A review of sociocultural factors that may underlie differences in African American and European American anxiety

Identifying Informal Help-Seeking Patterns in African American Couples

While African American couples are less likely to seek formal resources, such as couples therapy, that does not mean they do not seek relationship support. The literature suggests that informal or community resources play a large role in supporting African American couples. Yet, up to this point, quantitative research has yet to identify specific factors that increase informal couple help-seeking for African Americans. To address this gap, we examine how discrimination, racial identity, and religiosity are associated with informal couple help-seeking. We use two distinct types of common informal couple help-seeking (1) seeking help from a religious community and (2) seeking help from family and friends. Our study also attends to a meaningful aspect of couple help-seeking-relationship interdependence-via an actor-partner interdependence model (APIM). Our findings highlight the importance of informal resources in supporting African American relationships and the interdependent nature of couple help-seeking.

Measuring behavioral responses to a social stressor: Does the Social Performance Rating Scale have utility beyond social anxiety disorder?

The observer-rated Social Performance Rating Scale (SPRS) indexes anxious behaviors exhibited in social contexts. Although the SPRS has been used almost exclusively to study social anxiety disorder (SAD), other emotional disorders are also characterized by heightened responses to social stressors, hinting that the SPRS could serve as a transdiagnostic state measure of behavioral anxiety. To explore this possibility, adults with generalized anxiety disorder or major depressive disorder (n = 105) and adults with no psychopathology (n = 35) delivered a speech to a committee of mock behavioral experts. Behavioral anxiety observed during the speech was rated using the SPRS, then examined in relation to clinical and state measures of anxiety and depression. Contrary to our hypotheses, behavioral anxiety was not associated with clinician- or self-rated anxiety or depression severity. Instead, behavioral anxiety was heightened among individuals who specifically fear and avoid public speaking; who perceived the speech task to be more stressful; and who reported more emotional distress, somatic hyperarousal, and anxious and pessimistic thoughts at the time of the speech. The SPRS is a valid measure of anxious behavior in the many individuals, with and without SAD, who experience acute anxiety in social-evaluative contexts. As behavioral measures are resource-intensive to collect, research is needed to establish whether the SPRS predicts anxious behavior and functional impairment in real-world settings, over and above easier-to-obtain self-report measures.

Psychometric Assessment of Anxiety Measures in a Pilot Study of African American Patients with Obstructive Sleep Apnea

African American patient populations are disproportionately diagnosed with severe obstructive sleep apnea (OSA) compared to non-Hispanic white adults. Research suggests a link between OSA and anxiety. However, OSA and anxiety symptoms may present differently across minority groups. Research examining the reliability and validity of measures used to assess anxiety symptom severity in African American patient populations living with OSA is needed. This pilot study evaluated the reliability and validity of the Patient Reported Outcomes Measurement Information System (PROMIS) Anxiety short form and the longer State-Trait Anxiety Inventory-State (STAI-S) in a sample of African American adults recently diagnosed with OSA. In this cross-sectional pilot study, 32 African American patients newly diagnosed with OSA were recruited from an academic sleep medicine clinic in the Southeastern United States to complete survey measures. Participants completed the 6-item PROMIS Anxiety short form and 20-item STAI-S. Cronbach's alphas assessed the internal reliability of measures, and concurrent validity between measures was assessed using correlation coefficients (rs). Both PROMIS Anxiety and STAI-S showed excellent internal consistency with Cronbach's α ≥.90. The PROMIS Anxiety T-scores and STAI-S scores were positively moderately correlated with each other (rs = .68; p < .0001), indicating concurrent validity. These results illustrate that both the PROMIS Anxiety and STAI-S scales have strong internal reliability in this sample of African American adults with co-occurring OSA and prediabetes. The brief PROMIS Anxiety short-form measure is validated to the longer STAI measure in this sample. An advantage of the PROMIS Anxiety scale is that it has a lower participant burden when completing questionnaires, contributing to a more refined approach to diagnosis and management when both OSA and anxiety coexist. These findings also underscore the importance of validating psychometric measures in marginalized populations, such as African Americans, who have historically been underrepresented in psychometric research.

