The aim of the study was to examine the social networks of sexual minority youths and to determine the associations between social networks and depressive symptoms. Data were obtained from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative cohort study of American adolescents (N=14,212). Wave 1 (1994–1995) collected extensive information about the social networks of participants through peer nomination inventories, as well as measures of sexual minority status and depressive symptoms. Using social network data, we examined three characteristics of adolescents’ social relationships: (1) social isolation; (2) degree of connectedness; and (3) social status. Sexual minority youths, particularly females, were more isolated, less connected, and had lower social status in peer networks than opposite-sex attracted youths. Among sexual minority male (but not female) youths, greater isolation as well as lower connectedness and status within a network were associated with greater depressive symptoms. Moreover, greater isolation in social networks partially explained the association between sexual minority status and depressive symptoms among males. Finally, a significant 3-way interaction indicated that the association between social isolation and depression was stronger for sexual minority male youths than non-minority youths and sexual minority females. These results suggest that the social networks in which sexual minority male youths are embedded may confer risk for depressive symptoms, underscoring the importance of considering peer networks in both research and interventions targeting sexual minority male adolescents.
USA; sexual orientation; social networks; depression; minorities; adolescents
Exposure to stress is associated with a wide range of internalizing and externalizing problems in adolescents, including aggressive behavior. Extant research examining mechanisms underlying the associations between stress and youth aggression has consistently identified social information processing pathways that are disrupted by exposure to violence and increase risk of aggressive behavior. In the current study, we use longitudinal data to examine emotion dysregulation as a potential mechanism linking a broader range of stressful experiences to aggressive behavior in a diverse sample of early adolescents (N=1065). Specifically, we examined the longitudinal associations of peer victimization and stressful life events with emotion dysregulation and aggressive behavior. Structural equation modeling was used to create latent constructs of emotion dysregulation and aggression. Both stressful life events and peer victimization predicted subsequent increases in emotion dysregulation over a 4-month period. These increases in emotion dysregulation, in turn, were associated with increases in aggression over the subsequent 3 months. Longitudinal mediation models showed that emotion dysregulation mediated the relationship of both peer victimization (z=2.35, p=0.019) and stressful life events (z=2.32, p=0.020) with aggressive behavior. Increasing the use of adaptive emotion regulation strategies is an important target for interventions aimed at preventing the onset of adolescent aggressive behavior.
Stress; Peer victimization; Aggression; Emotion regulation; Adolescence
Despite the increased prevalence of weight discrimination, few studies have examined the association between perceived weight discrimination and the prevalence of current psychiatric disorders in the general population. This study utilized a subsample of overweight and obese individuals (N = 22,231) from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional nationally representative study of noninstitutionalized US adults. Perceived weight discrimination is associated with substantial psychiatric morbidity and comorbidity. These results remained significant after adjusting for a potential confound, perceived stress. Moreover, social support did not buffer against the adverse effects of perceived weight discrimination on mental health. Controlling for BMI did not diminish the associations, indicating that perceived weight discrimination is potentially harmful to mental health regardless of weight. These results highlight the urgent need for a multifaceted approach to address this important public health issue, including interventions to assist overweight individuals in coping with the mental health sequelae of perceived weight discrimination.
Lesbian, gay, and bisexual (LGB) populations exhibit elevated rates of psychiatric disorders compared to heterosexuals, and these disparities emerge early in the life course. We examined the role of exposure to early-life victimization and adversity—including physical and sexual abuse, homelessness, and intimate partner violence—in explaining sexual orientation disparities in mental health among adolescents and young adults.
Data were drawn from the National Longitudinal Study of Adolescent Health, Wave 3 (2001–2002), a nationally representative survey of adolescents. Participants included gay/lesbian (n=227), bisexual (n=245), and heterosexual (n=13,490) youths, ages 18–27. We examined differences in the prevalence of exposure to child physical or sexual abuse, homelessness or expulsion from one’s home by caregivers, and physical and sexual intimate partner violence according to sexual orientation. Next we examined the associations of these exposures with symptoms of psychopathology including suicidal ideation and attempts, depression, binge drinking, illicit drug use, tobacco use, alcohol abuse, and drug abuse. Finally, we determined whether exposure to victimization and adversity explained the association between sexual orientation and psychopathology.
