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1.  The Relationship between Obesity and Psychiatric Disorders across Ethnic and Racial Minority Groups in the United States 
Eating behaviors  2010;12(1):1-8.
Epidemiologic studies of obesity have not examined the prevalence and relationship of mental-health conditions with obesity for diverse ethnic and racial populations in the United States.
(1) To assess whether obesity was associated with diverse psychiatric diagnoses across a representative sample of non-Latino whites, Latinos, Asians, African-Americans, and Afro-Caribbeans; and (2) to test whether physical health status, smoking, sociodemographic characteristics, and psychiatric comorbidities mediate any of the observed associations.
Our analyses used pooled data from the NIMH Collaborative Psychiatric Epidemiology Surveys (CPES). Analyses tested the association between obesity and psychiatric disorders in a diverse sample of Americans (N=13,837), while adjusting for factors such as other disorders, age, gender, socioeconomic status, smoking and physical health status (as measured by chronic conditions and WHO-DAS scores) in different models.
The relationship between obesity and last-year psychiatric disorders varied by ethnicity/race. The likelihood of having mood or anxiety disorder was positively associated with obesity for certain racial/ethnic groups, but was moderated by differences in physical health status. Substance-use disorders were associated with decreased odds for obesity in African-Americans.
The role of physical health status (as measured by chronic conditions and WHO-DAS scores) dramatically changes the pattern of associations between obesity and psychiatric disorders, suggesting the important role it plays in explaining differential patterns of association across racial and ethnic groups.
PMCID: PMC3052947  PMID: 21184966
obesity; depression; anxiety; ethnic/racial minority groups
2.  Psychiatric Disorders and Labor Market Outcomes: Evidence from the National Latino and Asian American Study 
Health economics  2007;16(10):1069-1090.
This paper investigates to what extent psychiatric disorders and mental distress affect labor market outcomes in two rapidly growing populations that have not been studied to date – ethnic minorities of Latino and Asian descent, most of whom are immigrants. Using data from the National Latino and Asian American Study (NLAAS), we examine the labor market effects of having any psychiatric disorder in the past 12 months as well as the effects of experiencing psychiatric distress in the past 12 months. The labor market outcomes analyzed are current employment status, the number of weeks worked in the past year among those who are employed, and having at least one work absence in the past month among those who are employed. Our results show that among Latinos, psychiatric disorders and mental distress are associated with large, detrimental effects on employment and absenteeism, similar to effects found in analyses of mostly white, American born populations. Among Asians, we find more mixed evidence that psychiatric disorders and mental distress detract from labor market outcomes.
PMCID: PMC2675701  PMID: 17294497
mental illness; psychiatric disorders; mental distress; labor market outcomes; ethnicity; Latino and Asian Americans
3.  Comparative Prevalence, Correlates of Impairment, and Service Utilization for Eating Disorders across U.S. Ethnic Groups: Implications for Reducing Ethnic Disparities in Health Care Access for Eating Disorders 
The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the U.S. to non-Latino Whites.
Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES; [1]) were used.
The prevalence of anorexia nervosa (AN) and binge-eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non-Latino whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of ABE was greater among each of the ethnic minority groups in comparison to non-Latino Whites. Mental health service utilization was lower among ethnic minority groups studied than for non-Latino whites for respondents with a lifetime history of any eating disorder.
These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the U.S.
PMCID: PMC3011052  PMID: 20665700
Anorexia Nervosa; Bulimia Nervosa; Binge-eating disorder; Ethnicity
4.  Retention in Depression Treatment among Ethnic and Racial Minority Groups in the United States 
Depression and anxiety  2010;27(5):485-494.
Premature discontinuation of psychiatric treatment among ethnic-racial minorities is a persistent concern. Prior research on identifying factors associated with ethnic-racial disparities in depression treatment has been limited by the scarcity of national samples with adequate representation of minority groups and especially non-English speakers. In this article we aim to identify variations in the likelihood of retention in depression treatment among ethnic-racial minority groups in the US as compared to non-Latino whites. Secondly, we aim to identify factors which are related to treatment retention.
We use data from the Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences and correlates of depression treatment retention among a representative sample (n=564) of non-Latino whites, Latinos, African American and Asian respondents with last 12 month depressive disorder and who report receiving formal mental health treatment in the last year. We define retention as attending at least four visits or remaining in treatment over a 12 month period.
