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1.  Disparity in Depression Treatment among Racial and Ethnic Minority Populations in the United States 
Objective:
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.
Method:
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.
Results:
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).
Conclusion:
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.
doi:10.1176/appi.ps.59.11.1264
PMCID: PMC2668139  PMID: 18971402
2.  Prevalence of physical symptoms and their association with race/ethnicity and acculturation in the United States 
General Hospital Psychiatry  2012;34(4):323-331.
Objective
Physical symptoms are common and a leading reason for primary care visits, however data are lacking on their prevalence among racial/ethnic minorities in the United States. This study aimed to compare the prevalence of physical symptoms among White, Latino, and Asian Americans, and examine the association of symptoms and acculturation.
Methods
We analyzed data from the National Latino and Asian American Study, a nationally-representative survey of 4864 White, Latino, and Asian Americans adults. We compared the age- and gender-adjusted prevalence of fourteen physical symptoms among the racial/ethnic groups and estimated the association between indicators of acculturation (English proficiency, nativity, generational status, and proportion of lifetime in the United States) and symptoms among Latino and Asian Americans.
Results
After adjusting for age and gender, the mean number of symptoms was similar for Whites (1.00) and Latinos (0.95) but significantly lower among Asian-Americans (0.60, p < 0.01 versus Whites). Similar percentages of Whites (15.4%) and Latinos (13.0%) reported 3 or more symptoms, whereas significantly fewer Asian-Americans (7.7%, p<0.05 versus Whites) did. In models adjusted for sociodemographic variables and clinical status (psychological distress, medical conditions, and disability), acculturation was significantly associated with physical symptoms among both Latino and Asian Americans, such that the most acculturated individuals had the most physical symptoms.
Conclusions
The prevalence of physical symptoms differs across racial/ethnic groups, with Asian Americans reporting fewer symptoms than Whites. Consistent with a ‘healthy immigrant’ effect, increased acculturation was strongly associated with greater symptom burden among both Latino and Asian Americans.
doi:10.1016/j.genhosppsych.2012.02.007
PMCID: PMC3383871  PMID: 22460006
Acculturation; Asian Americans; Epidemiology; Hispanic Americans; Signs and Symptoms
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 
Objective
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.
Method
Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES; [1]) were used.
Results
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.
Discussion
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.
doi:10.1002/eat.20787
PMCID: PMC3011052  PMID: 20665700
Anorexia Nervosa; Bulimia Nervosa; Binge-eating disorder; Ethnicity
4.  Racial-Ethnic Disparities in Substance Abuse Treatment: The Role of Criminal History and Socioeconomic Status 
Objective
Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities.
Methods
Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005–2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt.
Results
Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models.
Conclusions
The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion.
doi:10.1176/appi.ps.62.11.1273
PMCID: PMC3665009  PMID: 22211205
5.  Depression Care in the United States 
Archives of general psychiatry  2010;67(1):37-46.
Objective:
To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States.
Design:
Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care.
Setting:
The 48 coterminous United States.
Participants:
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.
Results:
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.
Conclusions:
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.
doi:10.1001/archgenpsychiatry.2009.168
PMCID: PMC2887749  PMID: 20048221
6.  Racial/ethnic differences in the effects of psychiatric disorders on employment 
Atlantic economic journal : AEJ  2009;37(3):243-257.
Prior research on the disability burden of mental disorders has focused on the non-Latino white population, despite the growing size and importance of racial/ethnic minorities in the labor market and in the US population as a whole. This paper is one of the first to test for racial/ethnic differences in the effects of mental disorder on employment outcomes with data from the National Institute of Mental Health (NIMH) Collaborative Psychiatric Epidemiological Studies (CPES). We find that recent psychiatric disorder is associated with a reduction in the likelihood of employment for men of all racial/ethnic groups relative to non Latino whites with the possible exception of Caribbeans. These findings are driven by the effects of anxiety and affective disorders. For females, only affective disorders appear to detract from employment overall. Much larger negative effects are found for Latino women with anxiety disorders.
doi:10.1007/s11293-009-9182-x
PMCID: PMC2773508  PMID: 19898677
racial/ethnic minorities; mental health; psychiatric disorders; labor market outcomes
7.  Defining Racial and Ethnic Disparities in Pain Management 
Background
Substantial pain prevalence is as high as 40% in community populations. There is consistent evidence that racial/ethnic minority individuals are overrepresented among those who experience such pain and whose pain management is inadequate.
