Use of ministers for a serious personal problem among African Americans: findings from the national survey of American life

Absent Relations of Religious Coping to Telomere Length in African American and White Women and Men

OBJECTIVES

This study investigated whether race and sex moderated the relations of religious coping to telomere length (TL), a biomarker of cellular aging implicated in race-related health disparities.

METHODS

Participant data were drawn from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, which included 252 socioeconomically diverse African American and White men and women aged (30-64 years old). Cross-sectional multivariable regression analyses examined interactive associations of religious coping, race, and sex to TL, adjusting for other sociodemographic characteristics.

RESULTS

Religious coping was unrelated to TL in this sample (p's > .05). There were no notable race or sex differences. Post hoc exploratory analyses similarly found that neither secular social support coping use nor substance use coping was associated with TL.

CONCLUSION

There was no evidence to support that religious coping use provided protective effects to TL in this sample of African American and White women and men. Nevertheless, future studies should use more comprehensive assessments of religious coping and intersectional identities to provide an in-depth examination of religiosity/spirituality as a potential culturally salient protective factor in cellular aging among African Americans in the context of specific chronic stressors such as discrimination.

Are There Regional Differences in Mental Health among Black Americans? An Exploration of Explanatory Mechanisms

Using data from the National Survey of American Life (NSAL) (2001-2003), we examine regional differences in past-year anxiety disorder and past-year major depressive episodes among a geographically diverse sample of Black Americans (N = 3,672). We find that Black Americans residing in the South experience a mental health advantage over Black Americans living in other parts of the country, experiencing lower rates of both anxiety disorder and past-year major depression. We also examine the extent to which stress exposure, religious involvement, and neighborhood contexts help explain any regional differences. We find that stress exposure helps to explain much of the differences observed across regions, while religious involvement and neighborhood contexts help explain observed regional differences to a lesser extent. These findings highlight the importance of considering regional contexts in understanding intra-racial differences in mental health.

Stability and shifts in the combined positive and negative mental health of clergy: A longitudinal latent class and latent transition analysis study of united methodist pastors before and after the onset of COVID-19

COVID-19 and its associated restrictions presented unprecedented challenges for those in the helping professions. In this study, we seek to understand how the mental health of those who belong to one specific helping profession - clergy - changed in the context of COVID-19. Using longitudinal data of a sample of United Methodist pastors from the North Carolina Clergy Health Initiative, we conduct both cross-sectional and person-centered analyses to investigate how the overall mental health of this occupational group changed, as well as how different subgroups of clergy fared within the context of the pandemic, depending on their well-being prior to the onset of COVID-19. We found that the mental health of pastors suffered within the context of the pandemic, but that individual changes in mental health differed based on what the combined positive and negative mental health patterns of clergy were prior to the pandemic, for which we used latent class analysis to identify as Flourishing, Distressed, Languishing, or Burdened but Fulfilled. Of these subgroups, having Flourishing pre-pandemic status was protective of mental health following the onset of COVID-19, whereas the other three subgroups' mental health statuses worsened. This study is the one of the first longitudinal studies of helping professionals which has tracked changes in mental health before and after the onset of COVID-19. Our findings demonstrate the utility of considering positive and negative mental health indicators together, and they point to certain groups that can be targeted with well-being resources during future periods of acute or abnormal stress.

Engaging Black youth in depression and suicide prevention treatment within urban schools: study protocol for a randomized controlled pilot

BACKGROUND

Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City.

METHODS

A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use.

DISCUSSION

This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample.

TRIAL REGISTRATION

Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508.

The Saint Louis bridges program: A mental health network of more than one hundred churches and the mental health community

This article describes the history and development of a faith-based mental health network of over one hundred Black churches in North St Louis City and County. The Bridges to Care and Recovery (BCR) program is a joint effort of the Black faith community, three community hospitals, local universities, a school of medicine and funding from the city /state departments of mental health. The mission of BCR is to improve the fragmented mental health services to the Black community and to address the stigma of mental illness. This innovative program provides a blueprint for other metropolitan areas to emulate. The present paper is a detailed description of the key elements and services of the Bridges program.