Being seen by a mental health specialist as opposed to being seen by a generalist and having received medication are correlates of treatment retention for the entire sample. However, after adjusting for demographics, clinical factors including number of co-occurring psychiatric disorders and level of disability, African Americans are significantly less likely to be retained in depression treatment as compared to non-Latino whites.
Availability of specialized mental health services or comparable treatment within primary care could improve treatment retention. Low retention suggests persistent problems in the delivery of depression treatment for African Americans.
PMCID: PMC2927223  PMID: 20336808
Depression; Retention in Care; Ethnic-Racial Minorities
5.  Childhood Trauma and Psychiatric Disorders as Correlates of School Dropout in a National Sample of Young Adults 
Child development  2011;82(3):982-998.
The effect of childhood trauma, psychiatric diagnoses, and mental health services on school dropout among U.S. born and immigrant youth is examined using data from the Collaborative Psychiatric Epidemiology Surveys (CPES), a nationally representative probability sample of African Americans, Afro-Caribbeans, Asians, Latinos, and non-Latino Whites, including 2532 young adults, ages 21 to 29. The dropout prevalence rate was 16% overall, with variation by childhood trauma, childhood psychiatric diagnosis, race/ethnicity, and nativity. Childhood substance and conduct disorders mediated the relationship between trauma and school dropout. Likelihood of dropout was decreased for Asians, and increased for African Americans and Latinos, compared to non-Latino Whites as a function of psychiatric disorders and trauma. Timing of U.S. immigration during adolescence increased risk of dropout.
PMCID: PMC3089672  PMID: 21410919
6.  Prevalence, Patterns, and Correlates of Co-Occurring Substance Use and Mental Disorders in the US: Variations by Race/Ethnicity 
Comprehensive Psychiatry  2011;53(6):657-665.
This study examines racial/ethnic differences in the prevalence, patterns, and correlates of co-occurring substance use and mental disorders (COD) among Whites, Blacks, Latinos, and Asians using data from the Collaborative Psychiatric Epidemiology Studies.
We first estimated the prevalence of various combinations of different co-occurring depressive and anxiety disorders among respondents with alcohol, drug, and any substance use (alcohol or drug) disorders in each racial/ethnic group. We then estimated the prevalence of different patterns of onset and different psychosocial correlates among individuals with COD of different racial/ethnic groups. We used weighted linear and logistic regression analysis controlling for key demographics to test the effect of race/ethnicity. Tests of differences between specific racial/ethnic subgroups were only conducted if the overall test of race was significant.
Rates of COD varied significantly by race/ethnicity. Approximately 8.2% of Whites, 5.4% of Blacks, 5.8% of Latinos, 2.1% of Asians met criteria for lifetime COD. Whites were more likely than persons in each of the other groups to have lifetime COD. Irrespective of race/ethnicity, the majority of those with COD reported that symptoms of mental disorders occurred before symptoms of substance use disorders. Only rates of unemployment and history of psychiatric hospitalization among individuals with COD were found to vary significantly by racial/ethnic group.
Our findings underscore the need to further examine the factors underlying differences between minority and non-minority individuals with COD as well as how these differences might affect help seeking and utilization of substance abuse and mental health services.
PMCID: PMC3327759  PMID: 22152496
Substance abuse; mental disorders; co-occurring disorders; comorbidity; dual diagnosis; minorities; health disparities; CPES
7.  Prevalence of Psychiatric Illnesses among Ethnic Minority Elderly 
To compare lifetime and 12-month prevalence of DSM-IV psychiatric disorders among a national representative sample of older Latinos, Asians, African-Americans, and Afro-Caribbean to non-Latino Whites.
Cross-sectional study conducted in 2001 through 2004.
Urban and rural households in the contiguous United States.
A total of 4,245 community-dwelling residents aged 50 and older living in non-institutional settings. Data are from the NIMH Collaborative Psychiatric Epidemiology Surveys.
The World Health Organization Composite International Diagnostic Interview assessed lifetime and 12-month psychiatric disorders. Interviewers matched the cultural background and language preference of participants. Bayesian estimates compared psychiatric disorder prevalence rates among ethnic/racial groups.