Questions/purposes
The objectives of this paper are to (1) define parameters of and summarize evidence pertinent to racial/ethnic minority disparities in pain management, (2) identify factors contributing to observed disparities, and (3) identify strategies to minimize the disparities.
Methods
Scientific literature was selectively reviewed addressing pain epidemiology, differences in pain management of non-Hispanic whites versus racial/ethnic minority groups, and patient and physician factors contributing to such differences.
Results
Racial/ethnic minorities consistently receive less adequate treatment for acute and chronic pain than non-Hispanic whites, even after controlling for age, gender, and pain intensity. Pain intensity underreporting appears to be a major contribution of minority individuals to pain management disparities. The major contribution by physicians to such disparities appears to reflect limited awareness of their own cultural beliefs and stereotypes regarding pain, minority individuals, and use of narcotic analgesics.
Conclusions
Racial/ethnic minority patients with pain need to be empowered to accurately report pain intensity levels, and physicians who treat such patients need to acknowledge their own belief systems regarding pain and develop strategies to overcome unconscious, but potentially harmful, negative stereotyping of minority patients.
doi:10.1007/s11999-011-1770-9
PMCID: PMC3111792  PMID: 21249483
8.  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.
doi:10.1353/hpu.0.0289
PMCID: PMC2874983  PMID: 20453376
Social determinants; mental health; racial/ethnic disparities; children’s mental health
9.  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.
Objective
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.
Method
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.
Results
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.
Conclusions
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.
doi:10.1016/j.comppsych.2011.10.002
PMCID: PMC3327759  PMID: 22152496
Substance abuse; mental disorders; co-occurring disorders; comorbidity; dual diagnosis; minorities; health disparities; CPES
10.  ANTIDEPRESSANT USE IN A NATIONALLY REPRESENTATIVE SAMPLE OF COMMUNITY-DWELLING US LATINOS WITH AND WITHOUT DEPRESSIVE AND ANXIETY DISORDERS 
Depression and anxiety  2009;26(7):674-681.
Background:
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.
Method:
Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of Latino and non-Latino White adults antidepressant use.
Setting:
The 48 coterminous United States was the setting.
Participants:
Household residents aged 18 years and older (N=9,250).
Main outcome:
Past year antidepressant use.
Results:
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.
Discussion:
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.
doi:10.1002/da.20561
PMCID: PMC2882071  PMID: 19306305
Latinos; Hispanics; Cubans; Mexicans; Puerto Ricans; major depressive disorder; depression; anxiety disorders; antidepressive agents
11.  Cultural Beliefs and Mental Health Treatment Preferences of Ethnically Diverse Older Adult Consumers in Primary Care 
Background
Beliefs concerning the causes of mental illness may help explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their Caucasian counterparts. This study applies the Cultural Influences on Mental Health framework to identify the relationship between race/ethnicity and differences in: (1) beliefs on the cause of mental illness; (2) preferences for type of treatment; and (3) provider characteristics.
Method
Analyses were conducted using baseline data collected from participants who completed the Cultural Attitudes toward Healthcare and Mental Illness Questionnaire, developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multi-site randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1257 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos.
Results
African-Americans, Asian-Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared to Non-Latino Whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers.
