An Exploration of Mental Health Literacy Among African American Clergy

ABSTRACT

The purpose of this qualitative study was to explore African American clergy's mental health literacy with older congregants 60 years of age and older. Using a grounded theory approach, we recruited a purposive sample of 9 African American clergy representing diverse ages, denominations, locales, and educational levels. Data was coded and classified according to Kevin's (1976) Kevin, R. C. 1976. Factors influencing the judgment and referral of mental health presenting problems by clergymen and psychologists, Unpublished doctoral dissertation: University of Texas, Austin.  [Google Scholar] typology of pastoral counseling and Jorm et al.'s (1997) Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B. and Pollitt, P. 1997. “Mental health literacy”: A survey of the public's ability to recognize mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166: 182–186. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] conceptual model of mental health literacy. Findings from data analysis revealed study respondents were adherents of Kevin's Religious–Community (R–C) model. Additionally, the following themes emerged: loss of cognitive functioning, psychosocial stressors, religiosity, and appreciation for professional assistance, cultural barriers, and key informants/familiarity with formal mental health providers which partially maps onto Jorm et al.'s conceptual model of mental health literacy.     

Racial Differences in Attitudes Toward Professional Mental Health Treatment: The Mediating Effect of Stigma

Stigma associated with mental illness continues to be a pervasive barrier to mental health treatment, leading to negative attitudes about treatment and deterring appropriate care seeking. Empirical research suggests that the stigma of mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental illness, particularly African Americans. However, little research has examined the impact of stigma on racial differences in attitudes toward seeking mental health treatment. This study examined the hypothesis that stigma partially mediates the relationship between race and attitudes towards mental health treatment in a community-based sample of 101 African American and White older adults. Multiple regression analyses and classic path analysis was utilized to test the partial mediation model. Controlling for socio-demographic factors, African American older adults were more likely to have negative attitudes toward mental health treatment, and they also reported more public and internalized stigma than their White counterparts. As hypothesized, the relationship between race and attitudes toward mental health treatment was partially mediated by internalized stigma, suggesting that internalized stigma may cause older adults to develop negative attitudes about mental health treatment. The partial mediation model was not significant for public stigma, however. Implications for social work research and practice are discussed.     

Rural African American Clergy: An Exploration of Their Attitudes and Knowledge of Alzheimer's Disease

Rural African American clergy's ability to recognize Alzheimer's Disease (AD) and their capacity to provide support to elders with this illness has been neglected in the literature. Using a mental health literacy framework, the purpose of this research was to explore rural African American clergy knowledge and beliefs of AD. In-depth interviews were conducted with 9 African American clergy who oversaw churches in central Kentucky. Although few had direct experience with providing pastoral care to elders with AD, all clergy were literate and aware of the need for additional training. This study seeks to further clarify the role of African American clergy and their understanding of AD to inform the future development of appropriate interventions and establish better collaborative community treatment relationships.     

Self-Esteem Mediates the Relationship Between Volunteering and Depression for African American Caregivers

Research on the influence of volunteering on mental health outcomes has not placed enough focus on African American female caregivers who are at risk for adverse outcomes such as depression. This study addresses this gap by examining the mechanism through which volunteering might influence depressive symptoms using data collected from 521 African American female caregivers of older adults. Regression results indicate that although volunteering is inversely associated with depressive symptoms, self-esteem mediates this relationship. Findings suggest inclusion in volunteering for African American female caregivers may be relevant to promotion of their mental well-being.     

Predictors of mental health literacy among parents of youth diagnosed with mood disorders

Research reveals limited knowledge of children's mental health among caregivers. This paper identifies predictors of mental health literacy among parents of children diagnosed with mood disorders that are seeking or already receiving help. Secondary data analysis using multivariate regression was conducted on data from a randomized, controlled efficacy trial with a sample of 165 children. Mental health literacy was higher for parents who were female, white, higher educated and had children who were older, had a bipolar diagnosis or received more services. Lifetime experience with mental health disorders also predicted literacy. Public mental health efforts are needed to raise caregiver mental health literacy.     

