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.     

Residential Segregation,Health, and Health Care: Answering the Latino Question

The literature on the relationship between residential segregation and health outcomes for African Americans is well developed, but less is known about this association for Latinos in the USA. The literature for Latinos is limited, demonstrates mixed results, and suffers from data limitations. Using geographic concentration of poverty theory, we analyze the impact of Latino segregation on a series of health and health-care outcomes in order to better establish this relationship. This study uses data from the 2011 to 2012 Behavioral Risk Factor Surveillance System nested within metropolitan area-level data in a set of partial proportional odds and binary logistic multilevel regression models. We examine the relationship between Latino segregation and three health and health-care outcomes for 164 metropolitan areas in the USA. Overall, we find that Latino segregation is negatively related to good self-rated health, having a personal physician, and having health insurance for Latino respondents. Furthermore, for White respondents, no such association exists. As a result, residential segregation for Latinos contributes to the Latino–White health gap.     

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.     

Race and Ethnic Self-Identification Influences on Physical and Mental Health Statuses Among Blacks

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.     

Health-Related Stereotype Threat Predicts Health Services Delays Among Blacks

To our knowledge, no published research has developed an individual difference measure of health-related stereotype threat (HRST). We adapted existing measures of academic stereotype threat to the health domain on a sample of black college students (N = 280). The resulting health-related stereotype threat scale-24 (HRST-24) was assessed for internal consistency, construct and incremental validity, and whether it explains variance in self-reported delays among four preventive health behaviors—blood pressure and cholesterol assays, physical exams, and routine checkups. After adjusting for several control variables, the HRST-24’s (full scale α = 0.96) perceived black health inferiority (18 items; α = 0.96) and perceived physician racial bias (6 items; α = 0.85) subscales explained unique variance in delays among two of the four behaviors including a blood cholesterol check (p < .01) and routine checkup—albeit at marginal levels (p = .063) in the case of the latter. Overall, these data provide preliminary evidence of construct and incremental validity for the HRST-24 among blacks. Recommendations for administering the scale are provided and future directions for HRST research are discussed.     

The Role of Racial Microaggressions,Stress, and Acculturation in Understanding Latino Health Outcomes in the USA

A growing body of literature demonstrates important negative health effects from racial microaggressions for racial/ethnic minorities. However, at present, the bulk of the literature is focused on the case of black Americans with relatively little attention as to how this may play out for other racial/ethnic groups. Here, we examine the association of health and racial microaggressions in the case of Latinos. Furthermore, we disaggregate Latinos by language preference in order to see how acculturation to the USA may moderate the effect of racial microaggressions on health outcomes for the group. In a statistical analysis of the 2004 Behavioral Risk Factor Surveillance System, we examine the association between stress from racial microaggressions and self-rated health for Latinos of different levels of linguistic acculturation. We find that more acculturated Latinos (measured in terms of language preference) are more likely to experience physical stress from perceived racial microaggressions after accounting for social and demographic factors. Further, this stress is linked to overall poorer self-rated health for the group. However, we find no such association for less acculturated, Spanish-preference Latinos.     

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.     

Mental Health Among Mexican-Origin Immigrant Families: The Roles of Cumulative Sociodemographic Risk and Immigrant-Related Stress

The current study examined the unique effects of cumulative sociodemographic risk and immigrant-related stress on mental health symptoms among Mexican-origin immigrant parents and their school-age children. Further, this study tested whether the effects of cumulative sociodemographic risk and immigrant-related stress on child mental health were mediated by parent mental health. Participants included 104 Mexican-origin immigrant families. Families in the study had a child between the ages of 6 and 10 (M_age = 8.39; 61% female). Data were collected across three time points spaced 6 months apart. Immigrant-related stress was found to predict parent mental health, which in turn predicted child mental health. Cumulative sociodemographic risk did not predict parent or child mental health. Mental health symptoms generally decreased over time, but for children, change in mental health symptoms depended on parent mental health symptoms. Given the high levels of mental health symptoms among Mexican-origin parents and children, reducing a context of stress and promoting mental health interventions for Mexican-origin immigrants is critical.     