Conclusions
This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services.
doi:10.1097/JGP.0b013e318227f876
PMCID: PMC3258470  PMID: 21992942
race/ethnicity; health beliefs; older adults
12.  Using the Electronic Medical Record to Examine Racial and Ethnic Differences in Depression Diagnosis and Treatment in a Primary Care Population 
Objective
We assessed racial and ethnic differences in depression diagnosis and treatment in a primary care population.
Methods
A sample of primary care outpatients in 2007 was generated using the electronic medical record (EMR). Patients were considered depressed if their providers billed for depression-related codes; they were considered prescribed antidepressants if any antidepressants were on their medication list. Rates of diagnosis and medication prescription were estimated using a generalized linear model with a Poisson distribution, adjusting for covariates.
Results
In the resulting sample (n=85,790), all minority groups were less likely to be diagnosed with depression as compared to Whites (p<0.05); 11.36% of Whites had a depression diagnosis, as compared to 6.44% of Asian Americans, 7.55% of African Americans, and 10.18% of Latino Americans. Among those with a depression diagnosis (n=11,096), 54.07% of African Americans were prescribed antidepressant medications, as compared to 63.19% Whites (p<0.05); Asian Americans and Latino Americans showed a trend of being less likely to be prescribed antidepressant medications.
Conclusions
Our study illustrates differences in diagnosis and treatment for minority primary care patients, and is innovative in using the EMR to probe these differences. Further research is needed to understand the underlying reasons for these observed differences.
doi:10.4172/2167-1079.1000106
PMCID: PMC3919035  PMID: 24524015
Major Depressive Disorders; Minorities; Electronic Medical Records; Primary Care
13.  Differences in Diffusion of FDA Antidepressant Risk Warnings Across Racial-Ethnic Groups 
Objective: Numerous articles have identified that medical technologies diffuse more rapidly among non-Latino whites compared with other racial-ethnic groups. However, whether health risk warnings also diffuse differentially across racial-ethnic minority groups is uncertain. This study assessed racial-ethnic variation in children’s antidepressant use before and after the 2004 black-box warning concerning risks of antidepressants for youths. Methods: Data consisted of responses for white, black, and Latino youths ages five through 17 from the 2002–2008 Medical Expenditure Panel Survey (N = 44,422). The dependent variable was any antidepressant use in the prior year. Independent variables were race-ethnicity, year, psychological impairment, income, insurance status, region, and parents’ education level. Logistic regression models were used to assess antidepressant use conditional on race-ethnicity, time, interaction between race-ethnicity and time, need, socioeco-nomic status, and Institute of Medicine–concordant estimates of disparities in predicted antidepressant use before and after the warning. Results: The warnings affected antidepressant use differentially for whites, blacks, and Latinos. Usage rates among whites decreased from 3.3 to 2.1 percentage points between prewarning and postwarning, whereas usage rates remained steady among Latinos and increased among blacks. Findings were significant in multiple regression analyses, in which predictions were adjusted for need. Conclusions: The findings indicate that health safety information on antide-pressant usage among children diffused faster among whites than nonwhites, suggesting the need to improve infrastructure for delivering important health messages to racial-ethnic minority populations.
doi:10.1176/appi.ps.201200087
PMCID: PMC3686566  PMID: 23412363
14.  Prevalence of Psychiatric Illnesses among Ethnic Minority Elderly 
OBJECTIVES
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.
DESIGN
Cross-sectional study conducted in 2001 through 2004.
SETTING
Urban and rural households in the contiguous United States.
PARTICIPANTS
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.
METHODS
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.
RESULTS
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.
CONCLUSION
Prevalence rates vary considerably by ethnicity and race as well as by nativity for older minorities, suggesting different patterns of illness and risk.
doi:10.1111/j.1532-5415.2009.02685.x
PMCID: PMC2854540  PMID: 20374401
ethnicity; prevalence; psychiatric illness; older adults
15.  Latino Adolescent Reproductive and Sexual Health Behaviors and Outcomes: Research Informed Guidance for Agency-based Practitioners 
Clinical social work journal  2011;40(2):144-156.
