Men and Their Father Figures: Exploring Racial and Ethnic Differences in Mental Health Outcomes

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.     

Goal-Striving Stress and Racial Differences in Mental Health

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.     

Age Differences in Exposure and Reactivity to Interpersonal Tensions among Black and White Individuals across Adulthood

The present study examined age differences in exposure and reactivity to interpersonal tensions among white and black Americans. Participants from the National Study of Daily Experiences II (NSDE II, n = 1,696 white and n = 239 black; ages 34–84) reported their experiences of daily interpersonal tensions and well-being (positive and negative affect) over 8 days and provided salivary cortisol samples. A total of 40% of respondents reported having an argument and 62% reported avoiding an argument. Multilevel models estimated separately for black and white respondents revealed that older people reported fewer interpersonal tensions (i.e., less exposure) than did younger people. However, age differences in reactivity to tensions (e.g., appraisals, coping strategies, implications of tensions for affect and cortisol) varied by race. Although older black respondents reported tensions were less stressful than younger black respondents, there were fewer age difference in reactivity to tensions overall among black respondents compared with white respondents. Findings are consistent with the exposure-reactivity model and gerontological theories of emotion regulation but show that the specific age differences vary by race which may indicate unique strengths and vulnerabilities among whites and blacks.     

Racial Stratification and the Confederate Flag: Comparing Four Perspectives to Explain Flag Support

Recent events have brought attention to Confederate monuments positioned across the USA and polarized debates about their proper placement; however, prior research examining support for Confederate symbols is largely limited to white Americans. This study examines public support for the South Carolina Confederate flag using four perspectives of racial stratification—black/nonblack, combined race-ethnicity, ethnoracial pentagon, and nonwhite/white. Using data from two nationally representative surveys of noninstitutionalized US adults collected in 2000 and 2015 (n?=?7638), we identify associations between theories of racial stratification and Confederate flag stances. Multiple model fit indices indicate that the combined race-ethnicity theory of racial stratification best mapped onto public support followed by the ethnoracial pentagon and black/nonblack perspectives. The nonwhite/white model exhibited the poorest fit. Findings from logistic regressions showed that whites had significantly higher odds of supporting the Confederate flag compared to blacks and Latinos. Additionally, blacks had lower odds of flag support than Latinos, Asian Americans, Native Americans, Pacific Islanders, and multiracial respondents. We argue that an overlooked aspect of Confederate monuments is their signified antiblackness demonstrated in this study by greater support for the flag among all nonblack racial-ethnic groups. Findings imply that prioritizing whites’ views in discussions of Confederate monuments offers an inadequate depiction of public opinion by race-ethnicity. Disaggregating views via the combined race-ethnicity measure highlights racial-ethnic variation in support of the South Carolina Confederate flag.

     

Teacher-Based Racial Discrimination: The Role of Racial Pride and Religiosity Among African American and Caribbean Black Adolescents

This study explored the extent to which private regard and religiosity beliefs serve as protective factors for school bonding among African American and Caribbean black adolescents who experience racial discrimination in school. Findings are drawn from a nationally representative sample of (n = 810) African American and (n = 360) Caribbean black adolescents (52% girls) aged 13–17 (M_age = 15, SD = 1.42) years. Results suggest that perceiving racial discrimination from teachers was associated with lower levels of school bonding for African American and Caribbean black adolescents. For African American adolescents, perceiving more racial discrimination from teachers and reporting lower private regard beliefs was associated with less school bonding. The findings for Caribbean black adolescents revealed that endorsing moderate levels of religiosity and perceiving higher rates of teacher discrimination was associated with less school bonding. The developmental significance and implications for future research are discussed.     

Low Social Status Markers: Do They Predict Depressive Symptoms in Adolescence?