Shades of Black: Gendered Denominational Variation in Depression Symptoms Among Black Christians

Religion and spirituality (R/S) play a central role in shaping the contextual experiences of many Black people in the United States. Blacks are among the most religiously engaged groups in the country. Levels and types of religious engagement, however, can vary by subcategories such as gender or denominational affiliation. Although R/S involvement has been linked to improved mental health outcomes for Black people in general, it is unclear whether these benefits extend to all Black people who claim R/S affiliation irrespective of denomination and gender. Data from the National Survey of American Life (NSAL) sought to determine whether there are differences in the odds of reporting elevated depressive symptomology among African American and Black Caribbean Christian adults across denominational affiliation and gender. Initial logistic regression analysis found similar odds of elevated depressive symptoms across gender and denominational affiliation, but further analysis revealed the presence of a denomination by gender interaction. Specifically, there was a significantly larger gender gap in the odds of reporting elevated depression symptoms for Methodists than for Baptists and Catholics. In addition, Presbyterian women had lower odds of reporting elevated symptoms than Methodist women. This study's findings highlight the importance of examining denominational disparities among Black Christians, and suggest that denomination and gender may work in tandem to shape the R/S experiences and mental health outcomes of Black people in the United States.

Burden and Correlates of Mental Health Symptoms Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men Engaged in HIV Care in Atlanta

Mental health comorbidities are prevalent among young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV and can adversely impact HIV-related outcomes. We conducted a cross-sectional survey study with 100 YB-GBMSM recruited from two HIV care centers in Atlanta, and constructed multivariable logistic and linear regression models to examine correlates of depression, anxiety, trauma symptoms, and general well-being. In adjusted models, full-time employment was associated with fewer depressive symptoms, while HIV stigma and substance use were associated with higher levels of depressive symptoms. Younger age and full-time employment were negatively associated with severe anxiety, while HIV stigma was positively associated with severe anxiety and trauma symptoms. Trust in physicians, lower HIV stigma, full-time employment, and lack of substance use were associated with higher average general well-being scores. In conclusion, we found high frequency of depressive, anxiety, and trauma-related symptoms among this sample of YB-GBMSM living with HIV. Unemployment, substance use, and HIV stigma emerged as particularly salient correlates of psychological morbidity, suggesting a need for structural and community-level interventions to address mental health in this population.

We Are Our Sister's Keeper: The Experience of Black Female Clergy Responding to Intimate Partner Violence

Intimate partner violence (IPV) affects all populations, regardless of race, education, or socioeconomic status, but Black women experience higher rates of IPV (43.7%) in comparison with White women (34.6%). Although evidence indicates that faith-based organizations and clergy play key roles in preventing and responding to IPV among Black women, limited research has been conducted in this area, and existing studies have focused on Black male clergy leaders' response to IPV. Using transcendental phenomenology, we interviewed 12 Black female clergy regarding their role as responders to IPV among Black women in their congregation. Each clergy leader participated in a face-to-face interview. Data analysis followed the modified Van Kaam seven-step process. One overarching theme emerged-We Are Our Sister's Keeper, as well as three primary themes: Support Advocate, Spiritual Advisor, and Roadblocked Leader. The themes indicated that Black female clergy respond to the emotional and spiritual needs of Black women despite barriers (e.g., few outside resources, limited support from the Black church). The themes also suggested that clergy lack knowledge and training for responding to IPV. However, Black female clergy are passionate about providing holistic, culturally centered care by bridging the gap between the church and the community to better serve Black women who have experienced IPV. Findings support the importance of incorporating spiritual and emotional healing among this population when providing care and services. Further research is needed to develop interventions, such as a faith-based toolkit that incorporates community resources and guidance to better support Black female clergy leaders' ability to respond to IPV.