Gay/lesbian and bisexual respondents had higher levels of psychopathology than heterosexuals across all outcomes. Gay/lesbian respondents had higher odds of exposure to child abuse and housing adversity, and bisexual respondents had higher odds of exposure to child abuse, housing adversity, and intimate partner violence, than heterosexuals. Greater exposure to these adversities explained between 10–20% of the relative excess of suicidality, depression, tobacco use, and symptoms of alcohol and drug abuse among LGB youths compared to heterosexuals. Exposure to victimization and adversity experiences in childhood and adolescence significantly mediated the association of both gay/lesbian and bisexual orientation with suicidality, depressive symptoms, tobacco use, and alcohol abuse.
Exposure to victimization in early-life family and romantic relationships explains, in part, sexual orientation disparities in a wide range of mental health and substance use outcomes, highlighting novel targets for preventive interventions aimed at reducing these disparities.
Exposure to stress is potentially important in the pathway to alcohol use and alcohol use disorders. Stressors occur at multiple time points across the life course, with varying degrees of chronicity and severity.
We review evidence from epidemiologic studies on the relationship between four different stressors (fateful/catastrophic events, child maltreatment, common adult stressful life events in interpersonal, occupational, financial, and legal domains, and minority stress) and alcohol consumption and alcohol use disorders.
Studies generally demonstrate an increase in alcohol consumption in response to exposure to terrorism or other disasters. Research has demonstrated little increase in incident alcohol use disorders, but individuals with a history of alcohol use disorders are more likely to report drinking to cope with the traumatic event. Childhood maltreatment is a consistent risk factor for early onset of drinking in adolescence and adult alcohol use disorders, and accumulating evidence suggests that specific polymorphisms may interact with child maltreatment to increase risk for alcohol consumption and disorder. Stressful life events such as divorce and job loss increase the risk of alcohol disorders, but epidemiologic consensus on the specificity of these associations across gender has not been reached. Finally, both perceptions of discrimination and objective indicators of discrimination are associated with alcohol use and alcohol use disorders among racial/ethnic and sexual minorities.
Taken together, these literatures demonstrate that exposure to stress is an important component in individual differences in risk for alcohol consumption and alcohol use disorders. However, many areas of this research remain to be studied, including greater attention to the role of various stressors in the course of alcohol use disorders and potential risk moderators when individuals are exposed to stressors.
Stigma is a risk factor for mental health problems, but few studies have considered how stigma leads to psychological distress. The present research examined whether specific emotion-regulation strategies account for the stigma-distress association. In an experience-sampling study, rumination and suppression occurred more on days when stigma-related stressors were reported than on days when these stressors were not reported, and rumination mediated the relationship between stigma-related stress and psychological distress. The effect of social support on distress was moderated by the concealability of the stigma: Lesbian, gay, and bisexual (LGB) respondents reported more isolation and less social support than African American respondents subsequent to experiencing stigma-related stressors, whereas African Americans reported greater social support than LGB participants. Social isolation mediated the stigma-distress association among LGB respondents. In a second experimental study, participants who ruminated following the recall of an autobiographical discrimination event exhibited prolonged distress on both implicit and explicit measures relative to participants who distracted themselves; this finding provides support for a causal role of rumination in the stigma-distress relationship.
Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.
We sought to determine whether health care use and expenditures among gay and bisexual men were reduced following the enactment of samesex marriage laws in Massachusetts in 2003.
We used quasi-experimental, prospective data from 1211 sexual minority male patients in a community-based health center in Massachusetts.