Some markers of social disadvantage are associated robustly with depressive symptoms among adolescents: female gender and lower socioeconomic status (SES), respectively. Others are associated equivocally, notably black v. white race/ethnicity. Few studies examine whether markers of social disadvantage by gender, SES, and race/ethnicity jointly predict self-reported depressive symptoms during adolescence; this was our goal. Secondary analyses were conducted on data from a socioeconomically diverse community-based cohort study of non-Hispanic black and white adolescents (N = 1,263, 50.4% female). Multivariable general linear models tested whether female gender, black race/ethnicity, and lower SES (assessed by parent education and household income) and their interactions predicted greater depressive symptoms reported on the Center for Epidemiological Studies Depression Scale. Models adjusted for age and pubertal status. Univariate analyses revealed more depressive symptoms in females, blacks, and participants with lower SES. Multivariable models showed females across both racial/ethnic groups reported greater depressive symptoms; blacks demonstrated more depressive symptoms than did whites, but when SES was included this association disappeared. Exploratory analyses suggested blacks gained less mental health benefit from increased SES. However, there were no statistically significant interactions among gender, race/ethnicity, or SES. Taken together, we conclude that complex patterning among low social status domains within gender, race/ethnicity, and SES predicts depressive symptoms among adolescents.     

Mental Health Help-Seeking Profiles Among African Americans: Exploring the Influence of Religion

African Americans with mental health problems consult a variety of sources for assistance. Most studies report a preference for informal sources rather than professional sources of help with mental health concerns. While it is clear that African Americans seek help from both informal and professional sources, less known is whether there are unique subpopulations of African Americans that can be defined by their support and services use. Given the importance of religion in the lives of African Americans, it also important to understand the role of religious involvement in determining help-seeking behaviors. This study used latent class analysis and data from the National Survey of American Life (n = 1315) to identify distinct profiles of help-seeking behavior among African Americans with mental health disorders defined by informal (e.g., clergy, family, and friends) and professional sources (e.g., health and mental healthcare providers) of support and services. Findings revealed two help-seeking classes: Low Use/Informal Support (95%) and High Use/All Support (5%). Low subjective religious involvement was associated with membership in the Low Use/Informal Support class. High non-organizational religious involvement was associated with membership in the High Use/All Support class. No associations between demographic characteristics were found between the two classes. Findings highlight heterogeneity in help-seeking behavior among African Americans and the importance of considering multiple domains of religious involvement in influencing these behaviors. Findings highlight the importance of collaborative efforts between religious institutions, health and mental healthcare providers, family and friendship networks in the delivery of mental health care to African Americans.     

Ethnic Variations in the Relationship Between Socioeconomic Status and Psychological Distress Among Latino Adults

This study investigated the association between SES and psychological distress among Latinos. Data were from the National Latino and Asian American Study’s Cuban (N = 577), Mexican (N = 868), and Puerto Rican (N = 495) adult samples. Regression analysis was used to assess the association between SES measured as education, household income, and wealth and psychological distress for three Latino subgroups, respectively. Results indicate that wealth is the most important predictor for all three Latino groups. Cubans, Mexicans, and Puerto Ricans are all disadvantaged on wealth possession and being in debt is associated with more psychological distress for them. The health benefit of wealth is especially significant for Cubans and Puerto Ricans. In contrast with findings in many previous studies, household income is not significantly related to mental health. The finding that only wealth is weakly associated with psychological distress among Mexicans suggests that the Hispanic Health Paradox only applies to Mexicans. Education is strongly associated with distress among Cubans, with college degrees producing the largest protection from mental illness. Findings also indicate that physical health and discrimination are strongly associated with psychological distress independent of the SES measures. This study contributes to an understanding of the health significance of SES among Latinos. It highlights the importance of examining ethnic variations in the association of socioeconomic status and mental health among Latinos and of identifying the mental health impact of various measures of socioeconomic status.     