Considering religion and spirituality in precision medicine

The emerging era of precision medicine (PM) holds great promise for patient care by considering individual, environmental, and lifestyle factors to optimize treatment. Context is centrally important to PM, yet, to date, little attention has been given to the unique context of religion and spirituality (R/S) and their applicability to PM. R/S can support and reinforce health beliefs and behaviors that affect health outcomes. The purpose of this article is to discuss how R/S can be considered in PM at multiple levels of context and recommend strategies for integrating R/S in PM. We conducted a descriptive, integrative literature review of R/S at the individual, institutional, and societal levels, with the aim of focusing on R/S factors with a high level of salience to PM. We discuss the utility of considering R/S in the suitability and uptake of PM prevention and treatment strategies by providing specific examples of how R/S influences health beliefs and practices at each level. We also propose future directions in research and practice to foster greater understanding and integration of R/S to enhance the acceptability and patient responsiveness of PM research approaches and clinical practices. Elucidating the context of R/S and its value to PM can advance efforts toward a more whole-person and patient-centered approach to improve individual and population health.

African Americans' and Black Caribbeans' Religious Coping for Psychiatric Disorders

This study investigates the use of religious coping among African Americans and Black Caribbeans with 12-month DSM-IV psychiatric disorders. Data from the National Survey of American Life is used to examine three indicators of religious coping: 1) using prayer and other spiritual practices for mental health problems, 2) the importance of prayer in stressful situations, and 3) looking to God for strength. Three out of four respondents who had a mental health problem reported using prayer as a source of coping. Agoraphobia and drug abuse disorder were associated with the importance of prayer during stress. Individuals with generalized anxiety disorder were more likely to report that prayer was important during stressful experiences and that they looked to God for strength. These findings contribute to the limited, but growing body of research on the ways that African Americans and Black Caribbeans cope with psychiatric disorders.

Mental Health Service Utilization Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men in HIV Care: A Retrospective Cohort Study

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) face multiple psychosocial stressors, and are disproportionately impacted by HIV. Mental health care engagement is a promising avenue for addressing these disparities. To date, rates of mental health service utilization have not been examined specifically in this population. We conducted a retrospective cohort study among YB-GBMSM receiving care in a Ryan White-funded HIV care center that includes co-located HIV and mental health services. Of 435 unique YB-GBMSM patients, mental health concerns were identified in n = 191 (43.9%). Depressive symptoms were the most common concerns identified, followed by substance use, anxiety, and trauma. Among patients with identified mental health concerns who were not previously in mental health care, 79.1% were referred to mental health care, 56.3% set an appointment with a mental health provider, 40.5% were linked to mental health care (attended an initial visit), and 19.6% remained engaged in mental health care. Younger YB-GBMSM (age 18-24 years), who received care in a more integrated pediatric/adolescent part of the center, were more likely to have an appointment set once a concern was identified (χ² = 7.17; p = 0.007). Even in a setting with co-located HIV and mental health care services, we found significant gaps in engagement at each stage of a newly described mental health care continuum. Implications for intervention at the provider and systems levels are discussed.

Denominational and Gender Differences in Hypertension Among African American Christian Young Adults

Hypertension, a major cardiovascular disease risk factor, is disproportionately prevalent among African American young adults. Religion and spirituality (R/S) have been studied for their potential effect on blood pressure (BP) outcomes. Despite their disproportionate hypertension risk and high levels of R/S engagement, limited research explores BP differences among religious African Americans. This study investigates whether denominational affiliation predicts within-group differences in odds of having hypertension among African American Christian young adults. Data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were used to examine hypertension differences between 1932 African American young adults based on self-reported religious denomination. Gender-separated logistic regressions included religious service attendance and coping measures, as well as personal characteristics and health behaviors to adjust for potential effects on BP. The odds of having hypertension were higher for Pentecostal women compared to Baptist and Catholic women. Hypertension odds for women who reported attending services more than once weekly were lower than those who never attended church. For women, frequent use of religious coping predicted higher odds of having hypertension than seldom or never using religious coping. R/S variables did not predict significant differences among men. The health benefits of R/S do not appear to be consistent within African American Christian young adults. Religion may be viewed as a source of BP risk and resilience, especially among African American young women.