After gender adjustments, older non-Latino Whites had higher lifetime rates of any depressive disorder than African-Americans but were no different than older Latinos. Older Asians and Afro-Caribbean had significantly lower lifetime rates of any depressive, anxiety, and substance use disorders than non-Latino Whites. Immigrant Asians had higher lifetime rates of GAD than the U.S.-born Asians and immigrant Latinos had higher lifetime rates of dysthymia and GAD than U. S.-born Latinos. U.S. born Latinos had higher lifetime rates of substance abuse, especially alcohol abuse, than immigrant Latinos. There were no significant differences in the rates of 12-month psychiatric disorders between non-Latino whites and ethnic/racial minorities, except that older African-Americans had higher 12-month rates of any substance use disorder compared to non-Latino Whites.
Prevalence rates vary considerably by ethnicity and race as well as by nativity for older minorities, suggesting different patterns of illness and risk.
PMCID: PMC2854540  PMID: 20374401
ethnicity; prevalence; psychiatric illness; older adults
8.  Depression Care in the United States 
Archives of general psychiatry  2010;67(1):37-46.
To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States.
Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care.
The 48 coterminous United States.
Household residents 18 years and older (N=15 762) participated in the study.
Main Outcome Measures:
Past-year depression pharmacotherapy and psychotherapy using American Psychiatric Association guideline-concordant therapies. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode.
Mexican American and African American individuals meeting 12-month major depression criteria consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies despite depression severity ratings not significantly differing between ethnic/racial groups. All groups reported higher use of any past-year psychotherapy and guideline-concordant psychotherapy compared with pharmacotherapy; however, Caribbean black and African American individuals reported the highest proportions of this use.
Few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report underscores the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States.
PMCID: PMC2887749  PMID: 20048221
9.  Role of Referrals in Mental Health Service Disparities for Racial and Ethnic Minority Youth 
To investigate racial/ethnic differences in teachers’ and other adults’ identification and/or encouragement of parents to seek treatment for psychiatric problems in their children and to evaluate if and whether identification/encouragement is associated with service use.
Data on identification/encouragement to seek treatment for externalizing disorders (i.e., attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and/or conduct disorder) and internalizing disorders (i.e., major depressive episode/dysthymia and/or separation anxiety disorder) and services used were obtained for 6,112 adolescents (13–17 years of age) in the National Comorbidity Survey Adolescent Supplement. Racial/ethnic differences were examined for Latinos, non-Latino blacks, and non-Latino whites.
There were few racial/ethnic differences in rates of youth identification/encouragement and how identification/encouragement related to service use. Only non-Latino black youth with low severity internalizing disorders were less likely to be identified/encouraged to seek services compared with non-Latino white youth with the same characteristics (odds ratio [OR] = 0.4, 95% confidence interval [CI] = [0.2–0.7]). Identification/encouragement increased the likelihood of seeking services for externalizing and internalizing disorders for all youth. However, compared with their non-Latino white counterparts, non-Latino black youth who met criteria for internalizing disorders appeared less likely to have used any services (OR = 0.4, 95%, CI = 0.2–;0.7), after adjusting for identification/encouragement, clinical, and sociodemographic characteristics. Non-Latino black youth with internalizing disorders and without identification/encouragement were less likely to use the specialty care sector than their non-Latino white counterparts.
In this study of a nationally representative sample of adolescents, almost no ethnic/racial differences in identification/encouragement were found. However, identification/encouragement may increase service use for all youth.
PMCID: PMC3652396  PMID: 22721593
referral; disparities; ethnic; minority; services
10.  Valuing health in a racially and ethnically diverse community sample: an analysis using the valuation metrics of money and time 
Limited research in health valuation analyzes samples with high proportions of racial/ethnic minorities within the United States. The primary objective was to explore patterns of health valuation across race/ethnicity using the Collaborative Psychiatric Epidemiology Surveys. A secondary objective was to analyze whether mental health disorder and immigrant status were associated with these estimates.
Health valuation questions using different metrics (time and money) were analyzed. Ordered logit models stratified across poor and moderate health tested differences by race/ethnicity, with mental health disorder and immigrant status as covariates.
