzon, D., Keith, V. M., & Chatters, L. M. (In press). Everyday discrimination among African American men: The impact of criminal justice contact. Race and Justice.

The present study examined the impact of criminal justice contact on experiences of everyday discrimination among a national sample of African American men. African American men have a high likelihood of being the targets of major discrimination as well as experiencing disproportionate contact with the criminal justice system. Few studies, however, examine everyday discrimination (e.g., commonplace social encounters of unfair treatment) among this group. Using data from the National Survey of American Life, we provide a descriptive assessment of different types of everyday discrimination among African American men. Specifically, we examined differences in everyday discrimination among men who have never been arrested, those who have been arrested but not incarcerated, and men who have a previous history of criminal justice intervention categorized by type of incarceration experienced (i.e., reform school, detention, jail, or prison). Study findings indicated overall high levels of reported everyday discrimination, with increased likelihood and a greater number of experiences associated with more serious forms of criminal justice contact. However, in many instances, there were no or few differences in reported everyday discrimination for African American men with and without criminal justice contact, indicating comparable levels of exposure to experiences with unfair treatment.

 

2015

Assari, S. (2015). Ethnic and gender differences in additive effects of socio-economics, psychiatric disorders, and subjective religiosity on suicidal ideation among blacks. International Journal of Preventive Medicine, 6(1), 53-59.  PMCID: PMC4498310

Background: This study aimed to investigate the additive effects of socio-economic factors, number of psychiatric disorders, and religiosity on suicidal ideation among Blacks, based on the intersection of ethnicity and gender. Methods: With a cross-sectional design, data came from the National Survey of American Life, 2001–2003, which included 3570 African-American and 1621 Caribbean Black adults. Socio-demographics, perceived religiosity, number of lifetime psychiatric disorders and lifetime suicidal ideation were measured. Logistic regressions were fitted specific to groups based on the intersection of gender and ethnicity, while socioeconomics, number of life time psychiatric disorders, and subjective religiosity were independent variables, and lifetime serious suicidal ideation was the dependent variable. Results: Irrespective of ethnicity and gender, number of lifetime psychiatric disorders was a risk factor for lifetime suicidal ideation (odds ratio [OR] ranging from 2.4 for Caribbean Black women to 6.0 for Caribbean Black men). Only among African-American men (OR = 0.8, 95% confidence interval = 0.7–0.9), perceived religiosity had a residual protective effect against suicidal ideation above and beyond number of lifetime psychiatric disorders. The direction of the effect of education on suicidal ideating also varied based on the group. Conclusions: Residual protective effect of subjective religiosity in the presence of psychiatric disorders on suicidal ideation among Blacks depends on ethnicity and gender. African-American men with multiple psychiatric disorders and low religiosity are at very high risk for suicidal ideation.

 

Assari, S., & Caldwell, C. H. (2015). Gender and ethnic differences in the association between obesity and depression among black adolescents. Journal of Racial and Ethnic Health Disparities, 2(4), 481-493.

Aim: This study aimed to investigate the association between obesity and major depression disorder (MDD) in a nationally representative sample of Black adolescents in the USA. The study also tested the effects of ethnicity and gender as possible moderators. Method: Data came from the National Survey of American Life (NSAL)-Adolescents, a representative household mental health survey of Black adolescents in the USA. Participants consisted of 1170 Black adolescents (810 African Americans and 360 Caribbean Blacks). Obesity was defined determined by the cutoff points based on the body mass index (BMI) appropriate for age and gender. Twelve-month MDD was measured using the World Mental Health Composite International Diagnostic Interview (CIDI). In the first step, the association between obesity and MDD in the pooled sample, controlling for the main effects of gender and ethnicity. In the next steps, two interactions were tested: (1) obesity and ethnicity and (2) obesity and gender. Results: Although any associations between obesity and MDD in the pooled sample of Blacks were not found, there was a significant interaction between ethnicity and obesity on MDD. Upon testing the associations across intersections of ethnicity and gender, a positive association was found among Caribbean Black females but not Caribbean Black males, African American males, or African American female. Conclusion: The link between BMI and MDD among Blacks depends on ethnicity and gender, and risk of comorbid depression among Black youth with obesity is highest among Caribbean Black females.

 

Assari, S., & Lankarani, M. M. (2015). The association between obesity and weight loss intention weaker among blacks and men than whites and women. Journal of Racial and Ethnic Health Disparities, 2(3), 414-420. PMCID:  PMC4599706

Introduction: Although obesity is associated with weight loss intention, the magnitude of this association may differ across various populations. Using a nationally representative data of the USA, this study tested the variation of the association between obesity and weight loss intention based on race and gender. Methods: Data came from the National Survey of American Life (NSAL), 2001–2003, which enrolled 5810 nationally representative sample of adults (3516 African-Americans, 1415 Caribbean Blacks, and 879 non-Hispanic Whites). Socio-demographics, body mass index (BMI), and weight loss intention were measured. We fitted logistic regression models in the pooled sample with weight loss intention as the outcome, obesity (BMI > 30) as the predictor, while the effect of covariates was controlled. To test our moderation hypotheses, we entered race × obesity and gender × obesity interactions to the model. Results: Although the association between obesity and weight loss intention was significant among both race and gender groups, the magnitude of the association between obesity and weight loss intention was larger for women than men and Whites than Blacks. This finding suggests that individuals with obesity have less intention for weight loss if they are Black or men.  Conclusion: The link between obesity and weight loss intention depends on race and gender. Weight loss intention may not increase in response to obesity among Blacks and men, compared to Whites and women. Healthy weight programs in the USA may benefit from tailoring based on race and gender.

 

Assari, S., Watkins, D. C., & Caldwell, C. H. (2015). Race attribution modifies the association between daily discrimination and major depressive disorder among blacks: The role of gender and ethnicity. Journal of Race and Ethnic Health Disparities, 2(2), 200-210.

Objective: Although the association between discrimination and depression among Blacks is well-known, we do not know if this effect is influenced by race attribution. In this current study, we investigated the effect modification of race attribution on the association between everyday discrimination and major depressive disorder (MDD) among Blacks in the United States, and whether this effect modification is influenced by the intersection of ethnicity and gender. Methods: With a cross-sectional design, this study used data from the National Survey of American Life (NSAL), 2001–2003. The study included a nationally representative sample of Blacks (n = 5,008), composed of 3,570 African Americans and 1,438 Caribbean Blacks. Everyday discrimination, two single-item measures of race attribution (race as the major barrier against upward social mobility, and race as the main cause for being discriminated against) and 12-month MDD were measured. In the first step, we fit logistic regressions to the pooled sample. In the next step, we ran regressions specific to the intersections of ethnicity and gender. Interaction between race attribution and discrimination were also entered into the models. Results: Among Caribbean Black men, the belief that race is a major barrier against one’s own upward social mobility modified the association between exposure to daily discrimination and MDD. In this group, the association between discrimination and MDD was weaker among those who believed that race is a major barrier against one's own upward social mobility. Race attribution did not modify the association between discrimination and MDD among African American men, African American women, and Caribbean Black women. The other measure of race attribution (race as the main cause of being discriminated against) did not modify the association between discrimination and MDD in any ethnicity by gender subgroups. Conclusions: Among Caribbean Black men, the link between everyday discrimination and depression may depend on seeing race as the main barrier against upward social mobility. Among African American men and women, however, the link between discrimination and MDD does not depend on race attribution. Our results suggest that ethnicity, gender, and race attribution may alter the association between discrimination and risk of MDD among Blacks.

 

Bailey, Z. D., Okechukwu, C., Kawachi, I., & Williams, D. R. (2015). Incarceration and current tobacco smoking among black and Caribbean black Americans in the National Survey of American Life. American Journal of Public Health, 105(11), 2275-2282.  PMCID: PMC4605159

Objectives. We examined the relationship between having a history of incarceration and being a current smoker using a national sample of noninstitutionalized Black adults living in the United States. Methods. With data from the National Survey of American Life collected between February 2001 and March 2003, we calculated individual propensity scores for having a history of incarceration. To examine the relationship between prior incarceration and current smoking status, we ran gender-specific propensity-matched fitted logistic regression models. Results. A history of incarceration was consistently and independently associated with a higher risk of current tobacco smoking in men and women. Formerly incarcerated Black men had 1.77 times the risk of being a current tobacco smoker than did their counterparts without a history of incarceration (95% confidence interval [CI] = 1.20, 2.61) in the propensity score-matched sample. The results were similar among Black women (prevalence ratio = 1.61; 95% CI = 1.00, 2.57). Conclusions. Mass incarceration likely contributes to the prevalence of smoking among US Blacks. Future research should explore whether the exclusion of institutionalized populations in national statistics obscures Black–White disparities in tobacco smoking.

 

Bailey, Z. D., Williams, D. R., Kawachi, I., & Okechukwu, C. A. (2015). Incarceration and adult weight gain in the National Survey of American Life (NSAL). Preventive Medicine, 81, 380-386.

The United States has the unenviable distinction of having both the highest obesity rate among Organisation for Economic Co-operation and Development (OECD) member countries and the highest incarceration rate in the world. Further, both are socially patterned by race/ethnicity and socioeconomic position. Incarceration involves various health behaviors that could influence adult weight trajectory. We evaluated the associations between history and duration of adult incarceration and weight gain using the National Survey of American Life (N=6,082 adults residing in the 48 contiguous states between February 2001 and March 2003). We propensity score-matched individuals to control for the probability of having a history of incarceration. To examine the relation between prior incarceration and adult weight gain, we fit gender-stratified generalized estimating equations controlling for propensity of incarceration history, age, education, income, race/ethnicity, and marital status. For males (N=563), incarceration was associated with about a 1.77 kg/m2 lower gain in body mass index (BMI) during adulthood, after adjusting for age, education, income, race/ethnicity, and marital status in addition to the propensity of having a history of incarceration (95% CI: -2.63, -0.92). For females (N=286), no significant overall relationship was found between a history of incarceration and adult weight gain. In subgroup analyses among those with an incarceration history, we found no overall association between duration of incarceration and adult weight gain in men or women. In sensitivity analyses, neither tobacco smoking nor parity changed the results. The results of this study indicate that incarceration is associated with a lower transition of weight gain in males, but not females.

 

Brewton-Tiayon, S., Watkins, D. C., Matusko, N., & Jackson, J. S. (2015). Depression among blacks during late life: Examining within-group variations. Aging Medicine: Prevention of Late-Life Depression, 9, 153-170.

Depression is one of the most prevalent mental health disorders experienced during late life. A life course perspective provides a useful frame to understand depressive patterns, highlighting pivotal periods of mental health vulnerability during important age-linked life stages. Research on Blacks during late life commonly treats Blacks as a monolithic group, diminishing the returns that a life course perspective can offer and perhaps masking within-group variations. This chapter provides a review of the extant literature on depression prevalence and depressive symptoms among African Americans and US- and foreign-born Caribbean Blacks with a focus on the late-life period. We conduct an analysis of lifetime major depressive episode, lifetime major depressive disorder, and depressive symptoms for each group globally and disaggregated by gender. The results show variations in prevalence rates and symptom patterns for each group as well as interactions between ethnicity, nativity, and gender. Findings illustrate the importance of targeted and tailored research, practice, and policy that can accommodate the variations within aging Black subgroups and their changing patterns of mental health vulnerability and advantage over the adult life course.

 

Brown, M. J., Cohen, S. A., & Mezuk, B. (2015). Duration of US residence and suicidality among racial/ethnic minority immigrants. Social Psychiatry and Psychiatric Epidemiology, 50(2), 257-267.  PMCID: PMC4469644

Purpose: The immigration experience embodies a range of factors including different cultural norms and expectations, which may be particularly important for groups who become racial/ethnic minorities when they migrate to the US. However, little is known about the correlates of mental health indicators among these groups. The primary and secondary aims were to determine the association between duration of US residence and suicidality, and 12-month mood, anxiety, and substance use disorders, respectively, among racial/ethnic minority immigrants. Methods: Data were obtained from the National Survey of American Life and the National Latino and Asian American Survey. Multivariable logistic regression was used to determine the association between duration of US residence, and suicidality and 12-month psychopathology. Results: Among Afro-Caribbeans, there was a modest positive association between duration of US residence and 12-month psychopathology (P linear trend = 0.016). Among Asians there was a modest positive association between duration of US residence and suicidal ideation and attempts (P linear trend = 0.018, 0.063, respectively). Among Latinos, there was a positive association between duration of US residence, and suicidal ideation, attempts and 12-month psychopathology (P linear trend = 0.001, 0.012, 0.002, respectively). Latinos who had been in the US for >20 years had 2.6 times greater likelihood of suicidal ideation relative to those who had been in the US for <5 years (95 % CI 1.01–6.78). Conclusions: The association between duration of US residence and suicidality and psychopathology varies across racial/ethnic minority groups. The results for Latino immigrants are broadly consistent with the goal-striving or acculturation stress hypothesis.

 

Budhwani, H., Hearld, K. R., & Chavez-Yenter, D. (2015). Depression in racial and ethnic minorities: The impact of nativity and discrimination. Journal of Racial and Ethnic Health Disparities, 2(1), 34-42.

This research examines factors associated with lifetime major depressive disorder in racial and ethnic minorities residing in the USA, with an emphasis on the impact of nativity, discrimination, and health lifestyle behaviors. The Healthy Migrant Effect and Health Lifestyle Theory were used to inform the design of this project. The use of these frameworks not only provides insightful results but also expands their application in mental health disparities research. Logistic regression models were implemented to examine risk factors associated with lifetime major depressive disorder, comparing immigrants to their American-born counterparts as well as to American-born Whites. Data were derived from the Collaborative Psychiatric Epidemiology Surveys (n = 17,249). Support was found for the hypothesis that certain immigrants, specifically Asian and Afro-Caribbean, have lower odds of depression as compared their non-immigrant counterparts. Although, Hispanic immigrants directionally had lower odds of depression, this finding was not statistically significant. Furthermore, engaging in excessive alcohol consumption was associated with higher rates of depression (odds ratio (OR) = 2.09, p < 0.001), and the effect of discrimination on depression was found to be significant, even when controlling for demographics. Of all racial and ethnic groups, foreign-born Afro-Caribbeans had the lowest rate of depression at 7 % followed by foreign-born Asians at 8 %.

 

Budhwani, H., Hearld, K. R., Chavez-Yenter, D. (2015). Generalized anxiety disorder in racial and ethnic minorities: A case of nativity and contextual factors. Journal of Affective Disorders, 175(1), 275-280.

Background: Minorities comprise more than one third of the U.S., and research on the correlates and causes of depression, anxiety, and other mental illnesses have yielded mixed results in minority groups necessitating an understanding of causes and correlates of health. Thus, the aim of this paper is to evaluate the relationship between minority status, contextual factors, and lifetime Generalized Anxiety Disorder. Methods: Logistic regression models were implemented, comparing immigrants to their American-born counterparts as well as to American-born Whites. Results: Foreign-born Afro-Caribbeans exhibited lower rates of lifetime GAD. A lower percentage of foreign-born minorities met the criteria for GAD as compared to their American-born counterparts, and all racial and ethnic groups met the criteria for lifetime GAD at a lower rate as compared to American-born Whites. Discussion: By using theory proactively and including contextual factors, this multi-faceted approach to health disparities research yielded findings which both supported historic beliefs but created opportunities for supplemental research looking at immigrants and GAD. Key findings were that health lifestyle choices and exposure to discrimination significantly affected the chance of having GAD. Nativity was protective; however, its effect was ameliorated by exposure to discrimination or engagement in alcohol abuse. Thus, this study offers practical insight into environmental factors for clinicians caring for racial and ethnic minorities diagnosed with GAD.

 

Carlisle, S. K. (2015). Perceived discrimination and chronic health in adults from nine ethnic subgroups in the USA. Ethnicity and Health, 20(3), 309-326.

Objective. This comparative analysis examines the association between chronic cardiovascular, respiratory and pain conditions, race, ethnicity, nativity, length of residency, and perceived discrimination among three racial and nine ethnic subgroups of Asian Americans (Vietnamese, Filipino, and Chinese), Latino-American (Cuban, Portuguese, and Mexican), and Afro-Caribbean American (Haitian, Jamaican, and Trinidadian/Tobagonian) respondents. Design. Analysis used weighted Collaborative Psychiatric Epidemiology Surveys–merged data from the National Latino and Asian American Study and the National Survey of American Life. Logistic regression analysis was conducted to determine which groups within the model were more likely to report perceived discrimination effects. Results. Afro-Caribbean subgroups were more likely to report perceived discrimination than Asian American and Latino-American subgroups were. Logistic regression revealed a significant positive association with perceived discrimination and chronic pain only for Latino-American respondents. Conclusion. Significant differences in reports of perceived discrimination emerged by race and ethnicity. Caribbean respondents were more likely to report high levels of perceived discrimination; however, they showed fewer significant associations related to chronic health conditions compared to Asian Americans and Latino-Americans. Examination of perceived discrimination across ethnic subgroups reveals large variations in the relationship between chronic health and discrimination by race and ethnicity. Examining perceived discrimination by ethnicity may reveal more complex chronic health patterns masked by broader racial groupings.

 

Carlisle, S. K., & Stone, A. L. (2015). Effects of perceived discrimination and length of residency on the health of foreign-born populations. Journal of Racial and Ethnic Health Disparities, 2(4), 434-444.

This study explores the relationship between chronic conditions, perceived discrimination, and length of residency among three racial groups of foreign-born respondents: Afro-Caribbean, Asian, and Latino Americans. Analysis utilized Collaborative Psychiatric Epidemiology Surveys (CPES) merged data from the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). Afro-Caribbean subgroups were more likely than Asian and Latino American subgroups to report perceived discrimination. Logistic regression analysis was conducted to determine which groups within the model were more likely to report chronic health conditions. Perceived discrimination was found to vary by race and was inversely associated with chronic respiratory conditions for Afro-Caribbeans. In general, years of US residency were associated with health across all chronic conditions where those in the USA longer were more likely to experience health-related problems. Perceived discrimination revealed mixed results.

 

Carter, R., Caldwell, C. H., Matusko, N., & Jackson, J. S. (2015). Heterosexual romantic involvement and depressive symptoms in black adolescent girls: Effects of menarche and perceived social support. Journal of Youth and Adolescence, 44(4), 940-951.
NOTE: ADOLESCENT PAPER!

Research has accumulated to demonstrate that depressive symptoms are associated with heterosexual romantic involvement during adolescence, but relatively little work has linked this body of literature to the existing literature on associations between early pubertal timing and adolescent depressive symptoms. This study extends prior research by examining whether early menarche and heterosexual romantic involvement interact to predict depressive symptoms in a national sample of Black adolescent girls (N = 607; M age = 15 years; 32 % Caribbean Black and 68 % African American). We further examined whether the adverse effects of heterosexual romantic involvement and early menarche would be mediated by perceived social support from mothers, fathers, and peers. Path analysis results indicated that girls who report current involvement in a heterosexual romantic relationship also reported high levels of perceived peer support than girls with no romantic involvement. High levels of perceived peer support, in turn, predicted low levels of depressive symptoms. Romantically involved girls with an early menarche also reported significantly less depressive symptoms than girls not romantically involved with an early menarche. Neither perceived maternal support nor perceived paternal support mediated associations between heterosexual romantic involvement, menarche, and depressive symptoms. The findings suggest that individual and social factors can impede heterosexual romantic involvement effects on depressive symptoms in Black adolescent girls.

 

Clark, T. T., Salas-Wright, C. P., Vaughn, M. G., & Whitfield, K. E. (2015). Everyday discrimination and mood and substance use disorders: A latent profile analysis with African Americans and Caribbean blacks. Addictive Behaviors, 40, 119-125.

Perceived discrimination is a major source of health-related stress. The purpose of this study was to model the heterogeneity of everyday-discrimination experiences among African American and Caribbean Blacks and to identify differences in the prevalence of mood and substance use outcomes, including generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder among the identified subgroups. The study uses data from the National Survey of American Life obtained from a sample of African American and Caribbean Black respondents (N = 4,462) between 18 and 65 years. We used latent profile analysis and multinomial regression analyses to identify and validate latent subgroups and test hypotheses, yielding 4 classes of perceived everyday discrimination: Low Discrimination, Disrespect and Condescension, General Discrimination, and Chronic Discrimination. Findings show significant differences exist between the Low Discrimination and General Discrimination classes for major depressive disorder, alcohol-use disorder, and illicit drug-use disorder. Moreover, we find significant differences exist between the Low Discrimination and Chronic Discrimination classes for the four disorders examined. Compared with the Chronic Discrimination class, members of the other classes were significantly less likely to meet criteria for generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder. Findings suggest elevated levels of discrimination increase risk for mood and substance-use disorders. Importantly, results suggest the prevalence of mood and substance-use disorders is a function of the type and frequency of discrimination that individuals experience.

 

Chatters, L. M., Taylor, R. J., Woodward, A. T., & Nicklett, E. J. (2015). Social support from church and family members and depressive symptoms among older African Americans. American Journal of Geriatric Psychiatry, 23(6), 559-567. PMCID: PMC4216772

Objective: This study examined the influence of church- and family-based social support on depressive symptoms and serious psychological distress among older African Americans. Methods: The analysis is based on the National Survey of American Life. Church- and family-based informal social support correlates of depressive symptoms (CES-D) and serious psychological distress (K6) were examined. Data from 686 African Americans aged 55 years or older who attend religious services at least a few times a year are used in this analysis. Results: Multivariate analysis found that social support from church members was significantly and inversely associated with depressive symptoms and psychological distress. Frequency of negative interactions with church members was positively associated with depressive symptoms and psychological distress. Social support from church members remained significant but negative interaction from church members did not remain significant when controlling for indicators of family social support. Among this sample of churchgoers, emotional support from family was a protective factor and negative interaction with family was a risk factor for depressive symptoms and psychological distress. Conclusion: This is the first investigation of the relationship between church- and family-based social support and depressive symptoms and psychological distress among a national sample of older African Americans. Overall, the findings indicate that social support from church networks was protective against depressive symptoms and psychological distress. This finding remained significant when controlling for indicators of family social support.

 

Coleman, A., O’Neil, J., Asencio, M., Caldwell, C., & Ferris, A. (2015). The role of male closeness on black adolescent male weight status in father-present versus male-kinship households. The FASEB Journal, 29(1 supp.), LB386.

NOTE: Adolescent paper

Black males from the ages of 12-19 years olds are the only adolescent group in the United States to experience a significant increase in obesity rates from 1999-2010. This rise translates into an increase in the odds of obesity prevalence of 1.05 annually. This study used the National Survey of American Life-Adolescent, a nationally representative sample of African American and Caribbean Black adolescents (n=434), to examine the relationship between male closeness and BMI in father-present and male-kinship households among Black adolescents. Obesity levels were similar between father-present (19%) and kinship households (20%). However, a greater percentage of adolescent males in male-kinship homes (68%) were normal weight than in father-present homes (60%). Male-kinship homes reported higher percentages of male closeness (49%) in comparison to father-present homes (46%). Ethnic differences were not present between households. In the initial bivariate analysis, Paternal Closeness Scores were negatively correlated with BMI in adolescent males who reported excellent relationship with a male in their life (p=.05). Yet, after accounting for age, household income, ethnicity, and participation in sports, higher male closeness was only predictive of lower BMI in kinship homessage (p=<.01). Family structure has a macro level role on obesity in Black adolescent males. Future interventions among Black adolescents should focus on male bonding as a way to reduce obesity levels.

 

DeVylder, J. E., Lehmann, M., Chen, F.-P. (2015). Social and clinical correlates of the persistence of psychotic experiences in the general population. Schizophrenia Research, 169(1-3), 286-291.

Recent epidemiological evidence suggests that sub-threshold psychotic experiences commonly occur in the general population. When these experiences persist over time, they may increase risk for psychotic disorder or lead to other clinical or functional impairments. The aims of this study were to distinguish the relative importance of sociodemographic factors and clinical factors, including characteristics of the psychotic experiences themselves, in determining the course of psychotic symptoms over time. Participants were drawn from the Collaborative Psychiatric Epidemiology Surveys. We tested for retrospectively-reported predictors of current psychotic experiences among individuals who reported lifetime psychotic experiences, with onset prior to the past year (n = 921), using logistic regression. Persistence was primarily related to demographic variables, with lower odds associated with being married and having at least a college education. Individuals reporting prior to the past year auditory hallucinations were more likely to have persistent psychotic experiences than those reporting other types of psychotic experiences. Interventions aiming at strengthening family support and social skills may reduce the likelihood of persistence among individuals with psychotic experiences, thereby reducing risk for psychotic disorders and other related outcomes. Future studies should continue to identify predictors of persistence versus remission and further explore clinical services for those with persistent psychotic experiences.

 

DeVylder, J. E., Lukens, E. P., Link, B. G., & Lieberman, J. A. (2015). Suicidal ideation and suicide attempts among adults with psychotic experiences: Data from the Collaborative Psychiatric Epidemiology Surveys. JAMA Psychiatry, 72(3), 219-225.

Importance:  Suicide is a leading cause of preventable death, especially among individuals with psychotic disorders, and may also be common among nonclinical populations of adults with subthreshold psychotic experiences. Understanding this association has the potential to critically bolster suicide prevention efforts. Objectives:  To examine the association between 12-month suicidality and 12-month psychotic experiences and to test the hypotheses that psychotic experiences are associated with increased prevalence of suicidal ideation and suicide attempts during the concurrent period and with greater severity of suicidal behavior. Design, Setting, and Participants:  Cross-sectional survey data were drawn from a large general population-based sample of households in the United States identified through the Collaborative Psychiatric Epidemiology Surveys (2001-2003). Adult household residents (n = 11,716) were selected using a clustered multistage sampling design with oversampling of racial/ethnic minority groups. Logistic regression models were adjusted for potential demographic confounders and co-occurring DSM-IV mental health conditions. Exposures:  Twelve-month psychotic experiences assessed with the Composite International Diagnostic Interview, version 3.0 psychosis screen. Main Outcomes and Measures:  Twelve-month suicidal ideation and suicide attempts.  Results: Respondents reporting psychotic experiences were more likely to report concurrent suicidal ideation (odds ratio [OR], 5.24; 95% CI, 2.85-9.62) and suicide attempts (OR, 9.48; 95% CI, 3.98-22.62). Most respondents with psychotic experiences (mean [SE], 65.2% [4.2%]) met criteria for a DSM-IV depressive, anxiety, or substance use disorder. Among respondents with suicidal ideation, those with psychotic experiences were likely to make an attempt during the concurrent 12-month period (OR, 3.49; 95% CI, 1.05-11.58) when adjusting for co-occurring psychiatric disorders. In contrast, depressive (OR, 1.67; 95% CI, 0.62-4.52), anxiety (OR, 1.57; 95% CI, 0.40-6.09), and substance use disorders (OR, 1.64; 95% CI, 0.24-11.17) did not reliably identify those at risk for attempts among respondents with suicidal ideation. The mean (SE) 12-month prevalence of suicide attempts among individuals reporting ideation and psychotic experiences and meeting criteria for any psychiatric disorder was 47.4% (10.9%) compared with 18.9% (4.8%) among those with just ideation and a disorder. Psychotic experiences were especially prevalent among individuals reporting severe attempts and may account for nearly one-third of attempts with intent to die (population attributable risk, 29.01%) in the United States annually. Conclusions and Relevance:  Assessment of psychotic experiences among individuals with suicidal ideation has potential clinical and public health utility in reducing the prevalence of suicide attempts, particularly attempts with intent to die.

 

Diette, T. M., Goldsmith, A. H., Hamilton, D., Darity Jr., W. (2015). Skin shade stratification and the psychological cost of unemployment: Is there a gradient for black females? Review of Black Political Economy, 42(1-2), 155-177.

The purpose of this paper is to formally evaluate whether the deleterious impact of unemployment on mental health increases as skin shade darkens for black women in the U.S. Using data drawn from the National Survey of American Life, we find strong evidence of a gradient on depression between skin shade and unemployment for black women. These findings are consistent with the premises of the emerging field of stratification economics. Moreover, the findings are robust to various definitions of skin shade. Unemployed black women with darker complexions are significantly more likely to suffer their first onset of depression than unemployed black females with lighter skin shade. While in some cases, lighter skinned black women appeared not to suffer adverse effects of unemployment compared to their employed counterparts, persons with dark complexions did not enjoy the same degree of protection from poor mental health.

 

Earl, T. R., Fortuna, L. R., Gao, S., Williams, D. R., Neighbors, H., Takeuchi, D., & Alegría, M. (2015). An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life. Ethnicity and Health, 20(3), 273-292.

Objective. To examine racial-ethnic differences in the endorsement and attribution of psychotic-like symptoms in a nationally representative sample of African-Americans, Asians, Caribbean Blacks, and Latinos living in the USA. Design. Data were drawn from a total of 979 respondents who endorsed psychotic-like symptoms as part of the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). We use a mixed qualitative and quantitative analytical approach to examine sociodemographic and ethnic variations in the prevalence and attributions of hallucinations and other psychotic-like symptoms in the NLAAS and NSAL. The lifetime presence of psychotic-like symptoms was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) psychotic symptom screener. We used logistic regression models to examine the probability of endorsing the four most frequently occurring thematic categories for psychotic-like experiences by race/ethnicity (n > 100). We used qualitative methods to explore common themes from participant responses to open ended questions on their attributions for psychotic-like symptoms. Results. African-Americans were significantly less likely to endorse visual hallucinations compared to Caribbean Blacks (73.7% and 89.3%, p < .001), but they endorsed auditory hallucinations symptoms more than Caribbean Blacks (43.1% and 25.7, p < .05). Endorsing delusions of reference and thought insertion/withdrawal were more prevalent for Latinos than for African-Americans (11% and 4.7%, p < .05; 6.3% and 2.7%, p < .05, respectively). Attribution themes included: supernatural, ghosts/unidentified beings, death and dying, spirituality or religiosity, premonitions, familial and other. Respondents differed by race/ethnicity in the attributions given to psychotic like symptoms. Conclusion. Findings suggest that variations exist by race/ethnicity in both psychotic-like symptom endorsement and in self-reported attributions/understandings for these symptoms on a psychosis screening instrument. Ethnic/racial differences could result from culturally sanctioned beliefs and idioms of distress that deserve more attention in conducting culturally informed and responsive screening, assessment and treatment.

 

Hayward, R. D., & Krause, N. (2015). Religion and strategies for coping with racial discrimination among African Americans and Caribbean blacks. International Journal of Stress Management, 22(1), 70-91.

This study examines the relationship between facets of religious behavior, religious identity, and church-based social support with strategies used for coping with racial discrimination. Data come from the National Survey of American Life and includes separate representative samples of African Americans (n = 2,032) and Caribbean Blacks (n = 857). Binary logistic regression was used to determine the relationship between 8 religion variables and the likelihood of using each of 7 coping strategies. Among African Americans, religious factors were related to greater likelihood of coping by using prayer, working harder, and talking the situation over with others, and had mixed effects on seeking to resolve the problem. Among Caribbean Blacks, religious factors were related to greater likelihood of coping by using prayer, seeking resolution, and working harder, with mixed effects on coping with passive acceptance, self-blame, and anger. Consumption of religious media, strength of identification with the Black church, and spirituality played the largest roles, with religiosity, church-based social support, and negative church interaction also related to coping outcomes. Results indicate that religious involvement may be associated with some potentially negative coping styles, especially among Caribbean Blacks, in addition to some positive ones. They also suggest that there may be ethnic group differences among Black Americans in terms of the influence of religion on some potentially important coping outcomes.

 

Hearld, K. R., Budhwani, H., & Chavez-Yenter, D. (2015). Panic attacks in minority Americans: The effects of alcohol abuse, tobacco smoking, and discrimination. Journal of Affective Disorders, 174, 106-112.

Background: Lifetime prevalence of panic attacks is estimated at 22.7%, and research on the correlates and causes of depression, anxiety, and other mental illnesses have yielded mixed results in minority groups. Therefore, the purpose of this study is to evaluate the relationship between panic attacks, minority status, and nativity by focusing on the effects of health lifestyle behaviors and discrimination. Methods: Multivariate analysis was performed using logistic regression, which was used to estimate the probability of meeting the criteria for panic attacks (n=17,249). Results: Demographic and socioeconomic variables had significant associations; females had over 2.4 times higher odds than males of meeting the criteria for panic attacks. The more frequently respondents were treated as dishonest, less smart, with disrespect, threatened, or called names, the more likely they met the criteria for panic attacks. Additionally, smoking and alcohol abuse were significant predictors of panic attacks. Those who abused alcohol have over 2 times the odds of having panic attacks. Similarly, smokers had 52% higher odds of panic attacks than non-smokers. Limitations: The primary limitation of this project was the lack of a true acculturation measure with a secondary limitation being the inability to determine respondents׳ legal status. Conclusions: Key findings were that health lifestyle choices and exposure to discrimination significantly affected the chance of having panic attacks. Nativity was protective; however, its effect was ameliorated by exposure to discrimination or engagement in smoking behavior or alcohol abuse. Thus, this study offers insight into contextual factors for clinicians caring for racial and ethnic minorities diagnosed with panic attacks.

 

Hudson, D. L., Purnell, J. Q., Duncan, A. E., & Baker, E. (2015). Subjective religiosity, church attendance, and depression in the National Survey of American Life. Journal of Religion and Health, 54(2), 584-597.

Studies have consistently indicated that blacks report lower rates of depression than whites. This study examined the association between religion and depression and whether religion explained lower rates of depression among blacks compared to whites. Data were drawn from the National Survey of American Life, a multi-ethnic sample of African Americans, Caribbean Blacks, and non-Hispanic whites (n = 6,082). African Americans and Caribbean Blacks reported higher mean levels of subjective religiosity than whites, but there were no significant differences in levels of church attendance. African Americans (OR 0.54; CI 0.45–0.65) and Caribbean Blacks (OR 0.66; CI 0.48–0.91) reported significantly lower odds of depression than whites. Differences in subjective religiosity and church attendance did not account for the association between major depression and African American and Caribbean Black race/ethnicity relative to whites. More research is needed to examine whether there are other factors that could protect against the development of depression.