In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean= 5.00 vs mean=4.67; P=.05; Cohen’s d=0.17), mental health care visits (mean= 24.72 vs mean= 22.20; P=.03; Cohen’s d=0.35), and mental health care costs (mean= $2442.28 vs mean= $2137.38; P= .01; Cohen’s d=0.41), compared with the 12 months before the law change. These effects were not modified by partnership status, indicating that the health effect of same-sex marriage laws was similar for partnered and nonpartnered men.
Policies that confer protections to same-sex couples may be effective in reducing health care use and costs among sexual minority men.
The vast majority of research on HIV-related stigma has been cross sectional, and few studies have examined whether experiencing stigma is associated with sexual risk behaviors.
The purpose of this study is to examine the prospective relationships between experiencing HIV-related stigma and symptoms of anxiety and depression, as well as sexual transmission risk behavior.
The sample included HIV-infected men who have sex with men (n = 314) who participated in a secondary HIV-prevention study at their primary care site. Participants were assessed at baseline, and then completed follow-up assessments at 3, 6, 9, and 12 months.
Experiencing HIV-related stigma was prospectively associated with symptoms of depression (β = 0.16, p < .001), panic (β = 0.11, p = .01), and generalized anxiety (β = 0.05, p = .05). In addition, perceiving HIV-related stigma was prospectively associated with transmission risk behaviors, including unprotected receptive or insertive anal intercourse with HIV-seronegative or status unknown partners (β = 0.06, p = .047).
Experiencing HIV-related stigma may increase risk for sexual transmission risk behavior and mental health problems.
HIV-related stigma; HIV risk behaviors; Depression; Anxiety; MSM
Emotion regulation deficits have been consistently linked to psychopathology in cross-sectional studies. However, the direction of the relationship between emotion regulation and psychopathology is unclear. This study examined the longitudinal and reciprocal relationships between emotion regulation deficits and psychopathology in adolescents.
Emotion dysregulation and symptomatology (depression, anxiety, aggressive behavior, and eating pathology) were assessed in a large, diverse sample of adolescents (N = 1,065) at two time points separated by seven months. Structural equation modeling was used to examine the longitudinal and reciprocal relationships between emotion dysregulation and symptoms of psychopathology.
The three distinct emotion processes examined here (emotional understanding, dysregulated expression of sadness and anger, and ruminative responses to distress) formed a unitary latent emotion dysregulation factor. Emotion dysregulation predicted increases in anxiety symptoms, aggressive behavior, and eating pathology after controlling for baseline symptoms but did not predict depressive symptoms. In contrast, none of the four types of psychopathology predicted increases in emotion dysregulation after controlling for baseline emotion dysregulation.
Emotion dysregulation appears to be an important transdiagnostic factor that increases risk for a wide range of psychopathology outcomes in adolescence. These results suggest targets for preventive interventions during this developmental period of risk.
emotion regulation; depression; anxiety; aggression; eating pathology; adolescence
Background Lesbian, gay and bisexual (LGB) populations evidence higher rates of psychiatric disorders than heterosexuals, but most LGB individuals do not have mental-health problems. The present study examined risk modifiers at the social/contextual level that may protect LGB individuals from the development of psychiatric disorders.
Methods Data are drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34 653), a nationally representative study of non-institutionalized US adults. Risk variables included social isolation and economic adversity. High state-level concentration of same-sex couples, obtained from the US Census, was examined as a protective factor.
Results The past-year prevalence of major depression and generalized anxiety disorder was lower among LGB respondents living in states with higher concentrations of same-sex couples, compared with LGB respondents in states with lower concentrations. Additionally, the increased risk for mood and anxiety disorders among LGB individuals exposed to economic adversity and social isolation was evident only in states with low concentrations of same-sex couples. These interactions between the risk and protective factors were not found among heterosexuals, suggesting specificity of the effects to LGB individuals. Results were not attenuated after controlling for socio-demographic factors, state-level income inequality, state-level policies targeting LGBs and state-level attitudes towards LGB-relevant issues.