Asians in moderate health and Latinos were willing to pay more for health than non-Latino whites. Asians in moderate health were willing to trade more time for health. Latinos in poor health were less willing to trade time and gave disproportionate zero-trade responses. Lifetime history of anxiety disorder was positively associated with both metrics. Immigrant status confounded money valuation for Asians in moderate health, and time valuation for Latinos in poor health.
Health valuation estimates vary across race/ethnicity depending upon the metric. Time valuation scenarios appear less feasible for Latinos in poor health. More research is necessary to understand these differences and the role of immigrant status in health valuation.
PMCID: PMC3596787  PMID: 20680690
Health valuation; Utilities; Racial/ethnic minorities; Mental health
11.  Neighborhood Context and Substance Use Disorders: A Comparative Analysis of Racial and Ethnic Groups in the United States 
Drug and alcohol dependence  2012;125(Suppl 1):S35-S43.
There is evidence that ethnic/racial minorities are conferred differential risk for substance use problems based on where they live. Despite a burgeoning of research focusing on the role of neighborhood characteristics on health, limited findings are available on substance use. Our study uses nationally representative data (N= 13, 837) to examine: (1) What neighborhood characteristics are associated with risk of substance use disorders?; (2) Do the associations between neighborhood characteristics and substance use disorders remain after adjusting for individual-level factors?; and (3) Do neighborhood characteristics associated with substance use disorders differ by race/ethnicity after adjusting for individual-level factors?
Data were drawn from the Collaborative Psychiatric Epidemiology Studies (CPES-Geocode file) with 836 Census tracts. Analyses included African Americans, Asians, Caribbean Blacks, Latinos, and non-Latino whites. Separate logistic regression models were fitted for any past-year substance use disorder, alcohol use disorder, and drug use disorder.
Living in more affluent and residentially unstable census tracts was associated with decreased risk of past-year substance use disorder, even after adjusting for individual-level factors. However, when we investigated the interaction of race/ethnicity and census latent factors with past-year substance use disorders, we found different associations for the different racial/ethnic groups. We also found different associations between neighborhood affluence, residential instability and any past-year substance use and alcohol disorders by nativity.
Characteristics of the environment might represent differential risk for substance disorders depending on a person’s ethnicity/race and nativity status.
PMCID: PMC3488110  PMID: 22699095
neighborhood context; substance use disorders; alcohol; drugs; racial/ethnic minorities; nativity
12.  Racial/Ethnic Differences in Internalizing and Externalizing Symptoms in Adolescents 
The prevalence of most adult psychiatric disorders varies across racial/ethnic groups and has important implications for prevention and intervention efforts. Research on racial/ethnic differences in the prevalence of internalizing and externalizing symptoms and disorders in adolescents has been less consistent or generally lacking. The current study examined the prevalence of these symptom groups in a large sample of sixth, seventh, and eighth graders in which the three major racial/ethnic groups in the U.S. (White, Black, and Hispanic/Latino) were well-represented. Hispanic females reported experiencing higher levels of depression, anxiety, and reputational aggression than other groups. Black males reported the highest levels of overtly aggressive behavior and also reported higher levels of physiologic anxiety and disordered eating than males from other racial/ethnic groups. Hispanic females also exhibited higher levels of comorbidity than other racial/ethnic groups.
PMCID: PMC2881593  PMID: 17508278
Racial/ethnic differences; Adolescence; Anxiety; Depression; Eating pathology; Aggression
13.  Prevalence of Lifetime DSM-IV Affective Disorders among Older African Americans, Black Caribbeans, Latinos, Asians and Non-Hispanic Whites 
The purpose of this study is to estimate lifetime prevalence of 7 psychiatric affective disorders for older non-Hispanic Whites, African Americans, Caribbean Blacks, Latinos and Asian Americans and examine demographic, socioeconomic, and immigration correlates of those disorders.
Data are taken from the older sub-sample of the Collaborative Psychiatric Epidemiology Surveys. Selected measures of lifetime DSM-IV psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder, major depressive disorder, and dysthymia).
Community epidemiologic survey.
Nationally representative sample of adults aged 55 and older (n=3,046).
Disorders were assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI).