 

Hughes, M., Kiecolt, K. J., Keith, V. M., & Demo, D. H. (2015). Racial identity and well-being among African Americans. Social Psychology Quarterly, 78(1), 25-48.

How racial identity influences self-esteem and psychological well-being among African Americans remains unresolved due to unexplained inconsistencies in theoretical predictions and empirical findings. Using data from the National Survey of American Life (N = 3,570), we tested hypotheses derived from social identity theory and the internalized racism perspective. Findings support social identity theory in showing that African Americans strongly identify with their group and view it very positively. In addition, those who identify more with their group and evaluate it more positively have greater self-esteem, greater mastery, and fewer depressive symptoms. However, findings also support the internalized racism perspective by showing that when group evaluation is relatively negative, racial identification is related to lower mastery and higher depressive symptoms. We conclude that both social identity theory and the internalized racism perspective are necessary for understanding how racial identity is related to self-attitudes and mental health among African Americans.

 

Jones, C., & Erving, C. L. (2015). Structural constraints and lived realities: Negotiating racial and ethnic identities for African Caribbeans in the United States. Journal of Black Studies, 46(5), 521-546.

This study examines the racial and ethnic identity preferences of U.S.-born and foreign-born African Caribbeans, and the extent to which social contextual factors shape and alter these identities. Using qualitative and quantitative data, we address the following questions: Are African Caribbeans more likely to exhibit an ethnic identity, a racial identity, or both? What contextual factors (i.e., socioeconomic status, social distancing, discrimination, and region) affect the way African Caribbeans identify? The results indicate that foreign-born African Caribbeans are more likely to adopt an ethnic identity while U.S.-born African Caribbeans are more likely to identify racially. In addition, discrimination was a crucial factor in the identity preferences of African Caribbeans across both the qualitative and quantitative analyses. The results of the qualitative study showed that African Caribbeans were able to negotiate between their racial and ethnic identities which were inherently shaped by residing in the Midwest.

 

Lacey, K. K., Parnell, R., Mouzon, D. M., Matusko, N., Head, D., Abelson, J. M., & Jackson, J. S. (2015). The mental health of US Black women: The roles of social context and severe intimate partner violence. BMJ Open, 5(10). PMCID: PMC4611204

Objective: Black women continue to have rates of mental health conditions that can be negative for their well-being. This study examined the contribution of social and contextual factors and severe physical intimate partner violence on the mental health of US Black women (African-American and Caribbean Black). Setting: Data were largely collected via in-person community interviews at participants’ homes. Participants: We studied 3277 African-American and Black Caribbean women from the 2001–2003 National Survey of American Life (NSAL), the largest and most complete sample of Blacks residing in the USA. Primary and secondary outcomes: Key outcomes included an array of psychiatric disorders based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Results: Bivariate results revealed noticeably high rates of any anxiety disorder, post-traumatic stress disorder, any substance disorder, alcohol abuse disorder, suicide ideation and attempts, and any overall mental disorder among African-American women relative to Caribbean Black women. Multiple social and contextual factors were associated with various mental disorders among both sets of Black women in multivariate models, with the most consistent associations found for severe physical intimate partner violence. Everyday discrimination was associated with anxiety disorders (95% AOR=2.08 CI 1.23 to 3.51), eating disorders (95% AOR=2.69 CI 1.38 to 5.22), and any disorder (95% AOR=2.18 CI 1.40 to 3.40), while neighbourhood drug problems contributed to mood (95% AOR=1.19 CI 1.04 to 1.36), substance disorders (95% AOR=1.37 CI 1.11 to 1.69) and any disorder (95% AOR=1.18 CI 1.03 to 1.34). Conclusions: Severe physical intimate partner violence, discrimination, and to a lesser extent, neighbourhood problems are important predictors of Black women's health, findings that inform intervention and clinical services tailored to meet the needs of Black women from diverse ethnic and cultural backgrounds.

 

Lacey, K. K., Sears, K. P., Govia, I. O., Forsythe-Brown, I., Matusko, N., & Jackson, J. S. (2015). Substance use, mental disorders and physical health of Caribbeans at-home compared to those residing in the United States. International Journal of Environmental Research and Public Health, 12(1), 710-734. PMCID: PMC4306888

Abstract: This study compares the health conditions of domestic Caribbeans with those living in the United States to explore how national context and migration experiences might influence substance use (i.e., alcohol or drug) and other mental and physical health conditions. The study is based upon probability samples of non-institutionalized Caribbeans living in the United States (1621), Jamaica (1216) and Guyana (2068) 18 years of age and over. Employing descriptive statistics and multivariate analytic procedures, the results revealed that substance use and other physical health conditions and major depressive disorder and mania vary by national context, with higher rates among Caribbeans living in the United States. Context and generation status influenced health outcomes. Among first generation black Caribbeans, residing in the United States for a longer length of time is linked to poorer health outcomes. There were different socio-demographic correlates of health among at-home and abroad Caribbeans. The results of this study support the need for additional research to explain how national context, migratory experiences and generation status contribute to understanding substance use and mental disorders and physical health outcomes among Caribbean first generation and descendants within the United States, compared to those remaining in the Caribbean region.

 

Lacey, K. K., Sears, K. P., Matusko, N., & Jackson, J. S. (2015). Severe physical violence and black women's health and well-being. American Journal of Public Health, 105(4), 719-724.

Objectives. We evaluated the association between intimate partner violence and the mental and physical health status of US Caribbean Black and African American women. Methods. We used 2001 to 2003 cross-sectional data from the National Survey of American Life—the most detailed study to date of physical and mental health disorders of Americans of African descent. We assessed participants’ health conditions by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Washington, DC; American Psychological Association) Composite International Diagnostic Interview. Results. We found differences in health conditions between abused African American and Caribbean Black women. There were increased risks for lifetime dysthymia, alcohol dependence, drug abuse, and poor perceived health for African American victims of partner abuse, and binge eating disorder was associated with partner violence among Caribbean Black women. Conclusions. Severe intimate partner violence was associated with negative mental and physical health outcomes for US Black women, with different patterns between African American and Caribbean Blacks. Understanding intimate partner violence experiences of US Black women requires recognition of key intragroup differences, including nativity and immigrant status, and their differential relationships to women’s health.

 

Lankarani, M. M., & Assari, S. (2015). Association between number of comorbid medical conditions and depression among individuals with diabetes; race and ethnic variations. Journal of Diabetes and Metabolic Disorders, 14, 56. PMCID: PMC4496852

Background: Medical and psychiatric comorbidities are commonly comorbid with diabetes. Race and ethnicity may, however, modify the link between medical and psychiatric comorbidities in individuals with diabetes. In this study we compared Non-Hispanic Whites, African Americans, and Caribbean Blacks with diabetes for the association between number of comorbid medical conditions and lifetime and 12-month major depressive disorder (MDD) in individuals with diabetes. Methods: Data came from the National Survey of American Life (NSAL), 2001–2003. We included 603 patients with diabetes (75 non-Hispanic Whites, 396 African Americans, and 131 Caribbean Blacks). Number of comorbid medical conditions was the independent variable, lifetime and 12-month MDD were dependent variables, and age, gender, education, marital status, employment, and body mass index were covariates. Race- and ethnic- specific logistic regressions were used to determine race and ethnic differences in the associations between number of chronic medical conditions and lifetime and 12-month MDD, while the effect of all covariates were controlled. Results: Number of chronic medical conditions was positively associated with lifetime MDD among non-Hispanic Whites (OR = 1.719, 95 % CI = 1.018 – 2.902) and African Americans (OR = 1.235, 95 % CI = 1.056– 1.445) but not Caribbean Blacks (P > .05). Number of chronic medical conditions was also associated with 12-month MDD among non-Hispanic Whites (OR = 1.757, 95 % CI = 1.119 – 2.759) and African Americans (OR = 1.381, 95 % CI = 1.175 - 1.623) but not Caribbean Blacks (P > .05). Conclusions: This study shows race- and ethnic- differences in the association between number of medical comorbidities and MDD among patients with diabetes. These findings invite researchers to study the mechanisms behind race- and ethnic- differences in vulnerability and resilience to the mental health effects of chronic medical conditions.

 

Levine, D. S., Taylor, R. J., Nguyen, A. W., Chatters, L. M., & Himle, J. A. (2015). Family and friendship informal support networks and social anxiety disorder among African Americans and black Caribbeans. Social Psychiatry and Psychiatric Epidemiology, 50(7), 1121-1133.  PMCID: PMC4466030

Background: This study explores relationships between Social Anxiety Disorder (SAD) and quality and frequency of involvement with family and friends. Methods: Data are from a nationally representative sample of African American and Black Caribbean adults (n = 5191), the National Survey of American Life. SAD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. Results: Findings indicated that among both populations, close supportive ties with family members and friends are protective against meeting criteria for SAD. Negative interactions with family (e.g., conflicts), however, are a risk factor for SAD among both African Americans and Black Caribbeans. For African Americans, an interaction indicates that the relationship between negative interaction and social anxiety is much stronger among African Americans who are not emotionally close to their families. For Caribbean Blacks, an interaction suggests that the odds of meeting criteria for SAD were higher among Black Caribbeans who had high negative interaction with family as well as low levels of friendship closeness. Limitations: The cross-sectional nature of the study does not allow for causal attributions for findings. Conclusions: This study demonstrates that SAD may impact black ethnic subgroups differently, which has important implications for understanding the nature, etiology, and treatment of this disorder.

 

Markey, E. J. (2015). The impact of caregiving on the development of major depressive disorder and generalized anxiety disorder. Journal of European Psychology Students, 6(1), 17-24.

Providing care for a relative is associated with psychological distress and a higher prevalence of psychological disorders. This study investigated the prevalence of anxiety and depressive disorders among the caregiving population. The study was based on data drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES). Binary logistic regressions were conducted to examine these associations and to identify factors influencing the development of depressive and anxiety disorders. The analysis indicated that respondents providing care for a relative were at a higher risk of developing a psychological disorder. A number of socio-demographic variables were identified as increasing the risk of developing a psychological disorder such as being younger, female and divorced. The findings highlight the importance of support and interventions for family caregivers.

 

McShall, J. R., & Johnson, M. D. (2015). The association between relationship distress and psychopathology is consistent across racial and ethnic groups. Journal of Abnormal Psychology, 124(1), 226-231. PMCID: PMC4333071

The association between intimate relationship discord and DSM–IV Axis I psychiatric disorders has been described in studies that oversampled White participants; however, the racial and ethnic differences in marital distress and divorce as well as in prevalence rates of some forms of psychopathology led us to hypothesize that the association between relationship discord and psychopathology would vary across races and ethnicities. Relationship quality and psychopathology were assessed in three national surveys (the National Comorbidity Survey Replication, the National Latino and Asian American Study, and the National Survey of American Life), for a total sample size of 10,057. We found that the log odds of being diagnosed with both narrow-band (e.g., major depressive disorder) and broad-band disorders (e.g., mood disorder) were negatively associated with relationship quality consistently across 11 different racial and ethnic groups. We discuss the implications of the cross-cultural reliability of the association between relationship discord and psychopathology in the context of etiological models and culturally competent practices.

 

Monk, E. P. (2015). The cost of color: Skin color, discrimination, and health among African-Americans. American Journal of Sociology, 121(2), 396-444.

In this study, the author uses a nationally representative survey to examine the relationship(s) between skin tone, discrimination, and health among African-Americans. He finds that skin tone is a significant predictor of multiple forms of perceived discrimination (including perceived skin color discrimination from whites and blacks) and, in turn, these forms of perceived discrimination are significant predictors of key health outcomes, such as depression and self-rated mental and physical health. Intraracial health differences related to skin tone (and discrimination) often rival or even exceed disparities between blacks and whites as a whole. The author also finds that self-reported skin tone, conceptualized as a form of embodied social status, is a stronger predictor of perceived discrimination than interviewer-rated skin tone. He discusses the implications of these findings for the study of ethnoracial health disparities and highlights the utility of cognitive and multidimensional approaches to ethnoracial and social inequality.

 

Oh, H., Abe, J., Negi, N., & DeVylder, J. (2015). Immigration and psychotic experiences in the United States: Another example of the epidemiological paradox? Psychiatry Research, 229(3), 784-790.

In Europe, it is widely established that immigration increases risk for psychotic disorder. However, research has yet to confirm this association in the United States, where immigrants paradoxically report better health status than their native-born counterparts. Further, few studies have examined this topic with respect to sub-threshold psychotic experiences, which are more common than psychotic disorders in the general population. This study analyzes the (1) National Comorbidity Survey-Replication, (2) the National Latino and Asian American Survey, and (3) the National Survey of American Life, in order to determine whether generation status had any impact on risk for lifetime and 12-month PE, and whether these associations vary across racial/ethnic groups, adjusting for demographic variables and socioeconomic status. We found an absence of an immigration effect on PE across various ethnic groups and across various geographic areas, and found that immigration is actually protective among Latinos, supporting the idea that the epidemiological paradox extends to the psychosis phenotype.

 

Rodriguez-Seijas, C., Stohl, M., Hasin, D. S., & Eaton, N. R. (2015). Transdiagnostic factors and mediation of the relationship between perceived racial discrimination and mental disorders. JAMA Psychiatry, 72(7), 706-713.

Importance:  Multivariable comorbidity research indicates that many common mental disorders are manifestations of 2 latent transdiagnostic factors, internalizing and externalizing. Environmental stressors are known to increase the risk for experiencing particular mental disorders, but their relationships with transdiagnostic disorder constructs are unknown. The present study investigated one such stressor, perceived racial discrimination, which is robustly associated with a variety of mental disorders. Objective:  To examine the direct and indirect associations between perceived racial discrimination and common forms of psychopathology. Design, Setting, and Participants:  Qualitative analysis of 12 common diagnoses that were previously assessed in a nationally representative sample (N = 5191) of African American and Afro-Caribbean adults in the United States, taken from the National Survey of American Life, and used to test the possibility that transdiagnostic factors mediate the effects of discrimination on disorders. The data were obtained from February 2001 to March 2003. Latest variable measurement models, including factor analysis, and indirect effect models were used in the study. Main Outcomes and Measures:  Mental health diagnoses from reliable and valid structured interviews and perceived race-based discrimination. Results:  While perceived discrimination was positively associated with all examined forms of psychopathology and substance use disorders, latent variable indirect effects modeling revealed that almost all of these associations were significantly mediated by the transdiagnostic factors. For social anxiety disorder and attention-deficit/hyperactivity disorder, complete mediation was found. Conclusions and Relevance:   The pathways linking perceived discrimination to psychiatric disorders were not direct but indirect (via transdiagnostic factors). Therefore, perceived discrimination may be associated with risk for myriad psychiatric disorders due to its association with transdiagnostic factors.

 

Samples, H., & Mojtabai, R. (2015). Antidepressant self-discontinuation: Results from the Collaborative Psychiatric Epidemiology Surveys. Psychiatric Services, 66(5), 455-462.

Objective: The goal of this study was to examine the extent and correlates of self-discontinuation of antidepressant medications without physician advice. Methods: Among 1,411 participants of the nationally representative Collaborative Psychiatric Epidemiology Surveys who reported using antidepressants in the past year, sociodemographic and clinical correlates of self-discontinuation of medication without physician advice or approval were examined, along with participants’ reasons for discontinuation. Results:  A total of 313 (22%) antidepressant users in the preceding year reported discontinuing their antidepressant medication without physician advice or approval. Older individuals had reduced odds of self-discontinuing antidepressants. Participants with an anxiety or substance use disorder and those prescribed an antidepressant by a provider other than a psychiatrist had higher odds of self-discontinuation. Participants with public insurance had lower odds of self-discontinuation than those with private insurance. The two most commonly reported reasons for self-discontinuation of antidepressants were side effects and experiencing no benefit from the medication.  Conclusions:  Physicians prescribing antidepressants need to clearly communicate the expected benefits of treatment, the minimum duration of use required to experience benefits, and the potential side effects of these medications, particularly to younger patients, those with anxiety disorders, and patients treated in general medical settings, all of whom have increased odds of self-discontinuation.

 

Scorza, P., Masyn, K. E., Salomon, J. A., & Betancourt, T. S. (2015). A latent transition analysis for the assessment of structured diagnostic interviews. Psychological Assessment, 27(3), 975-984.

Structured diagnostic interviews administered by lay people are commonly used to assess psychiatric disorders, including depression, in large epidemiologic studies. Many interviews utilize “gate” questions, such as screening questions, that allow interviewers to skip entire survey sections for a particular respondent, saving time and reducing respondent fatigue. However, most depression estimates based on these response data are predicated on the assumption that the gate questions function without measurement error or bias. The tenability of this assumption is questionable, and its violation could compromise the reliability and validity of those estimates of depression. In this study, we used a novel application of latent transition analysis to cross-sectional data, accounting for measurement error in different response pathways through the depression module in the World Mental Health Composite International Diagnostic Interview. The analysis included data from 19,734 participants ≥18 years of age in the Comprehensive Psychiatric Epidemiologic Surveys. The latent transition analysis, allowing for measurement error in screening questions and exclusion criteria, produced a higher estimate of the lifetime probability of experiencing depression than did the algorithm based on the Diagnostic and Statistical Manual for Mental Disorders, 4th Edition, Text Revision. This illustration of latent transition analysis applied to item-level data from a complex structured diagnostic tool with gate questions demonstrates the potential utility of an analytic approach that does not automatically assume gate questions function without measurement error. This model could also be used to probe for evidence of measurement bias in the form of differential item function when using structured diagnostic tools in different cultures and languages.

 

Smith, C. W. (2015). Ethnicity and the role of group consciousness: A comparison between African Americans and black immigrants. Politics, Groups, and Identities, 1(2), 199-220.

This article examines the role of context on the mobilization of politicized racial group consciousness among African Americans and Black immigrants. I use data from a nationally representative sample of African Americans and Black immigrants to gain a better understanding of what policy areas and political behaviors are influenced by racial group consciousness. This article, overall, not only sheds light on the circumstances under which group consciousness influences Blacks in the United States but it also provides a comparative analysis of how group consciousness influences African Americans and Black immigrants differently.

 

St. Vil, N. M. (2015). A culture of mutual support: The impact of giving and receiving of practical and emotional support on African American marital satisfaction. Journal of Family Social Work, 18(2), 78-89.

Although the literature has discussed the extensive family network ties of African Americans and its implications for marital satisfaction, few studies incorporate primarily African American samples in studies of marital satisfaction and social networks. This study draws on a sample of African American married couples from the National Survey of American Life and explores the impact of mutual support, giving and receiving of practical and emotional support, on the marital satisfaction of husbands and wives. Results from the ordinal logistic regression analyses reveal that emotional support received from family and support given to friends are significantly related to husbands’ marital satisfaction whereas emotional support received from family and negative interaction with family contributes to wives’ marital satisfaction. Research and practice implications with African American married couples are discussed.

 

Taylor, R. J., Chae, D. H., Lincoln, K. D., & Chatters, L. M. (2015). Extended family and friendship support networks are both protective and risk factors for major depressive disorder and depressive symptoms among African-Americans and black Caribbeans. Journal of Nervous and Mental Disease, 203(2), 132-140. PMCID: PMC4310769

Abstract: This study explores relationships between lifetime and 12-month Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) major depressive disorder (MDD), depressive symptoms, and involvement with family and friends within a national sample of African-American and Black Caribbean adults (n = 5191). MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview and depressive symptoms were assessed using the Center for Epidemiologic Studies–Depression subscale and the K6. Findings indicated that among both populations, close supportive ties with family members and friends are associated with lower rates of depression and MDD. For African-Americans, closeness to family members was important for both 12-month and lifetime MDD, and both family and friend closeness were important for depressive symptoms. For Caribbean Blacks, family closeness had more limited associations with outcomes and was directly associated with psychological distress only. Negative interactions with family (conflict, criticisms), however, were associated with higher MDD and depressive symptoms among both African-Americans and Black Caribbeans.

 

Torres, E. R., Sampselle, C. M., Neighbors, H. W., Ronis, D. L., & Gretebeck, K. A. (2015). Depressive symptoms and walking in African Americans. Public Health Nursing, 32(5), 381-387. PMCID: PMC4457717

Objective: Although increased frequency of physical activity is associated with fewer depressive symptoms in African-Americans, most studies do not focus on a specific type of activity. Identifying the activity can provide helpful information for designing interventions that focus on depressive symptoms. The objective of this study was to examine the odds of depressive symptoms in relation to walking in African-Americans. Design and Sample: A secondary analysis was performed on the National Survey of American Life. The sample was made up of community-dwelling African-American women (n = 1,903) and men (n = 1,075) who did not meet the DSM-IV-TR criteria for depression. Measures:
Walking was measured by self-reported frequency (i.e., never, rarely, sometimes, often). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the odds of depressive symptoms in relation to walking. Results: Women who reported often walking had lower odds for depressive symptoms than women who reported never walking (OR = 0.56, 95% CI = 0.38–0.82). Walking frequency was not related to depressive symptoms in men. Conclusions: Walking frequency is a modifiable risk factor for elevated depressive symptoms in African-American women.

 

Watkins, D. C., Assari, S., & Johnson-Lawrence, V. (2015). Race and ethnic group differences in comorbid major depressive disorder, generalized anxiety disorder, and chronic medical conditions. Journal of Racial and Ethnic Health Disparities, 2(3), 385-394.

This study tested whether race and ethnic group differences exist for lifetime major depressive disorder and/or general anxiety disorder with one or more chronic medical conditions. Data from the National Survey of American Life, which included 3570 African American, 1438 Caribbean Black, and 891 non-Hispanic White adults were analyzed. Outcomes included at least one and multiple chronic medical conditions, from a list of 14 medical conditions (e.g., arthritis, cancer, diabetes, kidney disease, stroke, heart disease, etc.). Logistic regressions were fitted to data to determine how the association between major depressive disorder, general anxiety disorder, and one or more chronic medical conditions vary across race and ethnicity. Lifetime major depressive disorder (but not lifetime general anxiety disorder) was associated with at least one chronic medical condition among African Americans and Caribbean Blacks, but not non-Hispanic Whites. Lifetime major depressive disorder was similarly associated with multiple chronic medical conditions among African Americans, Caribbean Blacks, and non-Hispanic Whites. For Caribbean Blacks, stronger associations were found between major depressive disorder and general anxiety disorder with one or more chronic medical conditions compared to African Americans and non-Hispanic Whites. Findings suggest that race and ethnicity may shape the links between comorbid psychiatric disorders and chronic medical conditions. Mental health screening of individuals with chronic medical conditions in primary health-care settings may benefit from tailoring based on race and ethnicity. More research is needed to understand why associations between physical and mental health vary among race and ethnic groups.

 

Weaver, A., Himle, J. A., Taylor, R. J., Matusko, N., & Abelson, J. M. (2015). Urban vs rural residence and the prevalence of depression and mood disorder among African American women and non-Hispanic white women. JAMA Psychiatry, 72(6), 576-583. PMCID: PMC4456259

IMPORTANCE: There is a paucity of research among African Americans and rural residents. Little is known about the association between urbanicity and depression or about the interaction of urbanicity, race/ethnicity, and sex on depression and mood disorder prevalence. OBJECTIVE: To examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month major depressive disorder (MDD) and mood disorder prevalence for African American women and non-Hispanic white women. DESIGN, SETTING, AND PARTICIPANTS: The US National Survey of American Life data were used to examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month diagnoses of DSM-IV MDD and mood disorder among female respondents, who included noninstitutionalized African American, Caribbean black, and non-Hispanic white women in the United States between February 2001 and June 2003. Participants included 1462 African American women and 341 non-Hispanic white women recruited from the South because all suburban and rural National Survey of American Life respondents resided in this region. Bivariate multiple logistic regression and adjusted prevalence analyses were performed. Urban, suburban, or rural location (assessed via Rural-Urban Continuum Codes), self-reported race/ethnicity, and sociodemographic factors (age, education, household income, and marital
status) were included in the analysis. MAIN OUTCOMES AND MEASURES: Lifetime and 12-month MDD and mood disorder assessed via the World Mental Health Composite International Diagnostic Interview. RESULTS: Compared with urban African American women, rural African American women had a significantly lower odds of meeting criteria for lifetime (odds ratio [OR], 0.39; 95%CI, 0.23-0.65) and 12-month (OR, 0.29; 95%CI, 0.18-0.46) MDD and for lifetime (F = 0.46; 95%CI, 0.29-0.73) and 12-month (F = 0.42; 95%CI, 0.26-0.66) mood disorder. However, the interaction of urbanicity and race/ethnicity suggested that rural non-Hispanic white women had a significantly higher odds of meeting criteria for lifetime (OR, 2.76; 95%CI, 1.22-6.24) and 12-month (OR, 9.48; 95%CI, 4.65-19.34) MDD and for lifetime (OR, 2.27; 95%CI, 1.06-4.87) and 12-month (OR, 5.99; 95%CI, 3.01-11.94) mood disorder than rural African American women. Adjusted prevalence analyses revealed significantly lower rates of lifetime (4.2%) and 12-month (1.5%) MDD among rural African American women than their urban counterparts (10.4%vs 5.3%; P <= .01). The same pattern was found for mood disorder, with rural African American women experiencing significantly lower rates of lifetime (6.7%) and 12-month (3.3%) mood disorder when compared to urban African American women (13.9%vs 7.6%; P <= .01) Conversely, rural non-Hispanic white women had significantly higher rates of 12-month MDD (10.3%) and mood disorder (10.3%) than their urban counterparts (3.7%vs 3.8%; P <= .01). CONCLUSIONS AND RELEVANCE: Rural residence differentially influences MDD and mood disorder prevalence among African American women and non-Hispanic white women. These findings offer a first step toward understanding the cumulative effect of rural residence and race/ethnicity on women’s depression prevalence, suggesting the need for further research in this area.

 

Woodward, A. T., Chatters, L. M., Taylor, H. O., & Taylor, R. J. (2015). Professional service use for a serious personal problem: Comparing older African Americans, black Caribbeans, and non-Hispanic whites using the National Survey of American Life. Journal of Aging and Health, 27(5), 755-774. PMCID:  PMC4486639

Objectives: Examines combinations of professionals visited for a serious personal problem. Method: The sample includes those aged 55 and above (N = 862) from the National Survey of American Life (NSAL). Latent class analysis was used to identify groups of respondents based on types of professionals visited. Multinomial logistic regression was used to identify factors associated with group membership. Results: Classes included health provider plus clergy, physician plus mental health provider, and limited provider use. Whites were more likely than African Americans to fall into the health provider plus clergy and physician plus mental health provider classes. Those with physical and emotional problems were more likely to be in the health provider plus clergy and physician plus mental health provider classes, respectively. Discussion: Most respondents were in the limited provider use class suggesting that for many problems, minimal professional help is utilized. Physicians and clergy were important across all three classes.

 

Borges, G., Orozco, R., Breslau, J., & Miller, M. (2014). An observational study of the impact of service use on suicidality among adults with mental disorders. Injury Epidemiology, 1, 29-35.

Background: It is unclear whether treatment of mental disorders reduces the probability that a) people without suicidal ideation will begin to contemplate suicide, or b) people who have thought about killing themselves (but have not attempted suicide) will go on to make an attempt.  Methods: Mental disorders, service use for emotional or substance use problems, and suicidality were assessed using the World Mental Health version of the Composite International Diagnostic Interview. Discrete-time survival analysis was used to establish the temporal priority of mental health service use and suicide-related outcomes among the 5,862 participants in the Collaborative Psychiatric Epidemiological Surveys who reported a mental disorder.  Results: Use of specialty mental health services, but not other types of services for emotional or substance use problems, was associated with an increased risk of future suicide ideation (OR = 1.27, CI = 1.01–1.60). However, respondents with a history of suicidal ideation were less likely to report a subsequent suicide attempt if they had received any type of service for emotional or substance use problems (OR = 0.62, CI = 0.46–0.83), regardless of the type of service received (i.e., it did not matter whether the service received was mental health care, general medical care, or non-health care related).  Conclusions: Among persons with frank DSM disorders and suicidal ideation, the receipt of treatment is associated with a lower rate of subsequent suicide attempts, compared with those who never received treatment, regardless of treatment provider type. Follow-up studies are a logical next step to our observational investigation.

 

Byers, A. L., Covinsky, K. E., Neylan, T. C., & Yaffe, K. (2014). Chronicity of posttraumatic stress disorder and risk of disability in older persons. JAMA Psychiatry, 71(5), 540-546. PMCID: PMC4119004

Importance:  Little is known about the association between posttraumatic stress disorder (PTSD) and disability into later life. Most studies of late-life psychiatric disorders and function have focused on depression and generalized anxiety disorder. Objectives:  To determine the association between PTSD and disability among older adults and investigate if association differs by chronicity of PTSD. Design, Setting, and Participants:  In total, 3287 participants 55 years and older (mean [SD] age, 66.0 [8.7] years, 60.1% women) involved in the Collaborative Psychiatric Epidemiology Surveys (2001-2003), including 3 aggregated, nationally representative studies (National Comorbidity Survey Replication, National Survey of American Life, and National Latino and Asian American Study). Analyses used weights and complex design-corrected statistical tests to infer generalizability to the US population. Main Outcomes and Measures:  Disability defined by 5 domains (out of role, self-care, mobility, cognition, and social) using the World Health Organization Disability Assessment Schedule. Results:  Of the 3.7% older adults who had a history of PTSD defined by DSM-IV criteria, 1.8% had persistent PTSD into later life (age of onset <55 years as well as a recent diagnosis). Frequency of any disability was 79.7% for persistent PTSD, 69.6% for pre–late life (age of onset <55 years and age at last diagnosis <55 years), and 36.9% for no PTSD (P < .001). In logistic regression analyses, adjusting for demographics, smoking, individual medical conditions, depression, generalized anxiety disorder, and substance use disorders, respondents with persistent PTSD were 3 times more likely to have any disability than were respondents with no PTSD (odds ratio, 3.18; 95% CI, 1.32-7.64). Global disability results were nonsignificant for pre–late life relative to no PTSD (odds ratio, 1.99; 95% CI, 0.97-4.08). Conclusions and Relevance:  Disability in older Americans is strongly associated with PTSD, particularly PTSD that persists into later life. These findings suggest that monitoring and treatment of PTSD are important over the long term.

 

Carlisle, S. K. (2014). Disaggregating race and ethnicity in chronic health conditions: Implications for public health social work. Social Work in Public Health, 29(6), 616-628.

This study examines the ethnic subgroup variation in chronic health by comparing self-reports of chronic conditions across diverse ethnic subgroups of Asian American (Vietnamese, Filipino, Chinese), Latino American (Cuban, Portuguese, Mexican), and African Caribbean (Haitian, Jamaican, Trinidadian/Tobagonian) respondents. This analysis utilizes linked data from the Collaborative Psychiatric Epidemiology Surveys (CPES). Logistic regression revealed significant subgroup differences in reports of chronic respiratory, cardiovascular, and pain conditions across nine ethnic subgroups masked by racial categorization. Findings suggest that precautions must be taken by public health social workers as there may be far more ethnic heterogeneity than is apparent among broad racial categories.

 

Clark, T. (2014). Perceived discrimination, depressive symptoms, and substance use in young adulthood. Addictive Behaviors, 39(6), 1021-1025. PMCID: PMC4020515

Perceived discrimination is an important health-related stressor. As suggested by the stress-coping model, substance use often serves as a means to reduce the negative effects of perceived discrimination. This study uses data from the National Survey of American Life-Adults to examine the structural relationship of perceived discrimination and depressive symptoms with lifetime and recent substance use among African American and African Caribbean young adults. Respondents (N = 1,910) were18–35 years old. Compared with African Caribbeans, African Americans report significantly higher levels of depressive symptoms and both lifetime and recent substance use. Multiple-group structural equation modeling is used to evaluate model fit and test hypothesized models. Results show good fit of the hypothesized models in both African Americans and African Caribbeans. Full measurement and structural invariance is found across ethnicity. Mediation models explain 18.5% and 47.4% of the variance in lifetime substance use for African Americans and African Caribbeans, respectively, and 23.5% and 35.0% of the variance in recent substance use for African Americans and African Caribbeans, respectively. Mediation tests indicate depressive symptoms partially mediate the relationship between perceived discrimination and lifetime substance use and fully mediated this relationship for recent substance use. This study is the first to demonstrate a positive association between perceived racial discrimination and substance use among African Caribbean young adults. Study findings illuminate the influence of perceived discrimination on substance use and the mechanisms of this relationship among African American and African Caribbean young adults.

 

Dagadu, H. E., & Christie-Mizell, A. (2014). Heart trouble and racial group identity: Exploring ethnic heterogeneity among black Americans. Race and Social Problems, 6(2), 143-160.

Heart disease is the leading cause of death among men and women in the United States, and compared to other racial and ethnic groups, Blacks between the ages of 45 and 65 have the highest likelihood of dying from heart disease. Nevertheless, relatively little is known about intragroup variation among the US Black population. In this study, utilizing a nationally representative sample of Black Americans, we examine the relationship between heart trouble and racial group identity for two groups of Blacks: African Americans and Caribbean Blacks. We include two measures of racial group identity: closeness to other Blacks and Black group evaluation. Our results reveal three important patterns. First, closeness to other Blacks is suppressed by Black group evaluation. Second, at low levels of closeness to other Blacks, there is little difference between African Americans and Caribbean Blacks in the probability of heart trouble. However, as closeness to other Blacks increases, the probability of heart trouble increases for African Americans, but decreases for Caribbean Blacks. Finally, with respect to positive Black group evaluation, both African Americans and Caribbean Blacks benefit and experience a lower probability of heart trouble.

 

DeVylder, J. E., Burnette, D., & Yang, L.H. (2014). Co-occurrence of psychotic experiences and common mental health conditions across four racially and ethnically diverse population samples. Psychological Medicine, 44(16), 3503-3513.