Major Depressive Disorder and Cardiovascular Disease in African-American Women

Major depression is a risk factor for cardiovascular disease (CVD). This study used the National Survey of American Life (NSAL) to examine the co-occurrence of major depressive disorder (MDD) and CVD in a nationally representative sample of African American women (n = 2,216). Results from a series of logistic regression models indicated high rates of MDD and CVD in the sample, and the African American women with MDD were 1.59 times more likely to have CVD compared to those without MDD. High rates of MDD/CVD co-morbidity appeared across those living in and not living in poverty. These individuals demonstrated greater functional impairment and were high users of mental health services. Our findings validate that MDD and CVD co-occur and the need for more holistic interventions are warranted. The interface of co-morbid health conditions is critical to developing integrated models of care. Integrated health care systems are central for improving physical and mental health outcomes. These findings facilitate developing targeted assessment procedures and culturally appropriate treatment interventions. Increased knowledge regarding the role of gender, chronic health conditions, and the burden of mental illness in African American Women provides the opportunity to examine other chronic health conditions co-occurring with MDD.     

A Collaboratively Designed Child Mental Health Service Model: Multiple Family Groups for Urban Children with Conduct Difficulties

This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.     

Correlates of Psychological Distress and Major Depressive Disorder Among African American Men

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.     

A racial comparison of Family Group Decision Making in the USA1

This study examined Family Group Decision Making (FGDM) among a nationally representative sample of African‐American and White children investigated for maltreatment in the US. While FGDM was developed for work with ethnic minority families, there is no research on how this is being carried out in the US, where African‐American children are overrepresented in child welfare services. The study views racial differences in child, caregiver and maltreatment characteristics related to FGDM; composition of FGDM meetings; service referrals and receipt; and service satisfaction. Data are from the National Survey of Child and Adolescent Well‐being (NSCAW), a study of 5501 children ages 0–14. Current analyses include African‐American and White children (n= 4129). Stratified, bivariate and multivariate regression analyses were used. Results showed that while race was not related FGDM receipt, different characteristics lead to FGDM among African‐American and White families. Surprisingly, caregivers report feeling no more involved in decision‐making in association with FGDM. FGDM is provided at low rates overall (10%) and less frequently among White caseworkers. Child access to mental health services increases in relation to FGDM. Implications are discussed.     

Predicting Retention in Three Substance Abuse Treatment Modalities Among Anglo,African American,and Mexican American Juvenile Offenders

Abstract

Many of the same factors that predict delinquent behavior also predict adolescent drug use. This study examined factors that predict, and interventions that maximize, substance abuse treatment retention in three modalities among high-risk Anglo, Mexican American, and African American juvenile offenders. The study sample includes youth (N = 211) who were discharged from probation supervision and who received substance abuse services through a CSAT-funded federal demonstration project. The key predictors examined included the stage-of-change (i.e., precontemplation, contemplation, preparation) in which a juvenile fell, various dimensions captured by the Comprehensive Addiction Severity Index for Adolescents, and other intervention status (probation, case management, and mental health treatment). The research questions were addressed using statistical models known as survival analysis that treated time from entry into substance abuse treatment to exit from substance abuse treatment as the outcomes. Among key findings were that females were 73% more likely to leave day treatment relative to males; for each additional family problem ever experienced, Mexican American adolescents were 15% more likely to leave residential treatment compared with African American adolescents; and African American and Mexican American adolescents in the contemplation stage-of-change were 50% less likely to leave day treatment compared with Anglo adolescents. Applications for practice and research with this population are discussed.     

Reassessing a Theory of Professional Expertise: A Cross-National Investigation of Expert Mental Health Social Workers

This paper presents the findings from a cross-national studyof expert mental health social workers in Melbourne, Australiaand San Jose, California, USA. In this study, expert socialworkers were selected based on a peer-nomination process andthey were invited to participate in two-hour focus group interviewsin which they described memorable practice situations. Detailedaccounts of these practice situations were gathered from nineteenAustralian and American expert practitioners employed in community-basedmental health settings. The study findings corroborate manyof the dimensions that are explicated in a theory of professionalexpertise developed by Fook et al. (2000). Further, the findingsdescribe the skilful and ethical comportment of these socialworkers in the context of often complex and challenging practicesituations. Narrative accounts are used to demonstrate the distinguishingdimensions and features of expert practice described by Fookand her colleagues, especially when providing services to peoplewith chronic mental illness. In-depth articulation of practiceexpertise using cross-national data enhances social work researchand pedagogy by providing important exemplars that inform morefully the development of empirically based practice theories.     

Treating Older Persons with Severe Mental Illness in the Community: Impact of an Interdisciplinary Geriatric Mental Health Team

Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease in depressive symptoms and in psychiatric hospitalizations, and an increase in life satisfaction at 6 months were found. No change in health nor medical hospitalizations were reported. This study provides preliminary support for the feasibility and efficacy of a MGHIT approach in treating older community-dwelling adults with severe mental illnesses. Implications for social workers are discussed.     