Conclusions These results provide evidence for the protective effect of social/contextual influences on the prevalence of psychiatric disorders in LGB individuals. Measures of the social environment should be incorporated into future research on the mental health of LGB populations.
Sexual orientation; social epidemiology; mental health
Discrimination is a risk factor for health-risk behaviors, including alcohol abuse. Far less is known about the mechanisms through which discrimination leads to alcohol-related problems, particularly during high-risk developmental periods such as young adulthood.
The present study tested a mediation model using prospective data from a large, diverse sample of 1,539 college students. This model hypothesized that discrimination would be associated with established cognitive (positive alcohol expectancies) and affective (negative affect and coping motives) risk factors for alcohol-related problems, which would account for the prospective association between discrimination and alcohol problems.
Structural Equation Modeling indicated that discrimination was associated cross-sectionally with negative affect and more coping motives for drinking, but not with greater alcohol expectancies. Coping motives mediated the prospective relationship between discrimination and alcohol-related problems. Additionally, results indicated significant indirect effects from discrimination to alcohol-related problems through negative affect and coping motives. These associations were evident for multiple groups confronting status-based discrimination, including women, racial/ethnic minorities, and lesbian/gay/bisexual individuals.
This study identified potential affective mechanisms linking discrimination to alcohol-related problems. Results suggest several avenues for prevention and intervention efforts with individuals from socially disadvantaged groups.
discrimination; alcohol-related problems; coping motives; alcohol expectancies; negative affect; college students
To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.
A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006–2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.
Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96–0.99]).
This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation–related disparities in suicide attempts.
suicide attempts; sexual orientation; disparities; social determinants of health
Lesbians, gays, and bisexuals (LGBs) are at increased risk for alcohol use during young adulthood, but the mechanisms remain inadequately understood. The aim of the present study was to examine the trajectories and determinants of alcohol use among LGB young adults who were sampled prospectively. The sample included 111 LGB individuals (47 women and 64 men) and 2,109 heterosexuals (1,279 women and 830 men), who were assessed at three time points: during the summer after their senior year of high school and during the fall and spring of their freshman year of college. Hierarchical linear modeling analyses indicated that lesbians consumed more alcohol than their heterosexual peers during high school, whereas gay men increased their alcohol use at greater rates than heterosexual men during the initial transition to college. Positive alcohol expectancies and social norms mediated this relation for both men and women. The results extend the generalizability of these processes and highlight the importance of considering normative social–cognitive influences in the development of alcohol use among LGB young adults.
alcohol use; LGB young adults; social norms; alcohol expectancies
Members of stigmatized groups are at increased risk for mental health problems, and recent research has suggested that emotion dysregulation may be one mechanism explaining the stigma-distress association. However, little is known regarding characteristics that predict vulnerabilities to emotion dysregulation and subsequent distress. We examined whether anti-gay attitudes would predict poorer emotion regulation and greater psychological distress in 31 lesbian, gay, and bisexual (LGB) respondents. Respondents completed implicit and explicit attitude measures at baseline, and participated in an experience sampling study examining stigma-related stressors, emotion regulation strategies, and mood over the course of ten days. Implicit and explicit attitude measures were not correlated. LGB respondents with greater implicit anti-gay attitudes engaged in significantly more rumination and suppression and reported more psychological distress. Rumination fully mediated the prospective association between implicit prejudicial attitudes and psychological distress, and suppression was a marginally significant mediator.
stigma; emotion regulation; psychological distress; implicit attitudes; LGB
Peer victimization experiences represent developmentally salient stressors among adolescents and are associated with the development of internalizing symptoms. However, the mechanisms linking peer victimization to adolescent psychopathology remain inadequately understood. This study examined emotion dysregulation as a mechanism linking peer stress to changes in internalizing symptoms among adolescents in a longitudinal design. Peer victimization was assessed in a large (N = 1,065) racially diverse (86.6% non-White) sample of adolescents ages 11 to 14 using the Revised Peer Experiences Questionnaire. Emotion dysregulation and symptoms of depression and anxiety were also assessed. Structural equation modeling was used to create a latent construct of emotion dysregulation from measures of discrete emotion processes and of peer victimization and internalizing symptoms. Peer victimization was associated with increased emotion dysregulation over a 4-month period. Increases in emotion dysregulation mediated the relationship between relational and reputational, but not overt, victimization and changes in internalizing symptoms over a 7-month period. Evidence for a reciprocal relationship between internalizing symptoms and relational victimization was found, but emotion dysregulation did not mediate this relationship. The implications for preventive interventions are discussed.