Perceived Racial Discrimination in Health Care and Race Differences in Physician Trust

Racial discrimination in health care is more often perceived by racial minority patients than by whites. In this study, we explored whether two types of perceived racial discrimination, perceptions that the healthcare system is racially biased in general (perceived institutional racial discrimination) and perceptions that one has personally encountered racial discrimination while seeking health care (perceived interpersonal racial discrimination), mediated racial differences in patients’ trust in physicians. We examined this in a sample of black (N = 127) and white (N = 303) patients being treated in two Veterans Affairs orthopedic clinics for advanced osteoarthritis. Patients completed measures of perceived institutional and interpersonal racial discrimination in health care before meeting with an orthopedic surgeon and a measure of physician trust after the visit. Using a multiple mediator bootstrapping procedure, we tested whether perceived institutional and/or interpersonal racial discrimination mediated the association between race and trust. Compared to whites, blacks reported lower physician trust (M = 4.00 vs. 4.17, β = ?0.15, 95 % CI = ?0.25, ?0.05), more perceived institutional racial discrimination (M = 3.13 vs. 2.60, β = 0.43, 95 % CI = 0.25, 0.61), and more perceived interpersonal racial discrimination (M = 1.94 vs. 1.21, β = 0.60, 95 % CI = 0.47, 0.74). Perceived interpersonal, but not institutional, racial discrimination mediated the race difference in physician trust and accounted for 55 % of the variance. Our finding that lower physician trust among black patients than white patients was explained by perceptions of interpersonal racial discrimination in health care suggests that issues of racial discrimination may need to be addressed in order to foster minority patients’ trust in physicians.     

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.     

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.     

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.     

Who has Housing Affordability Problems? Disparities in Housing Cost Burden by Race, Nativity, and Legal Status in Los Angeles

Housing costs are a substantial component of US household expenditures. Those who allocate a large proportion of their income to housing often have to make difficult financial decisions with significant short-term and long-term implications for adults and children. This study employs cross-sectional data from the first wave of the Los Angeles Family and Neighborhood Survey collected between 2000 and 2002 to examine the most common US standard of housing affordability, the likelihood of spending 30 % or more of income on shelter costs. Multivariate analyses of a low-income sample of US-born Latinos, whites, African Americans, authorized Latino immigrants, and unauthorized Latino immigrants focus on baseline and persistent differences in the likelihood of being cost burdened by race, nativity, and legal status. Nearly half or more of each group of low-income respondents experience housing affordability problems. The results suggest that immigrants’ legal status is the primary source of disparities among those examined, with the multivariate analyses revealing large and persistent disparities for unauthorized Latino immigrants relative to most other groups. Moreover, the higher odds of housing cost burden observed for unauthorized immigrants compared with their authorized immigrant counterparts remains substantial, accounting for traditional indicators of immigrant assimilation. These results are consistent with emerging scholarship regarding the role of legal status in shaping immigrant outcomes in the United States.     

Immigration and Economic Conditions Among Older Asian Americans

This study compares native-immigrant gaps in economic conditions among older Asian Americans to those in other racial groups. This study uses the American Community Survey data collected from 2006 to 2010. The sample consists of Asians, whites, blacks, and Hispanics, who are 65 years old or older (N = 2,205,148). The dependent variables are per capita income, poverty, asset income, homeownership, and vehicle ownership. This study employs linear and logit regressions. Analysis results show that older native Asian Americans’ economic statuses are comparable to or better than older native whites. Older immigrant Asian Americans’ economic situations are worse off than older immigrant whites but better off than their black and Hispanic counterparts. Regression analyses indicate that native-immigrant gaps among older Asian Americans are significantly larger than those among other racial groups. These findings suggest that the public perception of economically successful immigrant Asians is not consistent with the economic reality of older immigrant Asian Americans. Analysis results call for further research on native-immigrant gaps among older Asian Americans and policy interventions to enhance economic security among older minority groups, including older immigrant Asian Americans.     