Background: Prior research with racially/ethnically homogeneous samples has demonstrated widespread co-occurrence of psychotic experiences (PEs) and common mental health conditions, particularly multi-morbidity, suggesting that psychosis may be related to the overall severity of psychiatric disorder rather than any specific subtype. In this study we aimed to examine whether PEs are associated with the presence of specific disorders or multi-morbidity of co-occurring disorders across four large racially/ethnically diverse samples of adults in the USA. Method: Data were drawn from the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL) and separately from the Asian and Latino subsamples of the National Latino and Asian American Study (NLAAS). Logistic regression models were used to examine the relationship between PEs and individual subtypes of DSM-IV disorder, and to test for a linear dose–response relationship between the number of subtypes and PEs. Results: Prevalence of PEs was moderately greater among individuals with each subtype of disorder in each data set [odds ratios (ORs) 1.8–3.8], although associations were only variably significant when controlling for clinical and demographic variables. However, the sum of disorder subtypes was related to odds for PEs in a linear dose–response fashion across all four samples. Conclusions: PEs are related primarily to the extent or severity of psychiatric illness, as indicated by the presence of multiple psychiatric disorders, rather than to any particular subtype of disorder in these data. This relationship applies to the general population and across diverse racial/ethnic groups.

 

Garrido, M. M., & Boockvar, K. S. (2014). Perceived symptom targets of antidepressants, anxiolytics, and sedatives: The search for modifiable factors that improve adherence. Journal of Behavioral Health Services & Research, 41(4), 529-538.  PMCID: PMC3883894

Expectations about treatment and beliefs about illness influence adherence in physical disorders, but the extent to which this occurs in mood disorders is unknown. Identifying modifiable factors, such as beliefs, may improve adherence to mood disorder medications. Data from the Collaborative Psychiatric Epidemiology Surveys were used to examine relationships among perceived symptom targets of medication (mood only, non-mood only, mood, and non-mood) and self-reported adherence to antidepressants, anxiolytics, and sedatives. The sample included 807 community-dwelling individuals with and without depression and anxiety who regularly took one of these medications in the year before the survey. Slightly over half (53.2 %) of respondents were adherent. Perceived medication purpose was only significantly related to adherence among Latino respondents. Latino respondents who viewed their symptom target as non-mood only were the most adherent. Perceived symptom targets of medications were not associated with most patients' adherence behaviors for antidepressants, anxiolytics, and sedatives.

 

Hughes, M., Kiecolt, K. J., & Keith, V. M. (2014). How racial identity moderates the impact of financial stress on mental health among African Americans. Society and Mental Health, 4(1), 38-54.

Financial stress, which is common among African Americans, has been linked to higher psychological distress. This study examines whether racial identity moderates the association of financial stress with depressive symptoms. If so, through what mechanisms does it operate? We investigated these questions in a moderated mediation analysis, using data from the National Survey of American Life (N = 3,570). Of the two racial identity dimensions examined, positive group evaluation but not closeness to other African Americans was associated with less adverse effects of financial stress on depressive symptoms. In addition, we tested two mechanisms that could explain the buffering effect. Psychological resources (self-esteem and, less consistently, mastery), explained 26% to 46% of the buffering effects of racial identity; family support explained 8%. That is, positive group evaluations fortify African Americans in the face of hard times. They do so primarily through their association with a greater sense of self-worth.

 

Hughes, A. K., Woodward, A. T., & Velez-Ortiz, D. (2014). Chronic illness intrusion: Role impairment and time out of role in racially and ethnically diverse older adults. The Gerontologist, 54(4), 661-669.

Purpose of the study: Little is known about the effects of chronic illness on social role participation among racially and ethnically diverse older adults. This study was undertaken to better understand disruptions in role among African American, black Caribbean, white, Latino, and Asian older adults with arthritis, heart disease, or diabetes. Design and methods: This study consisted of a cross-sectional secondary data analysis of the Collaborative Psychiatric Epidemiology Surveys. Role disruption was operationalized using time out of role and role impairment in the past 30 days. Data from participants aged 65 and older were used in negative binomial regression analyses. Results: Overall, prevalence of role impairment occurred more often than time out of role. Race and ethnicity were not associated with time out of role, but they were for role impairment. Whites experienced more role impairment than any other racial or ethnic group. Within-group analyses identified that chronic illness, role participation, and socioeconomic factors are related in different ways depending on race or ethnicity. It appears that for some racially and ethnically diverse older adults, higher income and education are protective against role disruption. Implications: Race and ethnicity are factors in how the social roles of older adults are affected by chronic illness, and it appears that role disruption varies with type of illness. Interventions to support older adults with chronic illness should take into account the cultural factors related to role disruption.

 

Kim, G., Parton, J. M., Ford, K.-L., Bryant, A. N., Shim, R. S., & Parmelee, P. (2014). Geographic and racial-ethnic differences in satisfaction with and perceived benefits of mental health services. Psychiatric Services, 65(12), 1474-1482. PMCID: PMC4329273

Objective:  This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. Methods:  Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. Results:  In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. Conclusions:  The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.


Lee, H., Wildeman, C., Wang, E. A., Matusko, N., & Jackson, J. S. (2014). A heavy burden: The cardiovascular health consequences of having a family member incarcerated. American Journal of Public Health, 104(3), 421-427. PMCID: PMC3953802

Objectives. We examined the association of family member incarceration with cardiovascular risk factors and disease by gender. Methods. We used a sample of 5470 adults aged 18 years and older in the National Survey of American Life, a 2001–2003 nationally representative crosssectional survey of Blacks and Whites living in the United States, to examine 5
self-reported health conditions (diabetes, hypertension, heart attack or stroke, obesity, and fair or poor health). Results. Family member incarceration was associated with increased likelihood of poor health across all 5 conditions for women but not for men. In adjusted models, women with family members who were currently incarcerated had 1.44 (95% confidence interval [CI] = 1.03, 2.00), 2.53 (95% CI = 1.80, 3.55), and 1.93 (95% CI = 1.45, 2.58) times the odds of being obese, having had a heart attack or stroke, and being in fair or poor health, respectively. Conclusions. Family member incarceration has profound implications for women’s cardiovascular health and should be considered a unique risk  factor that contributes to racial disparities in health.

 

Levine, D. S., Himle, J. A., Abelson, J. M., Matusko, N., Dhawan, N., Taylor, R. J. (2014). Discrimination and social anxiety disorder among African-Americans, Caribbean blacks, and non-Hispanic whites. Journal of Nervous and Mental Disease, 202(3), 224-230.

The present study investigated the relationship between discrimination and social anxiety disorder (SAD) in a sample of African-Americans, Caribbean blacks, and non-Hispanic whites using the National Survey of American Life, the most comprehensive study of psychopathology among American blacks to date (N = 6082). Previous work has highlighted a strong association between discrimination and mental health symptoms (Keith, Lincoln, Taylor, and Jackson [Sex Roles 62:48–59, 2010]; Kessler, Mickelson, and Williams [J Health Soc Behav 40:208–230, 1999]; Soto, Dawson-Andoh, and BeLue [J Anxiety Disord 25:258–265, 2011]). However, few studies have examined the effects of particular types of discrimination on specific anxiety disorders or among different black subgroups. In this study, logistic regression analyses indicated that everyday but not major experiences of discrimination are associated with SAD for African-Americans, Caribbean blacks, and non-Hispanic whites. This study adds to the extant literature by demonstrating that specific types of discrimination may be uniquely associated with SAD for different ethnic/racial groups.

 

Lincoln, K. D., Abdou, C., & Lloyd, D. (2014). Race and socioeconomic differences in obesity and depression among black and non-Hispanic white Americans. Journal of Health Care for the Poor and Underserved, 25(1), 257-275.

Obesity and depression often co-occur; however, the association between these conditions is poorly understood, especially among racial/ethnic minority groups. Using multinomial logistic regression and data from the National Survey of American Life, the relationships between race, ethnicity, and sociodemographic factors to the joint classification of body mass index categories and depression among African Americans, Caribbean Blacks, and non-Hispanic Whites were examined. Differential risk for the combination of obesity and depression by sociodemographic status was found. Being African American, female, young, married, or having low income or education increases the risk for obesity without depression. Risk factors for obesity with depression include being female, young, married and having a low income. Race was not a significant predictor of obesity with depression relative to normal weight without depression status. However, racial differences were observed among the non-depressed. Non-depressed African Americans were more likely than non-depressed Whites or Caribbean Blacks to be obese.

 

Monk Jr., E. P. (2014). Skin tone stratification among black Americans, 2001-2003. Social Forces, 92(4), 1313-1337.

In the past few decades, a dedicated collection of scholars have examined the matter of skin tone stratification within the black American population and found that complexion has significant net effects on a variety of stratification outcomes. These analyses relied heavily on data collected between 1950 and 1980. In particular, many scholars have utilized the National Survey of Black Americans (1979–1980). This leaves the question of whether or not the effect of skin tone on stratification outcomes remains decades later. Newly available data from the National Survey of American Life (2001–2003) are used to examine this question. I find that skin tone is significantly associated with Black Americans' educational attainment, household income, occupational status, and even the skin tone and educational attainment of their spouses. Consequently, this study demonstrates that skin tone stratification among Black Americans persists into the 21st century. I conclude by discussing the implications of these findings for the study of ethnoracial inequality in the United States and beyond.

 

Mouzon, D. M. (2014). Relationships of choice: Can friendships or fictive kinships explain the race paradox in mental health? Social Science Research, 44, 32-43.

African Americans typically exhibit similar or better mental health outcomes than whites, an unexpected pattern given their disproportionate exposure to psychosocial stressors. The “race paradox in mental health” has been attributed to presumed stronger social ties among blacks but there is scarce empirical research in this regard. Using data from the 2001-2003 National Survey of American Life (N = 4,086), I test whether more abundant and higher quality friendships and fictive kin relationships among African Americans (if they exist) account for the race paradox in mental health. I find few race differences in the quantity and quality of friendships and fictive kinships and these differences did not explain the race paradox in mental health. Future research should investigate other potential resilience mechanisms among African Americans to explain their relatively positive mental health outcomes.

 

Oh, H., Yang, L. H., Anglin, D. M., & DeVylder, J. E. (2014). Perceived discrimination and psychotic experiences across multiple ethnic groups in the United States. Schizophrenia Research, 157(1-3), 259-265.

Objective: The objective of this study was to examine the relationship between perceived discrimination and psychotic experiences (PE) using validated measures of discrimination and a racially/ethnically diverse population-level sample. Methods: Data were drawn from two population-level surveys (The National Latino and Asian American Survey and The National Survey of American Life), which were analyzed together using survey weights and stratification variables. The analytic sample (N = 8990) consisted of Latino, Asian, African–American, and Afro-Caribbean adults living in the United States. Separate unadjusted and adjusted multivariable logistic regression models were used, first to examine the crude bivariate relationship between perceived discrimination and PE, and second to examine the relationship adjusting for demographic variables. Adjusted logistic regression models were also used to examine the relationships between perceived discrimination and specific sub-types of PE (auditory and visual hallucinatory experiences, and delusional ideation). Results: When compared to individuals who did not report any discrimination, those who reported the highest levels of discrimination were significantly more likely to report both 12-month PE (Adjusted OR = 4.590, p < 0.001) and lifetime PE (adjusted OR = 4.270, p < 0.001). This held true for visual hallucinatory experiences (adjusted OR = 3.745, p < 0.001), auditory hallucinatory experiences (adjusted OR = 5.649, p < 0.001), and delusional ideation (adjusted OR = 7.208, p < 0.001). Conclusion: Perceived discrimination is associated with the increased probability of reporting psychotic experiences in a linear Fashion in the US general population.

 

Peterson, T. L., Chatters, L. M., Taylor, R. J., & Nguyen, A. W. (2014). Subjective well-being of older African Americans with DSM IV psychiatric disorders. Journal of Happiness Studies, 15(5), 1179-1196. PMCID: PMC4198057

This study examined demographic and mental health correlates of subjective well-being (i.e., life satisfaction, happiness) using a national sample of older African Americans with psychiatric disorders. We used a subsample of 185 African Americans, 55 and older with at least one of thirteen lifetime psychiatric disorders from The National Survey of American Life: Coping with Stress in the Twenty-first Century. The findings indicated that among this population of older adults who had a lifetime psychiatric disorder, having a lifetime suicidal ideation was associated with life satisfaction but not happiness. Further, having a 12-month anxiety disorder or a lifetime suicidal ideation was not associated with happiness. Having a 12-month mood disorder, however, was negatively associated with an individual’s level of happiness, as well as their life satisfaction. Additionally, there were two significant interactions. Among men, employment was positively associated with life satisfaction, and marriage was associated with higher levels of happiness among men but not women. The overall pattern of findings reflects both similarities and departures from prior research confirming that well-being evaluations are associated with multiple factors.

 

Raposo, S., El-Gabalawy, R., Erickson, J., Mackenzie, C. S., & Sareen, J. (2014). Associations between anxiety disorders, suicide ideation, and age in nationally representative samples of Canadian and American adults. Journal of Anxiety Disorders, 28(8), 823-829.

Suicidal behaviors are of significant concern for the individuals displaying such behavior and for service providers who encounter them. Using nationally representative samples of Canadian and American adults, we aimed to examine: Whether age moderated the relationship between having any anxiety disorder and suicide ideation (SI), the prevalence of SI among younger and older adults, and whether age and individual anxiety disorders were differentially associated with SI. Age moderated the relationship between any anxiety disorder and SI among Americans only. Past-year SI was less prevalent among older, compared to younger, adults; Though, nearly every anxiety disorder was associated with increased odds of SI among younger and older Canadian and American adults after controlling for covariates. Effect sizes were particularly large for older American adults, but were coupled with large confidence intervals. Findings contribute to a growing literature suggesting that SI in the context of anxiety is a highly prevalent and complex mental health problem across the adult lifespan.

 

Robinson, M. A., & Cheng, T. C. (2014). Exploring physical health of African Americans: A social determinant model. Journal of Human Behavior in the Social Environment, 24(8), 899-909.

The objective was to examine the relationships between socioeconomic, structural, community, and individual factors and health outcomes of African Americans in the United States using a modified version of the social determinants of health model in a nationally representative sample of 2,926 non-elderly African American adults. This empirical evidence supports the hypothesis that there is a positive relationship between socioeconomic/structural determinants and health outcomes of African Americans. Results show poor housing and low income contribute to poorer health outcomes; therefore, in order to improve the health outcome, programs are needed that provide their residents with adequate and safe housing and employment. Moreover, local, state, and federal governmental entities need to work together to rebuild and revitalize the housing in African American communities.

 

Rose, T., Joe, S., Shields, J., & Caldwell, C. H. (2014). Social integration and the mental health of black adolescents. Child Development, 85(3), 1003-1018.

NOTE: ADOLESCENT PAPER!

The influence of family, school, and religious social contexts on the mental health of Black adolescents has been understudied. This study used Durkheim's social integration theory to examine these associations in a nationally representative sample of 1,170 Black adolescents, ages 13–17. Mental health was represented by positive and negative psychosocial well-being indicators. Results showed that adolescents' integration into family and school were related to better mental health. In addition, commitment to religious involvement positively influenced mental health. Although the direct effect of religious involvement was inversely related to mental health, mediation analyses revealed a positive influence through religious commitment. Findings suggest a greater emphasis on all three social contexts when designing strategies to improve the mental health of Black adolescents.

 

Simning, A., Conwell, Y., Mohile, S. G., & van Wijngaarden, E. (2014). The moderating effect of age on the 12-month prevalence of anxiety and depressive disorders in adults with a lifetime history of cancer. American Journal of Geriatric Psychiatry, 22(12), 1399-1409. PMCID: PMC3968240

Objective: To determine how age may modulate the association of a history of cancer with a 12-month history of anxiety and depressive disorders. Methods: The authors used population-based, cross-sectional surveys, the Collaborative Psychiatric Epidemiology Surveys. These surveys were conducted in the United States in 2001–2003 and included 16,423 adult participants, of whom 702 reported a cancer history. The Composite International Diagnostic Interview evaluated the presence of a 12-month history of anxiety and depressive disorders. Results: Among those with a cancer history, older adults (≥60 years old) were less likely than younger adults (18–59 years old) to have a 12-month history of an anxiety or depressive disorder. Compared with their peers without cancer, younger adults with a cancer history had more anxiety (23.8% versus 13.9%) and depressive (16.0% versus 9.5%) disorders, whereas older adults with a cancer history had lower levels of anxiety (3.7% versus 6.3%) and depressive (1.9% versus 3.9%) disorders. In multivariable modeling, there was a statistically significant interaction between age group and cancer history, with the risk for anxiety and depressive disorders elevated in the younger age group with a cancer history (odds ratio: 5.84 and odds ratio: 6.13, respectively) but decreased in the older age group with a cancer history (odds ratio: 0.55 and odds ratio: 0.45, respectively). Conclusion: The authors' findings suggest a considerable age-dependent variation with regard to anxiety and depressive disorders in adults with a cancer history. Investigation of the mechanisms contributing to this apparent age differential in risk could have important mental illness treatment implications in this population.

 

Smith, C. W. (2014).  Black Mosaic: The Politics of Black Pan-Ethnic Diversity. New York, NY: New York University Press.

Historically, Black Americans have easily found common ground on political, social, and economic goals. Yet, there are signs of increasing variety of opinion among Blacks in the United States, due in large part to the influx of Afro-Latino, Afro-Caribbean, and African immigrants to the United States. In fact, the very definition of “African American” as well as who can self-identity as Black is becoming more ambiguous. Should we expect African Americans’ shared sense of group identity and high sense of group consciousness to endure as ethnic diversity among the population increases? In Black Mosaic, Candis Watts Smith addresses the effects of this dynamic demographic change on Black identity and Black politics. Smith explores the numerous ways in which the expanding and rapidly changing demographics of Black communities in the United States call into question the very foundations of political identity that has united African Americans for generations. African Americans’ political attitudes and behaviors have evolved due to their historical experiences with American Politics and American racism. Will Black newcomers recognize the inconsistencies between the American creed and American reality in the same way as those who have been in the U.S. for several generations? If so, how might this recognition influence Black immigrants’ political attitudes and behaviors? Will race be a site of coalition between Black immigrants and African Americans? In addition to face-to-face interviews with African Americans and Black immigrants, Smith employs nationally representative survey data to examine these shifts in the attitudes of Black Americans. Filling a significant gap in the political science literature to date, Black Mosaic is a groundbreaking study about the state of race, identity, and politics in an ever-changing America.

 

Sullivan, S. M., Brashear, M. M., Broyles, S. T., & Rung, A. L. (2014). Neighborhood environments and obesity among Afro-Caribbean, African American, and Non-Hispanic white adults in the United States: Results from the National Survey of American Life. Preventive Medicine, 61, 1-5.

Objective: To examine possible associations between perceived neighborhood environments and obesity among a U.S. nationally representative sample of Afro-Caribbean, African American, and Non-Hispanic white adults. Methods: Data was used from the 2001-2003 National Survey of American Life (NSAL). All measures including neighborhood characteristics, height, and weight were self-reported. Multivariate logistic regression was used to compute ORs of obesity (BMI ≥ 30 kg/m2) based on perceived neighborhood physical and social characteristics. Results: The odds of obesity were significantly lower for adults who reported involvement in clubs, associations, or help groups (OR: 0.62; 95% CI: 0.44, 0.85) and perceived that they had a park, playground, or open space in their neighborhood (OR: 0.68; 95% CI: 0.47, 0.98). These associations remained significant after adjusting for leisure-time physical activity. Race/ethnicity appeared to modify the association between involvement in clubs, associations, or help groups and obesity. Conclusions: Providing parks, playgrounds, or open space or increasing the perception of those amenities may assist in the prevention of obesity, especially in ethnically diverse neighborhoods in the United States. More research is needed to investigate how perceptions of the neighborhood environment influence obesity and whether perceptions of the neighborhood environment differ between individuals within the same neighborhoods.

 

Taylor, R. J., Chatters, L. M., & Brown, R. K. (2014). African American religious participation. Review of Religious Research, 56(4), 513-538. PMCID: PMC4285628

This study examines the socio-demographic correlates of religious participation using data from the African American sub-sample of the National Survey of American Life (NSAL, 2001–2003). Twelve indicators of organizational religiosity, non-organizational religiosity, subjective religiosity, religious non-involvement and religious identity are examined. Both standard (e.g., age, gender) and novel (e.g., incarceration history, military service, welfare history, co-habitation, remarriage) demographic variables are utilized. Female gender, older age, being in a first marriage and Southern residency are consistently associated with higher religious involvement. Three significant differences between urban Southerners and rural Southerners indicate that rural Southerners were more likely to be official members of their church, read religious materials more frequently, and felt that religion was more important in their home during childhood than their urban Southern counterparts. Persons in cohabiting relationships and those who have been incarcerated report lower levels of organizational religious participation and feel less close to religious people (but are similar to their counterparts for non-organizational and subjective religiosity). Persons with previous military service read religious materials, pray, and request prayer from others less frequently (but are similar to their counterparts for organizational and subjective religiosity). Findings suggest that for stigmatized life circumstances (incarceration and cohabitation), social processes within religious institutions may inhibit organizational religious participation. This study contributes to the broader literature by focusing on subgroup differences in diverse forms of religious involvement within a large and nationally representative sample of African Americans and provides a more nuanced portrait of African American religious participation.

 

Taylor, R. J., Forsythe-Brown, I., Taylor, H. O., & Chatters, L. M. (2014). Patterns of emotional social support and negative interactions among African American and black Caribbean extended families. Journal of African American Studies, 18(2), 147-163. PMCID: PMC4286156

This study examines patterns of emotional support and negative interaction (i.e., criticism, conflict) from extended family members using data on African Americans and Caribbean Blacks from the National Survey of American Life. A pattern variable was constructed that describes four types of extended family networks: (1) high emotional support and high negative interaction (ambivalent), (2) high emotional support and low negative interaction (optimal), (3) low emotional support and low negative interaction (estranged) and (4) low emotional support and high negative interaction (strained). Multi-nominal logistic regression was used to investigate the sociodemographic and familial (e.g., frequency of family contact) correlates of the patterns of extended family networks. Family closeness and contact, as well as gender, age and marital status were associated with extended family network types. Optimal family networks were associated with higher levels of family contact and closeness; women, younger adults and unmarried persons were more likely than their counterparts to have more advantageous extended family networks. Overall, findings for African Americans and Caribbean Blacks revealed both important similarities (e.g., gender, marital status, family closeness and contact) and differences (e.g., age) in the sociodemographic and familial correlates of diverse extended family networks.

 

Unnever, J. D. (2014). A Theory of African American Offending: A test of core propositions. Race and Justice, 4(2), 98-123.

Analyzing the National Survey of American Life, which includes 3,570 Blacks, this research is the first to test core hypotheses of Unnever and Gabbidon’s Theory of African American Offending. A core assertion of Unnever and Gabbidon’s theory, which specifically and only focuses on Blacks, is that their offending is associated with the degree to which they encounter racial injustices. This article focuses on two forms of racial injustice that are prominently highlighted by Unnever and Gabbidon—racial discrimination and racist stereotypes. The results reveal that Blacks who experience racial discrimination and “buy into” the pejorative stereotype that they are violent are more likely to offend, as they experience heightened states of low self-control, anger, and depression. The data also show that experiences with racial injustices increase the likelihood that Blacks will become dependent on substances/alcohol. These findings were generated while including other correlates of arrests, including demographic characteristics, whether Blacks identify with other Blacks, the number of relatives in jail or prison, and strength of family bonds. The theoretical importance of these findings is discussed.

 

Uzogara, E. E., Lee, H., Abdou, C. M., & Jackson, J. S. (2014). A comparison of skin tone discrimination among African American men: 1995 and 2003. Psychology of Men and Masculinity, 15(2), 201-212. PMCID: PMC4365794

This study investigated perceptions of skin tone discrimination among adult African American men. Research has suggested that through negative African American stereotypes, out-group members (Whites) perceive light-skinned African Americans favorably and dark-skinned African Americans unfavorably. However, it is unclear how treatment by in-group members (other African Americans) uniquely affects men. Using data from the 1995 Detroit Area Study and the 2003 National Survey of American Life, we investigated these relationships among African American men representing a wide range of socioeconomic groups. We found that African American men’s perceptions of out-group and in-group treatment, respectively, were similar across time. Light-skinned men perceived the least out-group discrimination while dark-skinned men perceived the most out-group discrimination. In appraisals of skin tone discrimination from in-group members, medium-skinned men perceived the least discrimination, while both light- and dark-skinned men perceived more in-group discrimination. Additionally, men of lower social economic groups were more affected by skin tone bias than others. Future research should explore the influence of these out- and in-group experiences of skin tone discrimination on social and psychological functioning of African American men.

 

Villatoro, A. P., & Aneshensel, C. S. (2014). Family influences on the use of mental health services among African Americans. Journal of Health and Social Behavior, 55(2), 161-180. PMCID: PMC4395552

We examine how families influence mental health service (MHS) utilization among African Americans by drawing on the concept of family ambivalence, which encompasses both family support and stress, and by placing utilization within the context of family histories of psychiatric disorder and treatment. Data are from the 2001–2003 National Survey of American Life, a nationally representative sample of African American adults (n = 3,149), including a clinical need subsample (n = 605) of respondents with a disorder. Negative family interactions have indirect positive effects on use of any MHS through need for care, whereas family social support lacks any effect. Although poor self-rated mental health (SRMH) is associated with greater utilization of any and specialty MHS given family histories of no disorder or treated disorder, utilization is low given a family history of untreated disorder, irrespective of SRMH. Screening for family histories of psychiatric disorder in primary care is recommended.

 

Williams, S.-L., L. (2014). Mental health service use among African-American emerging adults, by provider type and recency of use. Psychiatric Services, 65(10), 1249-1255. PMCID: PMC4183708

Objective:  This study examined factors associated with mental health service utilization among African-American emerging adults, specifically, when services were used (recency) and the types of providers visited (mental health versus non–mental health). Methods:  Guided by the behavioral model for vulnerable populations, secondary analysis of responses to the National Survey of American Life (2001–2003) was conducted. A nationally representative sample of African-American emerging adults, ages 18–29 (N=806), were assessed with the Composite International Diagnostic Interview. “Evaluated need” was determined by endorsement of mood, anxiety, substance use, or impulse control diagnoses. Respondents who reported a need for services for emotional or substance use problems were considered to have a “perceived need.” Those who reported voluntary use of mental health or general medical services to address these problems were considered to have utilized services. Results:  Twenty-five percent of the sample utilized services in their lifetime, whereas 9% utilized services in the past 12 months. Females were more likely than males to utilize services in three of the four service use categories (lifetime, mental health sector, and non–mental health sector). Respondents with an evaluated need for services were two to 12 times more likely to have used services compared with those without a need for them. Conclusions:  Little is known about why African-American emerging adults underutilize mental health services. Being female and having an evaluated need for services were associated with greater odds of service use, which would suggest the need for additional examination of gender differences in service utilization and greater mental health outreach and education among African-American males.

Agyemang, A. A., Mezuk, B., Perrin, P., & Rybarczyk, B. (2014). Quality of depression treatment in black Americans with major depression and comorbid medical illness. General Hospital Psychiatry, 36(4), 431-436. PMCID: PMC4141460

Objective: To evaluate how comorbid type 2 diabetes (T2DM) and hypertension (HT) influence depression treatment and to assess whether these effects operate differently in a nationally-representative community-based sample of Black Americans. Methods: Data came from the National Survey of American Life (N=3,673), and analysis is limited to respondents who met lifetime criteria for major depression (MD) (N=402). Depression care was defined according to American Psychiatric Association (APA) guidelines and included psychotherapy, pharmacotherapy, and satisfaction with services. Logistic regression was used to examine the effects of T2DM and HT on quality of depression care. Results: Only 19.2% of Black Americans with MD alone, 7.8% with comorbid T2DM, and 22.3% with comorbid HT reported APA guideline-concordant psychotherapy or antidepressant treatment. Compared to respondents with MD alone, respondents with MD + T2DM/HT were no more or less likely to receive depression care. Respondents with MD + HT + T2DM were more likely to report any guideline-concordant care (OR=3.32 95% CI [1.07, 10.31]). Conclusions:  Although individuals with MD and comorbid T2DM + HT were more likely to receive depression care, guideline-concordant depression care is low among Black Americans, including those with comorbid medical conditions.

Ahmed, A. O., Buckley, P. F., & Mabe, P. A. (2012). Latent structure of psychotic experiences in the general population. Acta Psychiatrica Scandinavica, 125(1), 54-65.

Objective:  There have been increasing pressures to adopt or incorporate dimensional representations in various sections of DSM-5 including the psychotic disorders section. Thus far, findings offered as evidence of a continuous distribution of psychosis are limited given their exclusive focus on the manifest rather than latent structure of psychotic experiences. The current study sought to determine whether or not psychotic experiences possess a taxonic or dimensional latent structure. Method:  We investigated the latent structure of psychotic experiences in the Collaborative Psychiatric Epidemiological Surveys (CPES) and the National Comorbidity Survey (NCS). We analyzed responses of participants in these surveys with three multivariate taxometric procedures (MAMBAC, MAXEIG, and L-Mode) after summing responses on the surveys into three indicators of positive psychosis. Results:  Taxometric results tended to support a dimensional, rather than taxonic structure for psychotic experiences. In the CPES, all taxometric methods produced graphical and numerical support for a dimensional structure. In the NCS, MAMBAC appeared to slightly support a taxonic structure, whereas MAXEIG and L-Mode supported a dimensional structure. Conclusion:  There appears to be a dimensional distribution of psychotic experiences in the general population. This supports the incorporation of dimensional representations of psychotic symptoms in the current diagnostic system.

Ahmed, A. O., Green, B. A., Clark, C. B., Stahl, K. C., & McFarland, M. E. (2011). Latent structure of unipolar and bipolar mood symptoms. Bipolar Disorders, 13(5-6), 522-536.

Objectives: The taxonic versus dimensional status of mood symptoms has been the subject of debate among mental health professionals. Conventional diagnostic models suggest that mood disorders are categorical; however, the inability of categorical models to adequately account for subthreshold unipolar and bipolar presentations and the heterotypic continuity of symptoms in unipolar and bipolar cases has resulted in growing support for dimensional views. The current study sought to evaluate the relative viabilities of categorical and dimensional models of mood symptoms within a taxometric framework. Methods: We examined the latent structure of mood symptoms in an epidemiological sample drawn from the Collaborative Psychiatric Epidemiological Surveys. Using three taxometric procedures (MAMBAC, MAXEIG, and L-Mode), we analyzed indicators of mania and depression created from the mood symptoms section of the survey. Results: The taxometric analyses supported a taxonic rather than dimensional structure for mania and depression. Membership in the mania and depressive taxa was associated with meeting criteria for DSM-IV lifetime manic episode and major depressive disorder, respectively. We identified a subset of 700 individuals falling into both taxa; membership in this subset was associated with lifetime bipolar disorder status. Group membership predicted designated external variables including help-seeking, family history, and duration of impairment. Within taxon and/or complement groups, severity scores still appeared to predict external variables. Conclusion: Our findings suggest that although taxonic, mood disorders possess meaningful dimensional variation.

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.

Alang, S. M. (2014). Racial variations in the effects of structural and psychological factors on depressive symptoms: A structural equation modeling approach. Mental Health and Prevention, 2(1-2), 2-10.

Despite greater exposure to risk factors for psychiatric distress, African Americans in the United States have similar or lower rates of common psychiatric disorders compared to Whites. This paper assesses whether the effects of structural and psychological resources on depressive symptoms vary by race. Findings from the National Survey of American Life show that while income matters more for Whites, education is a stronger predictor of mental health among African Americans, and its effects are mediated by mastery and self-esteem. These findings shed light on the epidemiology of depression and identify significant mental health resources among African Americans and Whites.

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.

Alegría, M., Fortuna, L. R., Lin, J. Y., Norris, F. H., Gao, S., Takeuchi, D. T., Jackson, J. S., Shrout, P. E., & Valentine, A. (2013). Prevalence, risk, and correlates of posttraumatic stress disorder across ethnic and racial minority groups in the United States. Medical Care, 51(12), 1114-1123. PMCID: PMC3922129

OBJECTIVES: We assess whether posttraumatic stress disorder (PTSD) varies in prevalence, diagnostic criteria endorsement, and type and frequency of potentially traumatic events (PTEs) among a nationally representative US sample of 5071 non-Latino whites, 3264 Latinos, 2178 Asians, 4249 African Americans, and 1476 Afro-Caribbeans. METHODS: PTSD and other psychiatric disorders were evaluated using the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) in a national household sample that oversampled ethnic/racial minorities (n=16,238) but was weighted to produce results representative of the general population. RESULTS: Asians have lower prevalence rates of probable lifetime PTSD, whereas African Americans have higher rates as compared with non-Latino whites, even after adjusting for type and number of exposures to traumatic events, and for sociodemographic, clinical, and social support factors. Afro-Caribbeans and Latinos seem to demonstrate similar risk to non-Latino whites, adjusting for these same covariates. Higher rates of probable PTSD exhibited by African Americans and lower rates for Asians, as compared with non-Latino whites, do not appear related to differential symptom endorsement, differences in risk or protective factors, or differences in types and frequencies of PTEs across groups. CONCLUSIONS: There appears to be marked differences in conditional risk of probable PTSD across ethnic/racial groups. Questions remain about what explains risk of probable PTSD. Several factors that might account for these differences are discussed, as well as the clinical implications of our findings. Uncertainty of the PTSD diagnostic assessment for Latinos and Asians requires further evaluation.

Alegría, M., Lin, J., Chen, C-N., Duan, N., Cook, B., & Xiao-Li, M. (2012). The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services. Health Services Research, 47(3pt2), 1322-1344.