Latinos are the largest and fastest growing minority youth group in the United States. Currently, Latino adolescents experience higher rates of teen pregnancy compared to any other racial or ethnic group and have disproportionately high levels of sexually transmitted infections and HIV. Latino teens are also affected by a number of social problems such as school dropout, poverty, depression and limited access to healthcare, which contributes to disparities in reproductive health outcomes for this population. Relatively few intervention research studies and programs have been dedicated to reducing sexual risk among Latino youth, despite their particular vulnerabilities in experiencing negative reproductive health outcomes. We provide recommendations for identifying the unique reproductive health needs of Latino youth and specific applied strategies so that agency-based social workers and other providers can develop family-based interventions that improve adolescent Latino sexual and reproductive health.
doi:10.1007/s10615-011-0355-0
PMCID: PMC3532516  PMID: 23279981
Latino; adolescent; sexual and reproductive health; agency-based providers
16.  Examining the Role of Race and Ethnicity in Relapse Rates of Major Depressive Disorder 
Comprehensive psychiatry  2010;52(2):151-155.
Objective
We test the hypothesis that racial or ethnic differences exist in relapse rates to fluoxetine discontinuation in Major Depressive Disorder (MDD).
Method
Data are from a prospective study examining the relapse rates secondary to fluoxetine discontinuation in MDD. Subjects in the discontinuation phase consisted of 255 adults aged 18 to 65, 214 subjects who self-identified as Caucasian, 22 as African American, 13 as Latino American, and six as Asian American.
Results
In both the fluoxetine and placebo groups, no statistically significant differences emerged when comparing time to relapse for minority groups as compared to the Caucasian population. Adjusting for statistically significant predictors of relapse (symptom severity, neurovegetative symptom pattern, gender) and for educational level did not change the outcome of the survival analyses.
Conclusions
Although the size of minority groups in this sample was modest, in a randomized, controlled trial setting, minority and Caucasian patients may have similar rates of relapse in MDD. This finding reinforces the importance of maintenance treatment in relapse for both minority as well as Caucasian patients with MDD. Given the self-selecting nature of clinical trials, future studies are needed to further examine the potential influence of underlying cultural factors on clinical outcomes in minority populations.
doi:10.1016/j.comppsych.2010.05.004
PMCID: PMC3052934  PMID: 21295221
Major Depression; Minority populations; Relapse
17.  Sex, Race/Ethnicity, and Romantic Attractions: Multiple Minority Status Adolescents and Mental Health 
This study examined the association between multiple minority statuses and reports of suicidal thoughts, depression, and self-esteem among adolescents. Data from the National Longitudinal Study of Adolescent Health were used to examine mental health outcomes across racial/ethnic groups for same-sex-attracted youths and female youths. Hispanic/Latino, African American, and White female adolescents reported more suicidal thoughts, higher depression, and lower self-esteem compared with male adolescents in their racial/ethnic group. Same-sex-attracted youths did not consistently demonstrate compromised mental health across racial/ethnic groups. Follow-up analyses show that White same-sex-attracted female adolescents reported the most compromised mental health compared with other White adolescents. However, similar trends were not found for racial/ethnic minority female youths with same-sex attractions.
doi:10.1037/1099-9809.10.3.200
PMCID: PMC3559128  PMID: 15311974
sexual minority youths; racial/ethnic minority youths; adolescents; multiple minority status; adolescent mental health
18.  Valuing health in a racially and ethnically diverse community sample: an analysis using the valuation metrics of money and time 
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1007/s11136-010-9713-6
PMCID: PMC3596787  PMID: 20680690
Health valuation; Utilities; Racial/ethnic minorities; Mental health
19.  Role of Referrals in Mental Health Service Disparities for Racial and Ethnic Minority Youth 
Objective
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.
Method
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.