Differences in Anxiety Sensitivity Among Black and White Veterans

Black Americans are at greater risk for more severe and enduring consequences of anxiety disorders than White Americans, highlighting the need to identify malleable risk and maintenance factors. The current study aimed to examine racial differences in anxiety sensitivity and anxiety sensitivity facets between Black and White veterans (N = 285; 58% Black, 77% Male; Mage = 43.51, SD = 11.87) presenting to a PTSD specialty clinic at a Veterans Affairs (VA) hospital. In addition to a diagnostic interview, veterans were asked to complete a brief battery of self-report questionnaires to assist with diagnostic clarification and treatment planning. Results revealed a significant difference in anxiety sensitivity total scores between Black (M = 44.5, SD = 17.2) and White veterans (M = 36.1, SD = 17.7), such that Black veterans evinced higher levels. When examining anxiety sensitivity subfacets, Black veterans also evinced elevated levels of physical (M = 14.4, SD = 6.6) and cognitive concerns (M = 15.2, SD = 6.5) compared to White veterans (M = 9.8, SD = 6.2; M = 11.7, SD = 6.6, respectively). Results indicate that anxiety sensitivity is a relevant risk factor among Black veterans. Future studies should examine the extent to which anxiety sensitivity is modifiable in such populations.

Treatment Seeking for Anxiety and Depression Among Black Adults: A Multilevel and Empirically Informed Psycho-Sociocultural Model

Black adults with anxiety and/or depressive disorders underutilize outpatient psychotherapy and pharmacological treatment compared to White adults. Notably, anxiety and depressive disorders tend to be chronic and Black individuals with these disorders experience greater functional impairment than White individuals. Documented racial disparities in mental health treatment initiation indicate a need for research that addresses culture-specific barriers to treatment. This review paper critically evaluates existing theoretical models of treatment seeking among Black adults to inform a novel integrated, culturally contextualized model. This model extends previous ones by incorporating factors relevant to treatment seeking among Black adults (e.g., racial identity, perceived discrimination, medical mistrust) and critically examines how these factors intersect with key factors at three levels of influence of the treatment seeking process: the individual level, the community level, and the societal level. We posit interactions among factors at the three levels of influence and how these may impact treatment seeking decisions among Black adults. This model informs suggestions for enhancing interventions designed to support outpatient service use among Black adults.

Religious Involvement and DSM-IV Anxiety Disorders Among African-Americans

ABSTRACT

This study examined the relationship between eight measures of religious involvement and five anxiety disorders among a nationally representative sample of African-Americans ( N = 3403). The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition , World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime prevalence for each disorder. Logistic regression indicated weekly service attendance was inversely associated with 12-month and lifetime panic disorder, lifetime agoraphobia, and 12-month and lifetime posttraumatic stress disorder (PTSD). Prayer was inversely associated with 12-month agoraphobia, 12-month social phobia, and lifetime PTSD. Listening to religious radio and looking to God for strength were also inversely related to, respectively, 12-month and lifetime panic disorder. Conversely, reading religious materials was positively associated with 12-month panic disorder, 12-month agoraphobia, lifetime PTSD, and lifetime generalized anxiety disorder. The results are discussed in light of conceptual models that specify multiple and sometimes divergent pathways through which religion impacts health, and suggestions for clinicians addressing anxiety disorders are delineated.

Examining the promotive versus the protective impact of culturally informed shift-&-persist coping in the context of discrimination, anxiety, and health behaviors

This study aims to better understand how racially/ethnically minoritized youth exhibit adaptive psychological functioning (less anxiety) and health behaviors (better sleep and less binge drinking) in the context of discrimination, ethnic-racial identity and coping. Among 364 minoritized emerging adults (Mage  = 18.79, 85.2% female), we utilized higher-order factor analysis to examine how culturally informed shift-&-persist (S&P), a higher-order construct explaining associations between coping factors (shift, persist, spiritually based coping, civic engagement), and ethnic-racial identity were related to anxiety, binge drinking, and sleep in the context of discrimination. Culturally informed S&P promoted better sleep and less anxiety controlling for discrimination. No significant effects were observed for binge drinking and no moderated effects were observed across outcomes. The harmful effect of discrimination on sleep was intensified for those with stronger ethnic-racial identities. The promotive and potentially protective effects of culturally informed S&P coping differs across mental health and health behavior outcomes.