peer victimization; emotion regulation; depression; anxiety; internalizing symptoms
We examined associations between perceived discrimination due to race/ethnicity, sexual orientation, or gender; responses to discrimination experiences; and psychiatric disorders.
The sample included respondents in the 2004 to 2005 National Epidemiologic Survey on Alcohol and Related Conditions (N|=|34|653). We analyzed the associations between self-reported past-year discrimination and past-year psychiatric disorders as assessed with structured diagnostic interviews among Black (N|=|6,587); Hispanic (N|=|6,359); lesbian, gay, and bisexual (LGB) (N|=|577); and female (N|=|20|089) respondents.
Black respondents reported the highest levels of past-year discrimination, followed by LGB, Hispanic, and female respondents. Across groups, discrimination was associated with 12-month mood [odds ratio (ORs)|=|2.1–3.1], anxiety (ORs|=|1.8–3.3), and substance use (ORs|=|1.6–3.5) disorders. Respondents who reported not accepting discrimination and not discussing it with others had higher odds of psychiatric disorders (ORs|=|2.9–3.9) than did those who did not accept discrimination but did discuss it with others. Black respondents and women who accepted discrimination and did not talk about it with others had elevated rates of mood and anxiety disorders, respectively.
Psychiatric disorders are more prevalent among individuals reporting past-year discrimination experiences. Certain responses to discrimination, particularly not disclosing it, are associated with psychiatric morbidity.
Sexual minority adolescents appear to be at increased risk for internalizing disorders relative to their heterosexual peers, but there is a paucity of research explaining this elevated risk. Emotion regulation deficits are increasingly understood as important predictors of internalizing psychopathology among general samples of adolescents. The present study sought to examine whether deficits in emotion regulation could account for disparities in internalizing symptoms between sexual minority and heterosexual adolescents.
The present study utilized longitudinal data from a racially/ethnically diverse (68% non-Hispanic Black and Hispanic/Latino) community sample of 1,071 middle school students (ages 11–14).
Adolescents who endorsed same-sex attraction evidenced higher rates of internalizing symptoms at both time points. Structural equation modeling indicated that sexual minority adolescents exhibited greater deficits in emotion regulation (rumination and poor emotional awareness) than their heterosexual peers. Emotion regulation deficits in turn mediated the relationship between sexual minority status and symptoms of depression and anxiety.
The results demonstrate the importance of considering normative psychological processes in the development of internalizing symptomatology among sexual minority adolescents, and suggest emotion regulation deficits as specific targets of prevention and intervention efforts with this population. Future studies are needed to determine whether stigma-related stressors are responsible for emotion regulation deficits among sexual minority youth.
Depression; anxiety; emotion regulation; sexual minority youth
Anxiety sensitivity represents a robust risk factor for the development of anxiety symptoms among both adolescents and adults. However, the development of anxiety sensitivity among adolescents remains inadequately understood. In this study, the authors examined the role of stressful life events as a risk factor for the development of elevated anxiety sensitivity. Anxiety sensitivity was then examined in a longitudinal design as a mechanism linking stressful life events to changes in anxiety symptoms. Stressful life events, anxiety sensitivity, and internalizing symptoms were assessed in a diverse community sample of adolescents (N = 1,065) at 3 time points spanning 7 months. The results indicated that stressful life events were longitudinally associated with increases in anxiety sensitivity and that certain types of stressful life events, specifically events related to health and events related to family discord, were differentially predictive of increases in anxiety sensitivity. Moreover, anxiety sensitivity mediated the longitudinal relation between stressful life events and anxiety symptoms. Evidence was also found for the predictive specificity of anxiety sensitivity to symptoms of anxiety but not depression.
anxiety sensitivity; stress; anxiety; depression; adolescence
Stressful life events represent potent risk factors for the development of internalizing symptoms among adolescents. However the mechanisms linking stress to adolescent psychopathology remain inadequately understood. This study examined the role of emotion dysregulation as a mechanism linking stress to changes in internalizing symptoms among adolescents.