Religion and Mental Health in Racial and Ethnic Minority Populations: A Review of the Literature

Religion has been an important source of resiliency for many racial and ethnic minority populations. Given the salience, sociohistorical context, and importance of religion in the lives of black and Latino Americans, this literature review focuses on the mental health and well-being outcomes of religion among black and Latino Americans across the adult life course and specifically in later life. This review provides an overview of religious participation and religiosity levels and an in-depth discussion of extant research on the relationship between the multiple dimensions of religiosity and mental health in these 2 populations. Racial differences between blacks, Latinos, and non-Latino whites are also examined. Suggestions for limitations of the current literature and future directions for research on religion and mental health in racial/ethnic minority populations, especially older minorities, are proposed.

Professional service use among older African Americans, Black Caribbeans, and Non-Hispanic Whites for serious health and emotional problems

This study examined racial and ethnic differences in professional service use by older African Americans, Black Caribbeans, and Non-Hispanic Whites in response to a serious personal problem. The analytic sample (N = 862) was drawn from the National Survey of American Life. Findings indicated that African Americans and Black Caribbeans were less likely to use services than Whites. Type and race of providers seen varied by respondents' race and ethnicity. Among respondents who did not seek professional help, reasons for not seeking help varied by ethnicity. Study findings are discussed in relation to practice implications.

Where Our Bright Star Is Cast: Religiosity, Spirituality, and Positive Black Development in Urban Landscapes

Social science research offers a particular, narrow view of the lived experiences of Black urban-residing people. When the religious and spiritual lives of Black urban residents are viewed through this narrow lens, the diversity of religious and spiritual experiences and the connections between everyday life and positive outcomes, such as compassion, hope, liberation, joy, etc., become flattened, doing a disservice to the very people whose experiences we aim to understand. We contend that understanding the link between religiosity, spirituality, and positive development among Black urban-residing people requires us to pay attention to the ways that faith helps Black people to navigate the sequelae of five distinct sociopolitical features of urban life. We propose a conceptual framework that links these sociopolitical factors to religiosity, spirituality, and positive development among Black youth and adults residing in urban spaces. We conclude with recommendations applicable to the study of Black urban religiosity and spirituality.

Religious Community Partnerships: a Novel Approach to Teaching Psychiatry Residents about Religious and Cultural Factors in the Mental Health Care of African-Americans

OBJECTIVE

Promoting awareness in residency training about the influence of religion on the doctor's and patient's ability to negotiate a patient-centered treatment plan is challenging and yet important for improving the quality of mental health care for religious individuals. This paper aims to explore the use of community partners and non-psychiatry faculty to provide this education within psychiatry residency programs.

METHODS

Fifty-one psychiatry residents at an academic psychiatric hospital took part in a 4-h interdisciplinary workshop aimed at improving doctors' overall approach to treating African-American Christian patients. Community-based African-American clergy and mental health professionals, hospital-based psychiatrists, and primary care physicians facilitated educational sessions. A majority of the facilitators were African-American. A pre- and post-workshop survey was administered to measure change in participant attitudes and comfort levels associated with exposure to the workshop. Paired t tests on three subscales were used to calculate change in attitudes on pre- to post-workshop surveys.

RESULTS

Resident scores on each of the three factor subscales increased significantly between pre- and post-workshop assessments: comfort in discussions with patients about spirituality [t [17] = 2.758; p = 0.013]; willingness to collaborate with clergy [t [16] = 3.776; p = 0.002]; and importance of religion to mental health [t [17] = 3.645; p = 0.002].

CONCLUSION

Findings suggest that collaboration between academic and community-based clergy, physicians, and other mental health providers may be a feasible method of improving psychiatry trainees' comfort in addressing religion in psychiatric care to ultimately provide more culturally competent care.