Major depressive disorder and social phobia were the two most prevalent disorders among the 7 psychiatric conditions. Overall, non-Hispanic Whites and Latinos consistently had higher prevalence rates of disorders, African Americans had lower prevalence of major depression and dysthymia, and Asian Americans were typically less likely to report affective disorders than their counterparts. There is variation across groups in the association of demographic, socioeconomic, and immigration variables with disorders.
This study furthers our understanding of the racial and ethnic differences in the prevalence of DSM-IV disorders among older adults and the correlates of those disorders. It highlights the importance of examining both between-and within-group differences in disorders and the complexity of the mechanisms associated with differences across groups. Findings from this study underscores the need for future research that more clearly delineates subgroup differences and similarities.
PMCID: PMC3391316  PMID: 21987438
Depression; anxiety; elderly; race; ethnicity
Depression and anxiety  2009;26(7):674-681.
Antidepressant drugs are among the most widely prescribed drugs in the United States; however, little is known about their use among major ethnic minority groups.
Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of Latino and non-Latino White adults antidepressant use.
The 48 coterminous United States was the setting.
Household residents aged 18 years and older (N=9,250).
Main outcome:
Past year antidepressant use.
Compared to non-Latino Whites, few Latinos, primarily Mexican Americans, with 12-month depressive and/or anxiety disorders reported past year antidepressant use. Mexican Americans (OR=0.48; 95%CI=0.30–0.77) had significantly lower odds of use compared to non-Latino Whites, which were largely unaffected by factors associated with access to care. Over half of antidepressant use was by respondents not meeting 12-month criteria for depressive or anxiety disorders. Lifetime depressive and anxiety disorders explained another 21% of past year antidepressant use, leaving another 31% of drug use unexplained.
We found a disparity in antidepressant use for Mexican Americans compared to non-Latino Whites that was not accounted for by differences in need and factors associated with access to care. About one third of antidepressant use was by respondents not meeting criteria for depressive or anxiety disorders. Our findings underscore the importance of disaggregating Latino ethnic groups. Additional work is needed to understand the medical and economic value of antidepressant use beyond their primary clinical targets.
PMCID: PMC2882071  PMID: 19306305
Latinos; Hispanics; Cubans; Mexicans; Puerto Ricans; major depressive disorder; depression; anxiety disorders; antidepressive agents
15.  The Effects of Race, Ethnicity, and Mood/Anxiety Disorders on the Chronic Physical Health Conditions of Men From a National Sample 
American journal of men's health  2013;7(4 0):58S-67S.
Racial/ethnic differences in health are evident among men. Previous work suggests associations between mental and physical health but few studies have examined how mood/anxiety disorders and chronic physical health conditions covary by age, race, and ethnicity among men. Using data from 1,277 African American, 629 Caribbean Black, and 371 non-Hispanic White men from the National Survey of American Life, we examined associations between race/ethnicity and experiencing one or more chronic physical health conditions in logistic regression models stratified by age and 12-month mood/anxiety disorder status. Among men <45 years without mood/anxiety disorders, Caribbean Blacks had lower odds of chronic physical health conditions than Whites. Among men aged 45+ years with mood/anxiety disorders, African Americans had greater odds of chronic physical health conditions than Whites. Future studies should explore the underlying causes of such variation and how studying mental and chronic physical health problems together may help identify mechanisms that underlie racial disparities in life expectancy among men.
PMCID: PMC3895415  PMID: 23609347
race; ethnicity; comorbidities; mental health; chronic physical health conditions
16.  Assessing Racial/Ethnic Differences in the Social Consequences of Early-Onset Psychiatric Disorder 
Individuals with early onset of psychiatric disorder have worse social outcomes than individuals with adult onset. It is unknown whether this association varies by racial/ethnic group. Identifying groups at risk for poor social outcomes is important for improving clinical and policy interventions. We compared unemployment, high school dropout, arrest, and welfare participation by race/ethnicity and time of onset using a nationally representative sample of Whites, Blacks, Asians, and Latinos with lifetime psychiatric disorder. Early onset was associated with worse social outcomes than adult onset. Significant Black-White and Latino-White differences in social outcomes were identified. The association between early onset and negative social outcomes was similar across Whites, Latinos, and Blacks. For Asians, the association between unemployment and early onset was opposite that of Whites. Increasing early detection and treatment of psychiatric illness should be prioritized. Further study will clarify the association between onset and social outcomes among sub-ethnic populations.