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.     

An Ecological Approach to Racial Environments and Their Relationship to Mental Health

Although research has demonstrated that aspects of racial environments such as racial experiences and racial diversity can relate to psychological health and well-being, few studies have examined what specifically happens when individuals move from one racial environment to another. The present study asked 179 African Americans transitioning to a predominantly white institution (freshmen or junior transfers) about racial diversity (percentage of African Americans) at their prior institution, racial experiences at their prior institution, and racial experiences at the current institution and examined how these characteristics related to self-reported depression. Overall, we found that more negative previous racial experiences predicted greater depressive symptoms in college. Results also revealed a significant three-way interaction such that more positive current racial experiences predicted less depressive symptoms, but only for those students coming from predominantly negative racial environments—low racial diversity and more negative racial experiences. Our findings highlight the complex role of past and present racial environmental factors in influencing psychological health. Implications for African American college students’ success and well-being are discussed.     

Nativity and citizenship status affect Latinos’ health insurance coverage under the ACA

ABSTRACT

The 2010 Patient Protection and Affordable Care Act (ACA) aimed to increase health insurance access for the over 47 million uninsured people in the U.S.A., among whom ethnoracial minorities had the highest uninsured rates before the ACA. Studies have shown that Latinos have had the greatest improvements in health coverage under the ACA, but many may be at a significant disadvantage, specifically due to their nativity and immigration status, as the ACA explicitly excludes unauthorised immigrants from most of its provisions. Using the 2015 Latino National Health and Immigration Survey, a nationally representative sample of Latinos (n?=?1493), we find that variation in health insurance access among Latinos can be traced to immigration status. This study finds no differences among U.S.-born versus foreign-born Latinos in the likelihood of being uninsured in 2015. However, among foreign-born Latinos, unauthorised immigrants are five times more likely than naturalised citizens to be uninsured and less likely to visit a primary care provider or clinic, even after controlling for other factors including language, income and education.     

Understanding Racial and Ethnic Disparities in Arrest: The Role of Individual,Home, School,and Community Characteristics

Contact with the justice system can lead to a range of poor health and social outcomes. While persons of color are disproportionately represented in both the juvenile and criminal justice systems, reasons for these patters remain unclear. This study sought to examine the extent and sources of differences in arrests during adolescence and young adulthood among blacks, whites, and Hispanics in the USA. Multilevel cross-sectional logistic regression analyses were conducted using data from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 12,752 respondents). Results showed significantly higher likelihood of having ever been arrested among blacks, when compared to whites, even after controlling for a range of delinquent behaviors (odds ratio = 1.58, 95 % confidence interval = 1.27, 1.95). These black–white disparities were no longer present after accounting for racial composition of the neighborhood, supporting the growing body of research demonstrating the importance of contextual variables in driving disproportionate minority contact with the justice system.     

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 Imagery and Support for Voter ID Laws

Previous research suggests that calls for voter ID laws include racialized appeals and that racial attitudes influence support for such laws. This study uses an experiment to test whether exposure to racial imagery also affects support for voter ID laws. The data come from a survey experiment embedded in the 2012 Cooperative Congressional Election Study (N = 1,436) randomizing the race of a voter and poll worker shown to respondents (African American voter and poll worker, white voter and poll worker, or no image). The results show that white respondents who saw an image of an African American voter and poll worker expressed greater support for voter ID laws than those in the no image condition, even after controlling for the significant effects of racial resentment and political ideology. Exposure to an image of a white voter and poll worker did not produce a similar effect. The findings provide new evidence that public opinion about voter ID laws is racialized.