Objective: To estimate whether racial/ethnic behavioral health service disparities are likely to be reduced through insurance expansion coverage expected through the Affordable Health Care Act. Data Sources: Pooled data from the nationally representative NIMH Collaborative Psychiatric Epidemiological Studies (2001–2003). Study Design: We employ a novel reweighting method to estimate service disparities in the presence and absence of insurance coverage. Data Collection: Access to care was assessed by whether any behavioral health treatment was received in the past year. Need was determined by presence of prior year psychiatric disorder, psychiatric diagnoses, physical comorbidities, gender, and age. Principal Findings: Improving patient education and availability of community clinics, combined with insurance coverage reduces service disparities across racial/ethnic groups. However, even with expanded insurance coverage, approximately 10 percent fewer African Americans with need for behavioral health services are likely to receive services compared to non-Latino whites while Latinos show no measurable disparity. Conclusions: Expansion of insurance coverage might have different effects for racial/ethnic groups, requiring additional interventions to reduce disparities for all groups.

Alegría, M. Molina, K. M., & Chen, C.-N. (2014). Neighborhood characteristics and differential risk for depressive and anxiety disorders across racial/ethnic groups in the United States. Depression and Anxiety, 31(1), 27-37.

Background: The prevalence of psychiatric disorders varies depending on the person's neighborhood context, their racial/ethnic group, and the specific diagnoses being examined. Less is known about specific neighborhood features that represent differential risk for depressive and anxiety disorders (DAD) across racial/ethnic groups in the United States. This study examines whether neighborhood etiologic factors are associated with DAD, above and beyond individual-level characteristics, and whether these associations are moderated by race/ethnicity. Methods: We utilized nationally representative data (N = 13,837) from the Collaborative Psychiatric Epidemiology Studies (CPES-Geocode file). Separate weighted multilevel logistic regression models were fitted for any past-year depressive and/or anxiety disorder, any depressive disorder only, and any anxiety disorder only. Results: After adjusting for individual-level characteristics, African Americans living in a neighborhood with greater affluence and Afro-Caribbeans residing in more residentially unstable neighborhoods were at increased risk for any past-year depressive disorder as compared to their non-Latino white counterparts. Further, Latinos residing in neighborhoods with greater levels of Latino/immigrant concentration were at increased risk of any past-year anxiety disorder. Lastly, Asians living in neighborhoods with higher levels of economic disadvantage were at decreased risk of any past-year depressive and/or anxiety disorders compared to non-Latino whites, independent of individual-level factors. Differences across subethnic groups are also evident. Conclusions: Results suggest neighborhood characteristics operate differently on risk for DAD across racial/ethnic groups. Our findings have important implications for designing and targeting interventions to address DAD risk among racial/ethnic minorities.

Anglin, D. M., Lighty, Q., Yang, L. H., Greenspoon, M., Miles, R. J., Slonim, T., Isaac, K., & Brown, M. J. (2014). Discrimination, arrest history, and major depressive disorder in the U.S. black population. Psychiatry Research, 219(1), 114-121.

Everyday discrimination contributes negatively to depressive symptomatology among Blacks in the US and being arrested could add to this depression. Using data from the National Survey on American Life, the present study determined the association between an arrest history and major depressive disorder (MDD), while accounting for discrimination among African Americans, US-born Afro-Caribbeans and first-generation Black immigrants. Findings from logistic regression analyses adjusted for discrimination suggested an arrest history is associated with 12-month MDD (Adjusted OR=1.47; 95% CI=1.02–2.10) and lifetime MDD (Adjusted OR=1.56 CI=1.17–2.09). Accounting for drug and alcohol dependence attenuated the association between arrest history and 12-month MDD, but not lifetime MDD. The associations between arrest history and both 12-Month and lifetime MDD, and discrimination and lifetime MDD varied by ethnic/immigrant group. Specifically, while the association between arrest history and MDD (both 12-month and lifetime) was strongest among US-born Afro-Caribbeans, evidence consistent with the immigrant paradox, the association between discrimination and lifetime MDD was particularly relevant for first-generation Black immigrants, suggesting discrimination may hinder the protection of first-generation status. Mental health prevention and treatment programs should target the stress associated with being arrested and experiencing discrimination among US Blacks.

Aranda, M. P., Chae, D. H., Lincoln, K. D., Taylor, R. J., Woodward, A. T., & Chatters, L. M. (2012). Demographic correlates of DSM-IV major depressive disorder among older African Americans, black Caribbeans, and non-Hispanic whites: Results from the National Survey of American Life. International Journal of Geriatric Psychiatry, 27(9), 940-947. PMCID: PMC3418432

Objectives: To examine the demographic correlates of lifetime and 12-month prevalence of major depressive disorder (MDD) among older African Americans, Black Caribbeans, and non-Hispanic Whites. Methods: Data are from adults aged 55 years and older (n = 1439) recruited to the National Survey of American Life (NSAL; 2001–2003). The Diagnostic and Statistical Manual Version IV World Mental Health Composite International Diagnostic Interview was used to assess the 12-month and lifetime MDD. Weighted logistic regression was used to model demographic correlates of MDD. Results: The population prevalence of lifetime and 12-month MDD were 11.2% and 4.1%, respectively. Bivariate analyses revealed that younger respondents and those with greater disability had a higher prevalence of both lifetime and 12-month MDD compared with those who were older and who had lower disability. Multivariable logistic regressions controlling for demographic characteristics revealed that non-Hispanic Whites had the greatest odds of lifetime MDD (OR = 2.27, 95% CI = 1.32, 3.93). Women had significantly greater odds of lifetime MDD compared with men (OR = 2.49, 95% CI = 1.14, 5.41); there were no gender differences in 12-month MDD. Other significant predictors of MDD were marital status and region of residence. Conclusions: The distribution, correlates, and nature of associations with MDD vary as a function of whether we examined lifetime vs. 12-month MDD. Future work should account for within group differences among older adults with depression. Understanding MDD correlates and the nature of intergroup diversity can inform the identification of particularly vulnerable subgroups as well as appropriate treatment approaches.

Archibald, P., Dobson-Sydnor, K., Daniels, K., & Bronner, Y. (2013). Explaining African-Americans’ depressive symptoms: A stress-distress and coping perspective. Journal of Health Psychology, 18(3), 321-331.

Findings from five community surveys suggest that the depressive symptom scores of African-Americans are the same as, or lower than, those of Whites. This seems at odds with the minority status hypothesis that predicts higher rates of mental disorders for African-Americans. However, little is known about the role of African-American coping capacity during the life stress process which may shed light on the seeming contradiction. This cross-sectional survey examined the role of spirituality-coping, sense of control, and stress in predicting depressive symptoms among 3570 African-Americans. The findings showed that sense of control mediates the relationship between spirituality, life stressors, and depressive symptoms.

Asnaani, A., Richey, J. A., Dimaite, R., Hinton, D. E., & Hofmann, S. G. (2010). A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. Journal of Nervous and Mental Disease, 198(8), 551-555. PMCID: PMC2931265

In order to examine race-ethnic differences in the lifetime prevalence rates of common anxiety disorders, we examined data from the Collaborative Psychiatric Epidemiology Studies (CPES). The samples included 6,870 White Americans, 4,598 African Americans, 3,615 Hispanic Americans, and 1,628 Asian Americans. White Americans were more likely to be diagnosed with social anxiety disorder, generalized anxiety disorder, and panic disorder than African Americans, Hispanic Americans, and Asian Americans. African Americans more frequently met criteria for post-traumatic stress disorder than White Americans, Hispanic Americans and Asian Americans. Asian Americans were also less likely to meet the diagnoses for generalized anxiety disorder and post-traumatic stress disorder than Hispanic Americans, and were less likely to receive social anxiety disorder, generalized anxiety disorder, panic disorder, and post-traumatic stress disorder diagnoses than White Americans. The results suggest that race and ethnicity need to be considered when assigning an anxiety disorder diagnosis, and possible reasons for the observed differences in prevalence rates between racial groups are discussed.

Assari, S. (2013). Race and ethnicity, religion involvement, church-based social support and subjective health in United States: A case of moderated mediation. International Journal of Preventive Medicine, 4(2), 208-217.

Background: To test if social support and ethnicity mediate/moderate the association between religion involvement and subjective health in the United States. Methods: This is a secondary analysis of National Survey of American Life, 2003. Hierarchical regression was fit to a national household probability sample of adult African Americans (n = 3570), Caribbean Blacks (n = 1621), and Whites (n = 891). Frequency of church attendance, positive/negative church‑based social support, ethnicity, and subjective health (overall life satisfaction and self-rated mental health) were considered as predictor, mediator, moderator and outcome, respectively. Results: Frequency of church attendance had a significant and positive association with mental health and life satisfaction among all ethnic groups. Frequency of church attendance was also correlated with positive and negative social support among all ethnic groups. Church‑based social support fully mediated the association between frequency of church attendance and overall life satisfaction among African Americans but not among Caribbean Blacks, or Whites. Church‑based social support, however, partially mediated the association between frequency of church attendance and overall mental health among African Americans but not among Caribbean Blacks or Whites. Conclusion: Ethnicity shapes how church‑based social support mediates the association between religious involvement and subjective health. Our results showed a moderating mediation effect of ethnicity and social support on the religious involvement-subjective health linkage, in a way that it is only among African Americans that social support is a pathway for the beneficial health effect of religious involvement.

Assari, S. (2014). Additive effects of anxiety and depression on body mass index among blacks: Role of ethnicity and gender. International Cardiovascular Research Journal, 8(2), 44-51. PMCID: PMC4058483

Background: Most studies on mental health associates of obesity have focused on depression and less is known about the role of anxiety in obesity. Objectives: This study compared the additive effects of General Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) on Body Mass Index (BMI) across sub-populations of Blacks based on the intersection of ethnicity and gender. Methods: Data came from the National Survey of American Life (NSAL), 2001 - 2003. The participants consisted of 3,570 African Americans and 1,621 Caribbean Blacks. Twelve-month MDD and GAD were determined using the World Mental Health Composite International Diagnostic Interview (CIDI). Levels of BMI were categorized based on being equal to or larger than 25, 30, 35, and 40 kg/m2. We fitted linear regression models specific for our groups, which were defined based on the intersection of ethnicity and gender. Additionally, age, education, marital status, employment, and region were controlled. Results: Among Caribbean Black men and African American women, lifetime GAD, but not MDD, was associated with high BMI. Among Caribbean Black women, lifetime MDD, but not GAD, was associated with high BMI. Conclusions: Intersection of ethnicity and gender may determine how anxiety and depression are associated with BMI among Blacks. Sub-populations of Blacks (e.g. based on ethnicity and gender) may have specific mental health determinants or consequences of obesity. Future research should investigate how and why the additive effects of anxiety and depression on obesity vary across ethnic and gender groups of Blacks.

Assari, S. (2014). Association between obesity and depression among American blacks: Role of ethnicity and gender. Journal of Racial and Ethnic Health Disparities, 1(1), 36-44.

Aim: This study tested the association between obesity and major depressive disorder (MDD) in a national representative sample of Black adults in the USA. The study also explored the above association in subsamples based on ethnicity and gender. Method: Data came from the National Survey of American Life (NSAL), a household mental health survey of adult Black Americans. Participants consisted of 5,191 Black adults (3,570 African Americans and 1,621 Caribbean Blacks). Classes I to III of obesity were defined based on body mass index (BMI) of equal or larger than 30, 35, and 40 kg/m2, respectively. Twelve-month MDD was determined using the World Mental Health Composite International Diagnostic Interview (CIDI), a fully structured diagnostic interview. For each ethnicity–gender subgroup, we ran a separate logistic regression model. We tested gradient and threshold effects of BMI on MDD. Unadjusted and adjusted odds ratios (ORs) were reported. Result: Direction of association between BMI and MDD was reversed among men and women. Among men, there was a positive association between BMI and MDD, while among women, the association was negative. The gradient effect of BMI level on MDD reached statistical significance only among African American men (OR = 0.71, 95 % confidence interval (CI) = 0.51–0.99). Among women, a significant interaction was found between the effects of BMI ≥40 and African American ethnicity on odds of developing MDD [change in OR = 8.840, 95 % CI = 1.315–59.418]. That interaction term suggests that the effect of BMI ≥40 on MDD is significantly smaller among African American women than Caribbean Black women. Conclusion: The direction and magnitude of the association between BMI and MDD among Blacks depend on ethnicity and gender. Risk of comorbid depression among women with severe obesity among Black women is smaller among African Americans than Caribbean Blacks.

Assari, S. (2014). Chronic kidney disease, anxiety and depression among American blacks; Does ethnicity matter? International Journal of Travel Medicine and Global Health, 2(4), 133-139.

Introduction: Chronic kidney disease (CKD) is known to be associated with deterioration of mental health. However, it is clear that this link is over and beyond the effects of socio-economic factors and other medical conditions. This study had two aims: 1) to compare the association between CKD and general anxiety disorder (GAD) among the two major ethnic groups of American Blacks (e.g. African Americans and Caribbean Blacks), and 2) to compare the association between CKD and major depressive episode (MDE) between African Americans and Caribbean Blacks. Methods: We analyzed data from African Americans and Caribbean Blacks who participated in the National Survey of American Life (NSAL). Self-reported physician diagnosis of CKD was the independent variable. Outcomes were 12- month GAD and MDE measured by the World Mental Health Composite International Diagnostic Interview (CIDI), a fully structured diagnostic interview. Ethnic-specific logistic regressions were used to determine the associations between CKD and 12- month GAD and MDE, after controlling for the effects of age, sex, educational level, and 13 other medical conditions. Results: Although CKD was positively associated with GAD and MDE in bivariate analysis, this association did not remain statistically significant in the multivariate analysis which controlled for socio-economic factors and other medical conditions. The study suggested that the main confounders for the association between CKD, GAD, and MDE vary based on ethnicity. For instance, the chronic medical condition that may play the role of confounder for the association between CKD and 12-month GAD among African Americans and Caribbean Blacks might be hypertension and heart disease, respectively. Conclusion: Possible confounders of the associations between CKD and GAD and MDE among American Blacks vary by ethnicity. Further research is needed to determine the links between different types of CKD and poor mental health among American Blacks. Consideration of ethnicity might be important in evaluation and treatment of mental health problems among Black patients with CKD.

Assari, S. (2014). Chronic medical conditions and major depressive disorder: Differential role of positive religious coping among African Americans, Caribbean blacks, and non-Hispanic whites. International Journal of Preventative Medicine, 5(4), 405-413.  PMCID: PMC4018588

Background: This study was aimed to investigate the main and buffering effects of positive religious coping on the association between the number of chronic medical conditions and major depressive disorder (MDD) among African Americans, Caribbean Blacks and Non‑Hispanic Whites. Methods: This cross‑sectional study used data from the National Survey of American Life, 2001 and 2003. This study enrolled 3,570 African Americans, 1,438 Caribbean Blacks and 891 Non‑Hispanic Whites. Number of chronic conditions and positive religious coping were independent variables, 12‑month MDD was the outcome and socio‑economic characteristics were controls. We fitted the following three ethnic‑specific logistic regressions for data analysis. In Model I, we included the number of chronic conditions and controls. In Model II, we added the main effect of religious coping. In Model III, we included an interaction between
religious coping and number of chronic conditions. Results: Based on Model I, number of chronic conditions was
associated with higher odds of 12‑month MDD among all race/ethnic groups. Model II showed a significant and negative association between religious coping and MDD among Caribbean Blacks (odds ratio [OR] =0.55, 95% confidence Interval [CI] =0.39‑0.77), but not African Americans or Hispanic Whites. Model III suggested that, only among Caribbean Blacks, the effect of chronic medical conditions on MDD is smaller in the presence of high positive religious coping (OR for interaction = 0.73, 95% CI = 0.55‑0.96). Conclusions: Although the association between multiple chronic conditions and MDD may exist regardless of race and ethnicity, race/ethnicity may shape how positive religious coping buffers this
association. This finding sheds more light onto race and ethnic differences in protective effects of religiosity on mental health of populations.

Assari, S. (2014). Race and ethnic differences in associations between cardiovascular diseases, anxiety, and depression in the United States. International Journal of Travel Medicine and Global Health, 2(3), 103-109.

Introduction: Although cardiovascular diseases and psychiatric disorders are linked, it is not yet known if such link are independent of comorbid medical diseases and if these associations depend on race and ethnicity. This study aimed to determine if the associations between cardiovascular diseases with general anxiety disorder (GAD) and major depressive episode (MDE) are independent of comorbid medical diseases and if these links differ among African Americans, Caribbean Blacks, and Non-Hispanic Whites. Methods: This cross-sectional study enrolled African American, Caribbean Black, and Non-Hispanic White adults who had participated in the National Survey of American Life (NSAL), 2001 - 2003. Data on socio-economics (age, sex, and education level) were measured. Self-reported physician diagnosed cardiovascular diseases (heart disease, atherosclerosis, hypertension, and stroke) and chronic medical conditions (peptic ulcer, cancer, diabetes, liver disease, kidney Disease, asthma, other chronic respiratory diseases, sickle cell anemia, and glaucoma) were measured. The 12-month GAD and MDE were measured using the Composite International Diagnostic Interview (CIDI). Logistic regressions were fitted to data to determine the association between cardiovascular diseases, and to determine if 12-month GAD and 12-month MDE are independent of socio-economic status and comorbid chronic medical diseases across race and ethnic groups. Results: Above and beyond other medical conditions, heart disease and atherosclerosis were associated with 12-month GAD among Caribbean Blacks, but not African Americans or non-Hispanic Whites. Hypertension was associated with 12-month MDD among African Americans, and heart disease was associated with 12-month MDE among Caribbean Blacks. None of the cardiovascular diseases were associated with 12-month MDD among non-Hispanic Whites, while all the other medical conditions were controlled. Conclusion: Our study showed race and ethnicity may be associated with specific patterns of comorbidity between cardiovascular diseases and 12-month MDD and GAD. By other means, the link between psychiatric disorders and cardiovascular diseases may depend on race and ethnicity. More research is needed to explore the behavioral and mental health profile of individuals with heart disease based on race and ethnicity. Race and ethnicity should inform mental health evaluation of patients with cardiovascular diseases.

Assari, S. (2014). Synergistic effects of lifetime psychiatric disorders on suicidal ideation among blacks in the USA. Journal of Racial and Ethnic Health Disparities, 1(4), 275-282.

Purpose: In this study, we aimed to investigate the synergistic effects of lifetime psychiatric disorders including general anxiety disorder (GAD), major depressive disorder (MDD), and drug abuse disorder (DAD) on serious suicidal thoughts among a nationally representative sample of Blacks in the USA. Methods: For this study, we used data of 5,181 Black (3,570 African-American and 1,621 Caribbean Black) adults who participated in the National Survey of American Life (NSAL), 2001–2003. Three lifetime psychiatric disorders (i.e., MDD, GAD, and DAD) were considered as independent variables. Lifetime serious suicidal ideation was considered as the dependent variable. Age, gender, ethnicity, education, employment, marital status, and region were control variables. Logistic regression was used to determine separate, additive, and synergistic effects of GAD, MDD, and DAD on serious suicidal thoughts. Results: Individuals with comorbid GAD and MDD [odds ratio (OR) = 3.61, 95 % confidence interval (CI) = 1.26–10.33], GAD and DAD (OR = 3.22, 95 % CI = 1.05–9.85), and MDD and DAD (OR = 2.25, 95 % CI = 1.16–4.35) were at highest risk of suicidal ideation. In the absence of GAD and MDD, DAD was associated with higher odds of suicidal ideation (OR = 3.55, 95 % CI = 2.15–5.87); however, in the absence of DAD, neither GAD nor MDD was associated with suicidal ideation. Gender also modified the synergistic effects of GAD, MDD, and DAD on suicidal ideation. Conclusions: Based on our study, GAD, MDD, and DAD have synergistic effects on suicidal thoughts among Blacks. Results may have implications for the reduction of suicide due to psychiatric disorders among Blacks.

Assari, S., Dejman, M., & Neighbors, H. W. (In press). Ethnic differences in separate and additive effects of anxiety and depression on self-rated mental health among blacks. Journal of Racial and Ethnic Health Disparities.

Aim: The aim of this study was to explore ethnic differences in the separate and additive effects of anxiety and depression on self-rated mental health (SRMH) of Blacks in the USA. Methods: With a cross-sectional design, we used data from a national household probability sample of African Americans (n = 3570) and Caribbean Blacks (n = 1621) who participated in the National Survey of American Life, 2001–2003. Demographic factors, socio-economic factors, 12-month general anxiety disorder (GAD) and major depressive disorder (MDD), and current SRMH were measured. In each ethnic group, three logistic regressions were used to assess the effects of GAD, MDD, and their combinations on SRMH. Results: Among African Americans, GAD and MDD had separate effects on SRMH. Among Caribbean Blacks, only MDD but not GAD had separate effect on SRMH. Among African Americans, when the combined effects of GAD and MDD were tested, GAD but not MDD was associated with SRMH. Conclusion: The separate and additive effects of GAD and MDD on SRMH among Blacks depend on ethnicity. Although single-item SRMH measures are easy methods for the screening of mental health need, community-based programs that aim to meet the need for mental health services among Blacks in the USA should consider within-race ethnic differences in the applicability of such instruments.

Assari, S., & Lankarani, M. M. (In press). Association Between Stressful Life Events and Depression; Intersection of Race and Gender. Journal of Racial and Ethnic Health Disparities.

Background: Although stressful life events (SLEs) and depression are associated, we do not know if the intersection of race and gender modifies the magnitude of this link. Using a nationally representative sample of adults in the USA, we tested if the association between SLE and major depressive episode (MDE) depends on the intersection of race and gender. Methods: Data came from the National Survey of American Life (NSAL), 2003, a cross-sectional survey that enrolled 5899 adults including 5008 Blacks (African-Americans or Caribbean Blacks), and 891 Non-Hispanic Whites. Logistic regression was used for data analysis. Stressful life events (past 30 days) was the independent variable, 12-month MDE was the dependent variable, and age, educational level, marital status, employment, and region of country were controls. Results: In the pooled sample, SLE was associated with MDE above and beyond all covariates, without the SLE × race interaction term being significant. Among men, the SLE × race interaction was significant, suggesting a stronger association between SLE and MDE among White men compared to Black men. Such interaction between SLE × race could not be found among women. Conclusions: The association between SLE and depression may be stronger for White men than Black men; however, this link does not differ between White and Black women. More research is needed to better understand the mechanism behind race by gender variation in the stress–depression link.

Assari, S., Lankarani, M. M., & Lankarani, R. M. (2013). Ethnicity modifies the effects of anxiety and drug use on suicidal ideation among black adults in the United States. International Journal of Preventive Medicine, 4(11), 1151-1157. PMCID: PMC3883248

Background: This study aimed to investigate the moderating effect of ethnicity on the effects of multiple psychiatric disorders on serious suicidal thoughts among a nationally representative sample of Black adults in the United States.
Methods: For this study, we used data of 5,181 Black adults (3,570 African Americans and 1,621 Caribbean Blacks) who participated in the National Survey of American Life, 2001-2003. Five lifetime psychiatric disorders (i.e., major depression disorder, general anxiety disorder, alcohol abuse disorder, drug abuse disorder and posttraumatic stress disorder) were considered as independent variables. Lifetime serious suicidal ideation was considered as the dependent variable. Logistic regressions were used to determine if ethnicity modifi es the effects of each psychiatric disorder on serious suicide ideation. Ethnicity was conceptualized as the possible moderator and socio-demographics (i.e., age, gender, education level, employment, marital status and country region) were control variables. Results: Among African Americans, major depression disorder, general anxiety disorder, posttraumatic stress disorder and alcohol abuse disorder were associated with higher odds of suicidal thoughts. Among Caribbean Blacks, major depression disorder and drug abuse disorder were associated with higher odds of suicidal thoughts. In the pooled sample, the interaction between ethnicity and anxiety disorder was statistically significant, while the interaction between ethnicity and drug abuse disorder was marginally significant. Conclusions: Based on our study, ethnicity shapes vulnerability of United States Black adults’ suicidality due to psychiatric disorders. General anxiety disorder seems to be a more important risk factor for suicidal ideation among African Americans while drug abuse disorder might contribute more to the risk of suicidal thoughts among Caribbean Blacks.

Assari, S., Lankarani, M. M., & Moazen, B. (2012). Religious beliefs may reduce the negative effect of psychiatric disorders on age of onset of suicidal ideation among blacks in the United States. International Journal of Preventive Medicine, 3(5), 358-364. PMCID: PMC3372078

Objective: To evaluate the possible interaction between religious beliefs and psychiatric disorders among Black Americans. Methods: In this study, we used data of 5181 adult Black Americans who had participated in National Survey of American Life (NSAL) from February 2001 to June 2003. Variables such as socio-demographics, religious beliefs, and psychiatric disorders were entered in a Cox regression to determine the possible interaction between psychiatric disorders (0, 1, ≥2) and the subjective religiosity on age of onset of suicidal thought among the participants. Main outcome was age of the first serious suicidal ideation. Results: A dose-dependent effect of number of psychiatric disorders on suicidal ideation was observed. Psychiatric disorders had a higher impact on age of suicidal ideation among those with low self-reported religiosity. Conclusion: Religious beliefs may buffer the effect of psychiatric disorders on suicidal thought. Blacks who are less religious and suffer psychiatric disorders are at the highest risk for early suicidal ideation.

Barnes, D. M., Keyes, K. M., & Bates, L. M. (2013). Racial differences in depression in the United States: How do subgroup analyses inform a paradox? Social Psychiatry and Psychiatric Epidemiology, 48(12), 1941-1949. PMCID: PMC3834079

Purpose: Non-Hispanic Blacks in the US have lower rates of major depression than non-Hispanic Whites, in national household samples. This has been termed a “paradox,” as Blacks suffer greater exposure to social stressors, a risk factor for depression. Subgroup analyses can inform hypotheses to explain this paradox. For example, it has been suggested that selection bias in household samples undercounts depression in Blacks; if selection is driving the paradox, Black–White differences should be most pronounced among young men with low education. Methods: We examined Black–White differences in lifetime major depression in subgroups defined simultaneously by sex, age, and education using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the Collaborative Psychiatric Epidemiology Surveys (CPES).  Results: In NESARC and CPES, Blacks had lower odds than Whites of lifetime major depression in 21 and 23 subgroups, respectively, of 24. All statistically significant differences were in subgroups favoring Blacks, and lower odds in Blacks were more pronounced among those with more education. Conclusions: These results suggest that hypotheses to explain the paradox must posit global mechanisms that pertain to all subgroups defined by sex, age, and education. Results do not lend support for the selection bias hypothesis.

Becares, L., Nazroo, J., & Jackson, J. S. (2014). Ethnic density and depressive symptoms among African Americans: Threshold and differential effects across social and demographic subgroups. American Journal of Public Health, 104(12), 2334-2341.

Objectives. We examined the association between Black ethnic density and depressive symptoms among African Americans. We sought to ascertain whether a threshold exists in the association between Black ethnic density and an important mental health outcome, and to identify differential effects of this association across social, economic, and demographic subpopulations. Methods. We analyzed the African American sample (n = 3570) from the National Survey of American Life, which we geocoded to the 2000 US Census. We determined the threshold with a multivariable regression spline model. We examined differential effects of ethnic density with random-effects multilevel linear regressions stratified by sociodemographic characteristics. Results. The protective association between Black ethnic density and depressive symptoms changed direction, becoming a detrimental effect, when ethnic density reached 85%. Black ethnic density was protective for lower socioeconomic positions and detrimental for the better-off categories. The masking effects of area deprivation were stronger in the highest levels of Black ethnic density. Conclusions. Addressing racism, racial discrimination, economic deprivation, and poor services—the main drivers differentiating ethnic density from residential segregation—will help to ensure that the racial/ethnic composition of a neighborhood is not a risk factor for poor mental health.

Becares, L., Nazroo, J., Jackson, J., & Heuvelman, H. (2012). Ethnic density effects on health and experienced racism among Caribbean people in the US and England: A cross-national comparison. Social Science and Medicine, 75(12), 2107-2115.

Studies indicate an ethnic density effect, whereby an increase in the proportion of racial/ethnic minority people in an area is associated with reduced morbidity among its residents, though evidence is varied. Discrepancies may arise due to differences in the reasons for and periods of migration, and socioeconomic profiles of the racial/ethnic groups and the places where they live. It is important to increase our understanding of how these factors might promote or mitigate ethnic density effects. Cross-national comparative analyses might help in this respect, as they provide greater heterogeneity in historical and contemporary characteristics in the populations of interest, and it is when we consider this heterogeneity in the contexts of peoples' lives that we can more fully understand how social conditions and neighbourhood environments influence the health of migrant and racial/ethnic minority populations. This study analysed two cross-sectional nationally representative surveys, in the US and in England, to explore and contrast the association between two ethnic density measures (black and Caribbean ethnic density) and health and experienced racism among Caribbean people. Results of multilevel logistic regressions show that nominally similar measures of ethnic density perform differently across health outcomes and measures of experienced racism in the two countries. In the US, increased Caribbean ethnic density was associated with improved health and decreased experienced racism, but the opposite was observed in England. On the other hand, increased black ethnic density was associated with improved health and decreased experienced racism of Caribbean English (results not statistically significant), but not of Caribbean Americans. By comparing mutually adjusted Caribbean and black ethnic density effects in the US and England, this study examined the social construction of race and ethnicity as it depends on the racialised and stigmatised meaning attributed to it, and the association that these different racialised identities have on health.

Barragan, A., Yamada, A.-M., Lee, K. K., & Barrio, C. (In press). Correlates in the endorsement of psychotic symptoms and services use: Findings from the Collaborative Psychiatric Epidemiology Surveys. Community Mental Health Journal.

Endorsement of psychotic symptoms serves as an indicator of significant health issues and interpersonal distress. Seeking services is the ultimate recourse for many individuals, yet few studies have assessed the help-seeking process in a nationally representative sample. This study, guided by Lewis-Fernández et al.’s (J Nerv Ment Dis 197(5):337–347, 2009) analyses, examined the association of lifetime endorsement of psychotic symptoms with demographic, clinical and support system variables and types of services received. Based on nationally weighted epidemiological data, 11.6 % of adults reported one or more psychotic symptoms. Psychotic symptoms were associated with poor physical and mental health, specifically depressive, anxiety, and substance use disorders. Respondents were more likely to receive services from both informal and mental health providers and were more likely to be hospitalized than those not endorsing psychotic symptoms. Study findings inform community efforts to develop comprehensive services for individuals experiencing psychotic symptoms.

Beristianos, M. H., Maguen, S., Neylan, T. C., & Byers, A. L. (In press). Trauma exposure and risk of suicidal ideation among older adults. American Journal of Geriatric Psychiatry.

Objective: To determine if trauma exposure is associated with suicidal ideation in a nationally-representative sample of older adults. Methods: This study included 3,277 participants 55 years and older involved in the Collaborate Psychiatric Epidemiology Surveys (2001-2003). Results: Of the 84.8% older adults who were exposed to any trauma, 2.2% endorsed late-life suicidal ideation. Multivariable models fully-adjusted for sociodemographics, PTSD, MDD and substance use revealed exposure to serious accidents/illness was associated with suicidal ideation (odds ratio [OR]: 2.55, 95% confidence interval [CI]: 1.16-5.59, Wald χ2=5.47, df=1, p=0.019). Investigation of specific traumas within the category revealed that life-threatening illness was specifically associated with suicidal ideation in older adults (OR: 2.12, 95% CI: 1.34-3.36, Wald χ2=10.33, df=1, p=0.001). Conclusions: These findings highlight the need for monitoring of suicidal ideation among older adults who have been informed of a life-threatening illness diagnosis.

Blostein, F., Assari, S., & Caldwell, C. H. (In press). Gender and ethnic differences in the association between body image dissatisfaction and binge eating disorder among blacks. Journal of Racial and Ethnic Health Disparities.

BACKGROUND: The research on binge eating has overwhelmingly focused on Whites. We aimed to study gender and ethnic differences in the association between body image dissatisfaction and binge eating in a nationally representative sample of Black adults in the USA. METHODS: This cross-sectional study used data from the National Survey of American Life (NSAL), 2003-2004. Self-identified Caribbean Black (n = 1621) and African American (3570) adults aged 18 and older were enrolled. The independent variable was body dissatisfaction measured with two items. Using the World Health Organization Composite International Diagnostic Interview (WHO-CIDI), outcome was lifetime binge eating without hierarchy according to the DSM-IV criteria. Covariates included age, socioeconomic factors (i.e., education and marital status), and body mass index. Ethnicity and gender were focal moderators. Logistic regressions were used for data analysis. RESULTS:  Despite comparable prevalence of lifetime binge eating (5 vs 4 %, p > 0.05), African Americans reported higher body image dissatisfaction than Caribbean Blacks (36 vs 29 %, p > 0.05). In the pooled sample, body dissatisfaction was a strong predictor of lifetime binge eating disorders. There was a significant interaction (p = 0.039) between ethnicity and body image dissatisfaction on binge eating, suggesting a stronger association between body image dissatisfaction and lifetime binge eating for Caribbean Blacks (OR = 11.65, 95 % 6.89-19.72) than African Americans (OR = 6.72, 95 % CI 3.97-11.37). Gender did not interact with body image dissatisfaction on binge eating. CONCLUSION: Ethnic variation in the link between body image dissatisfaction and binge eating may be due to within-race cultural differences in body image between African Americans and Caribbean Blacks. This may include different definitions, norms, and expectations regarding the body size. Findings suggest that ethnicity may bias relevance of body image dissatisfaction as a diagnostic criterion for binge eating disorders among diverse populations of Blacks.

Bodenlos, J. S., Lemon, S. C., Schneider, K. L., August, M. A., & Pagoto, S. L. (2011). Associations of mood and anxiety disorders with obesity: Comparisons by ethnicity. Journal of Psychosomatic Research, 71(5), 319-324.