Discrimination and anxiety: Using multiple polygenic scores to control for genetic liability

An established body of research indicates that discrimination is associated with increased symptoms of anxiety and negative affect. However, the association cannot be interpreted unambiguously as an exposure effect because a common set of genetic factors can simultaneously contribute to increased liability for symptoms of anxiety, negative affect, and the perception of discrimination. The present study elucidates the association between discrimination and anxiety/negative affect by implementing strict genetic controls in a large sample of adults. We used data from the biomarker project of the Study of Midlife Development in the United States (MIDUS), a national probability sample of noninstitutionalized, English-speaking respondents aged 25 to 74 y. Participants who consented to provide genetic data were biologically unrelated and of European ancestry as determined by genotype principal components analysis (n = 1,146). A single structural regression model was fit to the data with three measures of discrimination specified to load onto a latent factor and six measures of anxiety and negative affect specified to load onto a second latent factor. After accounting for potential genetic confounds-polygenic scores for anxiety, depression, and neuroticism and the first five genetic principal components-greater discrimination was associated with greater anxiety/negative affect (β = 0.53, SE = 0.04, P < 0.001). Findings suggest that measures of perceived discrimination should be considered environmental risk factors for anxiety/negative affect rather than indices of genetic liability for anxiety, depression, or neuroticism. Clinical interventions and prevention measures should focus on ways to mitigate the impact of discrimination to improve mental health at the population level.

Perceived Discrimination Trajectories and Depressive Symptoms Among Middle-Aged and Older Black Adults

BACKGROUND AND OBJECTIVES

Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults.

RESEARCH DESIGN AND METHODS

Data were analyzed from a subsample of black Health and Retirement Study respondents (2006-2018, N = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested.

RESULTS

Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49-1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06-1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29-1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point.

DISCUSSION AND IMPLICATIONS

Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination.

Association Between Physical Fitness and Anxiety in Children: A Moderated Mediation Model of Agility and Resilience

Background: Anxiety is one of the most prevalent mental health problems in children. Although physical fitness as a predictor of mental health, the mechanisms underlying any association between physical fitness and anxiety in children have been understudied. Thus, the aim of the present study was to determine whether an association exists between physical fitness and anxiety and to explore the roles of agility and resilience in such an association. Methods: This cross-sectional study investigated 269 children aged 7 to 12 years from three public primary schools in Shanghai (China). Physical fitness and agility were objectively measured, and resilience and anxiety were assessed using self-reported questionnaires. The moderated mediation model was examined using the SPSS PROCESS macro, in which the moderator variable was agility, and the mediator variable was resilience. Results: Physical fitness was inversely associated with anxiety. Resilience partially and indirectly mediated this association, and agility moderated the association between physical fitness and resilience. Physical fitness had a greater impact on resilience in children with higher agility levels. Conclusions: Agility moderated the mediation of resilience on the indirect, inverse association between physical fitness and anxiety; thus, incorporating methods to develop agility and resilience may lead to better outcomes for physical fitness programs designed to prevent or alleviate anxiety in children.

Race and cultural factors in an RCT of prolonged exposure and sertraline for PTSD

The efficacy of treatments for posttraumatic stress disorder (PTSD) among African Americans is less clear given underrepresentation in clinical research. Additionally, intervention research examining race has typically not considered within-group heterogeneity, such as acculturation, ethnic identity, and cultural attitudes. In a randomized controlled trial, African American (n = 43) and Caucasian (n = 130) individuals received prolonged exposure (PE) or sertraline for PTSD, comparing: treatment response, retention, and treatment beliefs and preferences. Indirect effects of cultural variables were also examined. African Americans reported stronger ethnic identity (d = 0.71), less positive attitudes toward other groups (d = 0.36), and less acculturation (d = 0.51) than Caucasians. Noninferiority analyses indicated clinically equivalent PTSD outcomes for African Americans and Caucasians in both treatments. Groups showed comparable improvements in depression and functioning, and similar treatment preferences and beliefs. African Americans attended fewer sessions in PE (d = 0.87) and sertraline (d = 0.53) than Caucasians. Indirect effects analyses indicated positive cultural attitudes toward other ethnoracial groups were consistently associated with better treatment outcome and retention. Despite no differential effectiveness, findings may highlight the need to target retention among African Americans. Within-group cultural aspects of race may be an informative complement to basic, categorical conceptualizations.