Comparison on predictors of mental health service use among Asian older adults

Studies have mostly examined mental health service use of older Asian immigrant combining all Asian Americans into one group whereas immigration backgrounds and socioeconomic status of each Asian minority group are different. Therefore, this study aimed to identify predictors of mental health service use within specific ethnic groups among older Asian adults focusing on Chinese, Japanese, Korean, Filipino, and Vietnamese in California. The Behavioral Model for Vulnerable Populations (BMVP) is used to guide the secondary data analysis of a sample of 3,453 older Asian immigrants from the California Health Interview Survey (CHIS). Logistic and linear regression analyses are performed to examine predictors of mental health service use and the frequency of mental health service use, respectively. As results, mental health‐seeking patterns differ by ethnicity within the older Asian immigrant sample, not being married (Korean), higher levels of acculturation (Filipino), lower levels of neighborhood cohesion (Korean and Vietnamese), higher levels of perceived safety (Korean) and lower levels of perceived safety (Vietnamese), higher levels of mental distress (Korean and Filipino), and having perceived need (all) were related to more visits for mental health services. The study findings highlight the necessity of cultural competency services and programs for each Asian ethnicity.     

A Model for Community-Based Mental Health Services for Older Adults:

The mental health needs of older adults have historically been underserved by existing mental health service delivery systems. This paper presents a model for the delivery of comprehensive mental health services to older adults in their own homes, based on sound clinical practice, and incorporating a cross-cultural perspective coupled with a strong social and community support base.     

The Fallacy of Generalizing from Egg Salad in False-Belief Research

Geraerts et al. (2008)   reported that misleading individuals with false beliefs about having gotten sick on egg salad in childhood can reduce the probability of subsequently consuming egg salad. They concluded that their results "… have important implications for people's food and dieting choices…" (p. 752). We argue that their conclusion represents a fundamental generalization problem. We report new findings that, together with other recent studies, data on disgust and the fact that hard boiled eggs produce a chemical associated with rotten food, suggest that Geraerts et al.'s success in reducing individuals' interest in eating egg salad is likely restricted to less appealing foods that are less frequently consumed. Because of potential applicability of their results to public health and well-being, and the more general applicability of the false-feedback paradigm to legal cases, it is important to accurately limit these conclusions and generalizations.     

Gender Differences in Determinants of Self-Rated Health Among African American in Omaha Nebraska: A Church-Based Study

Abstract

This study assessed the gender differences in determinants of fair/poor self-rated health among African American churchgoers in Omaha, Nebraska. Using data collected from 353 African American (245 women and 108 men) by the Center for Reducing Health Disparities at the University of Nebraska Medical Center in 2017, univariate and multivariate logistic regressions were performed to examine the gender differences in the relationships between fair/poor self-rated health and potential health determinants. Overall, 14.3% of women and 17.6% of men reported fair/poor self-rated health. There was a significant association between depression and poor/fair self-rated health among women (p?=?0.044) and men (p?=?0.001). For women, the fully controlled model confirmed the crude association between perceived poor/fair self-rated health and heart disease (OR = 3.10) and education (OR = 2.19). For men, the final model identified significant determinants of perceived fair/poor self-rated health such as depression (OR = 12.51) and diabetes (OR = 3.89). When assessing gender differences in determinants of self-rated health, similarities are higher than differences between the two groups. In both groups, the presence of depression was the strongest determinant of poor health. Future research should assess the immunological aspects of the association between psychological factors and perceived chronic diseases.     

Development of a Multimodal Assessment Framework for Helping Older African American Women Transition Out of Homelessness

Increasingly vulnerability to homelessness is affecting older African American women because more than any other group these women are susceptible to even minor changes in socioeconomic conditions. This article describes the evolution of an assessment strategy and process found to be useful in planning older African American women's transition from homelessness. The assessment strategy was developed as part of a multimethod, multilevel research and development program the purpose of which is to identify and test tools and interventions useful in helping older African American women leave homelessness. The article offers background on the action research project in which the assessment framework was developed, examines the method for the construction of the framework, describes the assessment process, and considers the integration of specific assessment tools into the advocacy process.     

Religion and coping in older adults: a social work perspective

Religion is an important coping resource for many older adults. This paper briefly describes social work's religious roots, makes a distinction between religion and spirituality for older adults, and presents empirical data showing how older adults employ religious strategies to cope with life challenge. The study reports on religious coping in an available sample of 79 European American and African American older adults residing in urban community dwellings. Implications suggest how social workers and others may support religious coping.