Objective: To describe the rates of mood disorders, the social and demographic correlates of mood disorders, and mental health services utilization among African American, Caribbean black, and non-Hispanic white mothers. Method: Study data were collected between February 2001 and June 2003 as part of the National Survey of American Life: Coping With Stress in the 21 st Century. National household probability samples of African Americans and Caribbean blacks were surveyed using a slightly modified World Mental Health version of the World Health Organization Composite International Diagnostic Interview. Participants included 2,019 African American, 799 Caribbean black, and 400 non-Hispanic white mothers 18 years and older (N=3,218).The main outcomes measured were lifetime and 12-month diagnoses of DSM-IV mood disorders (major depressive episode, dysthymic disorder, bipolar I and II disorders) and mental health services utilization. Results: The lifetime prevalence estimate of mood disorders is higher for white mothers (21.67%) than for African American mothers (16.77%) and Caribbean black mothers (16.42%); however, 12-month mood disorder estimates are similar across groups. African American mothers have higher 12-month prevalence estimates of bipolar disorder (2.48%) than white mothers (0.59%) and Caribbean black mothers (1.16%). African American mothers with higher education levels and white mothers who became parents as teenagers are more likely to have a lifetime mood disorder. Less than half (45.8%) of black mothers with a past 12-month mood disorder diagnosis utilized mental health services. Among black mothers with a 12-month diagnosis of bipolar disorder, Caribbean blacks utilized mental health services at higher rates than African Americans. Conclusions: Demographic correlates for mood disorders varied by race and ethnicity. The findings illustrated underutilization of treatment by black mothers, especially African American mothers with bipolar disorder.

Boduszek, D., Belsher, R., Dhingra, K., & Ioannou, M. (2014). Psychosocial correlates of recidivism in a sample of ex-prisoners: The role of oppositional defiant disorder and conduct disorder. Journal of Forensic Psychiatry and Psychology, 25(1), 61-76.

The present study aimed to (a) examine the role of Oppositional defiant disorder (ODD) and Conduct disorder (CD) in predicting recidivism, while controlling for childhood arrest, perceived neighbourhood crime frequency, alcohol consumption, age and gender, and (b) explore the relevance of these factors in predicting risk of recidivism for males and females separately. Participants were 669 ex-prisoners identified in the National Survey of American Life. Results revealed that gender, CD and average daily alcohol consumption predicted recidivism. When separate models were estimated for males and females, only average daily alcohol consumption was predictive of female recidivism. By comparison, recidivism was significantly predicted in males by CD in youth and childhood arrest. ODD was also negatively associated with recidivism in males. Consequently, targeting variables identified as significant predictors of recidivism for both males and females, or males, is unlikely to be an optimal way of reducing repeat offending.

Boduszek, D., Hyland, P., Dhingra, K., & Mallett, J. (2013). The factor structure and composite reliability of the Rosenberg Self-Esteem Scale among ex-prisoners. Personality and Individual Differences, 55(8), 877-881.

The aim of this study was to examine the factor structure and composite reliability of the Rosenberg Self-Esteem Scale (RSES) using a sample of 669 ex-prisoners identified in the National Survey of American Life. Six distinct factor models, with uncorrelated measurement error terms, were specified and tested using confirmatory factor analysis (CFA). Results indicated that the two-factor model consisting of positive and negative latent variables provided a better fit to the data than the alternative models. Moreover, only positive self-esteem was a significant predictor of recidivism. Composite reliability indicated that the two factors were measured with very good reliability. The results consequently provide additional support for a two-dimensional model of the RSES within offender populations.

Boyd, R. C., Joe, S., Michalopoulos, L., Davis, E., & Jackson, J.S. (2011). Prevalence of mood disorders and service use among US mothers by race and ethnicity: Results from the National Survey of American Life. Journal of Clinical Psychiatry, 72(11), 1538-1545.

Objective:To describe the rates of mood disorders, the social and demographic correlates of mood disorders, and mental health services utilization among African American, Caribbean black, and non-Hispanic white mothers. Method: Study data were collected between February 2001 and June 2003 as part of the National Survey of American Life: Coping With Stress in the 21 st Century. National household probability samples of African Americans and Caribbean blacks were surveyed using a slightly modified World Mental Health version of the World Health Organization Composite International Diagnostic Interview. Participants included 2,019 African American, 799 Caribbean black, and 400 non-Hispanic white mothers 18 years and older (N=3,218).The main outcomes measured were lifetime and 12-month diagnoses of DSM-IV mood disorders (major depressive episode, dysthymic disorder, bipolar I and II disorders) and mental health services utilization. Results: The lifetime prevalence estimate of mood disorders is higher for white mothers (21.67%) than for African American mothers (16.77%) and Caribbean black mothers (16.42%); however, 12-month mood disorder estimates are similar across groups. African American mothers have higher 12-month prevalence estimates of bipolar disorder (2.48%) than white mothers (0.59%) and Caribbean black mothers (1.16%). African American mothers with higher education levels and white mothers who became parents as teenagers are more likely to have a lifetime mood disorder. Less than half (45.8%) of black mothers with a past 12-month mood disorder diagnosis utilized mental health services. Among black mothers with a 12-month diagnosis of bipolar disorder, Caribbean blacks utilized mental health services at higher rates than African Americans. Conclusions: Demographic correlates for mood disorders varied by race and ethnicity. The findings illustrated underutilization of treatment by black mothers, especially African American mothers with bipolar disorder.

Borges, G., Orozco, R., Rafful, C., Miller, E., & Breslau, J. (2012). Suicidality, ethnicity and immigration in the USA. Psychological Medicine, 42(6), 1175-1184.

Background. Suicide is the 11th leading cause of death in the USA. Suicide rates vary across ethnic groups. Whether suicide behavior differs by ethnic groups in the USA in the same way as observed for suicide death is a matter of current discussion. The aim of this  report was to compare the lifetime prevalence of suicide ideation and attempt among four main ethnic groups (Asians, Blacks, Hispanics, and Whites) in the USA. Method. Suicide ideation and attempts were assessed using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). Discrete time survival analysis was used to examine risk for lifetime suicidality by ethnicity and immigration among 15 180 participants in the Collaborative Psychiatric Epidemiological Surveys (CPES), a group of cross-sectional surveys. Results. Suicide ideation was most common among Non-Hispanic Whites (16.10%), least common among Asians (9.02%) and intermediate among Hispanics (11.35%) and Non-Hispanic Blacks (11.82%). Suicide attempts were equally common among Non-Hispanic Whites (4.69%), Hispanics (5.11%) and Non-Hispanic Blacks (4.15%) and less common among Asians (2.55%). These differences in the crude prevalence rates of suicide ideation decreased but persisted after control for  psychiatric disorders, but disappeared for suicide attempt. Within ethnic groups, risk for suicidality was low among immigrants prior to migration compared to the US born, but equalized over time after migration. Conclusions. Ethnic differences in suicidal behaviors are explained partly by differences in psychiatric disorders and low risk prior to arrival in the USA. These differences are likely to decrease as the US-born proportion of Hispanics and Asians increases.

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.

Butler-Barnes, S. T., Martin, P. P., Copeland-Linder, N., Seaton, E. K., Caldwell, C. H., & Jackson, J. S. (In press).  The protective role of religious involvement in African American and Caribbean black adolescents’ experiences of racial discrimination. Youth and Society.

For many Black adolescents, racial discrimination increases the risk of developing adverse psychological outcomes. The purpose of this study is to investigate the interrelationships among religious involvement, racial discrimination, and psychological outcomes among a nationally representative sample of African American adolescents and Caribbean Black adolescents from the National Survey of American Life. Multiple regression models were used to determine the interactive effects of religious involvement and racial discrimination experiences on Black adolescents’ psychological outcomes. Findings indicate that religious involvement was a protective factor for Caribbean Black adolescents but not African American youth. The implications of these findings underscore the varied roles of religious involvement for African American and Caribbean Black adolescents.

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.

Brown, R. K., Taylor, R. J., & Chatters, L. M. (In press). Religious non-involvement among African Americans, black Caribbeans and non-Hispanic Whites: Findings from the National Survey of American Life. Review of Religious Research.

This study examines the association between race/ethnicity, socio-demographic characteristics, and religious non-involvement among a national sample of African Americans, Black Caribbeans and Non-Hispanic Whites. The relationship between religious non-involvement and selected measures of religious participation, spirituality, religious coping is also examined. The study utilizes data from a national multi-stage probability sample, the National Survey of American Life (n = 6,082). Very few individuals, <1 out of 20 respondents, both never attended religious services and have no current denomination. Overall, <8 % have never attended religious services since the age of 18. Both African Americans and Black Caribbeans were significantly less likely than non-Hispanic Whites to report never attending religious services and not having a current denomination. The greater reliance upon religious institutions for support and guidance among African Americans and Black Caribbean Americans relative to Non-Hispanic Whites may help explain the importance of race in predicting religious non-involvement. Women, married persons, Southerners, and the more highly educated are significantly more likely to be involved in religion. Finally, this study indicates that the religiously non-involved are less likely than others to participate in religious activities, to identify as spiritual, and to rely upon religion to cope with trying circumstances. Nonetheless, even respondents who never attend religious services and do not have a denomination still report some level of religious participation along with relatively high levels of religious coping. We posit that religious non-involvement is less indicative of apostasy, but rather likely reflects a critique of organized religion.

Brown, T. N., Bell, M. L., & Patterson, E. J. (In press). Imprisoned by empathy: Familial incarceration and psychological distress among African American men in the National Survey of American Life. Journal of Health and Social Behavior.

The stress process model predicts that current incarceration of a family member should damage the health status of the inmate’s relatives. We address this prediction with data from the National Survey of American Life, focusing exclusively on African American men (n = 1,168). In survey-adjusted generalized linear models, we find that familial incarceration increases psychological distress, but its effect attenuates ostensibly after controlling for other chronic strains. Familial incarceration remains statistically insignificant with the introduction of mastery and family emotional support and their respective interactions with familial incarceration. However, a statistical interaction between familial incarceration and former incarceration reveals that levels of psychological distress are significantly higher among never-incarcerated respondents whose family members are incarcerated but significantly lower among formerly incarcerated respondents whose family members are incarcerated. We conclude that familial incarceration’s influence on black men’s mental health status may be more complex than extant theory predicts.

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.

Carlisle, S. K. (2012). Nativity differences in chronic health conditions between nationally representative samples of Asian American, Latino American, and Afro-Caribbean American respondents. Journal of Immigrant and Minority Health, 14(6), 903-911.

Immigrants on average have better health than native-born residents. However, no clear understanding of prevalence of chronic conditions across foreign-born groups exists, and few studies include Afro-Caribbean populations. This study utilizes the National Latino and Asian American Study and the National Survey of American Life to investigate nativity differences in reports of chronic cardiovascular, respiratory, and pain conditions between foreign-born (n = 3,579) and native-born (n = 1,409) respondents. Native-born respondents were significantly more likely than foreign-born counterparts to report chronic respiratory [c2(1, n = 4,958) 30.78, P ≤ .05] and pain [c2(1, n = 4,958) 3.77, P ≤ .05] conditions. Logistic regression models reveal significant associations between chronic conditions and other demographic factors known to influence immigrant health. Afro-Caribbean populations were less likely than other foreign-born respondents to report respiratory and pain conditions. Findings illustrate the importance of comparing health profiles across native-born and foreign-born counterparts with the inclusion of Afro-Caribbean Americans.

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.

Chae, D. H., Lincoln, K. D., & Jackson, J. S. (2011). Discrimination, attribution, and racial group identification: Implications for psychological distress among black Americans in the National Survey of American Life (2001-2003). American Journal of Orthopsychiatry, 81(4), 498-506.

There is increasing evidence that experiencing discrimination may contribute to poor mental health among Black Americans. However, few studies have distinguished between discrimination attributed to race versus other forms of discrimination or have compared differences in their psychological implications. Using nationally representative data on 5,191 Black Americans in the National Survey of American Life (NSAL; 2001–2003), this study examined serious psychological distress (SPD) in relation to discrimination attributed to racial versus nonracial causes and also investigated whether racial group identification may be a buffer. We found that discrimination was associated with greater odds of SPD, regardless of attribution. Racial attributions were associated with higher odds of SPD compared with attributions to nonracial causes for each level of discrimination. High racial group identification buffered the negative effect of moderate levels of both racially and nonracially attributed discrimination. Our results provide evidence for the negative influence of discrimination on SPD among Black Americans and indicate that high racial group identification may somewhat mitigate their negative mental health effects. Our study suggests that discrimination and racial group identification should be addressed to protect against psychological distress among Black Americans.

Chae, D. H., Nuru-Jeter, A. M., Lincoln, K. D., & Jacob Arriola, K. R. (2012).  Racial discrimination, mood disorders, and cardiovascular disease among black Americans. Annals of Epidemiology, 22(2), 104-111. PMCID: PMC3253956

Purpose: To examine associations between racial discrimination, mood disorders, and cardiovascular disease (CVD) among Black Americans. Methods: Weighted logistic regression analyses were performed on a nationally representative sample of Black Americans (n = 5022) in the National Survey of American Life (NSAL; 2001–2003). Racial discrimination and CVD were assessed via self-report. Mood disorder was measured with the World Health Organization Composite International Diagnostic Interview. Results: Model-adjusted risk ratios (RRs) revealed that participants with a history of mood disorder had greater risk of CVD (RR, 1.28; 95% confidence interval (CI), 1.12–1.45). This relationship was found specifically among those younger than 50 years of age (RR, 1.56; 95% CI, 1.27–1.91). There was a significant interaction between racial discrimination and mood disorder in predicting CVD in the total (F = 2.86, 3 df, p = .047) and younger sample (F = 2.98, 3 df, p = .047). Participants with a history of mood disorder who reported high levels of racial discrimination had the greatest risk of CVD. Conclusions: The association between racial discrimination and CVD is moderated by history of mood disorder. Future studies may examine pathways through which racial discrimination and mood disorders impact CVD risk among Black Americans.

Chartrand, H., Sareen, J., Toews, M., & Bolton, J. M. (2012). Suicide attempts versus nonsuicidal self-injury among individuals with anxiety disorders in a nationally representative sample. Depression and Anxiety, 29(3), 172-179.

Background: This study is aimed to determine whether anxiety disorders are associated with suicide attempts with intent to die and to further investigate the characteristics of deliberate self-harm (DSH) among anxiety disorders. Method: Data came from the Collaborative Psychiatric Epidemiological Surveys (N = 20,130; age 18 years and older; response rate = 72.3%). DSM-IV anxiety disorders were assessed using the World Mental Health Composite International Diagnostic Interview. People with an anxiety disorder endorsing a history of DSH were subcategorized as those who made suicide attempts (n = 159; individuals who intended to die), versus those who made nonsuicidal self-injuries (n = 85; individuals who did not intend to die). Results: Anxiety disorders were associated with both suicide attempts and nonsuicidal self-injury (NSSI). People with generalized anxiety disorder and social phobia who engaged in DSH were more likely to have made a suicide attempt than a NSSI, independent of the effects of mood and substance use disorders. In addition, individuals with generalized anxiety disorder and social phobia who engaged in DSH were more likely to engage in this behavior multiple times, and at least one of those times was a suicide attempt. Conclusion: This study suggests that anxiety disorders are associated with suicide attempts with intent to die. Social phobia and generalized anxiety disorder appear to be associated with the more worrisome patterns of DSH including multiple suicide attempts.

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) 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., Jackson, J.S. (2008) Race and Ethnic Differences in Religious Involvement: African Americans, Caribbean Blacks and Non-Hispanic Whites. Ethnic and Racial Studies. 32(7): 1143-1163. PMCID2962581.

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., 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., Lincoln, K. D., Nguyen, A., & Joe, S. (2011). Church-based social support and suicidiality among African Americans and black Caribbeans. Archives of Suicide Research, 15(4), 337-353.

This study explores the relationship between church-based informal social support and lifetime prevalence of suicide ideation and attempts within a representative national sample of African American and Black Caribbean adults. Characteristics of church-based social support networks, as well as emotional support and negative interaction with church members were examined in relation to lifetime suicide ideation and attempts. This study used data from the National Survey of American Life (2001–2003). Frequency of interaction with church members was positively associated with suicide attempts, while subjective closeness to church members was negatively associated with suicide ideation. Emotional support, service attendance, and negative interaction with church members were unrelated to both suicide ideation and attempts. Findings are discussed in relation to research on church-based support networks, different models linking church support and suicidality, and the mechanisms by which church-based networks deter suicide ideation and attempts.

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.

Cheng, T. C., & Robinson, M. A. (2013). Factors leading African Americans and black Caribbeans to use social work services for treating mental and substance use disorders. Health and Social Work, 38(2), 99-109.

This secondary analysis of 5,000 African Americans and black Caribbeans explored how their use of social work services to address mental and substance use disorders was associated with the disorder involved as well as their perceived need for services, belief system, family resources, proximity to services, social–structural factors, and demographic characteristics. The sample was extracted from a national data set. Results of multinomial logistic regression showed that use of social work services was increased by dual diagnosis, substance use disorder alone, and mental disorder alone; by deteriorating mental health; by perceived stigma in treatment use; by welfare receipt and insurance coverage for mental health services; and by college graduation. Results also showed that use of services outside social work was promoted by dual diagnosis, substance use disorder alone, and mental disorder alone; by deteriorating mental health; by experience of racial discrimination; by insurance coverage for mental health services; by college education or  graduation; and by female gender and increasing age. The findings’ implications for social work intervention and education are discussed.

Chou, T., Asnaani, A., & Hofmann, S. G. (2012). Perception of racial discrimination and psychopathology across three U.S. ethnic minority groups. Cultural Diversity and Ethnic Minority Psychology, 18(1), 74-81.

To examine the association between the perception of racial discrimination and the lifetime prevalence rates of psychological disorders in the three most common ethnic minorities in the United States, we analyzed data from a sample consisting of 793 Asian Americans, 951 Hispanic Americans, and 2,795 African Americans who received the Composite International Diagnostic Interview through the Collaborative Psychiatric Epidemiology Studies. The perception of racial discrimination was associated with the endorsement of major depressive disorder, panic disorder with agoraphobia, agoraphobia without history of panic disorder, posttraumatic stress disorder, and substance use disorders in varying degrees among the three minority groups, independent of the socioeconomic status, level of education, age, and gender of participants. The results suggest that the perception of racial discrimination is associated with psychopathology in the three most common U.S. minority groups.

Cohen, C. I., & Marino, L. (2013). Racial and ethnic differences in the prevalence of psychotic symptoms in the general population. Psychiatric Services, 64(11), 1103-1109.

Objective: This study determined the prevalence of psychotic symptoms among racial-ethnic groups in a representative sample of American adults and explored the relationship of these symptoms with race/ethnicity, psychological distress, and dysfunction. Methods: Data from the Collaborative Psychiatric Epidemiology Surveys were used, which combines three nationally representative surveys: the National Comorbidity Survey Replication, National Survey of American Life, and National Latino and Asian American Study. The sample comprised 16,423 respondents, and the analysis adjusted for design effects. Results: The adjusted lifetime and 12-month prevalence rates of psychotic symptoms were 11.6% and 1.4%, respectively. Latinos and blacks had higher lifetime rates (13.6% and 15.3%, respectively) than whites (9.7%) and Asians (9.6%). In logistic regression analysis, lifetime reports of psychotic symptoms were associated with Latino ethnicity, a lifetime diagnosis of a substance use disorder or posttraumatic stress disorder, lifetime psychological
distress, and current dysfunction (limitations in daily activities). Prevalence rates of psychotic symptoms among  respondents with and without lifetime distress, respectively, were as follows: Asian, 5.4% and 6.4%; Latino, 19.9% and 8.2%; black, 21.1% and 9.9%; and white, 13.1% and 5.1%. Conclusions: Race-ethnicity was differentially associated
with psychotic symptoms, with Latinos reporting more lifetime symptoms than other groups after the analysis controlled for other factors. Little evidence was found that psychotic symptoms are “idioms of distress”; respondents who reported lifetime psychotic symptoms were prone to a higher lifetime prevalence of distress, and this association was not specific to any racial-ethnic group. Although psychotic symptoms are often transient, their presence appears to signal a  propensity to experience distress.

Cyders, M. A., & Coskunpinar, A. (2011). Depression, impulsivity and health-related disability: A moderated mediation analysis. Journal of Research in Personality, 45(6), 679-682.

The goal of the current study is to examine how impulsivity affects the relationship between depression and health-related disability. Specifically, we examined impulsivity as a possible moderator of this relationship, as well as alcohol use, smoking, and binge eating as possible mediators. The study utilized the Collaborative Psychiatric Epidemiological Surveys (N = 20,013, mean age = 43.38, female = 57.3%). We conducted a series of moderated mediation analyses to test hypotheses. In all analyses, the relationship between depression and health-related disability was mediated by each maladaptive coping behavior, and the relationship between depression and the behavior was moderated by impulsivity. The study supports the utility of examining the individual difference mechanisms that might drive the relationship between depression and health-related disability.

DeVylder, J. E., & Lukens, E. P. (2013). Family history of schizophrenia as a risk factor for axis I psychiatric conditions. Journal of Psychiatric Research, 47(2), 181-187.

People with first-degree relatives with schizophrenia are at an elevated risk of developing the disorder themselves. High rates of psychotic symptoms in non-psychotic disorders, high rates of comorbidity in psychotic disorders, and diversity of outcomes following psychosis-risk states together suggest that this vulnerability may be for psychiatric conditions in general, not limited to schizophrenia. In this study, data from the National Survey of American Life (NSAL) were used to examine the association between having a first-degree relative with schizophrenia and the lifetime development of a range of non-psychotic axis I psychiatric disorders using adjusted odds ratios. Having a relative with schizophrenia was associated with increased risk for most non-psychotic psychiatric conditions examined, including those expected to be associated with schizophrenia (affective, anxiety, and substance use disorders) and those not expected (bulimia, disorders of childhood onset), excluding respondents with lifetime psychotic symptoms and controlling for demographic factors. Family history of schizophrenia among this predominantly African-American and Afro-Caribbean sample appears to be a risk factor for a range of axis I diagnoses, supporting a continuous rather than categorical nature of psychiatric vulnerability. Future studies should examine whether these associations are due to genetic or environmental factors, or both.

Do, E. K., & Mezuk, B. (2013). Comorbidity between hypomania and substance use disorders. Journal of Affective Disorders, 150(3), 974-980. PMCID: PMC4080889

Background: Bipolar disorder is associated with substance use and misuse. However, to date few studies have examined the relationship between hypomania and substance misuse and dependence in the general population. Methods: Data come from the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys (CPES), a set of multi-stage area probability samples of US adults (N=10,404). Multivariable linear and logistic regression was used to assess the relationship between DSM-IV hypomania and nicotine, alcohol, cannabis, cocaine, and prescription drug use. Models were adjusted for age, gender, education, and marital status. Stratified analyses and interaction terms were used to determine whether the relationship between hypomania and substance misuse varied by race/ethnicity. Results: The 12-month prevalence of hypomania was 0.5%. Hypomania was more common among African Americans (0.9%) relative to non-Hispanic Whites (0.5%) or other race/ethnicities (0.7%). Individuals with hypomania were 3.6 (95% CI: 1.5, 8.5) and 2.9 (95% CI: 1.3, 6.8) times more likely to also meet criteria for alcohol abuse/dependence and drug abuse/dependence relative to individuals without. The relationship between hypomania and substance use outcomes did not vary by race/ethnicity. Limitations: The primary limitation of this study is its cross-sectional design, which precludes any inference about the causal nature of comorbid hypomania-substance use. Conclusions: Hypomania is associated with increased likelihood of substance use and dependence/abuse across a broad range of substances. These associations were consistent across racial/ethnic groups. Findings indicate that even sub-syndromal conditions, such as hypomania, are significantly related to substance use and misuse in the community.

Doyle, O., Joe, S., & Caldwell, C. H. (2012). Ethnic differences in mental illness and mental health service use among black fathers. American Journal of Public Health, 102(S2), S222-S231. PMCID: PMC3340980

Objectives. We have presented nationally representative data on the prevalence and correlates of mental illness and mental health service use among African American and Caribbean Black (US-born and foreign-born) fathers in the United States. Methods. We have reported national estimates of lifetime and 12-month prevalence rates of mental illness, correlates, and service use among African American (n = 1254) and Caribbean Black (n = 633) fathers using data from the National Survey of American Life, a national household survey of Black Americans. We used bivariate cross-tabulations and Cox proportional hazards regression approaches and adjusted for the National Survey of American Life's complex sample design. Results. The prevalence of mental illness, sociodemographic correlates, and service use among Black fathers varied by ethnicity and nativity. US-born Caribbean Black fathers had alarmingly high rates of most disorders, including depression, anxiety, and substance disorders. Mental health service use was particularly low for African American and foreign-born Caribbean Black fathers. Conclusions. These results demonstrate the need for more research on the causes and consequences of mental illness and the help-seeking behavior of ethnically diverse Black fathers.

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.

Erving, C. L. (2011). Gender and physical health: A study of African American and Caribbean black adults. Journal of Health and Social Behavior, 52(3), 383-399.

Although gender disparities in health in the United States remain a primary concern among health professionals, less is known about this phenomenon within the black American population. Using the National Survey of American Life, the author examines gender differences in self-rated health, chronic illness, and functional limitations among African Americans (n = 3,330) and Caribbean blacks (n = 1,562) and the extent to which the availability of resources explains these differences. The results reveal a consistent disadvantage among African American women across indicators of health. The gender-health relationship among Caribbean blacks is somewhat weaker, but there is a health disadvantage for immigrant women and U.S.-born Caribbean men when certain resources are taken into account. These findings illustrate the importance of the intersections of race, ethnicity, and nativity in our understanding of gender differences in health.

Forbush, K. T., & Watson, D. (2013). The structure of common and uncommon mental disorders. Psychological Medicine, 43(1), 97-108.

Background: Co-morbidity patterns in epidemiological studies of mental illness consistently demonstrate that a latent internalizing factor accounts for co-morbidity patterns among unipolar mood and anxiety disorders, whereas a latent externalizing factor underlies the covariation of substance-use disorders and antisocial behaviors. However, this structure needs to be extended to include a broader range of disorders.Method: Exploratory and confirmatory factor analyses were used to examine the structure of co-morbidity using data from the Collaborative Psychiatric Epidemiological Surveys (n = 16 233). Results In the best-fitting model, eating and bipolar disorders formed subfactors within internalizing, impulse control disorders were indicators of externalizing, and factor-analytically derived personality disorder scales split between internalizing and externalizing. Conclusions: This was the first large-scale nationally representative study that has included uncommon mental disorders with sufficient power to examine their fit within a structural model of psychopathology. The results of this study have important implications for conceptualizing myriad mental disorders.

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, K. L., Bryant, A. N., & Kim, G. (In press). Age differences in satisfaction with and perceived benefit from mental health services: Results from the Collaborative Psychiatric Epidemiology Surveys. Journal of Geriatric Psychiatry.

Objective: This study examined variation by age in satisfaction with and perceived benefit from mental health services (MHS). Methods: Drawn from the nationally representative Collaborative Psychiatric Epidemiology Surveys (2001–2003), the current sample included 1286 adults from age 18 to 87 years who had at least one DSM-IV diagnosis and had used MHS during the past year. Multiple linear regression analyses were used to predict satisfaction with and perceived benefit from past year MHS use. Independent variables were sociodemographic factors and objective and perceived needs. Results: Results from multiple linear regression analyses showed that older age was positively associated with both MHS satisfaction (p < 0.05, β = 0.105) and perceived amount of benefit (p < 0.05, β = 0.106), as was better self-rated mental health (p < 0.001, β = 0.186; p < 0.001, β = 0.177). A greater number of comorbid psychiatric diagnoses was negatively associated with satisfaction (p < 0.05, β = −0.089). Marital status was found to be a moderator of the effect of age: for married respondents, age had a significant effect on both outcome variables (p < 0.05, β = 0.102; p < 0.05, β = 0.105), but for unmarried respondents, it did not. Conclusions: Our findings show clear evidence of age differences in satisfaction with and perceived benefit from MHS. The findings provide important implications for future interventions targeted to improve MHS satisfaction. Age-specific strategies should be developed to prevent delay in mental health treatment.

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.

Garrido, M. M., Kane, R. L., Kaas, M., & Kane, R. A. (2009). Perceived need for mental health care among community-dwelling older adults. Journal of Gerontology: Social Sciences, 64B(6), 704-712. PMCID: PMC2763014

Only half of older adults with a mental disorder use mental health services, and little is known about the causes of perceived need for mental health care (MHC). We used logistic regression to examine relationships among depression, anxiety, chronic physical illness, alcohol abuse and/or dependence, sociodemographics, and perceived need among a national sample of community-dwelling individuals 65 years of age and older (the Collaborative Psychiatric Epidemiology Surveys data set). Less than half of respondents with depression or anxiety perceived a need for care. Perceived need was greater for respondents with more symptoms of depression regardless of whether they met diagnostic criteria for a mental illness. History of chronic physical conditions, history of depression or anxiety, and more severe mental illness were associated with greater perceived need for MHC. Future studies of perceived need should account for individual perceptions of mental illness and treatment and the influence of social networks.

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.

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. (2013). Comorbid cardiovascular disease and major depression among ethnic and racial groups in the United States. International Psychogeriatrics, 25(5), 833-841.

BACKGROUND: To describe and examine the distribution, disability, and treatment associated with comorbid cardiovascular disease and major depressive disorder (CVD/MDD) among middle-aged and older ethnic/racial groups in the United States. METHODS: Cross-sectional data from a national probability sample of household resident adults (18 years and older; N = 16,423) living in the 48 coterminous United States were analyzed. We defined comorbid CVD/MDD as the presence of CVD (e.g. diabetes, hypertension, heart disease, and stroke) among adults who met MDD criteria at or after age 50 years. RESULTS: Two-thirds of middle-aged and older American adults meeting criteria major depression at or after age 50 years also reported a diagnosis of comorbid CVD. Blacks were most likely to meet our comorbid CVD/MDD (74.4%) criteria. The disease burden of depression was also highest among Black respondents. Differences in treatment due to race/ethnicity and comorbidity were not statistically significant. CONCLUSIONS: Our findings indicate that among middle-aged and older US adults meeting MDD criteria more than half would also report a comorbid CVD. Comorbid CVD/MDD rates varied between the considered ethnic/race groups. Functional impairment associated with comorbid CVD/MDD was higher than MDD alone; however, depression care rates did not differ remarkably. Among middle-aged and older adults meeting MDD criteria, comorbid CVD may be the rule rather than the exception.

González, H. M., Tarraf, W., Whitfield, K., Gallo, J. J. (2012). Vascular depression prevalence and epidemiology in the United States. Journal of Psychiatric Research, 46(4), 456-461.

Objective: To examine and describe vascular depression epidemiology in the United States. Methods: Cross-sectional data from a national probability sample of household resident adults (18-years and older; N = 16,423) living in the 48 coterminous United States were analyzed to calculate prevalence estimates of vascular depression, associated disability and treatment rates. In this study, vascular depression was defined as the presence of cardiovascular and cerebrovascular disease (CVD) and CVD major risk factors (e.g., diabetes, hypertension, heart disease, and obesity) among adults 50-years and older who also met 12-month DSM-IV major depression criteria. Results: We estimated that about 3.4% or approximately 2.64 million American adults 50-years and older met our criteria for vascular depression. Among adults who met criteria for lifetime major depression, over one-in-five (22.1%) were considered to have the vascular depression subtype. Secondly, vascular depression was associated with significantly increased functional impairment relative to the non-depressed population and adults meeting criteria for major depression alone. Although depression care use was significantly higher among vascular depression respondents relative to those with major depression alone, practice guideline concordant therapy use was not. Conclusions: Vascular depression appears to be an important public health problem that affects a large portion of the U.S. adult population with major depression, and that it is associated with excess functional impairment without concomitant better depression care.

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.

Goosby, B. J., Caldwell, C. H., Bellatorre, A., & Jackson, J. S. (2012). Ethnic differences in family stress processes among African-Americans and black Caribbeans. Journal of African American Studies, 16(3), 406-422.

Several theories of stress exposure, including the stress process and the family stress model for economically disadvantaged families, suggest that family processes work similarly across race/ethnic groups. Much of this research, however, treats African-Americans as a monolithic group and ignores potential differences in family stress processes within race that may emerge across ethnic groups. This study examines whether family stress processes differ intraracially in African-American and Black Caribbean families. Using data from the National Survey of American Life, a national representative data set of African-American and Black Caribbean families, we assess the extent to which parents’ stress appraisals and psychological adjustment are related to their adolescent children’s stress appraisals, psychological adjustment, and depressive symptoms. Our study illustrates that stress processes differ by ethnicity and operate through varying pathways in African-American and Black Caribbean families. The implications of intraracial variations in stress processes are discussed.

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.

Griffith, D. M., Johnson-Lawrence, V., Gunter, K., & Neighbors, H. W. (2011). Race, SES, and obesity among men. Journal of Race and Social Problems, 3(4), 298-306.

Over the last decade, obesity has increased significantly among men but few national studies have empirically examined racial and socioeconomic differences in obesity among men. In this paper, we utilized logistic regression to evaluate the potential associations that race and socioeconomic status may have with obesity among men in the National Survey of American Life: an in-person household survey of non-institutionalized U.S. blacks and whites who lived in communities where at least 10% of the community residents were black Americans. A greater proportion of black men were likely to be obese than white men, but no interaction among race, SES, and obesity was detected when potential confounding variables were included. There was not a relationship between SES and obesity for white men, but there was an apparent positive relationship between SES and obesity for black men that did not remain significant in adjusted models. No relationship was found between age and obesity among black men, though white men who were 55 and older were more likely than those 18–34 to be obese in confounder adjusted models. Among white men, no relationships were found between obesity and education, household income, or marital status. Black men in the lowest income category were less likely to be obese than those in the highest income category, in bivariate but not adjusted models. These findings suggest that the way racial, economic, stress and behavioral factors combine to affect obesity in black and white men may be different.

Habtegiorgis, A. E., & Paradies, Y. (2013). Utilising self-report data to measure racial discrimination in the labour market. Australian Journal of Labour Economics, 16(1), 5-41.