Measurement nonequivalence of the Clinician-Administered PTSD Scale by race/ethnicity: Implications for quantifying posttraumatic stress disorder severity

Research studies suggest racial/ethnic differences in posttraumatic stress disorder (PTSD) diagnosis and symptom severity. Few studies to date, however, have examined the extent to which these findings are due to differences in measurement properties of existing PTSD scales. This study examined measurement equivalence across race/ethnicity in the Clinician-Administered PTSD Scale (CAPS) by testing for differential item functioning (DIF) in the item response theory (IRT) framework. Participants were 506 trauma-exposed women (M = 39.41 years, SD = 8.94) who participated in the National Drug Abuse Treatment Clinical Trials Network Women and Trauma Study. PTSD severity score estimates were improved upon as part of IRT estimation incorporating symptom "weights" (i.e., factor loadings) and group-specific DIF. Six symptoms from the CAPS showed DIF, with the majority of differences in measurement driven by White/African American and White/Latina differences, particularly for (a) avoidance of thoughts and (b) a sense of foreshortened future. Despite both racial/ethnic minority groups being slightly (not significantly) more likely to receive a PTSD diagnosis, African Americans (p = .014; Cohen's d = -.22) and Latinas (p < .001; d = -.73) had significantly lower PTSD severity scores than Whites as estimated under IRT with group-specific DIF. Examination of PTSD severity scores based on symptom counts revealed these differences were either dampened (White/Latina difference d = -.39) or entirely negated (White/African American difference d = -.08). The findings suggest the importance of considering differences in symptom relevance across race/ethnicity and their impact on capturing symptom severity parallel to diagnostic criteria. Implications for clinical practice are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Understanding how discrimination can affect health

BACKGROUND

To provide an overview of the empirical research linking self-reports of racial discrimination to health status and health service utilization.

METHODS

A review of literature reviews and meta-analyses published from January 2013 to 2019 was conducted using PubMed, PsycINFO, Sociological Abstracts, and Web of Science. Articles were considered for inclusion using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) framework.

RESULTS

Twenty-nine studies met the criteria for review. Both domestic and international studies find that experiences of discrimination reported by adults are adversely related to mental health and indicators of physical health, including preclinical indicators of disease, health behaviors, utilization of care, and adherence to medical regimens. Emerging evidence also suggests that discrimination can affect the health of children and adolescents and that at least some of its adverse effects may be ameliorated by the presence of psychosocial resources.

CONCLUSIONS

Increasing evidence indicates that racial discrimination is an emerging risk factor for disease and a contributor to racial disparities in health. Attention is needed to strengthen research gaps and to advance our understanding of the optimal interventions that can reduce the negative effects of discrimination.

Posttraumatic Symptomatology and Alcohol Misuse Among Black College Students: Examining the Influence of Anxiety Sensitivity

Objective: Posttraumatic stress symptoms (PTSS) have been found to be associated with alcohol (mis)use among college students. Anxiety sensitivity has been theoretically and empirically linked to both PTSS and alcohol (mis)use. The goal of the present study was to extend research by examining the relations among PTSS, anxiety sensitivity, and alcohol misuse within a sample of trauma-exposed Black college students. Methods: Participants were 121 Black undergraduate college students who endorsed exposure to a traumatic event (M age = 22.98, 77.7% female). Results: Correlational findings provide support for significant positive relations between PTSS and both anxiety sensitivity and alcohol misuse. Further, analyses revealed a significant indirect effect of anxiety sensitivity on alcohol misuse through PTSS. Specifically, greater anxiety sensitivity was associated with higher levels of PTSS, which, in turn, were associated with higher levels of alcohol misuse. Conclusions: These findings suggest that the assessment of anxiety sensitivity may be useful in identifying trauma-exposed Black individuals who are likely to experience alcohol misuse and the clinical utility of addressing PTSS in this population reporting anxiety sensitivity to possibly prevent alcohol misuse and related negative consequences.