PMCID: PMC2874983  PMID: 20453376
Social determinants; mental health; racial/ethnic disparities; children’s mental health
17.  Use of complementary and alternative medicines for mental and substance use disorders: A comparison of African Americans, black Caribbeans, and non-Hispanic whites 
This study examined racial and ethnic differences in the use of complementary and alternative medicine (CAM) for the treatment of mental and substance use disorders.
This study used data from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R). The analytic sample included 631 African Americans and 245 black Caribbeans from the NSAL and 1,393 non-Hispanic whites from the NCS-R who met criteria for a mood, anxiety, or substance disorder in the past 12 months. Logistic regression was used to examine racial and ethnic differences in the use of any CAM as well as the use of CAM only compared to CAM use with services in another treatment sector.
Thirty-five percent of respondents used some form of CAM. Whites were more likely than blacks to use any CAM although there was no racial or ethnic difference in CAM use only vs. CAM use with traditional services. A higher proportion of blacks used prayer and other spiritual practices compared to whites. Among those with a mood disorder, black Caribbeans were less likely to use any CAM than African Americans.
Patterns of CAM use for treatment of mental disorders are similar to those found in relation to physical illness. The use of prayer is a major factor in racial differences in CAM use, however there are differences among black Americans that warrant further research.
PMCID: PMC3058881  PMID: 19797374
18.  The Prevalence, Comorbidity, and Age of Onset of Social Anxiety Disorder among U.S. Latinos 
The Journal of clinical psychiatry  2011;72(8):1096-1105.
Social Anxiety Disorder (SAD) is increasingly being recognized as a prevalent, unremitting, and highly comorbid disorder1 yet studies focusing on this disorder among U.S. Latinos and immigrant populations are not available. This article evaluates ethnic differences in the prevalence, comorbidity, and age of onset of SAD. Cultural and contextual factors associated with risk of SAD are also examined within the Latino population.
Data are analyzed using the National Latino and Asian American Study (NLAAS) and the National Comorbidity Survey-Replication (NCS-R). Both studies utilized the World Mental Health – Composite International Diagnostic Interview, which estimates the prevalence of lifetime and 12-month psychiatric disorders according to DSM-IV criteria.
Latinos (LAT) reported lower lifetime and 12-month SAD prevalence and a later age of onset than U.S.-born non-Latino Whites (NLW). On the other hand, LAT diagnosed with 12-month SAD reported higher impairment across home, work, and relationship domains than their NLW counterparts. Overall, high SAD comorbidity was found with depressive, anxiety, and substance-related disorders among both ethnic groups. However, relative to NLW, LAT who entered the U.S. after the age of 21 were less likely to have lifetime SAD comorbidity with drug abuse and dependence and more likely to report lifetime SAD comorbidity with agoraphobia.
Varied trajectories of SAD risk are present across ethnicity and nativity groups. Clinicians must consider how culture and ethnicity shape these different presentations and determine treatment options accordingly. Outreach efforts are needed to reach immigrant Latinos, and those with comorbid SAD and Agoraphobia in particular.
PMCID: PMC3597970  PMID: 21899817
Social Anxiety Disorder; Latinos; Immigrants; Comorbidity; Age of Onset; Impairment
19.  Service Utilization Differences for Axis-I Psychiatric and Substance Use Disorders Between White and Black Adults 
Although studies have shown disparities between black and white populations in service utilization for mental disorders, little information exists on whether such disparities apply equally across disorders. The objective of this study was to examine racial differences in lifetime prevalence of service utilization for mood and anxiety disorders and for alcohol and drug use disorders, with controls for predisposing, enabling, and need-for-service variables unequally distributed between racial-ethnic groups.
Data were from a face-to-face epidemiologic survey of 32,752 non-Hispanic white or black adults ages 18 and older residing in households and group quarters in the United States. Main outcome measures were treatment for mood, anxiety, and alcohol and drug use disorders.