Although economists have developed a series of approaches to modelling the existence of labour market discrimination, rarely is this topic examined by analysing self-report survey data. After reviewing theories and empirical models of labour market discrimination, we examine self-reported experience of discrimination at different stages in the labour market, among three racial groups utilising U.S. data from the 2001-2003 National Survey of American Life. Our findings indicate that African Americans and Caribbean blacks consistently report more experience of discrimination in the labour market than their non-Hispanic white counterparts. At different stages of the labour market, including hiring, termination and promotion, these groups are more likely to report discrimination than non-Hispanic whites. After controlling for social desirability bias and several human capital and socio-demographic covariates, the results remain robust for African Americans. However, the findings for Caribbean blacks were no longer significant after adjusting for social desirability bias. Although self-report data is rarely utilised to assess racial discrimination in labour economics, our study confirms the utility of this approach as demonstrated in similar research from other disciplines. Our results indicate that after adjusting for relevant confounders self-report survey data is a viable approach to estimating racial discrimination in the labour market. Implications of the study and directions for future research are provided.

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.

Harnois, C. E., & Ifatunji, M. (2011). Gendered measures, gendered models: Toward an intersectional analysis of interpersonal racial discrimination. Ethnic and Racial Studies, 34(6), 1006-1028.

In this paper we draw from black and multiracial feminist theories to argue that interpersonal racial discrimination should be understood as a potentially gendered phenomenon. While there are some discriminatory practices that are directed at both black men and black women, some forms of racial discrimination affect men more than women, and some affect women more than men. Still other forms may be gender-specific. Our review of existing literature shows that most survey research has utilized measures and models of racial discrimination that fail to account for these gender differences. Drawing on the 2001–2003 National Survey of American Life (NSAL) we demonstrate the importance of gender for understanding and analysing interpersonal racial discrimination. We offer concrete ways for social researchers to centralize gender in their analyses. By doing so, we hope to advance the development of an intersectional approach to racial discrimination.

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.

Himle, J. A., Taylor, R. J., Chatters, L. M. (2012). Religious involvement and obsessive compulsive disorder among African Americans and black Caribbeans. Journal of Anxiety Disorders, 26(4), 502-510.

Prior research is equivocal concerning the relationships between religious involvement and obsessive-compulsive disorder (OCD). The literature indicates limited evidence of denomination differences in prevalence of OCD whereas findings regarding OCD and degree of religiosity are equivocal. This study builds on prior research by examining OCD in relation to diverse measures of religious involvement within the National Survey of American Life, a nationally representative sample of African American and Black Caribbean adults. Bivariate and multivariate analyses (logistic regression) examine the relationship between lifetime prevalence of OCD and religious denomination, service attendance, non-organizational religiosity (e.g., prayer, religious media) subjective religiosity, and religious coping. Frequent religious service attendance was negatively associated with OCD, whereas Catholic affiliation (as compared to Baptist) and religious coping (prayer when dealing with stressful situations) were both positively associated with OCD. With regard to demographic factors, persons of older age and higher education levels were significantly less likely to have OCD.

Hudson, D. L., Bullard, K. M., Neighbors, H. W., Geronimus, A. T., Yang, J., & Jackson, J. S. (2012). Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men? Journal of Men’s Health, 9(2), 127-136. PMCID: PMC3371660

Background: Conventional wisdom suggests that increased socioeconomic resources should be related to better health. Considering the body of evidence demonstrating the significant association between racial discrimination and depression, we examined whether exposure to racial discrimination could attenuate the positive effects of increased levels of socioeconomic position (SEP) among African Americans. Specifically, this paper investigated the joint interactive effects of SEP and racial discrimination on the odds of depression among African Americans. Methods: Racial discrimination was measured using two measures, major and everyday discrimination. Study objectives were achieved using data from the National Survey of American Life, which included a nationally representative sample of African Americans (n = 3570). Logistic regression models were used to estimate the effects of SEP and racial discrimination on the odds of depression. Results: Reports of racial discrimination were associated with increased risk of depression among African American men who possessed greater levels of education and income. Among African American men, significant, positive interactions were observed between education and experiences of major discrimination, which were associated with greater odds of depression (P = 0.02). Additionally, there were positive interactions between income and both measures of racial discrimination (income x everyday discrimination, P = 0.013; income x major discrimination, P = 0.02), which were associated with increased odds of depression (P = 0.02). Conclusions: It is possible that experiences of racial discrimination could, in part, diminish the effects of increased SEP among African American men.

Hudson, D. L., Neighbors, H. W., Geronimus, A. T., & Jackson, J. S. (2012). The relationship between socioeconomic position and depression among a US nationally representative sample of African Americans. Social Psychiatry and Psychiatric Epidemiology, 47(3), 373-381. PMCID: PMC3279642

Purpose: Findings from previous studies have not revealed significant, inverse relationships between socioeconomic position (SEP) and depression among African Americans. This study examined the relationship between multiple indicators of SEP and Major Depressive Episode (MDE) among African Americans. Methods: Data were drawn from the National Survey of American Life main interview and re-interview. MDE, at both 12 month and lifetime intervals, was assessed using the World Mental Health version of the Composite International Diagnostic Interview. Logistic regression models were adjusted for demographics. Results: For 12-month MDE, household income and unemployment predicted greater odds of MDE among African American men, while there was an inverse relationship between education and 12-month MDE. Only unemployment was significantly associated with lifetime MDE among African American men. For African American women, a significant inverse relationship between household income and 12-month MDE was observed. Conclusions: Findings garnered from this study indicate that it is important to consider multiple measures of SEP in the prediction of depression among African Americans, and that the pattern of association between SEP and depression varies according to sex. Considering the paucity of studies that have explored the relationship between SEP and depression, additional research is needed to more firmly establish the relationship between SEP and depression. It is also important to consider stressors that may affect the relationship between SEP and depression among African Americans.


Hunte, H. E. R., & Barry, A. E. (2012). Perceived discrimination and DSM-IV-based alcohol and illicit drug use disorders. American Journal of Public Health, 102(12), e111-e117.

Objectives. We examined the relationship between everyday and major discrimination and alcohol and drug use disorders in a nationally representative sample of African Americans and Black Caribbeans. Methods. With data from the National Survey of American Life Study, we employed multivariable logistic regression analyses—while controlling for potential confounders—to examine the relationship between everyday and major discrimination and substance use disorders on the basis of Diagnostic and Statistical Manual of Mental Disorders criteria. Results. Every 1 unit increase in the everyday discrimination scale positively predicted alcohol (odds ratio [OR] = 1.02; P < .01) and drug use (OR = 1.02; P < .05) disorders. Similarly, each additional major discrimination event positively predicted alcohol (OR = 1.10; P < .05) and drug use (OR = 1.15; P < .01) disorders. Conclusions. To our knowledge, this study is the first to examine problematic usage patterns rather than infrequent use of alcohol and drugs in a national sample of African American and Black Caribbean adults and the first to examine this particular relationship in a national sample of Black Caribbeans.

Ida, A. K., & Christie-Mizell, C. A. (2012). Racial group identity, psychological resources, and depressive symptoms: Exploring ethnic heterogeneity among black Americans. Sociological Focus: An Interdisciplinary Journal of Body Weight and Society, 45(1), 41-62.

We utilized data from the National Survey of American Life to investigate the relationships among racial identity (closeness to other blacks and black group evaluation), psychosocial resources (self-esteem, mastery, and social support), and depressive symptoms. The data allowed us to explore ethnic heterogeneity among black Americans, with a sample of 2,953 African Americans and 1,140 Caribbean Blacks. Results indicated that for African Americans, the impact of racial identity and psychosocial resources were largely a direct pattern, in which black group evaluation, self-esteem, and mastery reduce depressive symptomatology. For Caribbean Blacks, racial identity and psychosocial resources were all directly and inversely related to depressive symptoms. We also found moderating effects for Caribbean Blacks; high levels of closeness to other blacks maximized the benefits of social support. Similarly, positive black group evaluation amplified the protective impact of mastery on depressive symptoms.

Ifatunji, M. A., & Harnois, C. E. (In press). An explanation for the gender gap in perceptions of discrimination among African Americans: Considering the role of gender bias in measurement. Sociology of Race and Ethnicity.

Studies indicate that African American men report more personal experiences with discrimination than do African American women. According to the subordinate male target hypothesis, this gender difference reflects an underlying reality in which African American men are the primary targets of anti-Black discrimination. From the perspective of intersectionality theory, African American women and men experience racial discrimination differently; and therefore greater reports of discrimination among African American men might be a result of measurement bias that favors the experiences of African American men vis-à-vis African American women. To assess these perspectives, the authors analyze data from the 1995 Detroit Area Study and the 2001–2003 National Survey of American Life. The authors use multiple-group confirmatory factor analytic models with latent means and categorical outcomes to observe the degree to which gender bias in measurement accounts for disparities in perceived discrimination among African American women and men. The results show that gender bias in the measures most often used to assess unfair treatment in social surveys is responsible for the gender gap in certain kinds of perceived discrimination among African Americans. Measures of everyday discrimination are mostly gender balanced, but measurement bias is responsible for a large portion of the gap in perceptions of major life discrimination and the entire gap when major life discrimination is attributed to race. The results highlight the importance of intersectionality theory for assessing discrimination, and the authors argue that revisions in the measurement of perceived discrimination are required to better reflect the experiences of African American women.

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.

Jaggi, L. J., Mezuk, B., Watkins, D. C., & Jackson, J. S. (In press). The relationship between trauma, arrest, and incarceration history among black Americans: Findings from the National Survey of American Life. Sociology and Mental Health.

Prior research indicates an association between exposure to trauma (e.g., being victimized) and perpetration of crime, especially in the context of chronic victimization. This study examines the relationship between trauma exposure, posttraumatic stress disorder (PTSD), and history of arrest and incarceration among a representative sample of black Americans from the National Survey of American Life (N = 5,189). One-third had a history of arrest, and 18 percent had a history of incarceration. Frequency of trauma exposure was associated with involvement with the criminal justice system. Relative to never experiencing trauma, experiencing ≥4 traumas was associated with elevated odds of arrest (odds ratio [OR] = 4.03), being jailed (OR = 5.15), and being imprisoned (OR = 4.41), all p < .01. PTSD was also associated with likelihood of incarceration among those with a history of trauma (OR = 2.18, p < .01). Both trauma exposure and trauma-associated psychopathology are associated with increased likelihood of arrest and incarceration in adulthood among black Americans.

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.

Johnson, E. M., & Coles, M. E. (In press). Failure and delay in treatment-seeking across anxiety disorder. Community Mental Health Journal.

Anxiety disorders are a significant mental health problem. Despite the availability of effective treatments most sufferers do not seek help. The current study assesses delays in treatment-seeking, failure to seek treatment, and reasons for delaying treatment for individuals with anxiety disorders. Data were drawn from the Collaborative Psychiatric Epidemiological Surveys including 3,805 participants and analyses focused on treatment-seeking variables. Results indicate that individuals with anxiety disorders are less likely to seek treatment from a professional and more likely to experience delays in obtaining both any treatment, and effective treatment, than individuals with other forms of mental illness (in this case unipolar depression or substance use disorders). Deficits in mental health literacy (knowledge and beliefs about mental illness) were commonly endorsed as reasons for having delayed seeking treatment. The current study highlights the importance of improving knowledge about anxiety disorders to improve treatment-seeking.

Johnson-Lawrence, V., Griffith, D. M., & Watkins, D. C. (2013). The effects of race, ethnicity, and mood/anxiety disorders on the chronic physical health conditions of men from a national sample. American Journal of Men’s Health, 7(4 Suppl), 58S-67S. PMCID: PMC3895415

Racial/ethnic differences in health are evident among men. Previous work suggests associations between mental and physical health but few studies have examined how mood/anxiety disorders and chronic physical health conditions covary by age, race, and ethnicity among men. Using data from 1,277 African American, 629 Caribbean Black, and 371 non-Hispanic White men from the National Survey of American Life, we examined associations between race/ethnicity and experiencing one or more chronic physical health conditions in logistic regression models stratified by age and 12-month mood/anxiety disorder status. Among men <45 years without mood/anxiety disorders, Caribbean Blacks had lower odds of chronic physical health conditions than Whites. Among men aged 45+ years with mood/anxiety disorders, African Americans had greater odds of chronic physical health conditions than Whites. Future studies should explore the underlying causes of such variation and how studying mental and chronic physical health problems together may help identify mechanisms that underlie racial disparities in life expectancy among men.

Jordan, J. T., & Samuelson, K. W. (In press). Predicting suicide intent: The roles of experiencing or committing violent acts. Suicide and Life-Threatening Behavior.

According to the interpersonal theory of suicide, repeated exposure to painful or provocative experiences is associated with lethal or nearly lethal suicide attempts. However, suicide research often focuses on suicide ideation or attempts, rather than intent. Using data from the Collaborative Psychiatric Epidemiological Surveys, we examined traumatic experiences, with a focus on repeated exposure to traumas, in individuals who described their suicide attempts as a strong intent to die versus a cry for help. Only repeated acts of committing violence were associated with high suicide intent, suggesting that individuals who engage in violence are at heightened risk for suicide.

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.

Kim, G., DeCoster, J., Chiriboga, D. A., Jang, Y., Allen, R. S., & Parmelee, P. (2011). Associations between self-rated mental health and psychiatric disorders among older adults: Do racial/ethnic differences exist? American Journal of Geriatric Psychiatry, 19(5), 416-422.

Obective: This study examined racial/ethnic differences in the association between self-rated mental health (SRMH) and psychiatric disorders among community-dwelling older adults in the United States. Design: Cross-sectional analyses of nationally representative data from the Collaborative Psychiatric Epidemiology Surveys (2001–2003). Setting: In-person household interviews. Participants: Older adults aged 60 and older (N = 1,840), including non-Hispanic Whites (N = 351), Blacks (N = 826), Hispanics (N = 406), and Asians (N = 257). Measurements: SRMH was measured with a single item, “How would you rate your own mental health?” Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnoses for mood and anxiety disorders were measured with the World Health Organization's World Mental Health version of the Composite International Diagnostic Interview. Results: Results from logistic regression analyses showed significant main effects of both SRMH and race/ethnicity on the presence of mood and anxiety disorders: people who have poor SRMH and are non-Hispanic Whites were more likely to have mood and anxiety disorders. There were also significant interaction effects between SRMH and race/ethnicity, such that the relation of SRMH with diagnoses of psychiatric disorders was strongest in non-Hispanic Whites. Conclusions: Racial/ethnic variations were found in the relationship between self-perception of mental health and DSM-IV psychiatric disorders. The findings suggest the need to develop race/ethnicity-specific strategies to screen psychiatric disorders in diverse elderly populations. Future studies are needed to investigate possible reasons for the racial/ethnic group differences.

Kim, G., Parton, J. M., DeCoster, J., Bryant, A. N., Ford, K. L., Parmelee, P. A. (In press). Regional variation of racial disparities in mental health service use among older adults. The Gerontologist.

Purpose: Given the paucity of research on the role of geography in mental health care, this study examined whether racial differences in mental health service use varied across geographic regions among older adults. Design and Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), blacks (n = 1,008) and whites (n = 1,870) aged 60 and older were selected for analysis. Logistic regression analyses were conducted. Results: Results showed significant racial disparities in mental health service use in the overall sample, as well as significant variation by region. Although no racial differences were observed in the Northeast, West, or Midwest regions, black elders in the South were significantly less likely than whites to use mental health services (odds ratios [OR], 2.08; 95% confidence interval [CI], 1.34–3.23). Implications: The findings suggest that improving the access to mental health care in certain regions, the South in particular, may be essential to reduce racial disparities at the national level. Policy implications are discussed.

Lacey, K. K., & Mouzon, D. M. (In press). Severe physical intimate partner violence and the mental and physical health of U.S. Caribbean black women. Journal of Women’s Health.

Background: Intimate partner violence is a threat to women's health. Relative to other racial/ethnic groups, African American and immigrant women are at an increased risk for violence. However, despite the growing presence of Caribbean Black immigrants in this country, few studies have examined the association between severe physical intimate partner violence (SPIPV) and the health of Caribbean Black women currently residing in the United States. This study examined the mental and physical health of U.S. Caribbean Black women with and without a history of SPIPV. We also explored the role of generational status—first, second, or third—in association with the physical and mental health of abused Caribbean Black women. Methods: Data from the National Survey of American Life, the largest and the only known representative study on Caribbeans residing in the United States, were analyzed. The World Health Organization (WHO) World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to determine DSM-IV mental disorders. The presence of physical health conditions was based on respondents' self-reports of physician diagnoses. Results: The findings indicate an association between SPIPV and the mental and physical health status of U.S. Caribbean Black women. Rates of physical conditions and mental health disorders were generally higher among women with a history of SPIPV than those without a history. Generational status also played a role in women's health outcomes. Conclusions: The study has interventions and preventive implications for both detecting and addressing the health needs of U.S. Caribbean Black women who experience severe physical abuse by an intimate partner.

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.

Le Cook, B., Doksum, T., Chen, C.-N., Carle, A., & Alegría, M. (2013). The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S. Social Science and Medicine, 84, 102-109. PMCID: PMC3659418

Racial and ethnic disparities in mental health care access in the United States are well documented. Prior studies highlight the importance of individual and community factors such as health insurance coverage, language and cultural barriers, and socioeconomic differences, though these factors fail to explain the extent of measured disparities. A critical factor in mental health care access is a local area's organization and supply of mental health care providers. However, it is unclear how geographic differences in provider organization and supply impact racial/ethnic disparities. The present study is the first analysis of a nationally representative U.S. sample to identify contextual factors (county-level provider organization and supply, as well as socioeconomic characteristics) associated with use of mental health care services and how these factors differ across racial/ethnic groups. Hierarchical logistic models were used to examine racial/ethnic differences in the association of county-level provider organization (health maintenance organization (HMO) penetration) and supply (density of specialty mental health providers and existence of a community mental health center) with any use of mental health services and specialty mental health services. Models controlled for individual- and county-level socio-demographic and mental health characteristics. Increased county-level supply of mental health care providers was significantly associated with greater use of any mental health services and any specialty care, and these positive associations were greater for Latinos and African-Americans compared to non-Latino Whites. Expanding the mental health care workforce holds promise for reducing racial/ethnic disparities in mental health care access. Policymakers should consider that increasing the management of mental health care may not only decrease expenditures, but also provide a potential lever for reducing mental health care disparities between social groups.

Lee, S. (2011).  Racial variations in major depressive disorder onset among immigrant populations in the United States. Journal of Mental Health, 20(3), 260-269.

Background and Aims. Considering the heterogeneity within the immigrant population, this study aimed to examine racial variations in major depressive disorder (MDD) onset and the factors associated with it among immigrants in the United States. Methods. Data from the Collaborative Psychiatric Epidemiology Surveys were analyzed. The Kaplan–Meier method was employed to estimate survival functions by race. The Cox proportional hazards model was employed to explore the factors associated with MDD onset after controlling for socio-demographic and immigration-related sample characteristics. Results. Asians showed the highest survival function, followed by African Americans. A Cox proportional hazards model indicated that those who were younger, female, and non-Asian were more likely to experience an MDD onset than were their older, male, and Asian counterparts. None of the immigration-related characteristics were found to be significantly associated with MDD onset among foreign-born individuals. Conclusions. Findings from this study reveal that different racial groups experience different patterns of MDD onset over time. Exploring the factors associated with MDD onset will help mental health providers identify vulnerable subgroups among immigrant populations and, in turn, promote adequate mental health services for them.

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.

Levine, D. S., Himle, J. A., Taylor, R. J., Abelson, J. M., Matusko, N., Muroff, J. R., & Jackson, J. S.  (In press). Panic disorder among African Americans, Caribbean blacks and non-Hispanic whites. Social Psychiatry & Psychiatric Epidemiology.      

Introduction: This study investigated co-morbidities, level of disability, service utilization and demographic correlates of panic disorder (PD) among African Americans, Caribbean blacks and non-Hispanic white Americans. Methods: Data are from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R). Results: Non-Hispanic whites are the most likely to develop PD across the lifespan compared to the black subgroups. Caribbean blacks were found to experience higher levels of functional impairment. There were no gender differences found in prevalence of PD in Caribbean blacks, indicating that existing knowledge about who is at risk for developing PD (generally more prevalent in women) may not be true among this subpopulation. Furthermore, Caribbean blacks with PD were least likely to use mental health services compared to African Americans and non-Hispanic whites. Conclusion: This study demonstrates that PD may affect black ethnic subgroups differently, which has important implications for understanding the nature and etiology of the disorder.

Libby, D. J., Pilver, C. E., & Desai, R. (In press). Complementary and alternative medicine use among individuals with posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy.

The purpose of the current study is to describe the patterns of complementary and alternative medicine (CAM) use for the treatment of mental and emotional problems among individuals with PTSD. Data from 599 individuals with past-year PTSD were obtained from the Collaborative Psychiatric Epidemiology Surveys. Descriptive analyses described the extent to which each of 15 CAM treatments were used. Multivariate analyses identified correlates of CAM use, organized according to a sociobehavioral model of health care utilization. Results demonstrated that 39% of individuals with PTSD reported using a CAM treatment to address their self-reported emotional and mental problems in the past year. Only 13% of CAM users saw a CAM practitioner for their CAM treatment. The most common types of CAM used were mind–body treatments, specifically relaxation or meditation techniques and exercise therapy. Correlates of CAM use in the past year included the predisposing factors of gender, race, and education, as well as the health need factor of comorbid psychiatric disorders. Individuals with PTSD were just as likely to use CAM as an alternative to conventional mental health care as they were to use CAM as a complement to conventional mental health care. Clinicians should discuss CAM use with their patients in order to avoid possible adverse interactions with conventional forms of care, to educate patients about the risks and benefits of CAM treatments, and to maximize the potential benefits of patients' various treatment approaches.

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., & Chae, D. H. (2012). Emotional support, negative interaction and major depressive disorder among African Americans and Caribbean blacks: Findings from the National Survey of American Life. Social Psychiatry and Psychiatric Epidemiology, 47(3), 361-372.

Objectives: Few studies have examined the association between social support, negative interaction, and major depressive disorder among representative samples of racial and ethnic minority groups. This study investigates the relationship between emotional support and negative interaction with family members on lifetime major depressive disorder among African Americans and Caribbean Blacks. Method: Cross-sectional epidemiologic data from the National Survey of American Life and multivariable logistic regression analyses were used to predict lifetime history of major depressive disorder and to examine the effect of perceived emotional support and negative interaction on major depressive disorder among 3,570 African Americans and 1,621 Caribbean Blacks aged 18 and older. Results: Multivariate analyses found that perceived emotional support was associated with lower odds of MDD for African Americans and Caribbean Blacks. Negative interaction with family was associated with greater odds of MDD for African Americans and Caribbean Blacks. Emotional support moderated the impact of negative interaction on MDD for Caribbean Blacks, but not for African Americans. Discussion: This is the first study to investigate the relationships between emotional support, negative interaction with family members and depressive disorder among African Americans and Caribbean Blacks. Negative interaction was a risk factor for depression and emotional support was a protective factor.

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. M. (In press). Correlates of emotional support and negative interaction among African Americans and Caribbean blacks. Journal of Family Issues.

This study explores the relationship of family and demographic factors to the frequency of receiving emotional support and the frequency of engaging in negative interactions with family members (i.e., criticism, burden, and being taken advantage of). The study uses the ambivalence framework and data from the National Survey of American Life, a national sample of African Americans and Caribbean Blacks (Caribbean Blacks). Overall, no significant differences were found between African Americans and Caribbean Blacks in the frequency of emotional support or negative interaction; several significant correlates (e.g., age, family closeness) were found for both groups. However, a number of unique associations were also demonstrated (e.g., marital status, frequency of family contact), indicating differences in the ways that these variables operate within the two populations. These and other findings are discussed in relation to the ambivalence framework and subgroup differences in family phenomena within the Black population.

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., Chatters, L. M., & Joe, S. (2012). Suicide, negative interaction and emotional support among black Americans. Social Psychiatry & Psychiatric Epidemiology, 47(12), 1947-1958.

Objectives: This study is the first to investigate the relationship between perceived emotional support and negative interaction with family members and suicide ideation and attempts among African American and Caribbean black adults. Method: Cross-sectional epidemiologic data from the National Survey of American Life and multivariable logistic regression analyses were used to examine the association between perceived emotional support and negative interaction and suicide behaviors among 3,570 African Americans and 1,621 Caribbean blacks age 18 and older. Results: Multivariate analyses found that perceived emotional support was associated with lower odds of suicide ideation and attempts for African Americans and Caribbean blacks. Negative interaction with family was associated with greater odds of suicide ideation among African Americans and Caribbean blacks. Ethnicity moderated the impact of emotional support and negative interaction on suicide attempts; among Caribbean blacks, those who reported more frequent emotional support from their family had a significantly greater reduced risk for suicide attempts than African Americans. The effect of negative interaction on suicide attempts was also more pronounced for Caribbean blacks compared to African Americans. Discussion: Negative interaction was a risk factor for suicide ideation and emotional support was a protective factor for attempts and ideation. These associations were observed even after controlling for any mental disorder. The findings demonstrate the importance of social relationships as both risk and protective factors for suicide and ethnic differences in suicidal ideation and attempts among black Americans.

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.

Lincoln, K. D., Taylor, R. J., Watkins, D. C., & Chatters, L. M. (2011). Correlates of psychological distress and major depressive disorder among African American men. Research on Social Work Practice, 21(3), 278-288. PMCID: PMC3112049

This study examines the demographic correlates of depressive symptoms, serious psychological distress (SPD), and major depressive disorder (MDD; 12-month and lifetime prevalence) among a national sample of African American men. Analysis of the National Survey of American Life (NSAL) data set provides first-time substantiation of important demographic differences in depressive symptoms (measured by the Center for Epidemiological Studies Depression scale [CES-D]), SPD (measured by the K6), and 12-month and lifetime MDD among African American men. Findings illuminate the heterogeneity within the African American male population. Findings also demonstrate the need for additional research focusing on within-group differences and a comprehensive research and mental health promotion agenda that recognizes the importance of improving access to education and employment and promoting healthy coping behaviors, while acknowledging the larger social context in which African American men live.

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.

Lo, C. C., & Cheng, T. C. (2012). Discrimination’s role in minority groups’ rates of substance-use disorder. American Journal of Addictions, 21(2), 150-156.

This study asked whether, among the three largest American racial/ethnic minorities, presence/absence of current substance-use disorder is explained to any degree by social status and discrimination. It examined interaction effects involving discrimination and social status, exploring whether social-status factors are channeled through discrimination, fostering disorder. Logistic regression techniques were applied to data from the nationally representative dataset 2001–2003 Collaborative Psychiatric Epidemiology Surveys. Findings generally suggest that presence of substance-use disorder is likely to be associated with perceived discrimination. Significant interaction effects were also found: Discrimination's strongest association with substance-use disorder was observed for Asian respondents with lower incomes and for Hispanic respondents with little education. This study significantly expands knowledge, since little research preceding it directly addressed relationships among social-status factors, discrimination, and substance-use disorder in minority populations. This study's results should encourage future researchers to further explore mechanisms of the mental health effects of discrimination.

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.

Manuel, R., Taylor, R. J., & Jackson, J. S. (2012). Race and ethnic group differences in socio-economic status: Black Caribbeans, African Americans and non-Hispanic whites in the United States. Western Journal of Black Studies, 36(3), 228-239.

This study investigated ethnic-related heterogeneity in socio-economic status among Black persons in the United States. Guided by arguments from sociology’s status attainment literature on the assimilation of ethnic groups, the study hypothesized ethnic and racial differences across seven measures of socio-economic status. The examination of data from the National Survey of American Life revealed differences between Caribbean Blacks and African Americans on five of the seven indicators of socio-economic status, depending on Caribbeans’ country-of-origin, or duration-of-stay in the United States. A Caribbean advantage characteristically defined the nature of the differences shown. The few differences between Caribbean Blacks and non-Hispanic Whites, in contrast to the greater prevalence of African American and non-Hispanic White differences additionally supported the thesis of Black ethnic-related economic heterogeneity.

Marques, L., Alegría, M., Becker, A. E., Chen, C-N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412-420. PMCID: PMC3011052

Objective: The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non-Latino Whites. Method: Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES;NIMH, 2007) were used. Results: The prevalence of anorexia nervosa (AN) and binge-eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non-Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non-Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non-Latino Whites for respondents with a lifetime history of any eating disorder. Discussion: These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States.

Marshall, G. L., Hooyman, N. R., Hill, K. G., & Rue, T. C. (In press). Association of socio-demographic factors and parental education with depressive symptoms among older African Americans and Caribbean blacks. Aging & MentalHealth.

Objective: The purpose of this study was to examine ethnic variation in the relationship between individual socio-demographic factors, parental educational level, and late-life depressive symptoms in older African Americans and Caribbean Blacks. Method: This cross-sectional study used data from the National Survey of American Life. A subsample of older African Americans (N = 837) and Caribbean Blacks (N = 271) was analyzed using multiple regression analysis. Results: Findings suggest differences in predictors of depressive symptoms for the two ethnic groups. Among older African Americans, lower educational attainment and lower income were predictive risk factors for higher depressive symptoms. Findings among older Caribbean Blacks suggest that nativity and income were significantly associated with depressive symptoms. This study did not find support for any association between parental education and late-life depressive symptoms. Conclusion: This study adds new information by considering ethnic variation in an examination of depressive symptoms in older Black Americans. The results contribute to the growing awareness of the older Caribbean Black population in the United States.

Marshall, G. L., Hooyman, N. R., Hill, K. G., & Rue, T. C. (2013). Association of socio-demographic factors and parental education with depressive symptoms among older African Americans and Caribbean blacks. Aging & Mental Health, 17(6), 732-737.

Objective: The purpose of this study was to examine ethnic variation in the relationship between individual socio-demographic factors, parental educational level, and late-life depressive symptoms in older African Americans and Caribbean Blacks. Method: This cross-sectional study used data from the National Survey of American Life. A subsample of older African Americans (N = 837) and Caribbean Blacks (N = 271) was analyzed using multiple regression analysis. Results: Findings suggest differences in predictors of depressive symptoms for the two ethnic groups. Among older African Americans, lower educational attainment and lower income were predictive risk factors for higher depressive symptoms. Findings among older Caribbean Blacks suggest that nativity and income were significantly associated with depressive symptoms. This study did not find support for any association between parental education and late-life depressive symptoms. Conclusion: This study adds new information by considering ethnic variation in an examination of depressive symptoms in older Black Americans. The results contribute to the growing awareness of the older Caribbean Black population in the United States.

Marshall, G. L., & Rue, T. C. (2012). Perceived discrimination and social networks among older African Americans and Caribbean blacks. Family & Community Health, 35(4), 300-311.

The relationship between perceived discrimination and depressive symptoms among older black American populations is poorly understood. Although a small number of studies have examined the relationship between stress and social support, few have examined the association between perceived discrimination, social networks, and depressive symptoms among a representative sample of older racial and ethnic groups. This study examines (a) the relationship between sociodemographic factors, perceived discrimination and depressive symptoms and (b) social networks as a potential moderator in the perceived discrimination and depressive symptom relationship between 2 groups of older black Americans. This was a cross-sectional study using data from the National Survey of American Life with a sample of older African Americans (N = 837) and Caribbean blacks (N = 271). Depressive symptoms were assessed using the 12-item Center for Epidemiological Studies Depression scale. Linear regression analyses were used to predict depressive symptoms. The relationship between perceived discrimination and depressive symptoms was significant in both groups. Social networks contributed as a protective factor for depressive symptoms for both groups. However, there was no significant moderation effect. Results suggest that regardless of ethnic affiliation, the experience of perceived discrimination is similar in both groups and is a risk factor for depressive symptoms. Future research is needed in this area to better understand the associations between sociodemographic factors, perceived discrimination, social networks, and their impact on depressive symptoms.

Martins, S. S., Ko, J., Kuwabara, S., Clarke, D., Alexandre, P., Zandi, P., Mendelson, T., Mortensen, P. B., & Eaton, W. (2012). The relationship of adult mental disorders to socioeconomic status, race/ethnicity, marital status, and urbanicity of residence. In W. Eaton (Ed.), Public Mental Health (pp. 151-199). New York: Springer University Press.

A comprehensive review of the literature suggests the central importance for adult mental disorders of the variables of socioeconomic status, race/ethnicity, marital status, and urbanicity of residence. Results are presented from the two best data sets for analyses of important social variables and common adult mental disorders: The Collaborative Psychiatric Epidemiology Surveys and the National Epidemiologic Study of Alcohol and Related Conditions. For the analysis of schizophrenia, data from the Danish Psychiatric Register are presented. Low socioeconomic status is associated with schizophrenia, major depressive disorder, anxiety disorders, and substance use disorders. Blacks and Hispanics have equal or even lower risk for major depressive disorder than Whites, but these groups are at higher risk for chronic or persistent depression than Whites. Ethnic minorities experience greater alcohol-related problems than Whites. Being unmarried is associated with a higher prevalence of anxiety disorders, major depressive disorder, bipolar disorder, and schizophrenia. Schizophrenia is associated with birth or residence in urban areas, but the relationship of urbanicity to other adult mental disorders is unclear.

McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011).  Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027-1035. PMCID: PMC3135672

Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N = 20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men.