The Role of Historical Knowledge in Perception of Race-Based Conspiracies

We test the hypothesis that knowledge of historically documented, anti-black conspiracies affects perceived plausibility of new, anti-black conspiracies. In Experiment 1 (N = 78), African Americans and European Americans read about a current conspiracy aimed at undermining either African American or European American–elected officials. African Americans perceived the anti-black conspiracy as more plausible and the conspiracy informant as more credible than did European Americans. The difference in perception of informant credibility was mediated by recognition of historically documented, anti-black conspiracies. In Experiment 2, we manipulated European Americans’ (N = 105) exposure to information about historically documented, anti-black conspiracies. European Americans who learned about actual, past anti-black conspiracies perceived new anti-black conspiracies as more plausible than did European Americans who learned about race-silent conspiracies or who did not learn about conspiracies. To the extent that European Americans lack awareness of incidents of racism in US history, they are likely to underestimate the possibility that racism impacts contemporary events.     

Racial Identity–Related Differential Attributions of Inadequate Responses to Hurricane Katrina: A Social Identity Perspective

This study examines the attribution of responsibility for the problematic response to Hurricane Katrina in the fall of 2005. Based on social identity theory, the study compared the attribution with racism and non-racism factors (situational vs. dispositional attributions) between African American and European American students (n = 505). As hypothesized, African American identity was related to greater racism attribution, even after controlling for demographics, faith factors, and cognitive-emotional reactions to the hurricanes. European American identity was associated with more executive-responsibility attributions, but the effect vanished after adjusting other factors. The study underscores the importance of acknowledging group identity rather than an overarching American identity in exploring the race effect after a national collective trauma. The consequential implications for disaster planning, future research investigation, and social service delivery are discussed.     

Discrimination and Help-Seeking: Use of Professional Services and Informal Support Among African Americans,Black Caribbeans,and Non-Hispanic Whites with a Mental Disorder

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.     

Race and Gender Concordance: Strategy to Reduce Healthcare Disparities or Red Herring? Evidence from a Qualitative Study

Healthcare treatment differences persist for African Americans even after controlling for socioeconomic status (van Ryn and Burke 2000). Although blacks represent a sizable percentage of the middle class, most disparities research does not address class heterogeneity. Furthermore, research indicates patient–provider race concordance may mitigate racial disparities in health care (Laveist and Neru-jeter in J Health Soc Behav 43(3):296–306, 2002; IOM in Unequal treatment: confronting racial and ethnic disparities in health care. National Academies Press, Washington, 2002). This study explores race and gender preference for black middle-class women in healthcare settings. The study uses in-depth interviews and focus groups to explore the experiences of thirty African American women between 38 and 67 in a large urban area. The majority of respondents expressed a strong preference for a female OB/GYN (of any race) while 9 preferred a female primary care provider (of any race). Although the women did not express an explicit race preference, they had a strong affinity for black female providers. Importantly, respondents complicated the idea of provider-level race preference by noting that other site-level factors like wait times and the site’s racial composition affected their racial preferences. Although increasing racial diversity among providers is generally positive, respondents suggest that alone will not ameliorate racial disparities. The complexities of the healthcare encounter, including time pressure, clinical uncertainty, and the patient’s desire for expertise regardless of race or gender, all impinge on respondents’ race preferences. Lastly, women noted that site-level factors may be conflated with the race of provider such that having a black provider does not necessarily lead to better care or protect women from discrimination or bias.     

Adolescent-Rated Health and Intention to Attend College: Variation by Race/Ethnicity and Levels of Health Status