White adults were consistently more likely than black adults to have had treatment for mood disorders (odds ratio [OR]=2.16, 95% confidence interval [CI]=1.80–2.59) and anxiety disorders (OR=1.77, 95% CI=1.43–2.19) after adjustment for predisposing and enabling factors and need for service (severity of disorder). In contrast no evidence of lower service utilization for treatment of alcohol use disorders emerged among black respondents (OR=.87, 95% CI .69–1.10). Moreover, white respondents with drug use disorders were significantly less likely than black respondents to receive treatment for a drug problem (OR=.64, 95% CI=.47–.88).
Differences in treatment between black and white adults depended on the specific disorder and type of treatment considered. Prevention and intervention strategies should address disorder-specific disparities in services received.
PMCID: PMC2729457  PMID: 18678687
20.  Considering Context, Place, and Culture: The National Latino and Asian American Study 
This paper provides a rationale and overview of procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization of Latinos and Asian Americans in the United States. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication; NCS-R) and African Americans (from the National Survey of American Life; NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research.
PMCID: PMC2774128  PMID: 15719529
culture; Latinos; Asian Americans; context; research design; acculturation; National Latino and Asian American Study; psychiatric epidemiology; NLAAS; service use; ethnicity; mental disorders; Bayesian analysis
21.  Disparity in Depression Treatment among Racial and Ethnic Minority Populations in the United States 
Prior work on racial/ethnic disparities in depression treatment has been limited by the scarcity of national samples that include an array of diagnostic and quality indicators and substantial non-English speaking minorities. Using nationally representative data (n=8762), we evaluate differences in access to and quality of depression treatments between ethnic/racial minority patients and non-Latino whites.
Access to mental health care was assessed by whether or not any mental health treatment was received in the past year. Quality treatment for acute depression was defined as four or more specialty/general health provider visits in the past year plus antidepressant use for 30 days or more; or eight or more specialty mental health provider visits of at least 30 minutes in length, with no antidepressant use.
For those with last year depressive disorder, 63.7% of Latinos, 68.7% of Asians and 58.8% of African Americans, vs. 40.2% of non-Latino whites, did not access any last year mental health treatment (significantly different at p<0.001). We also found that the disparities in the likelihood of both having access and receiving quality care for depression are significantly different for all minority groups as contrasted to non-Latino whites, except Latinos (marginally significant).
Simply relying on present healthcare systems without considering the unique barriers to quality care that apply for ethnic and racial minorities is unlikely to affect the pattern of disparities observed. Populations reluctant to come to the clinic for depression care may have correctly anticipated the limited quality available in usual care.
PMCID: PMC2668139  PMID: 18971402
22.  Racial/Ethnic Differences in the Association Between Obesity and Major Depressive Disorder: Findings from the Comprehensive Psychiatric Epidemiology Surveys 
Public Health Reports  2010;125(5):698-708.
This study examined whether the association between obesity and 12-month prevalence of major depressive disorder (MDD) varied according to racial/ethnic status and nativity in representative national samples of black, Latino, Asian, and non-Hispanic white people.
We used data from the Comprehensive Psychiatric Epidemiology Surveys.
In analyses by gender, obesity was associated with an elevated risk of MDD among non-Hispanic white women (adjusted odds ratio [AOR] =1.73; 95% confidence interval [CI] 1.27, 2.35; p=0.001). Formal test for interaction revealed significant variation by race present between non-Hispanic white women and black, Latin, and Asian women. No significant differences were evident among men. In analyses by nativity, the association between obesity and MDD was significant among U.S.-born non-Hispanic white women (AOR=1.62; 95% CI 1.16, 2.27; p=0.001) and U.S.-born black women (AOR=1.29; 95% CI 1.01, 1.66; p=0.041). Significant interactions were present among U.S.-born white and black women, Latin women, and Asian women. No significant interactions were evident among foreign-born women. Similarly, no significant differences were present among native-born or foreign-born men.
The findings suggest that the association between obesity and MDD varies according to racial/ethnic status and nativity. Understanding the link between obesity and depression may be imperative to designing interventions to address body weight maintenance and reduction strategies among women.
PMCID: PMC2925006  PMID: 20873286
23.  Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups 
Annals of internal medicine  2006;145(10):727-738.
Caring for a family member with dementia is extremely stressful, contributes to psychiatric and physical illness among caregivers, and increases the risk for caregiver death. Finding better ways to support family caregivers is a major public health challenge.