Mericle, A. A., Ta Park, V. M., Holck, P., & Arria, A. M. (2012). Prevalence, patterns, and correlates of co-occurring substance use and mental disorders in the United States: Variations by race/ethnicity. Comprehensive Psychiatry, 53(6), 657-665. PMCID: PMC3327759

Objective: This study examines racial/ethnic differences in the prevalence, patterns, and correlates of co-occurring substance use and mental disorders (COD) among Whites, Blacks, Latinos, and Asians using data from the Collaborative Psychiatric Epidemiology Studies. Method: We first estimated the prevalence of various combinations of different co-occurring depressive and anxiety disorders among respondents with alcohol, drug, and any substance use (alcohol or drug) disorders in each racial/ethnic group. We then estimated the prevalence of different patterns of onset and different psychosocial correlates among individuals with COD of different racial/ethnic groups. We used weighted linear and logistic regression analysis controlling for key demographics to test the effect of race/ethnicity. Tests of differences between specific racial/ethnic subgroups were only conducted if the overall test of race was significant. Results: Rates of COD varied significantly by race/ethnicity. Approximately 8.2% of Whites, 5.4% of Blacks, 5.8% of Latinos, and 2.1% of Asians met criteria for lifetime COD. Whites were more likely than persons in each of the other groups to have lifetime COD. Irrespective of race/ethnicity, most of those with COD reported that symptoms of mental disorders occurred before symptoms of substance use disorders. Only rates of unemployment and history of psychiatric hospitalization among individuals with COD were found to vary significantly by racial/ethnic group. Conclusions: Our findings underscore the need to further examine the factors underlying differences between minority and nonminority individuals with COD as well as how these differences might affect help seeking and utilization of substance abuse and mental health services.

Miller, B., Rote, S. M., & Keith, V. M. (In press). Coping with racial discrimination: Assessing the vulnerability of African Americans and the mediated moderation of psychosocial resources. Society and Mental Health.

Research demonstrates that the mental health of African Americans is negatively affected by discrimination, but few studies have investigated the effects of racial discrimination specifically and whether these effects vary by poverty and education levels. Using a sample of 3,372 African Americans from the National Survey of American Life (NSAL), we find a positive relationship between racial discrimination and depressive symptoms, with both lifetime and daily racial discrimination being more salient for depressive symptoms among impoverished African Americans than those living above 200% of the poverty line. Evaluating mediated moderation models, we also find that the conditional effects of socioeconomic status are mediated by poor African Americans’ having fewer psychosocial resources. Namely, lower levels of mastery are influential in accounting for poor African Americans’ greater vulnerability to both daily and lifetime discrimination. The findings highlight the importance of examining specific reasons for discrimination as well as mediated moderation in future research.

Miller, B., Rote, S. M., & Keith, V. M. (2013). Coping with racial discrimination: Assessing the vulnerability of African Americans and the mediated moderation of psychosocial resources. Society and Mental Health, 3(2), 133-150. PMCID: PMC4236835

Research demonstrates that the mental health of African Americans is negatively affected by discrimination, but few studies have investigated the effects of racial discrimination specifically and whether these effects vary by poverty and education levels. Using a sample of 3,372 African Americans from the National Survey of American Life (NSAL), we find a positive relationship between racial discrimination and depressive symptoms, with both lifetime and daily racial discrimination being more salient for depressive symptoms among impoverished African Americans than those living above 200% of the poverty line. Evaluating mediated moderation models, we also find that the conditional effects of socioeconomic status are mediated by poor African Americans’ having fewer psychosocial resources. Namely, lower levels of mastery are influential in accounting for poor African Americans’ greater vulnerability to both daily and lifetime discrimination. The findings highlight the importance of examining specific reasons for discrimination as well as mediated moderation in future research.

Molina, K. M., Alegría, M., & Chen, C-N. (2012). Neighborhood context and substance use disorders: A comparative analysis of racial and ethnic groups in the United States. Drug and Alcohol Dependence, 125(Suppl. 1), S35-S43. PMCID: PMC3488110

Background: There is evidence that ethnic/racial minorities are conferred differential risk for substance use problems based on where they live. Despite a burgeoning of research focusing on the role of neighborhood characteristics on health, limited findings are available on substance use. Our study uses nationally representative data (N = 13,837) to examine: (1) what neighborhood characteristics are associated with risk of substance use disorders?; (2) do the associations between neighborhood characteristics and substance use disorders remain after adjusting for individual-level factors?; and (3) do neighborhood characteristics associated with substance use disorders differ by race/ethnicity after adjusting for individual-level factors? Methods: Data were drawn from the Collaborative Psychiatric Epidemiology Studies (CPES-Geocode file) with 836 census tracts. Analyses included African Americans, Asians, Caribbean Blacks, Latinos, and non-Latino whites. Separate logistic regression models were fitted for any past-year substance use disorder, alcohol use disorder, and drug use disorder. Results: Living in more affluent and residentially unstable census tracts was associated with decreased risk of past-year substance use disorder, even after adjusting for individual-level factors. However, when we investigated the interaction of race/ethnicity and census latent factors with past-year substance use disorders, we found different associations for the different racial/ethnic groups. We also found different associations between neighborhood affluence, residential instability and any past-year substance use and alcohol disorders by nativity. Conclusions: Characteristics of the environment might represent differential risk for substance disorders depending on a person's ethnicity/race and nativity status.

Mouzon, D. M. (2013). Can family relationships explain the race paradox in mental health? Journal of Marriage and Family, 75(2), 470-485.

Biomedical research consistently finds that Blacks have worse physical health than Whites, an expected pattern given Blacks' greater exposure to psychosocial stress, poverty, and discrimination. Yet there is surprising lack of consensus regarding race differences in mental health, with most scholars finding similar or better mental health outcomes among Blacks than Whites. Past research often attributes this “race paradox in mental health” to the notion that Blacks have stronger family networks than Whites, yet few studies have explicitly tested whether stronger family relationships among Blacks (if they exist) can account for these findings. Using data from the 2003–2005 National Survey of American Life (N = 4,259) revealed that minimal race differences in family relationships fail to explain the race paradox in mental health. The results have implications for mental health measurement, the provision of culturally appropriate mental health care, and how scholars understand the nature of family relationships among Black Americans.

Mouzon, D. M., & McLean, J. S. (In press). Internalized racism and mental health among African-Americans, US-born Caribbean blacks, and foreign-born Caribbean blacks. Ethnicity and Health.

Objectives. The tripartite model of racism includes personally mediated racism, institutionalized racism, and the less-oft studied internalized racism. Internalized racism – or negative beliefs about one’s racial group – results from cultural racism that is endemic in American society. In this project, we studied whether these negative stereotypes are associated with mental health among African-Americans and Caribbean Blacks. Design. Using secondary data from the National Survey of American Life, we investigated the association between internalized racism and mental health (measured by depressive symptoms and serious psychological distress (SPD)) among these two groups. We also explored whether ethnicity/nativity and mastery moderate the association between internalized racism and mental health among African-Americans and Caribbean Blacks. Results. Internalized racism was positively associated with depressive symptoms and SPD among all Black subgroups. However, internalized racism was a weaker predictor of SPD among foreign-born Caribbean Blacks than US-born Caribbean Blacks and US-born African-Americans. Additionally, higher mastery was protective against distress associated with internalized racism. Conclusion. Internalized racism is an important yet understudied determinant of mental health among Blacks. Future studies should take into account additional heterogeneity within the Black population (e.g. African-born individuals) and other potential protective mechanisms in addition to mastery (e.g. self-esteem and racial identity).

Mouzon, D. M., Taylor, R. J., Keith, V., Nicklett, E. J., & Chatters, L. M. (In press). Discrimination and psychiatric disorders among older African Americans. International Journal of Geriatric Psychiatry.

Objectives: This study examined the impact of everyday discrimination (both racial and non-racial) on the mental health of older African Americans. Methods: This analysis is based on the older African American subsample of the National Survey of American Life (NSAL) (n = 773). We examined the associations between everyday discrimination and both general distress and psychiatric disorders as measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Six dependent variables were examined: lifetime mood disorders, lifetime anxiety disorders, any lifetime disorder, number of lifetime disorders, depressive symptoms as measured by the 12-item Center for Epidemiological Scale of Depression (CES-D), and serious psychological distress as measured by the Kessler 6 (K6). Results: Overall, racial and non-racial everyday discrimination were consistently associated with worse mental health for older African Americans. Older African Americans who experienced higher levels of overall everyday discrimination had higher odds of any psychiatric disorder, any lifetime mood disorder, any lifetime anxiety disorder, and more lifetime DSM-IV disorders, in addition to elevated levels of depressive symptoms and serious psychological distress. These findings were similar for both racial discrimination and non-racial discrimination. Conclusions: This study documents the harmful association of not only racial discrimination, but also non-racial (and overall) discrimination with the mental health of older African Americans. Specifically, discrimination is negatively associated with mood and anxiety disorders as well as depressive symptoms and psychological distress.

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., Sellers, S. L., Zhang, R., & Jackson, J. S. (2011). Goal-striving stress and racial differences in mental health. Race and Social Problems, 3(1), 51-62.

This study investigated the associations among goal-striving stress, racial related stressors, and mental health. Goal-striving stress was defined as the discrepancy between aspiration for and achievement of a better way of life, weighted by the subjective probability of success, and the level of disappointment experienced if those life goals were not realized. Data are from the National Survey of American Life’s African American (N = 3,570) and non-Hispanic white (N = 891) adult samples. Regression analysis was used to assess the relationship between goal-striving stress and five mental health outcomes: happiness, life satisfaction, self-esteem, psychological distress, and depressive symptoms. After controlling for socio-demographic factors, a personal problems checklist, and racial discrimination, goal-striving stress was significantly related to all mental health measures such that as goal-striving stress increased, mental health worsened. Additionally, the relationship of goal-striving stress to mental health was found to be conditional upon race. Specifically, goal-striving stress had a stronger effect among white Americans than African Americans. Goal-striving stress was associated differentially with lower levels of mental health for black and white Americans. Racial differences in the impact of goal-striving stress suggest a need for analyses exploring resilience and coping in relation to the impact of goal-striving stress on black–white differences in 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.

Nguyen, A. W., Chatters, L. M., Taylor, R. J., Levine, D. S., & Himle, J. A. (In press). Family, friends, and 12-month PTSD among African Americans. Social Psychiatry and Psychiatric Epidemiology.

Purpose: Despite a growing literature on the influence of social support on mental health, little is known about the relationship between social support and specific psychiatric disorders for African Americans, such as PTSD. This study investigated the relationship between social support, negative interaction with family and 12-month PTSD among African Americans. Methods: Analyses were based on a nationally representative sample of African Americans from the National Survey of American Life (n = 3315). Social support variables included emotional support from family, frequency of contact with family and friends, subjective closeness with family and friends, and negative interactions with family. Results: Results indicated that emotional support from family is negatively associated with 12-month PTSD while negative interaction with family is predictive of 12-month PTSD. Additionally, a significant interaction indicated that high levels of subjective closeness to friends could offset the impact of negative family interactions on 12-month PTSD. Conclusions: Overall, study results converged with previously established findings indicating that emotional support from family is associated with 12-month PTSD, while, negative interaction with family is associated with increased risk of 12-month PTSD. The findings are discussed in relation to prior research on the unique association between social support and mental health among African Americans.

Nguyen, A. W., Taylor, R. J., & Chatters, L. M. (In press). Church-based social support among Caribbean blacks in the United States. Review of Religious Research.

An emerging body of research notes the importance of church-based social support networks in the daily lives of Americans. However, few studies examine church-based support, and especially among ethnic subgroups within the U.S. Black population, such as Caribbean Blacks. This study uses data from the National Survey of American Life to examine demographic and religious participation (e.g., attendance, interaction) correlates of church-based social support (e.g., receipt of emotional support, receipt of general support, provision of support to others, and negative interaction) among Caribbean Blacks residing in the U.S. Multiple regression analyses indicated that religious participation was associated with all four dependent variables. Church attendance was positively associated with receiving emotional support, general social support, and providing support to others, but was not associated with negative interaction. Frequency of interaction with fellow congregants was positively associated with receiving emotional support, receiving general support, providing support to others and negative interaction. Demographic findings indicated that women provided more support to church members and experienced more negative interactions with members than did men. Education was positively associated with frequency of support; household income was negatively associated with receiving emotional support and providing social support to others. Findings are discussed in relation to the role of church-based support networks in the lives of Caribbean Black immigrants and communities.

Nobles, C. J., Thomas, J. J., Valentine, S. E., Gerber, M. W., Vaewsorn, A. S., & Marques, L. (In press). Association of premenstrual syndrome and premenstrual dysphoric disorder with bulimia nervosa and binge-eating disorder in a nationally representative epidemiological sample. International Journal of Eating Disorders.

Objective: Bulimia nervosa (BN) and binge eating disorder (BED) are associated with significant health impairment. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) comprise both psychological (disturbances in mood and affect) and physiological (bloating and changes in appetite) symptoms that may trigger binge eating and/or purging. Method: Female participants were drawn from the Collaborative Psychiatric Epidemiological Surveys, conducted from 2001 to 2003. Weighted multivariable logistic regression modeled the association between lifetime PMS and PMDD and lifetime odds of BN or BED. Results: Among 8,694 participants, 133 (1.0%) had BN and 185 (1.8%) BED. Additionally, 366 (4.2%) had PMDD and 3,489 (42.4%) had PMS. Prevalence of PMDD and PMS were 17.4 and 55.4% among those with BN, 10.7 and 48.9% among those with BED and 3.4 and 59.1% among those with subthreshold BED. After adjustment for age, race/ethnicity, income, education, body mass index, age at menarche, birth control use, and comorbid mental health conditions, PMDD was associated with seven times the odds of BN (OR 7.2, 95% CI 2.3, 22.4) and PMS with two times the odds of BN (OR 2.5, 95% CI 1.1, 5.7). Neither PMDD nor PMS were significantly associated with BED. Discussion: Women with PMS and PMDD have a higher odds of BN, independent of comorbid mental health conditions. PMS and PMDD may be important comorbidities to BN to consider in clinical settings, and future research should investigate whether PMS and PMDD affect the onset and duration of bulimic symptoms as well as the potential for shared risk factors across disorders.

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.

Pagoto, S. L., Schneider, K. L., Bodenlos, J. S., Appelhans, B. M., Whited, M. C., Ma, Y., & Lemon, S. C. (2012). Association of post-traumatic stress disorder and obesity in a nationally representative sample. Obesity, 20(1), 200-205.

Recent studies suggest a possible link between post-traumatic stress disorder (PTSD) and obesity risk, which would have implications for the development of obesity-related diseases in this population. The present study examined the association between PTSD and obesity and whether this association differed by sex in a representative sample of the US population. A secondary objective was to determine whether the association between PTSD and obesity was mediated by binge eating disorder (BED). Data were from the Collaborative Psychiatric Epidemiology Surveys (CPES), which comprises three nationally representative cross-sectional surveys that were conducted between 2001 and 2003. Logistic regression analyses weighted to represent the general US adult population were performed. In the total sample of 20,013 participants, rates of obesity were 24.1% for persons without a lifetime history of PTSD and 32.6% among persons with PTSD in the past year. Adjusting for socio-demographic characteristics, depression, substance and alcohol abuse/dependence, and psychotropic medication status, past year PTSD was associated with greater likelihood of obesity (odds ratio (OR) = 1.51; 95% confidence interval (CI) = 1.18, 1.95), with no differences by gender. BED did not statistically mediate the relationship between PTSD and obesity. The present study provides support for a link between PTSD and obesity. Findings further existing literature by indicating that the association is consistent across sexes and is not statistically mediated by BED.

Parker, L. J., & Hunte, H. E. (2013). Examining the relationship between the endorsement of racial/ethnic stereotypes and excess body fat composition in a national sample ofAfrican Americans and black Caribbeans. Ethnicity & Disease, 23(4), 462-468.

Using the National Survey of American Life, a nationally representative household survey of non-institutionalized US Blacks, our study examined whether the endorsement of racial/ ethnic stereotypes was associated with excess body fat composition among African Americans (n = 3,265) and Black Caribbeans (n = 1,332) living in the United States. We used ordinary least squares and multinomial logistic regression analyses controlling for potential confounders. Results from the linear regression suggested that the endorsement of racial/ethnic stereotypes was associated with increased body mass index and weight among African American males (b = .57, P < .05) and females (b = .50 P < .05). Further, results from the adjusted multinomial logistic regression suggested that African American males who endorsed racial/ethnic stereotypes were more likely to be obese (odds ratio = 1.33, P < .05), than African American males who did not endorse racial/ethnic stereotypes. Surprising, a positive relationship was not found among Black Caribbeans. Future studies should examine the relationship between internalized discrimination and endorsements of negative racial/ethnic stereotypes and excess fat accumulation among ethnically heterogeneous samples of Blacks.

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.

Perez, M. & Warren, C. S. (2012). The relationship between quality of life, binge-eating disorder, and obesity status in an ethnically diverse sample. Obesity, 20(4), 879-885.

This study examined the relationship between obesity status, binge-eating disorder (BED), and quality of life (QOL) in a large, ethnically diverse community sample of adult men and women. Using data from the Collaborative Psychiatric Epidemiological Surveys (N = 20,013), individuals were categorized into four groups: nonobese with BED (n = 142), nonobese without BED (n = 14,301), obese with BED (n = 136), and obese without BED (n = 4,863). Results indicated obese individuals with BED consistently reported the poorest QOL. Findings suggested that obesity status was more strongly related to physical health-related QOL variables (e.g., number of physical conditions, mobility impairment) whereas diagnostic status was more predictive of mental health and social functioning QOL variables (e.g., cognitive impairment, social interaction impairment, time out of role). The degree to which lifetime BED diagnosis was associated with impairment in social interaction differed across ethnic groups. For black individuals, the number of physical health conditions was associated with BED presence moreso than weight status.

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.

Pilver, C. E., Desai, R., Kasl, S., & Levy, B. R. (2011). Lifetime discrimination associated with greater likelihood of premenstrual dysphoric disorder. Journal of Women’s Health, 20(6), 923-931. PMCID: PMC3159126

Objectives: To evaluate whether the stressor of perceived discrimination was associated with premenstrual dysphoric disorder (PMDD) and premenstrual symptoms among minority women. This study builds on previous research that found perceived discrimination was positively associated with other psychiatric illnesses. Methods: Participants were 2718 Asian, Latina, and black premenopausal women aged 18–40 years who completed the World Mental Health Composite International Diagnostic Interview for the National Latino and Asian American Survey or the National Survey of American Life. Perceived discrimination was assessed with the Everyday Discrimination Scale. DSM-IV-based diagnostic algorithms generated a provisional lifetime diagnosis of PMDD. Results: Eighty-three percent of the participants reported experiencing discrimination (due to race, gender, age, height or weight, or other reasons) in their lifetimes. The frequency of perceived discrimination was positively associated with PMDD (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05-1.10) and premenstrual symptoms (OR 1.04, 95% CI 1.02-1.05), independent of demographic covariates and social desirability. Women reporting gender discrimination (OR 5.18, 95% CI 1.80-14.90), race discrimination (OR 4.14, 95% CI 1.54-11.11), and other forms of discrimination (OR 6.43, 95% CI 2.11-19.65) were significantly more likely than women without experiences of discrimination to have PMDD. Subtle discrimination was more strongly associated with PMDD (OR 1.12, 95% CI 1.01-1.23) than was blatant discrimination (OR 1.04, 95% CI 0.94-1.15). Conclusions: This study is the first to demonstrate that perceived discrimination is associated with PMDD and premenstrual symptoms. These findings suggest that the prevalence of these conditions may be lessened by reducing discrimination in women's lives.

Pilver, C. E., Kasl, S., Desai, R., & Levy, B. R. (2011). Health advantage for black women: Patterns in pre-menstrual dysphoric disorder. Psychological Medicine, 41(8), 1741-1750. PMCID: PMC3404818

Background: Pre-menstrual dysphoric disorder (PMDD) is commonly studied in white women; consequently, it is unclear whether the prevalence of PMDD varies by race. Although a substantial proportion of black women report symptoms of PMDD, the Biocultural Model of Women’s Health and research on other psychiatric disorders suggest that black women may be less likely than white women to experience PMDD in their lifetimes. Method: Multivariate multinomial logistic regression modeling was used with a sample of 2590 English-speaking, pre-menopausal American women (aged 18–40 years) who participated in the Collaborative Psychiatric Epidemiology Surveys in 2001–2003. The sample consisted of 1672 black women and 918 white women. The measure of PMDD yields a provisional diagnosis of PMDD consistent with DSM-IV criteria. Results: Black women were significantly less likely than white women to experience PMDD [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.25–0.79] and pre-menstrual symptoms (OR 0.64, 95% CI 0.47–0.88) in their lifetimes, independently of marital status, employment status, educational attainment, smoking status, body mass index, history of oral contraceptive use, current age, income, history of past-month mood disorder, and a measure of social desirability. The prevalence of PMDD was 2.9% among black women and 4.4% among white women. Conclusions: This study showed for the first time that black women were less likely than white women to experience PMDD and pre-menstrual symptoms, independently of relevant biological, social-contextual and psychological risk factors. This suggests that PMDD may be an exception to the usual direction of racial disparities in health. Further research is needed to determine the mechanisms that explain this health advantage.

Pilver, C. E., Levy, B. R., Libby, D. J., & Desai, R. A. (2011). Posttraumatic stress disorder and trauma characteristics are correlates of premenstrual dysphoric disorder. Archives of Women’s Mental Health, 14(5), 383-393. PMCID: PMC3404806

Posttraumatic stress disorder (PTSD) is often comorbid with premenstrual dysphoric disorder (PMDD) in women; however, it is unclear whether this relationship is driven by the trauma that may lead to PTSD or if PTSD is uniquely associated with PMDD. In this study, we examine trauma and PTSD as independent correlates of PMDD. Researchers conducted a cross-sectional, secondary data analysis of 3,968 female participants (aged 18–40) of the Collaborative Psychiatric Epidemiology Surveys. Women who had a history of trauma with PTSD (odds ratio, OR = 8.14, 95% confidence interval, CI = 3.56–18.58) or a history of trauma without PTSD (OR = 2.84, 95% CI = 1.26–6.42) were significantly more likely than women with no history of trauma to report PMDD. This graded relationship was also observed in association with premenstrual symptoms. Among trauma survivors, PTSD was independently associated with PMDD, although characteristics of participants' trauma history partially accounted for this association. Our study demonstrated that trauma and PTSD were independently associated with PMDD and premenstrual symptoms. Clinicians should be aware that women who present with premenstrual symptomatology complaints may also have a history of trauma and PTSD that needs to be addressed. This pattern of comorbidity may complicate the treatment of both conditions.

Pilver, C. E., Libby, D. J., & Hoff, R. A. (2013). Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample. Social Psychiatry & Psychiatric Epidemiology, 48(3), 437-446.

Purpose: Suicide is a major public health concern and a leading cause of death in the United States. Psychopathology is an established risk factor for non-fatal suicidal behavior; however, it is unclear whether Premenstrual Dysphoric Disorder (PMDD), a psychiatric disorder specific to women, is correlated with these outcomes. The objective of this study was to determine if PMDD status was associated with suicidal ideation, plans, and attempts, independent of socio-demographic factors and psychiatric comorbidity. Methods: We conducted a secondary data analysis of 3,965 American women aged 18–40 who participated in the Collaborative Psychiatric Epidemiology Survey. Descriptive statistics and forward stepwise logistic regression modeling were performed using SUDAAN software. Results: The prevalence of non-fatal suicidal behaviors increased in a graded fashion according to PMDD status. Although the control for demographic characteristics and psychiatric comorbidity greatly attenuated the unadjusted association between PMDD and suicidal behaviors, women with PMDD remained significantly more likely than women with no premenstrual symptoms to report suicidal ideation (OR 2.22; 95 % CI 1.40–3.53), plans (OR 2.27; 95 % CI 1.20–4.28), and attempts (OR 2.10; 95 % CI 1.08–4.08). Only the likelihood of suicidal ideation was significantly elevated among women with moderate/severe premenstrual syndrome (PMS; OR 1.49; 95 % CI 1.17–1.88), compared to women with no premenstrual symptoms. Conclusions: PMDD was strongly and independently associated with non-fatal suicidal behaviors among a nationally representative sample. These findings suggest that clinicians treating women with PMDD should assess and be vigilant for signs of non-fatal suicidal behavior, and that clinicians should evaluate and treat the premenstrual symptoms of women who express these behaviors.

Porche, M. V., Fortuna, L. R., Lin, J., & Alegría, M. (2011). Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults. Child Development, 82(3), 982-998. PMCID: PMC3089672

The effect of childhood trauma, psychiatric diagnoses, and mental health services on school dropout among U.S.-born and immigrant youth is examined using data from the Collaborative Psychiatric Epidemiology Surveys, a nationally representative probability sample of African Americans, Afro-Caribbeans, Asians, Latinos, and non-Latino Whites, including 2,532 young adults, aged 21–29. The dropout prevalence rate was 16% overall, with variation by childhood trauma, childhood psychiatric diagnosis, race/ethnicity, and nativity. Childhood substance and conduct disorders mediated the relation between trauma and school dropout. Likelihood of dropout was decreased for Asians, and increased for African Americans and Latinos, compared to non-Latino Whites as a function of psychiatric disorders and trauma. Timing of U.S. immigration during adolescence increased risk of dropout.


Richman, L. S., Boynton, M. H., Costanzo, P., & Banas, K. (2013). Interactive effects of discrimination and racial identity on alcohol-related thoughts and use. Journal of Basic and Applied Social Psychology, 35(4), 396-407.

The interrelationships among racial discrimination, non race-based rejection, racial identity (RI), and alcohol cognitions and use were assessed in this research. In Study 1, individuals who experienced overt discrimination and who were high in RI were less likely than those low in RI to meet criteria for alcohol abuse disorder. In Study 2, discrimination and rejection were causally related to a faster reaction time in a lexical decision task to alcohol-related concepts as compared to neutral words, especially for those low in RI. Implications of discrimination and rejection on substance use and other risky health behaviors are discussed.

Reeve, B. B., Willis, G., Shariff-Marco, S. N., Breen, N., Williams, D. R., Gee, G. C., Alegría, M., Takeuchi, D. T., Stapleton, M., & Levin, K. Y. (2011). Comparing cognitive interviewing and psychometric methods to evaluate a racial/ethnic discrimination scale.  Field Methods, 23(4), 397-419.

Proponents of survey evaluation have long advocated the integration of qualitative and quantitative methodologies, but this recommendation has rarely been practiced. The authors used both methods to evaluate the “Everyday Discrimination” scale (EDS), which measures frequency of various types of discrimination, in a multiethnic population. Cognitive testing included 30 participants of various race/ethnic backgrounds and identified items that were redundant, unclear, or inconsistent (e.g., cognitive challenges in quantifying acts of discrimination). Psychometric analysis included secondary data from two national studies, including 570 Asian Americans, 366 Latinos, and 2,884 African Americans, and identified redundant items as well as those exhibiting differential item functioning (DIF) by race/ethnicity. Overall, qualitative and quantitative techniques complemented one another, as cognitive interviewing findings provided context and explanation for quantitative results. Researchers should consider further how to integrate these methods into instrument pretesting as a way to minimize response bias for ethnic and racial respondents in population-based surveys.

Robinson, J. A., Bolton, J. M., Rasic, D., & Sareen, J. (2012). Exploring the relationship between religious service attendance, mental disorders, and suicidality among different ethnic groups: Results from a nationally representative survey. Depression and Anxiety, 29(11), 983-990.

Background: To date, sufficient data have not been available to examine ethnic differences in religiosity and mental health in the general population. However, evidence exists to suggest that the protective effects of religion may differ across ethnic groups. This study examined the relationship between religious attendance and mental health across ethnic groups. Methods: The Collaborative Psychiatric Epidemiologic Survey (N = 20,130) is a large, ethnically diverse sample of adult, US respondents. Frequency of attendance at religious services was measured as: at least once per week (reference group), one to three times per month, less than once per month, or less than once per year. Multiple logistic regression analyses examined associations between religious attendance and mood, anxiety and substance use disorders, as well as suicidal ideation and attempts. Models adjusted for sociodemographics and comorbidity. Results: Results differed when performed within each ethnicity. Infrequent religious attendance was associated with substance use disorders in Whites and Africans only (Adjusted Odds Ratio (AOR) = 2.30 [95% CI = 1.77–2.99]; AOR = 1.86 [1.25–2.79], respectively), and with anxiety and suicidal ideation in Whites (AOR = 1.44 [1.10–1.88]; AOR = 1.58 [1.24–2.01]) and Hispanics only (AOR = 2.35 [1.17–4.73]; AOR = 1.70 [1.15–2.52]). Asians were the only group in which religious attendance was associated with mood disorders (AOR = 4.90 [1.54–15.60]). Interaction terms were nonsignificant. Conclusions: The present study suggests that ethnicity is an important variable to consider in the relationship between religiosity and mental health. Future studies should attempt to either adjust for or stratify by ethnicity when examining these relationships.

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.

Sellers, S. L., Neighbors, H. W., Zhang, R., & Jackson, J. S. (2012). The impact of goal-striving stress on physical health of white Americans, African Americans, and Caribbean blacks. Ethnicity and Disease, 22(1), 21-28.

Objective: To contribute to the growing understanding of US Black-White health disparities by examining psychosocial stress as an important contributor to physical health problems. Methods: Data are from the National Survey of American Life, an integrated  National household probability sample of White Americans, African Americans, and Caribbean Blacks. Regression analysis was used to assess associations between goal-striving stress and hypertension, BMI, physical health problems, and self-rated health. Results: After accounting for sociodemographic factors and three additional stressors – personal problems, lifetime racial discrimination, and everyday racial discrimination–goal-striving stress was a significant predictor of hypertension, physical health problems, and diminished self-rated health. Ethnicity moderated the relationship; the negative association between goal-striving stress and physical health problems was strongest for Caribbean Blacks. Conclusions: This study extends the research on goal-striving stress and adds to a growing literature documenting relationships between social processes and disease.

Shim, R. S., Ye, J., Fry-Johnson, Y., Daniels, E., & Rust, G. (2012). Racial/ethnic disparities, social support, and depression: Examining a social determinant of mental health. Ethnicity and Disease, 22(1), 15-20.

Objective: We examined the risk of depression as it relates to social support among individuals from African American, Caribbean Black, and non-Hispanic White backgrounds. Methods: 6,082 individuals participated in the National Survey of American Life (NSAL), a nationally representative, psychiatric epidemiological, cross-sectional survey of household populations. The survey is designed to explore racial and ethnic differences in mental disorders. NSAL survey questions were used as a proxy for social support. Logistic regression analysis was used to examine the correlates between having a DSM-IV diagnosis of major depressive disorder in the past year, demographic variables, and social support. Results: African American race/ethnicity was associated with decreased odds of depression when compared to non-Hispanic Whites, even when controlling for social support variables and demographics (OR 50.51, 95% CI 50.43-0.60). We found a three-fold increase inrisk of depression among individuals who reported feeling ‘‘not very close at all’’ with family members compared to those who reported feeling ‘‘very close’’ to family (OR 53.35, 95% CI 51.81-6.19). Conclusions: These findings reinforce previous research documenting the important relationship between social support and depression, and perhaps should lead us to re-examine the individualistic models of treatment that are most evaluated in United States. The lack of evidence-based data on support groups, peer counseling, family therapy, or other social support interventions may reflect a majority-culture bias toward individualism, which belies the extensive body of research on social support deficits as a major risk factor for depression.

Simning, A., van Wijngaarden, E., & Conwell, Y. (2011). Anxiety, mood, and substance use disorders in United States African-American public housing residents. Social Psychiatry and Psychiatric Epidemiology, 46(10), 983-992. PMCID: PMC3044217

Background: African-Americans experience considerable mental healthcare disparities in the United States, but little is known about sensitive subgroups within this population. To better understand healthcare disparities within African-Americans communities, we characterized anxiety, mood, and substance use disorder prevalence and associated service utilization among public and non-public housing residents. Methods: We used data from a nationally representative sample of African-Americans recruited as part of the National Survey of American Life. Results: In public housing residents, the 12-month prevalence of anxiety disorders was 1.8 times higher than in non-public housing residents (P = 0.002), mood disorders was 1.4 times higher (P = 0.189), and substance use disorders was 2.2 times higher (P = 0.031). Public housing remained associated with mental illness after controlling for sociodemographics and chronic illness. Public and non-public housing residents did not differ significantly in mental healthcare utilization, but utilization was low with 16–30% of public housing residents with a 12-month disorder receiving mental health assistance. Conclusions: A relatively high proportion of African-American public housing residents suffered from psychiatric disorders, and few received mental healthcare assistance, indicating that further work is needed to enhance utilization.

Simning, A., van Wijngaarden, E., & Conwell, Y. (2012). The association of African Americans’ perceptions of neighborhood crime and drugs with mental illness. Social Psychiatry and Psychiatric Epidemiology, 47(7), 1159-1167. PMCID: PMC3278495

Background: Many African Americans are socioeconomically disadvantaged and live in neighborhoods containing chronic sources of stress. Although environmental stressors can contribute to the development of mental illness, there is a paucity of national studies examining the association of neighborhood crime and drug problems with psychiatric disorders. This study aims to determine if higher levels of perceived neighborhood problems are associated with greater prevalence of 12-month and lifetime psychiatric disorders among African Americans. Methods: To do so, we used cross-sectional data from the National Survey of American Life, which interviewed a nationally representative sample of 3,570 African Americans. Results: Of these African Americans, nearly 20 and 40% reported that crime and drug use are problems in their neighborhoods, respectively. Respondents reporting high levels of perceived neighborhood crime or drug problems are 1.5–2.9 times more likely to have a 12-month psychiatric disorder and 1.4–2.1 times more likely to have a lifetime psychiatric disorder compared to the other respondents. After accounting for sociodemographics and chronic disease, neighborhood crime remains associated with 12-month mood, 12-month substance use, and lifetime substance use disorders, whereas neighborhood drug problems remain significantly associated with 12-month and lifetime anxiety and substance use disorders. Conclusions: Among African Americans perceived neighborhood problems are widespread and positively associated with psychiatric disorders. Consideration of neighborhood context is important to more comprehensively understand mental illness and its treatment in this population.

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.

Sosulski, M. R., & Woodward, A. T. (2013). African American women living with mental disorders: Factors associated with help-seeking from professional services and informal supports. Social Work in Public Health, 28(7), 660-671.