Quantify the relationships between adolescent self-reported health and college intention in a diverse sample including Asians. Data were used from 3,737 adolescents ages 12–17 who completed the 2003 California Health Interview Survey. Self-reported intention to attend college/university was compared to other plans. Multivariate logistic models predicting college intention by health status (poor/fair, good, or very good/excellent) were performed with the entire sample and for each race/ethnicity separately. Age, poverty, gender, rural residence, and parental college education were controlled. Participants were 44 % white, 36 % Hispanic, 11 % Asian, and 9 % black. Overall, 10 % reported poor/fair health, 30 % good health, and 60 % very good/excellent health. Whites were the most likely to report very good/excellent health and Hispanics least likely (χ²(6) = 11.85; p < 0.01). Eighty-one percent had college plans, which also varied by race/ethnicity with Asians most likely to report college intentions and Hispanics least likely (χ²(3) = 3.97; p < 0.05). In the overall multivariate model, adolescents in poor/fair health (OR: 0.53; 95 % CI: 0.34–0.83) and good health (OR: 0.59; 95 % CI: 0.45–0.78) were significantly less likely to plan on college compared to those in very good/excellent health. Variation was seen by racial/ethnic group. For whites and blacks, only good health significantly predicted less college intention (compared to very good/excellent health) while only poor/fair health significantly predicted less college intention for Hispanics and Asians. Very good/excellent health in adolescence was associated with greater college intention compared to both fair/poor health and good health, but this relationship varied by race/ethnicity.     

Socioeconomic Differences among Blacks in America: Over Time Trends

Compared to Hispanic and Asian immigrants, black immigrants in the United States have been considerably less researched, and until very recently, black African immigrants remained a relatively understudied group. Using data from three waves of the US Census (1980, 1990, and 2000), we assess differences in earnings (and related measures of socioeconomic status) among male and female African Americans and black immigrants from Africa and the Caribbean. Results of the analysis suggest a sizeable earnings advantage for immigrants. Controlling for a host of human capital variables, however, reduced the gap between the earnings of African immigrants and native-born blacks, although the difference still remained statistically significant. No such attenuation was found for immigrants from the Caribbean. The results also indicate that for females only, the immigrant advantage has grown over time. Moreover, the findings show that additional years of work experience in the USA or in foreign countries correspond to a rather sizable increase in hourly earnings for both males and females, but, for males, this effect has grown weaker over time. Finally, men earned more than women, both overall and within comparison groups with the gap remaining relatively stable over time.     

Diverging Fortunes: Racial/Ethnic Inequality in Wealth Trajectories in Middle and Late Life

The primary aim of this study is to examine whether racial/ethnic inequality in wealth dissipates or increases between middle and late life, and by how much. To address this aim, this study draws on critical race and life course perspectives as well as 10 waves of panel data from the Health and Retirement Study and growth curve models to understand racial/ethnic inequality in wealth trajectories among whites, blacks, and Mexican Americans (N = 8337). Findings show that, by midlife, significant inequalities in net worth emerge between whites and their black and Mexican American counterparts. On average, white households have amassed a net worth of $105k by midlife, compared to less than $5k and $39k among black and Mexican American families, respectively. Moreover, whites experience much more rapid rates of wealth accumulation during their 50s and 60s than their minority counterparts, resulting in increasing wealth disparities with age, consistent with a process of cumulative disadvantage. At the peak of their wealth trajectory (at age 66), whites have approximately $245k more than blacks and $219k more than Mexican Americans. A wide range of socioeconomic, behavioral, and health factors account for a portion, but not all, of racial/ethnic inequality in wealth, suggesting that unobserved factors such as parental wealth, segregation, and discrimination may play a role in the production and maintenance of wealth inequality.     

A Paradox of Bias: Racial Differences in Forensic Psychiatric Diagnosis and Determinations of Criminal Responsibility

Although there is substantial evidence that African Americans receive unequal treatment in both the healthcare and criminal justice systems, less research has investigated the role of race when these two systems converge. Here, we examine the influence of race on patterns of forensic psychiatric diagnosis and determinations of criminal responsibility in pre-trial correctional facilities (e.g., forensic psychiatric hospitals). Data are from a medical chart review of 129 randomly selected competency evaluations that occurred in a pre-trial correctional psychiatric facility. Consistent with previous research, findings indicate that African Americans are disproportionately diagnosed with highly stigmatized psychotic spectrum disorders relative to whites. In addition, they unexpectedly indicate that African Americans are significantly more likely than whites to be found not criminally responsible by the court-appointed evaluating mental health professional, controlling for sociodemographic characteristics, number of violent and non-violent charges, and other potential confounding variables. Mediation analysis reveals the important and previously undocumented finding that the effect of race on criminal responsibility determinations is fully mediated by differential diagnosis. This suggests that patterns of racial inequality and potential bias in the diagnostic process may confer medical resources and other benefits for African Americans in the context of the criminal justice system.     