To test the effects of a structured multicomponent intervention on quality of life and clinical depression in caregivers and on rates of institutional placement of care recipients in 3 diverse racial or ethnic groups.
Randomized, controlled trial.
In-home caregivers in 5 U.S. cities.
212 Hispanic or Latino, 219 white or Caucasian, and 211 black or African-American caregivers and their care recipients with Alzheimer disease or related disorders.
Caregivers within each racial or ethnic group were randomly assigned to an intervention or to a control group. The intervention addressed caregiver depression, burden, self-care, and social support and care recipient problem behaviors through 12 in-home and telephone sessions over 6 months. Caregivers in the control group received 2 brief “check-in” telephone calls during the 6-month intervention.
The primary outcome was a quality-of-life indicator comprising measures of 6-month caregiver depression, burden, self-care, and social support and care recipient problem behaviors. Secondary outcomes were caregiver clinical depression and institutional placement of the care recipient at 6 months.
Hispanic or Latino and white or Caucasian caregivers in the intervention group experienced significantly greater improvement in quality of life than those in the control group (P < 0.001 and P = 0.037, respectively). Black or African-American spouse caregivers also improved significantly more (P = 0.003). Prevalence of clinical depression was lower among caregivers in the intervention group (12.6% vs. 22.7%; P = 0.001). There were no statistically significant differences in institutionalization at 6 months.
The study used only a single 6-month follow-up assessment, combined heterogeneous cultures and ethnicities into a single group, and excluded some ethnic groups.
A structured multicomponent intervention adapted to individual risk profiles can increase the quality of life of ethnically diverse dementia caregivers.
PMCID: PMC2585490  PMID: 17116917
24.  Disparities in treatment for substance use disorders and co-occurring disorders for ethnic/racial minority youth 
To review the literature on racial and ethnic disparities in behavioral health services and present recent data, focusing on services for substance use disorders (SUD) and comorbid mental health disorders for children and adolescents.
A literature review was conducted of behavioral health services for minority youth. Papers were included if specific comparisons in receipt of SUD services for youth were made by race or ethnicity. The review was organized following the Sociocultural Framework.
Compared to non-Latino Whites with SUD, Black adolescents with SUD report receiving less specialty and informal care, while Latinos with SUD report less informal services. Potential mechanisms of racial and ethnic disparities were identified in: federal and economic health care policies and regulations; the operation of the health care system and provider organization; provider level factors; the environmental context; the operation of the community system; and patient level factors. Significant disparities reductions could be achieved by adoption of certain state policies and regulations that increase eligibility in public insurance. There is also a need to study how the organization of treatment services might lead to service disparities, particularly problems in treatment completion. Institutional and family characteristics linked to better quality of care should be explored. Since treatments appear to work well independent of race/ethnicity, translational research to bring evidence based care in diverse communities can bolster their effectiveness.
Our review suggests promising venues to reduce ethnic and racial disparities in behavioral health services for ethnic and racial minority youth.
PMCID: PMC3488852  PMID: 21156267
disparities; behavioral health services; youth; race; ethnicity
25.  Prevalence and Correlates of Childhood-Onset Anxiety Disorders among Latinos and Non-Latino Whites in the United States 
Psicologia conductual  2009;17(1):89-109.
Anxiety disorders are the most prevalent class of psychiatric disorders (Kessler, et al., 2005) and their early onset places individuals at risk for a wide range of subsequent problems (Weissman, et al., 1999). Data from the National Latino and Asian American Study (NLAAS) and the National Comorbidity Survey-Replication (NCS-R) were used to investigate the prevalence and correlates of childhood-onset anxiety disorders among U.S.-born whites, U.S.-born Latinos, and foreign-born Latinos. Significant differences in rates of childhood-onset anxiety disorders were found, with foreign-born Latinos reporting the lowest rates. Across all three ethnicity/nativity groups, individuals with childhood-onset anxiety disorders had equal or higher levels of past-year impairment, relative to individuals with adult-onset anxiety disorders. The chronic course associated with childhood-onset anxiety disorders was also revealed to be present regardless of ethnicity and nativity, as indicated by the similarities across groups in the mean number of lifetime disorders and comorbidity rates. Treatment and assessment recommendations are discussed with respect to the findings.
PMCID: PMC2800359  PMID: 20046533

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