This study utilized data from the National Survey of American Life to investigate the use of professional services and informal support among Black women with a lifetime mood, anxiety, or substance use disorder. Forty-seven percent combined professional services and informal support, 14% relied on professional services only, 2% used informal support only, and 16% did not seek help. Co-occurring disorders, recent episodes, social networks, marital status, age, and level of education were significantly related to help seeking from professional and informal helpers, demonstrating the importance of both. Targeting interventions in these areas will likely increase treatment effectiveness.

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.

Stucky, B. D., Gottfredson, N. C., Panter, A. T., Daye, C. E., Allen, W. R., & Wightman, L. F. (2011). An item factor analysis and item response theory-based revision of the Everyday Discrimination Scale. Cultural Diversity and Ethnic Minority Psychology, 17(2), 175-185.

The Everyday Discrimination Scale (EDS), a widely used measure of daily perceived discrimination, is purported to be unidimensional, to function well among African Americans, and to have adequate construct validity. Two separate studies and data sources were used to examine and cross-validate the psychometric properties of the EDS. In Study 1, an exploratory factor analysis was conducted on a sample of African American law students (N = 589), providing strong evidence of local dependence, or nuisance multidimensionality within the EDS. In Study 2, a separate nationally representative community sample (N = 3,527) was used to model the identified local dependence in an item factor analysis (i.e., bifactor model). Next, item response theory (IRT) calibrations were conducted to obtain item parameters. A five-item, revised-EDS was then tested for gender differential item functioning (in an IRT framework). Based on these analyses, a summed score to IRT-scaled score translation table is provided for the revised-EDS. Our results indicate that the revised-EDS is unidimensional, with minimal differential item functioning, and retains predictive validity consistent with the original scale.

Taylor, J Jr., Belay, B., Park, S., Onufrak, S., & Dietz, W. (2013). Association of church-sponsored activity participation and prevalence of overweight and obesity in African American Protestants, National Survey of American Life, 2001-2003. Ethnicity and Disease, 23(3), 322-328. PMCID: PMC4471171

OBJECTIVE: This study examines the relationships between participation in the African American church and overweight/obesity (body mass index (BMI) > or = 25 kg/m2).  DESIGN: This cross-sectional analysis was based on the National Survey of American Life 2001-2003 and included 2,689 African American Protestant (AAP) adults. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for overweight/obesity. Two practices were examined--frequency of participation in church activities (excluding services) and frequency of church service attendance. Each practice was analyzed in separate models. Each model included the following covariates: age, marital status, education, poverty, smoking, and region of country. We also adjusted models for sex.  RESULTS: After adjustment, African American Protestant men (AAPM) who participated in church activities at least weekly were more likely to be overweight/obese (aOR=2.17; 95% CI = 1.25, 3.77) compared to AAPM who did not participate in church activities. There was no statistically significant association between overweight/obesity and participation in church activities for AAPW. There was no association between overweight/obesity and attendance of church services for AAP men and women combined. CONCLUSIONS: For AAPM, participation in church activities was significantly associated with overweight/obesity. Further studies are required to determine why this association occurs in AAPM but not AAPW. Studies looking at the wider application of the several successful health initiatives targeting the AAP community should also be considered.

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, J. Y., Caldwell, C. H., Baser, R. E., Matusko, N., Faison, N., & Jackson, J. S.  (2013). Classification and correlates of eating disorders among blacks: Findings from the National Survey of American Life. Journal of Health Care for the Poor and Underserved, 24(1), 289-310. PMCID: PMC3564508

OBJECTIVE: To assess classification adjustments and examine correlates of eating disorders among Blacks. METHODS: The National Survey of American Life (NSAL) was conducted from 2001-2003 and consisted of adults (n=5,191) and adolescents (n=1,170). The World Mental Health Composite International Diagnostic Interview (WMH-CIDI-World Health Organization 2004-modified) and DSM-IV-TR eating disorder criteria were used. RESULTS: Sixty-six percent of African American and 59% Caribbean Black adults were overweight or obese, while 30% and 29% of adolescents were overweight or obese. Although lifetime rates of anorexia nervosa and bulimia nervosa were low, binge eating disorder was high for both ethnic groups among adults and adolescents. Eliminating certain classification criteria resulted in higher rates of eating disorders for all groups. CONCLUSION: Culturally sensitive criteria should be incorporated into future versions of Diagnostic Statistical Manual (DSM) classifications for eating disorders that consider within-group ethnic variations.

Taylor, R. J., Brown, E., Chatters, L. M., & Lincoln, K. D. (2012). Extended family support and relationship satisfaction among married, cohabiting, and romantically involved African Americans and black Caribbeans. Journal of African American Studies, 16(3), 373-389.

Data from the National Survey of American Life are used to investigate relationship satisfaction and their relation to extended family relations (i.e., emotional support and negative interaction) among nationally representative samples of African American and Black Caribbean adults. The study contributes to the literature by focusing on two groups of unmarried persons—those who are cohabiting and persons who are unmarried/non-cohabiting—in addition to married persons. Findings indicate that emotional support from extended family is positively associated with relationship satisfaction for married and cohabiting African Americans and Black Caribbeans who are romantically involved. Negative interaction from extended family is associated with lower relationship satisfaction for married, cohabiting, and romantically involved African Americans and for married Black Caribbeans. Differences in the pattern of associations between extended family relations and relationship satisfaction are discussed in terms of the distinctive social and family contexts of Black Caribbean and African American families.

Taylor, R. J., Chae, D. H., Chatters, L. M., Lincoln, K. D., & Brown, E. (2012).  DSM-IV 12-month and lifetime major depressive disorder and romantic relationships among African Americans.  Journal of Affective Disorders, 142(1-3), 339-342. PMCID: PMC3483365

Background: This brief report examines the association between marital and relationship status and 12-month and lifetime prevalence of major depressive disorder (MDD) among African Americans. Previous work has found that adults with major depressive disorder are less likely to be married or in a cohabiting relationship. This report extends previous research by investigating whether unmarried, non-cohabiting African Americans with depression are also less likely to be involved in a romantic relationship. Methods: Data are from the African American sub-sample (n=3570) of the National Survey of American Life (NSAL; 2001–2003). The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime MDD. Weighted logistic regression was used. Results: The findings indicate that for both 12-month and lifetime major depressive disorder, African Americans who are depressed are not only less likely to be married; they are also significantly less likely to be involved in a romantic relationship. This is particularly the case for 12-month depression. Limitations: Due to limitations in the number of cohabiting respondents, currently married and cohabiting respondents were combined into a single category. Conclusion: The findings of this brief report highlight the importance of changes in marital and relationship circumstances of the U.S. population for research and practice on depression and other psychiatric disorders. Our study provides evidence for a more nuanced approach in which examining marital and romantic relationship status together promotes a better understanding of the impact of major depression on romantic unions.

Taylor, R. J., & Chatters, L. M. (2011). Religious media use among African Americans, black Caribbeans, and non-Hispanic whites: Findings from the National Survey of American Life. Journal of African American Studies, 15(4), 433-454. 

The purpose of this study was to examine the correlates of watching religious television programs and listening to religious radio programs. Data are taken from the National Survey of American Life, a nationally representative study of African Americans, Black Caribbeans, and non-Hispanic Whites. Several significant findings were noted. Both African Americans and Black Caribbeans watched religious television programs and listened to religious radio programs significantly more frequently than non-Hispanic whites. These differences in electronic religious media consumption were particularly large, especially listening to religious radio programming. Among African Americans and Black Caribbeans, several significant demographic differences in frequency of consuming religious programming (e.g., age, gender, region, marital status, immigration status) emerged. Lastly, our analysis found that consuming electronic religious programming did not substitute for attending church service but, instead, complemented weekly service attendance.

Taylor, R. J., Chatters, L. M., & Abelson, J. M. (2012). Religious involvement and DSM IV 12 month and lifetime major depressive disorder among African Americans. Journal of Nervous and Mental Disease, 200(10), 856-862. PMCID: PMC3464345

This study explores relationships between lifetime and 12-month DSM-IV major depressive disorder and religious involvement within a nationally representative sample of African American adults (n = 3,570). MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. Multivariate findings indicate that reading religious materials were positively associated with 12-month (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.001–1.29) and lifetime (OR, 1.12; 95% CI, 1.03–1.21) MDD, religious service attendance was inversely associated with 12-month and lifetime MDD, and religious coping was inversely associated with 12-month MDD (OR, 0.75, 95% CI, 0.57–0.99). Findings are discussed in relation to the role of religion for African American mental health, prior research on the effects of religious involvement on physical and mental health, and theoretical and conceptual models of religion-health connections that specify multiple and often divergent pathways (e.g., prevention and resource mobilization) by which diverse forms of religious involvement impact mental health.

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.

Taylor, R. J., Chatters, L. M., & Joe, S. (2011). Non-organizational religious participation, subjective religiosity, and spirituality among older African Americans and black Caribbeans. Journal of Religion and Health, 50(3), 623-645.

This study utilizes data from the National Survey of American Life to examine the sociodemographic and denominational correlates of religious involvement and spirituality among older African Americans and Black Caribbeans. Eleven measures of non-organizational religious participation, subjective religiosity, and spirituality are utilized. The findings indicate significant gender, income, region, marital status, denominational, and immigration status differences in religiosity and spirituality. Among older Black Caribbeans, income was a consistent correlate of religious participation and spirituality. The findings are discussed in relation to prior work in the area of religious involvement among older adults.


Taylor, R. J., Chatters, L. M., & Joe, S. (2011). Religious involvement and suicidal behavior among African Americans and black Caribbeans. Journal of Nervous and Mental Disease, 199(7), 478-486. PMCID: PMC3128792

This study explores the relationship between religious denomination, four dimensions of religious involvement, and suicidality (lifetime prevalence of suicide ideation and attempts) within a nationally representative sample of African American and Black Caribbean adults. The relationship between religious involvement and suicide for African Americans and Black Caribbeans indicated both similarities and differences. For both groups, religious involvement was largely protective of suicidal ideation and attempts, although, in some instances, specific measures were associated with higher suicidality. Looking to God for strength, comfort and guidance was protective against suicidal attempts and ideation, whereas stating that prayer is important in stressful situations was associated with higher levels of ideation for both groups and higher attempts among Black Caribbeans. For African Americans, reading religious materials was positively associated with suicidal ideation. Among Black Caribbeans, subjective religiosity was negatively associated with ideation and being Catholic was inversely associated with attempts while being Pentecostal was inversely associated with ideation. These findings are discussed in relation to previous research and current conceptual frameworks that specify multiple (e.g., prevention, resource mobilization) and often divergent pathways of religious effects on physical and mental health outcomes.

Taylor, R. J., Chatters, L. M., & Nguyen, A. W. (In press). Religious participation and DSM IV major depressive disorder among black Caribbeans in the United States. Journal of Immigrant and Minority Health.

This study examines the relationship between religious involvement and 12-month and lifetime DSM-IV major depressive disorder (MDD) within a nationally representative sample of Black Caribbean adults. MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI). Religious involvement included measures of religious coping, organizational and nonorganizational involvement, and subjective religiosity. Study findings indicate that religious involvement is associated with 12-month and lifetime prevalence of MDD. Multivariate relationships between religious involvement and MDD indicate lower prevalence of 12-month and lifetime MDD among persons who use religious coping and characterize themselves as being religious (for lifetime prevalence only); persons who frequently listen to religious radio programs report higher lifetime MDD. Lower rates of 12-month and lifetime MDD are noted for persons who attend religious services at least once a week (as compared to both higher and lower levels of attendance), indicating a curvilinear relationship. The findings are discussed in relation to previous research on religion and mental health concerns, conceptual models of the role of religion in mental health (e.g., prevention, resource mobilization) that specify multiple and often divergent pathways and mechanisms of religious effects on health outcomes, and the role of religion among Caribbean Blacks.

Taylor, R. J., Chatters, L. M., Woodward, A. T., & Brown, E. (2013). Racial and ethnic differences in extended family, friendship, fictive kin, and congregational informal support networks. Family Relations, 62(4), 609-624. PMCID: PMC4116141

This study examined differences in kin and nonkin networks 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 informal support from family, friendship, fictive kin, and congregation/church networks were utilized. African Americans were more involved in congregation networks, whereas non-Hispanic Whites were more involved in friendship networks. African Americans were more likely to give support to extended family members and to have daily interaction with family members. African Americans and Black Caribbeans had larger fictive kin networks than non-Hispanic Whites, but non-Hispanic Whites with fictive kin received support from them more frequently than African Americans and Black Caribbeans. The discussion notes the importance of examining kin and nonkin networks, as well as investigating ethnic differences within the Black American population.

Taylor, R. J., Forsythe-Brown, I., Lincoln, K. D., & Chatters, L. M. (In press). Extended family support networks of Caribbean black adults in the United States. Journal of Family Issues.

This article investigates the extended family social support networks of Caribbean Black adults (Afro-Caribbeans). Although there are several ethnographic accounts of familial ties and support exchanges among Black Caribbean immigrants, only a handful of studies use quantitative data. This article uses data from the National Survey of American Life, which contains the first national probability sample of Caribbean Blacks in the United States. Age, gender, income, material hardship, and immigration status were all associated with at least one of the four indicators of family support networks. Subjective family closeness and frequency of family contact were significantly associated with both giving and receiving informal support. A significant age and parental status interaction for receiving support indicated that older adults without children received assistance from their extended families less frequently than older adults with children. Overall, study findings affirm the importance of extended family networks for Caribbean Black adults.

Taylor, R. J., Nguyen, A. W., Sinkewicz, M., Joe, S., & Chatters, L. M. (In press). Comorbid mood and anxiety disorders, suicidal behavior, and substance abuse among black Caribbeans in the U.S.A.  Journal of African American Studies.

The purpose of this study was to examine nativity and country of origin differences in comorbid mood (major depressive disorder, dysthymia, and bipolar I and II disorders) and anxiety (post-traumatic stress disorder, panic disorder, agoraphobia, social phobia, generalized anxiety disorder, and obsessive compulsive disorder) disorders among Black Caribbeans in the U.S.A. The paper also examines the relationship between comorbid psychiatric disorders and substance abuse disorders and suicidal behavior. Data are taken from the Black Caribbean sub-sample (N = 1,621) of the National Survey of American Life. Multinomial logistic regression and logistic regression analysis are used and odd ratios, relative risk ratios, and 95 % confidence intervals are presented. Seven percent (7.19 %) of respondents had comorbid mood and anxiety disorders, 8.66 % had a mood disorder only, and 11.46 % had an anxiety disorder only. First-generation Black Caribbeans were less likely than US-born respondents to have a lifetime mood or anxiety disorder and also less likely to have a lifetime substance disorder or a lifetime suicidal attempt. Black Caribbean men were more likely than Black Caribbean women to: (1) have anxiety disorders only versus neither mood or anxiety disorders, (2) to have a substance disorder, and (3) to have had a suicidal attempt. Lastly, Black Caribbeans with both mood and anxiety disorders have significantly higher rates of mental health services utilization. These and other findings are discussed in detail.

Taylor, R.J., Woodward, A. T., Chatters, L. M., Mattis, J. S., & Jackson, J. S. (2011). Seeking help from clergy among black Caribbeans in the United States. Journal of Race and Social Problems, 3(4), 241-251.

This study examined use of clergy for serious personal problems within a representative sample of US black Caribbean adults from the National Survey of American Life. Logistic regression analysis was used and confirmed the importance of problem type, church involvement, and nativity as correlates of clergy use. Findings for black Caribbeans indicate similarities, as well as important departures from prior research on the correlates of clergy assistance among African Americans. These and other findings confirm the position of black Caribbeans as a distinctive ethnic subgroup within the general black population in the United States.

Thornton, M. C., Taylor, R. J., & Chatters, L. M. (2012). African American, black Caribbean, and non-Hispanic white feelings of closeness toward other racial and ethnic groups. Journal of Black Studies, 43(7), 749-772.

This study examines African Americans’, Black Caribbeans’, and non-Hispanic Whites’ perceptions of closeness to other racial and ethnic groups. The study uses data from a national probability sample, the National Survey of American Life (N = 6,082), and provides the first investigation of this topic among Black Caribbeans. Study findings reveal both similarities and significant differences between African Americans and Black Caribbeans in their levels of closeness to other groups. African Americans and Black Caribbeans were similar in their levels of closeness to Whites, American Indians, and Asian Americans. African Americans felt significantly closer to Black people in the United States than did Black Caribbeans. Conversely, Black Caribbeans felt significantly closer than African Americans to Black people from the Caribbean, Spanish-speaking people, and Black people in Africa. Non-Hispanic Whites felt significantly closer to Asian Americans than did either African Americans or Black Caribbeans. These and other findings are discussed in detail and reaffirm the continued importance of race in American life and intergroup relations.

Thornton, M. C., Taylor, R. J., & Chatters, L. M. (2013). African American and black Caribbean mutual feelings of closeness: Findings from a national probability sample.  Journal of Black Studies, 44(8), 798-828.

African American and Black Caribbean relations are described as strained. Standard portrayals of Black Caribbeans as a “model minority” that has effectively assimilated into the American landscape often make explicit their distinctiveness from and enmity toward African Americans. Analysis using National Survey of American Life data (N = 6,082), exploring the nature and correlates of intergroup perceptions, reveals that both groups characterize their mutual relationships as being close. Gender and region of residence influence African American feelings of closeness toward Black Caribbeans, while for Black Caribbeans, perceived discrimination was significantly associated with feelings of closeness to African Americans. Black Caribbean immigrants from Spanish-speaking countries and Haiti felt closer to African Americans than did Jamaicans. In addition, foreign-born Black Caribbeans (first generation) felt closer to Black people from the Caribbean than second-generation Black Caribbeans. These and other findings are discussed in relation to research on intergroup closeness among African Americans and Black Caribbeans.

Torres, E. (2012). Psychometric properties of the Center for Epidemiologic Studies Depression Scale in African American and black Caribbean US adults. Issues in Mental Health Nursing, 33(10), 687-696.

A 12-item version of the 20-item Center for Epidemiological Studies-Depression (CES-D) Scale was not validated in Black US adults but demonstrated strong psychometrics in other populations. Using data from the National Survey of American Life (n = 4,815), the psychometric properties of the scale were tested in African American and Black Caribbean adults. When compared with the DSM-IV-TR criteria for Major Depressive Disorder (MDD) and Dysthymia, most items in the CES-D Scale focus on depressed mood, providing evidence for content validity. Construct validity was questionable in African American and Black Caribbean men. The CES-D scores of African American men who met the DSM-IV-TR (APA, 2000) criteria for Dysthymia were not significantly different than African American men who did not (t = 1.9, p = .109). The CES-D scores of Black Caribbean men who met the DSM-IV-TR criteria for MDD were not significantly different than Black Caribbean men who did not (t = 1.6, p = .198), and none of the Black Caribbean men met the DSM-IV-TR criteria for Dysthymia. For the item, “I felt like everything I did was an effort,” all groups had item-to-total correlations and inter-item correlations below .30. After eliminating this item, the alpha for the remaining 11 items was .80 and .76 in African American and Black Caribbean women, respectively. African American and Black Caribbean men also had item-to-total correlations and inter-item correlations below .30 for the item “I felt that I was just as good as other people.” After eliminating these items, the alpha for the remaining 10 items was .73 in African American and Black Caribbean men. The cut-off score was 9 for the 11-item CES-D and 8 for the 10-item CES-D.

Torres, E. R. (2013). Disability and comorbidity among major depressive disorder and double depression in African–American adults. Journal of Affective Disorders, 150(3), 1230-1233. PMCID: PMC3759528

Background: Few studies have examined differences in disability and comorbity among major depressive disorder (MDD), dysthymia, and double depression in African–Americans (AA). Methods: A secondary analysis was performed on AA in the National Survey of American Life. Interviews occurred 2001–2003. A four stage national area probability sampling was performed. DSM-IV-TR diagnoses were obtained with a modified version of the World Health Organization's expanded version of the Composite International Diagnostic Interview. Disability was measured by interview with the World Health Organization's Disability Assessment Schedule II. Results: Compared to non-depressed AA, AA endorsing MDD (t=19.0, p=0.0001) and double depression (t=18.7, p=0.0001) reported more global disability; AA endorsing MDD (t=8.5, p=0.0063) reported more disability in the getting around domain; AA endorsing MDD (t=19.1, p=0.0001) and double depression (t=12.1, p=0.0014) reported more disability in the life activities domain. AA who endorsed double depression reported similar disability and comorbidities with AA who endorsed MDD. Few AA endorsed dysthymia. Limitations: This was a cross-sectional study subject to recall bias. The NSAL did not measure minor depression. Conclusions: The current study supports the idea of deleting distinct chronic subtypes of depression and consolidating them into a single category termed chronic depression.

Torres, E. R., Sampselle, C. M., Ronis, D. L., Neighbors, H. W., & Gretebeck, K. A. (In press). Leisure-time physical activity in relation to depressive symptoms in African Americans: Results from the National Survey of American Life. Preventive Medicine.

Objective: To examine the frequency of leisure-time physical activity (LTPA) in relation to depressive symptoms in a nationally representative sample of African American (AA) women and AA men with guidance by Stokols' Social Ecological Framework. Method: A secondary analysis of AA women (n = 1811) and AA men (n = 1038) was performed on the National Survey of American Life, where a four stage national area probability sampling was conducted. Interviews were conducted 2001–2003. Clinically depressed AA were excluded from the current study. LTPA was measured by self-report frequency (never, rarely, sometimes, often) of participation in sports/exercise. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the relationship between LTPA and depressive symptoms, adjusting for biopsychobehavioral and sociophysical environmental factors. Results: Compared with AA women and AA men who reported never participating in LTPA, the multivariate OR for depressive symptoms in AA women and AA men who reported participating in LTPA often was 0.42 (95% CI = 0.24–0.72) and 0.41 (95% CI = 0.25–0.69) respectively. Conclusion: Increased frequency of LTPA was associated with fewer depressive symptoms in a nationally representative sample of non-clinically depressed AAs.

Watkins, D. C., Hudson, D. L., Caldwell, C. H., Siefert, K., & Jackson, J. S. (2011). Discrimination, mastery, and depressive symptoms among African American men. Research on Social Work Practice, 21(3), 269-277.

Purpose: This study examines the influence of discrimination and mastery on depressive symptoms for African American men at young (18—34), middle (35—54), and late (55+) adulthood. Method: Analyses are based on responses from 1,271 African American men from the National Survey of American Life (NSAL). Results: Discrimination was significantly related to depressive symptoms for men ages 35 to 54 and mastery was found to be protective against depressive symptoms for all men. Compared to African American men in the young and late adult groups, discrimination remained a statistically significant predictor of depressive symptoms for men in the middle group once mastery was included. Implications: Findings demonstrate the distinct differences in the influence of discrimination on depressive symptoms among adult African American males and the need for future research that explores the correlates of mental health across age groups. Implications for social work research and practice with African American men are discussed.

Watkins, D. C., Johnson-Lawrence, V., & Griffith, D. M. (2011). Men and their father figures: Exploring racial and ethnic differences in mental health outcomes. Race and Social Problems, 3(3), 197-211.

Though gender, racial, and ethnic disparities in health in the United States are well documented, it is less clear how these factors intersect to produce patterns of mental health outcomes among men. This study examined the presence of father figures in the lives of African American, Caribbean black and non-Hispanic white American males until the age of 16; assessed the current socio-demographic factors of these men as adults; and explored whether these factors lead to variations in mental health outcomes. Regression models were used to examine the correlates of socio-demographic, psychosocial, and retrospective father figure measures for depressive symptoms and non-specific psychological distress among African American (n = 999), Caribbean black (n = 506), and non-Hispanic white men (n = 193) from the National Survey of American Life. Findings revealed racial and ethnic group differences by age, employment status, education, and household income on depressive symptoms (measured using the CES-D scale) and non-specific psychological distress (using the Kessler-6 scale). Findings suggested that being raised by a grandfather placed both African American and Caribbean black men at greater risk for depressive symptoms and non-specific psychological distress under certain socio-demographic conditions. This study is unique in that it considers the influence of father figures on the mental health outcomes of adult males across three racial and ethnic groups. We conclude with a discussion of the implications for future mental health research and practice with men of color.

Watkins, D. C., Wharton, T., Mitchell, J. A., Matusko, N., & Kales, H. C. (In press). Perceptions and receptivity of nonspousal family support: A mixed methods study of psychological distress among older, church-going African American men. Journal of Mixed Methods Research.

The purpose of this study was to explore the role of nonspousal family support on mental health among older, church-going African American men. The mixed methods objective was to employ a design that used existing qualitative and quantitative data to explore the interpretive context within which social and cultural experiences occur. Qualitative data (n = 21) were used to build a conceptual model that was tested using quantitative data (n = 401). Confirmatory factor analysis indicated an inverse association between nonspousal family support and distress. The comparative fit index, Tucker–Lewis fit index, and root mean square error of approximation indicated good model fit. This study offers unique methodological approaches to using existing, complementary data sources to understand the health of African American men.

Williams, M. T., Elstein, J., Buckner, E., Abelson, J., & Himle, J. (2012). Symptom dimensions in two samples of African Americans with obsessive-compulsive disorder. Journal of Obsessive-Compulsive & Related Disorders, 1(3), 145-152. PMCID: PMC3375170

Obsessive–compulsive disorder (OCD) is a leading cause of disability worldwide; however, there is lack of research that includes African Americans; thus it is unclear whether findings about symptom dimensions can be generalized to this population. A sample of adult African Americans with OCD (N=74) was recruited at the University of Pennsylvania (Penn) and administered the Yale–Brown Obsessive–Compulsive checklist (YBOCS) to better understand the phenomenology of OCD in African Americans. Frequencies of symptoms are reported and compared to findings from the National Survey of American Life (NSAL; N=54). A principal components analysis of YBOCS categories and items was performed on the Penn sample. A six-component solution was found, which included Contamination & Washing, Hoarding, Sexual Obsessions & Reassurance, Aggression & Mental Compulsions, Symmetry & Perfectionism, and Doubt & Checking, explaining 59.1% of the variance. Factors identified were similar to those of previous studies in primarily White samples. African Americans with OCD reported more contamination symptoms and were twice as likely to report excessive concerns with animals as European Americans with OCD. The results indicate the presence of cultural differences, which is consistent with findings among non-clinical samples. Implications of these findings are discussed.

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.

Williams, D. R., Haile, R., Mohammed, S. A., Herman, A., Sonnega, J., Jackson, J. S., & Stein, D. J. (2012). Perceived discrimination and psychological well-being in the USA and South Africa. Ethnicity & Health, 17(1-2), 111-133. PMCID: PMC3468317

Objective. To explore levels of perceived racial and non-racial discrimination and their associations with self-esteem and mastery in the USA and South Africa. Design. We used ordinary least square regressions to test the cross-sectional associations between discrimination and psychological resources using two national probability samples of adults: the National Survey of American Life and the South African Stress and Health Study. Results. Levels of perceived racial discrimination were higher in the USA than in South Africa. In the USA, both African-Americans and Caribbean Blacks have comparable or higher levels of self-esteem and mastery than Whites. In contrast, South African Whites have higher levels of both self-esteem and mastery than Africans, Coloureds, and Indians. Perceived discrimination, especially chronic everyday discrimination, is inversely related to self-esteem and mastery in both societies. In South Africa, stress and socioeconomic status (SES) but not discrimination are important determinants of racial differences in self-esteem and mastery. Conclusions. In two racialized societies, perceived discrimination acts independent of demographic factors, general stressors, social desirability bias, racial identity, and SES, to negatively affect the psychological resources of self-esteem and mastery.

Woodward, A. T. (2011). Discrimination and help-seeking: Use of professional services and informal support among African Americans, black Caribbeans, and non-Hispanic whites with a mental disorder. Race and Social Problems, 3(3), 146-159.

This study used data from the National Survey of American Life to investigate the use of professional services and informal support among African Americans, black Caribbeans, and non-Hispanic whites. Multinomial logistic regression was used to examine the association of race and perceived discrimination with the use of professional services only, informal support only, both professional services and informal support, or no help at all. Fifty-one percent of the sample used both professional services and informal support, 16% relied on professional services only, 20% used informal support only, and 13% did not seek help. Before controlling for other factors, African Americans and black Caribbeans were significantly less likely to receive either professional or informal help compared with whites. When everyday racial discrimination was included, racial differences in not seeking help were no longer significant. Household income also influenced the relationship between race and help-seeking. Other factors significantly associated with help-seeking include age, gender, education, employment status, insurance coverage, type and severity of disorder, and subjective closeness to family and friends. The association of these factors and implication of the findings for future research and mental health service delivery will be discussed.

Woodward, A. T. (2013). A latent class analysis of age differences in choosing service providers to treat mental and substance use disorders. Psychiatric Services, 64(11), 1087-1094.

Objective:  This study investigated choice of service provider for treatment of a mental or substance use disorder and its association with consumers’ age. Methods:  Data were from the Collaborative Psychiatric Epidemiology Surveys. Service users born between 1946 and 1964 were compared with those born in 1945 or earlier (N=4,082). Latent class analysis was used to identify groups of service users according to nine dichotomous items reflecting lifetime visits with different types of professionals. Multinomial logistic regression was used to analyze factors predicting latent class membership, with particular focus on both the direct and moderating effects of age. Analyses controlled for sociodemographic characteristics and disorder-related variables. Results:  Five classes of service user were identified. Class 1 (10.8%) included individuals who visited six of the nine types of providers (multiple providers visited). Class 2 (21.9%) had low probability of visiting most providers (limited providers visited). Class 3 (24.1%) visited a psychiatrist (primarily psychiatrist). Class 4 (28.1%) visited a family physician or other physician (primarily family physician). Class 5 (15.1%) visited a psychologist (primarily psychologist). A higher proportion of service users born before 1946 were in the primarily family physician class. Although 21% of service users born later also fell into this class, overall they were more evenly distributed across the five classes. Conclusions:  Family physicians played a significant role in behavioral health treatment for both age groups. However, findings suggest that younger adults may rely on more complex combinations of service providers that will require greater coordination between the behavioral and general health care systems in the future.

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., Abelson, J. M., & Matusko, N. (In press).  Major depressive disorder among older African Americans, Caribbean blacks, and non-Hispanic whites: Secondary analysis of the National Survey of American Life. Depression and Anxiety

Background: Previous epidemiological and clinical research on mental disorders has treated Blacks as a homogenous group and yet Blacks of Caribbean descent and African Americans differ with respect to ethnicity, national heritage, living circumstances, and immigration status. The purpose of this article is to examine the prevalence of major depressive disorder (MDD) among African Americans, Caribbean Blacks, and non-Hispanic whites aged 50 and older with data on psychiatric and physical comorbidity, mental illness severity, and service use. Methods: Secondary analysis of data from the National Survey of American Life, a national household probability sample of African Americans, Caribbean Blacks, and non-Hispanic Whites in the United States, were used (n = 1,950). The response rate was 72.3%. Results: Controlling for age, the lifetime prevalence rate of MDD was 12.1% and the 12-month rate was 5.2%. Older Whites and Caribbean Blacks had significantly higher lifetime prevalence than African Americans but 12-month rates were similar across the three groups. Rates of co-occurring psychiatric disorders and physical conditions were high and were similar for African Americans, Caribbean Blacks, and Whites. Most older adults had either moderate or severe 12-month MDD and most talked to at least one professional, most frequently a family doctor, psychiatrist, or other mental health professional. Conclusion: MDD among older adults is highly prevalent, often associated with other psychiatric disorders or chronic physical conditions, and is associated with high overall mental illness severity. Differences among older Blacks highlight the need for further research on this population to ensure appropriate treatment is being provided to these groups.

Woodward, A. T., Taylor, R. J., Bullard, K. M., Aranda, M. P., Lincoln, K. D., & Chatters, L. M. (2012). Prevalence of lifetime DSM-IV affective disorders among older African Americans, black Caribbeans, Latinos, Asians and non-Hispanic whites. International Journal of Geriatric Psychiatry, 27(8), 816-827. PMCID: PMC3391316

Objectives: The purpose of this study is to estimate lifetime prevalence of seven psychiatric affective disorders for older non-Hispanic White people, African Americans, Caribbean Black people, Latinos, and Asian Americans and examine demographic, socioeconomic, and immigration correlates of those disorders. Design: Data are taken from the older sub-sample of the Collaborative Psychiatric Epidemiology Surveys. Selected measures of lifetime DSM-IV psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder, major depressive disorder, and dysthymia). Setting: Community epidemiologic survey. Participants: Nationally representative sample of adults 55 years and older (n = 3046). Measurements: Disorders were assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. Results: Major depressive disorder and social phobia were the two most prevalent disorders among the seven psychiatric conditions. Overall, non-Hispanic White people and Latinos consistently had higher prevalence rates of disorders, African Americans had lower prevalence of major depression and dysthymia, and Asian Americans were typically less likely to report affective disorders than those of their counterparts. There is variation across groups in the association of demographic, socioeconomic, and immigration variables with disorders. Conclusions: This study furthers our understanding of the racial and ethnic differences in the prevalence of DSM-IV disorders among older adults and the correlates of those disorders. It highlights the importance of examining both between-group and within-group differences in disorders and the complexity of the mechanisms associated with differences across groups. Findings from this study underscore the need for future research that more clearly delineates subgroup differences and similarities.

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.

Woodward, A. T., Taylor, R. J., & Chatters, L. M. (2011). Use of professional and informal support by black men with mental disorders. Research on Social Work Practice, 21(3), 328-336. PMCID: PMC3113612

This study utilized data from the National Survey of American Life (NSAL) to investigate the use of professional services and informal support among African American and Caribbean black men with a lifetime mood, anxiety, or substance use disorder. Thirty-three percent used both professional services and informal support, 14% relied on professional services only, 24% used informal support only, and 29% did not seek help. African American men were more likely than Caribbean Blacks to rely on informal support alone. Having co-occurring mental and substance disorders, experiencing an episode in the past 12 months, and having more people in the informal network increased the likelihood of using professional services and informal supports. Marital status, age, and socioeconomic status were also significantly related to help seeking. The results suggests potential unmet need. However, the reliance on informal support also suggests a strong protective role that informal networks play in the lives of Black men.