School-Based Racial and Gender Discrimination among African American Adolescents: Exploring Gender Variation in Frequency and Implications for Adjustment

The present study examined school-based racial and gender discrimination experiences among African American adolescents in Grade 8 (n = 204 girls; n = 209 boys). A primary goal was exploring gender variation in frequency of both types of discrimination and associations of discrimination with academic and psychological functioning among girls and boys. Girls and boys did not vary in reported racial discrimination frequency, but boys reported more gender discrimination experiences. Multiple regression analyses within gender groups indicated that among girls and boys, racial discrimination and gender discrimination predicted higher depressive symptoms and school importance and racial discrimination predicted self-esteem. Racial and gender discrimination were also negatively associated with grade point average among boys but were not significantly associated in girls’ analyses. Significant gender discrimination X racial discrimination interactions resulted in the girls’ models predicting psychological outcomes and in boys’ models predicting academic achievement. Taken together, findings suggest the importance of considering gender- and race-related experiences in understanding academic and psychological adjustment among African American adolescents.     

Seeking Help from Clergy Among Black Caribbeans in the United States

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.     

Differences Between African Americans and Non-Hispanic Whites Utilization of Clergy for Counseling with Serious Personal Problems

There is a paradox in research on African Americans and non-Hispanic whites in the utilization of clergy. Research finds that African Americans have higher levels of religious service attendance and higher levels of contact with clergy. Research also finds that despite this, African Americans are less likely than non-Hispanic whites to seek out assistance from clergy for psychiatric disorders including depression and anxiety. The goal of this paper was to investigate race differences in the use of clergy for counseling for serious personal problems. It uses the National Survey of American Life. We find that non-Hispanic whites were more likely than African Americans to use clergy for a serious personal problem. The significant difference between African Americans and non-Hispanic whites appeared to be mediated by the fact that African Americans were more likely to have seen clergy in a religious setting and non-Hispanic whites were more likely to have seen clergy in other settings including hospitals.     

Influence of a Community Health Worker Intervention on Mental Health Outcomes among Low-Income Latino and African American Adults with Type 2 Diabetes

This study investigated the influence of a community health worker (CHW) diabetes lifestyle intervention on mental health outcomes. Our study was guided by the principles of community-based participatory research. Data were collected from 164 African American (N = 94) and Hispanic adults (N = 70) participating in a randomized, 6-month delayed intervention group design for improving glycemic control. The intervention time periods were baseline to 6 months for the treatment group and 6–12 months for the delayed group. Linear mixed models were used to conduct longitudinal analyses of the Problem Areas in Diabetes (PAID) and Patient Health Questionnaire (PHQ) scales. In the model adjusted for demographics, the PAID dropped significantly from pre-intervention to post-intervention within both the treatment and delayed groups (p < 0.05) with an average intervention effect of ?6.4 (p < 0.01). The PAID dropped even further within the immediate group from 6 to 12 months. Although the PHQ did not change significantly, the PHQ-2 had an average intervention effect of ?0.3 (p < 0.05) in the model adjusted for demographics. This study contributes to an understanding of how a CHW-led diabetes intervention can result in positive mental health outcomes for Latinos and African Americans with Type 2 diabetes. It also highlights the importance of further exploring what factors may contribute to racial/ethnic variation in mental health outcomes for African Americans and Latinos with diabetes and the role CHWs can play.