Results
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.
Conclusions
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.
doi:10.1016/j.jaac.2012.05.005
PMCID: PMC3652396  PMID: 22721593
referral; disparities; ethnic; minority; services
20.  Depression Interventions among Racial and Ethnic Minority Older Adults: A Systematic Review across 20 Years 
While there is strong evidence in support of geriatric depression treatments, much less is available with regard to older U.S. racial and ethnic minorities. The objectives of this review are to identify and appraise depression treatment studies tested with samples of U.S. racial and ethnic minority older adults. We include an appraisal of sociocultural adaptations made to the depression treatments in studies meeting our final criteria. Systematic search methods were utilized to identify research published between 1990 and 2010 that describe depression treatment outcomes for older adults by racial/ethnic group, or for samples of older adults that are primarily (i.e., >50%) racial/ethnic minorities. Twenty-three unduplicated articles included older adults and seven met all inclusion criteria. Favorable depression treatment effects were observed for older minorities across five studies based on diverse settings and varying levels of sociocultural adaptations. The effectiveness of depression care remains mixed although collaborative or integrated care shows promise for African Americans and Latinos. The degree to which the findings generalize to non-English-speaking, low acculturated, and low income older persons, and to other older minority groups (i.e., Asian and Pacific Islanders, and American Indian and Alaska Natives) remains unclear. Given the high disease burden among older minorities with depression, it is imperative to provide timely, accessible, and effective depression treatments. Increasing their participation in behavioral health research should be a national priority.
doi:10.1097/JGP.0b013e31825d091a
PMCID: PMC3479358  PMID: 22828202
Depression; Treatment; Minorities; Systematic Review; Sociocultural Adaptations
21.  Importance of race-ethnicity: An exploration of Asian, Black, Latino, and Multiracial adolescent identity 
This mixed-method study used a grounded theory approach to explore the meanings underlying the importance adolescents attach to their racial-ethnic identities. The sample consisted of 923 9th–12th grade students from Black, Latino, Asian, and Multiracial backgrounds. Thematic findings identified a broad range of explanations for adolescents’ racial-ethnic centrality, ranging from pride and cultural connection to ambivalence and colorblind attitudes. While racial-ethnic groups differed in reported levels of racial-ethnic centrality, few group differences were identified in participants’ thematic explanations, with the exception of racial-ethnic and gender differences for Positive Regard and Disengagement. These findings highlight the diversity of meanings adolescents attribute to their racial-ethnic centrality as well as the many commonalities among adolescents across gender and racial-ethnic groups.
doi:10.1037/a0018668
PMCID: PMC2868515  PMID: 20438152
racial identity; ethnic identity; gender and race; grounded theory
22.  Health service access across racial/ethnic groups of children in the child welfare system✩ 
Child abuse & neglect  2009;33(5):282-292.
Objective
This study examined health service access among children of different racial/ethnic groups in the child welfare system in an attempt to identify and explain disparities.
Methods
Data were from the National Survey of Child and Adolescent Well-Being (NSCAW). N for descriptive statistics = 2,505. N for multiple regression model = 537. Measures reflected child health services need, access, and enabling factors. Chi-square and t tests were used to compare across racial/ethnic groups. A logistic regression model further explored the greatest disparity identified, that between non-Latino/a Black and White children in caseworker-reported access to counseling.
Results
In general, caseworker reports of health care service receipt did not differ across racial/ethnic groups. However, Latino/a children had better reported access to vision services than non-Latino/a White children, and counseling access was lower for non-Latino/a Black children than non-Latino/a White children. Caseworkers' self-reported efforts to facilitate service access did not vary by race/ethnicity for any type of health care. In the multiple regression model, both private health insurance and a lack of insurance were negatively associated with counseling access, while a history of sexual abuse, adolescence, and greater caseworker effort to secure services were positively associated with access. Race was just barely nonsignificant after controlling for other factors expected to affect access.
