Attitudes and beliefs about mental health among African American older adults suffering from depression

Depression among older adults is a major public health concern leading to increased disability and mortality. Less than 3% of older adults utilize professional mental health services for the treatment of depression, less than any other adult age group. And despite similar rates of depression, African Americans are significantly less likely to seek, engage and be retained in professional mental health services than their white counterparts. Cultural differences in the way depression symptoms are manifested, defined, interpreted and labeled may in part explain some of these racial differences in help-seeking behaviors. Focus group methodology was utilized to identify and explore attitudes and beliefs about depression and mental health treatment utilization among 42 older African Americans who had recently suffered a major depressive episode. Thematic analysis of identified six overarching themes: (a) perceptions of depression, (b) the African American experience, (c) seeking treatment as a last resort, (d) myths about treatment, (e) stigma associated with seeking treatment and (f) culturally appropriate coping strategies. We discuss implications for practice, education and research.     

The Evolution of Community Mental Health Services in Asian American Communities

This paper explores the history of Asian immigration to the United States, and its intersections with the mental health system. As mental health care have evolved since the 1960s from institutions to the community, public mental health services for Asian Americans have become increasingly culturally relevant. Major policy shifts, trends in immigration, and mental health practice will be presented with a focus on the Bridge Program at the Charles B. Wang Community Health Center. Integrative practice and research models that extend evidence-based knowledge to Asian American communities and practice implications are discussed.     

Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools

African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.     

Understanding Italian American cultural norms

The components of Italian American culture in many ways provide a striking contrast to current American beliefs, values, and living habits. The challenge to the psychiatric nurse lies in maximizing the strengths of this culture to enhance the individual's ability to be what he or she can and chooses to be within the Italian culture and within the broader context of contemporary American society. By being culturally well informed and sensitive, and sharing goals and expectations with clients (Louie), the psychiatric nurse will be accepted and trusted to provide the kind of high quality care that will ultimately have a positive impact on the mental health status of Italian Americans.     

Mental Health Care for American Indians in Prison

Abstract

Based on an earlier finding that as many Native Americans in upstate New York received mental health care in prison as outside of prison during a 10-month period, this study was designed to investigate if prisons had become an alternative treatment option for Native Americans with a mental illness in New York State. The study was not able to answer this question due to the limited number of cases and to outside constraints. However, it is possible from the results to provide a picture of mental health needs and attitudes among Native American inmates which is surprising and instructive for those who provide psychiatric care to American Indians, either within or outside of prison walls. A noteworthy finding was the importance placed by these inmates on the use of culturally appropriate ceremonies to assist in their rehabilitation. Low rates of serious mental illness among the American Indian sample highlight the need for further study in this area.     

Culturally Competent Practice with African American Juvenile Sex Offenders

African American juveniles adjudicated for sexual offenses may struggle with the mistrust of both the judicial and treatment systems. Unlike general mental health services, juvenile sex offender treatment is often mandated by the court or child welfare services, thus these youths and their families must engage in the treatment process. Without clinicians and services that can acknowledge and respond to a minority youth’s experience in a sensitive, culturally competent manner, there could be significant resistance to treatment. Traditional treatment approaches fail to prioritize issues involving cultural competence. This article addresses the unique challenges of African American juvenile sex offenders and makes recommendations for creating culturally competent practice for these youth and their families.     

Providing psychiatric-mental health care for Native Americans: lessons learned by a non-Native American PMHNP

Providing culturally sensitive psychiatric-mental health nursing care to Native Americans requires a unique set of understandings. Traditional tribal customs and beliefs, historical events of the past 500 years, and acculturation and enculturation have affected Native Americans' health and well-being. In 2004, I had the opportunity to practice as a psychiatric-mental health nurse practitioner with a Native American tribe in the southwestern United States. This article describes the lessons I learned while practicing on the reservation and suggests ways other non-Native American practitioners can best serve this population.     