This study used a short-term longitudinal design. Stressful life events were assessed in a large diverse sample of adolescents (N = 1065), and emotion dysregulation and symptomatology outcomes were assessed at two subsequent time points. Structural equation modeling was used to examine the role of emotion dysregulation as a mediator of the association between stress and subsequent changes in internalizing symptoms.
Emotion dysregulation mediated the relationship between stressful life events and changes in internalizing symptoms over time. Sobel’s test indicated a significant indirect effect of stressful life events on subsequent symptoms of depression (z = 5.05, p < .001) and anxiety (z = 4.95, p < .001) through emotion dysregulation.
Stressful life events appear to disrupt the adaptive processing of emotion among adolescents. Emotion dysregulation represents an intrapersonal mechanism linking stress to poor mental health outcomes. The implications for preventive interventions are discussed.
Stress; Emotion regulation; Depression; Anxiety; Adolescence
Sexual minorities are at increased risk for multiple mental health burdens compared to heterosexuals. The field has identified two distinct determinants of this risk, including group-specific minority stressors and general psychological processes that are common across sexual orientations. The goal of the present paper is to develop a theoretical framework that integrates the important insights from these literatures. The framework postulates that (a) sexual minorities confront increased stress exposure resulting from stigma; (b) this stigma-related stress creates elevations in general emotion dysregulation, social/interpersonal problems, and cognitive processes conferring risk for psychopathology; and (c) these processes in turn mediate the relationship between stigma-related stress and psychopathology. It is argued that this framework can, theoretically, illuminate how stigma adversely affects mental health and, practically, inform clinical interventions. Evidence for the predictive validity of this framework is reviewed, with particular attention paid to illustrative examples from research on depression, anxiety, and alcohol use disorders.
stigma-related stress; general psychological processes; mediation; LGB populations; mental health disparities
This study sought to determine whether Black/White disparities in service utilization for mental health and substance use disorders persist or are diminished among individuals with psychiatric comorbidity in the general population.
The 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was used to identify individuals with lifetime co-occurring substance use disorders and mood/anxiety disorders (N=4,250; 3597 Whites and 653 Blacks). Lifetime service utilization for problems with mood, anxiety, alcohol and drugs was assessed.
Compared to Whites, Blacks with co-occurring mood or anxiety and substance use disorders were significantly less likely to receive services for mood or anxiety disorders, equally likely to receive services for alcohol use disorders, and more likely to receive some types of services for drug use disorders. Regardless of race/ethnicity, individuals with these co-occurring disorders were almost twice as likely to use services for mood/anxiety disorders than for substance use disorders.
Despite the fact that comorbidity generally increases the likelihood of service use, Black/White disparities in service utilization among an all-comorbid sample were found, although these disparities differed by type of disorder. Further research is warranted to understand the factors underlying these differences. Prevention and intervention strategies are needed to address the specific mental health needs of Blacks with co-occurring disorders, as well as the overall lack of service use for substance use disorders among individuals with co-occurring psychiatric conditions.
service utilization; race/ethnicity; comorbidity; mood/anxiety disorders; substance use disorders
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.
Efficient, organized assessment of substance use disorders is essential for clinical research, treatment planning, and referral to adjunctive services. In this article, we discuss the basic concepts of formalized assessment for substance abuse and addiction, as established by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, and describe six widely used structured assessment instruments. Our aim is to help researchers and clinical programs identify the instruments that best suit their particular situations and purposes.