Conclusions
One possible reason why Black children are less likely to be identified as needing counseling is the fact that they are less likely than White children to have reports of sexual abuse, which strongly predicts counseling access.
Practice implications
First, child welfare practice may be more equitable than many believe, with generally comparable health service access reported across children's racial/ethnic groups. Second, caseworkers may be under-identifying need for counseling services among Black children, although this might reflect less frequent reports of sexual abuse for Black children. Third, both privately insured and uninsured children were less likely to receive needed mental health counseling than those with public insurance. This suggests that policy makers should focus on increasing the numbers of children enrolled in public health insurance programs such as Medicaid and the State Children's Health Insurance Program (SCHIP).
doi:10.1016/j.chiabu.2008.11.003
PMCID: PMC2789595  PMID: 19481260
Disparities; Access; Mental health; Child welfare
23.  Examining differential treatment effects for depression in racial and ethnic minority women: a qualitative systematic review. 
OBJECTIVE: To examine effectiveness of depression treatment in racial and ethnic minority women. REVIEW METHODS: Inclusion criteria: 1) the study examined treatment of depression among racial and ethnic minority women age > 17, 2) data analysis was separated by race and ethnicity, and 3) the study was conducted in the United States. Interventions considered were: psychotropic medications, psychotherapy (including cognitive-behavioral, interpersonal therapy and any type of psychotherapy adapted for minority populations) and any type of psychotherapy combined with case management or a religious focus. Individual and group psychotherapy were eligible. Each study was critically reviewed to identify treatment effectiveness specific to racial and ethnic minority women. RESULTS: Ten published studies met the inclusion criteria (racial and ethnic minority participants n = 2,136). Seven of these were randomized clinical trials, one was a retrospective cohort study, one was a case series, and the remaining one had an indeterminate study design. Participants' age ranged from 18-74 years, with a higher proportion > 40 years. Most were low income. Differences in treatment responses between African-American, Latino and white women were found. Adapted models of care, including quality improvement and collaborative care, were found to be more effective than usual care and community referral in treating depression. Although medication and psychotherapy were both effective in treating depression, low-income women generally needed case management to address other social issues. CONCLUSION: Adapted models that allow patients to select the treatment of their choice (medication or psychotherapy or a combination) while providing outreach and other supportive services (case management, childcare and transportation) appear to result in optimal clinical benefits.
PMCID: PMC2569622  PMID: 17393951
24.  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.
SYNOPSIS
Objectives
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.
Methods
We used data from the Comprehensive Psychiatric Epidemiology Surveys.
Results
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.
Conclusions
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
25.  Experiences of Discrimination and Their Impact on the Mental Health among African American, Asian and Pacific Islander, and Latino Men Who Have Sex with Men 
American journal of public health  2013;103(5):868-874.
Objectives
We examined the associations between specific types and sources of discrimination and mental health outcomes among U.S. racial/ethnic minority men who have sex with men (MSM) and how these associations vary by race/ethnicity.
Methods
A chain-referral sample of 403 African American, 393 Asian and Pacific Islander (API), and 400 Latino MSM recruited in Los Angeles County, CA completed a standardized questionnaire.
Results
Past-year experiences of racism within the general community and perceived homophobia among heterosexual friends were positively associated with depression and anxiety. Past-year homophobia experienced within the general community was also positively associated with anxiety. These statistically significant associations did not vary across racial/ethnic groups. The positive association of perceived racism within the gay community with anxiety differed by race/ethnicity, and was statistically significant only for APIs. Perceived homophobia within the family was not associated with either depression or anxiety.
Conclusions
Higher levels of experiences of discrimination were associated with psychological distress among MSM of color. However, specific types and sources of discrimination were differentially linked to negative mental health outcomes among African American, API, and Latino MSM.
doi:10.2105/AJPH.2012.301052
PMCID: PMC3625493  PMID: 23488483

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