Western voodoo: providing mental health care to Haitian refugees

This article described certain aspects of Haitian life, voodoo and its role in Haitian society, the quality and quantity of psychiatric and mental health care for Haitians in Haiti, and suggestions for providing appropriate mental health care to Haitian refugees in the United States. Conway and Buchanan (1985) described what has helped Haitian refugees adapt in the transition to life in the United States: the strengths from their cultural heritage, such as fortitude; perseverance in the most arduous circumstances; deep religious faith; high self-respect; reliance on the extended family; and the tradition of sharing. Building on these assets may assist Western mental health-care providers in offering culturally sensitive mental health care to Haitians.     

Public relations and cultural aesthetics: designing health brochures

Brochures continue to be one of the most common tools available to health public relations practitioners. However, few studies have focused on the best ways to design health brochures for minority publics. Yet statistics show that African Americans and members of other minority publics suffer higher incidences of mortality from many diseases than do Caucasians. This two-part study examines ways to better design brochures to appeal to African American women. The study reveals that African American women prefer designs that reflect their cultural aesthetics. Part one of this study identifies a number of preferred design characteristics. Part two of this study tests the effectiveness of a culturally tailored brochure that advocates mammography screening. Results indicate that the brochures promoted significant gains in knowledge about breast cancer and mammography screening, a positive shift in perceived benefits of mammography, and a reduction in perceived barriers to getting mammograms. The brochure was preferred over standard “off the shelf” brochures that are not culturally tailored.     

Carers of People with Mental Illness from Culturally and Linguistically Diverse Communities

Australia is a multicultural country and it is common for families from culturally and linguistically diverse (CALD) communities to care for their relatives with mental illness. However, there are limited Australian studies examining the experiences of informal carers of people with mental illness from CALD communities. A scoping review was conducted to search for peer-reviewed articles reporting the perception of carers regarding their caregiving experiences, wellbeing, and needs. Using cultural responsiveness as a conceptual framework, this study analysed the findings of the identified studies to generate themes. Findings show that carers experience severe caregiving challenges and face considerably poor culturally oriented services in mental health. Social work implications concerning the need to provide culturally responsive practice in mental health services are discussed.     

Understanding the African American Research Experience (KAARE)

Summary

Despite recognition that the African American population is underrepresented in studies of health and mental health treatment and prevention efforts, few investigations have systematically examined barriers to African American research participation. Without their participation, treatment and prevention strategies designed to curtail the spread of HIV in their communities will be bound to achieve less than optimal outcomes. Based on the assumption that successful recruitment of African Americans requires knowledge of (a) their beliefs about research, (b) their perceptions of the research process and researchers, (c) their motivations to participate, and (d) the historical and social factors that may be the source of at least some ambivalence, the current study undertook semi-structured interviews with 157 African American, low-income mothers residing in a large urban community where they and their children were at high risk for HIV. Given the sensitive nature of the research topic, members of the community were trained to conduct the interviews. Qualitative and quantitative analyses of the interview content suggest that despite having been consented, many participants (a) are not aware of their rights under informed consent and (b) lack knowledge of how the research will be used. Despite this and the subtle suspicion of White researchers held by some, many decide to participate for altruistic reasons. The implications for recruitment of participants in general and African Americans in particular into HIV prevention studies are discussed as are the implications for service providers directly or indirectly involved in the development and delivery of these interventions.     

CAN A HIGH SENSE OF CONTROL AND JOHN HENRYISM BE BAD FOR MENTAL HEALTH?

Social stratification profoundly affects mental health. Specifically, substantial empirical evidence finds that higher status promotes mental health via a higher sense of control and a propensity to cope actively with problems. An unresolved issue, though, is whether the effects of sense of control and active coping on mental health are uniformly beneficial across levels of socioeconomic status. Perceived control and John Henryism, an active coping style, may undermine mental health, especially for lower-status persons, who lack resources. Using data from the National Comorbidity Survey for African Americans, Hispanics, and whites, we find that both sense of control and John Henryism tend to be monotonically related to positive mental health regardless of socioeconomic status and race/ethnicity.     

Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

The last mile of the way: understanding caregiving in African American families at the end-of-life

This research is based on in-depth ethnographic interviews and focus groups with 88 African American family caregivers from various regions of the United States during a stressful time in their family development--caregiving at the end-of-life--and the grieving during the aftermath. The study employed a stratified purposeful sampling strategy. Subjects were African Americans from the Northern, Southern, and Midwestern United States. Formal care is complicated by the distrust that many African Americans hold toward the health care system, which has resulted from years of exclusion, racism and discrimination. The findings highlight the importance of hearing from African American families to gain an understanding of what services, including family therapy and other psychotherapy, they will need during this process.     

Asian Community Mental Health Services at 35: a pioneering ethnic organization (1973-2008)

Asian Community Mental Health Services is a nonprofit organization that delivers mental health services to primarily Asian and Pacific Islander communities. From its early beginnings and over its 35-year history, the agency has had to overcome numerous challenges, including gaining legitimacy as a culturally specific nonprofit, combating stigma surrounding mental health issues within the Asian Pacific Islander community, building resources to fund service delivery, and developing an educated and culturally sensitive workforce. The history of the organization highlights the multiple challenges and rewards of developing a culturally specific nonprofit in an urban area as well as the important role that internal operations play in relation to nonprofit expansion and growth.     

African American Marital Satisfaction as a Function of Work-Family Balance and Work-Family Conflict and Implications for Social Workers

African Americans are more likely than any other race/ethnic group to report lower levels of marital satisfaction. Due to numerous benefits of marriage such as better physical and mental health, it is important to identify factors that impact African American marital satisfaction. This study examines the impact of work-family conflict and work-family balance on African American marital satisfaction. The results reveal a negative relationship between work-family conflict and marital satisfaction as well as differences in work-family factors that predict husbands' verses wives' marital satisfaction. The article offers implications for social work.     

Mental Health Recovery

Abstract

Strengths-based approaches that emphasize culturally competent services and naturally occurring community support may be more appropriate than traditional mental health services for African American adults with psychiatric disabilities. An examination of the literature on service utilization and treatment needs for this population highlights the paucity of empirical studies in these areas, while an exploration of the literature related to psychiatric recovery, a prominent strengths-based framework, reveals insufficient application of the approach to the specific interests of African American service recipients. We suggest that recovery is in fact highly compatible with such culturally relevant approaches as the Afrocentric model, and argue that the concept of recovery may therefore provide a resonant and particularly useful framework for practice with this population. Implications for research, practice and policy are discussed.     

Stifled Voices: Barriers to Help-Seeking Behavior for South African Childhood Sexual Assault Survivors

In South Africa, females under the age of 18 comprise approximately 40% of the rapes and other forms of sexual assault that occur. However, South African girls face multiple barriers to seeking help in the aftermath of sexual assault. This literature review provides an overview of childhood sexual assault in South African girls and addresses barriers to help-seeking behaviors. Risk factors as well as relevant sociocultural, economic, structural, and psychological perceptions regarding childhood sexual assault among South African girls are also discussed. Finally, clinical implications, culturally relevant psychotherapeutic techniques, and suggestions for future research are provided in an effort to reduce the negative mental health consequences for the victims.     

Healthcare Experiences of Latinos in a Nontraditional Destination Area

The purpose of this study was to describe the health and healthcare experiences of immigrant Latinos compared to USA-born Latinos, Whites, and African Americans in Greater Cincinnati, Ohio, a nontraditional immigrant destination area. Immigrant Latinos had significantly worse physical and mental health than other groups and significantly more barriers to healthcare. Latinos rated the degree to which their town is socially accepting of Latinos. Lower social acceptance was correlated with worse mental health and more barriers to healthcare. Geographic information system (GIS) mapping techniques revealed geographic patterns in the association between social acceptance of Latinos and health outcomes.