Attitudes and behaviors that differentiate clergy with positive mental health from those with burnout

Clergy provide significant support to their congregants, sometimes at a cost to their mental health. Identifying the factors that enable clergy to flourish in the face of such occupational stressors can inform prevention and intervention efforts to support their well-being. In particular, more research is needed on positive mental health and not only mental health problems. We conducted interviews with 52 clergy to understand the behaviors and attitudes associated with positive mental health in this population. Our consensual grounded theory analytic approach yielded five factors that appear to distinguish clergy with better versus worse mental health. They were: (1) being intentional about health; (2) a "participating in God's work" orientation to ministry; (3) boundary-setting; (4) lack of boundaries; and (5) ongoing stressors. These findings point to concrete steps that can be taken by clergy and those who care about them to promote their well-being.

Are Happiness and Life Satisfaction Different Across Religious Groups? Exploring Determinants of Happiness and Life Satisfaction

This study explores whether different religions experience different levels of happiness and life satisfaction and in case this is affected by country economic and cultural environment. Using World Value Survey (from 1981 to 2014), this study found that individual religiosity and country level of development play a significant role in shaping people's subjective well-being (SWB). Protestants, Buddhists and Roman Catholic were happier and most satisfied with their lives compared to other religious groups. Orthodox has the lowest SWB. Health status, household's financial satisfaction and freedom of choice are means by which religious groups and governments across the globe can improve the SWB of their citizens.

Black Sexual Minority Men's Disclosure of Sexual Orientation Is Associated With Exposure to Homonegative Religious Messages

Previous research has highlighted the homonegative atmospheres of many religious communities in Western society and their harmful impact on Black sexual minority (SM) people's mental and physical health. However, few studies have examined the relationship between sexual orientation disclosure to church members and exposure to homonegative religious messages in religious settings. This online quantitative study investigated this relationship among a sample of 320 Black SM men. The participants for this study were recruited nationally from across the United States and had a mean age of 34 years. Descriptive statistics and linear regression analyses were conducted. Findings indicated that sexual orientation disclosure to church members was significantly associated with exposure to homonegative religious messages, even when controlling for geographic region of residence and denominational affiliation. Black SM men who had higher levels of disclosure were exposed to fewer homonegative religious messages. The implications of these findings for health research and clinical work with Black SM men are discussed in detail.

"It's Kind of a Dichotomy": Thoughts Related to Calling and Purpose from Pastors Working and Counseling in Urban Resource-Poor Communities

Pastors serving low-income urban areas are first-responders to emotional issues by default, since fewer mental health resources are available. Thus, it is important to understand how pastors serving urban resource-poor areas reflect on their counseling role. Forty-eight Black, Hispanic, and White pastors with urban congregations in Los Angeles or Chicago reflect on their pastoral calling and its relation to their counseling role. Through phenomenology, the pastors' lived experiences as they counseled in an urban context were explored. Analysis revealed complex feelings about their counseling role in light of their resource-poor environments. Recommendations are provided based on the findings.

Profiles of Depression Help Seeking Among Black Americans: A Latent Class Approach

Although Black Americans have lower prevalence of depression compared to non-Hispanic Whites (10% vs. 17%), they are nearly twice as likely to have worse outcomes. One contributor to poor depression outcomes involves the ways in which Black Americans seek help for depression. However, little is known about depression help-seeking behavior, and the use of multiple sources of help, among Black Americans. This study used latent class analysis to identify unique constellations of depression help seeking, from multiple sources, among African American and Black Caribbeans. Results indicated four profiles of depression help seeking including Informal/Primary Care Utilizers (41.4%), Formal Mental Health Utilizers (40.6%), All Support Utilizers (9.8%), and Mixed Source Utilizers (8.2%). The constellation of each profile and demographic differences in class assignment are discussed. Results have implications for tailored depression interventions for Black Americans including community-based psychoeducation and cultural competence training for mental health providers.

Differences between African Americans and Non-Hispanic Whites Utilization of Clergy for Counseling with Serious Personal Problems

There is a paradox in research on African Americans and non-Hispanic whites in the utilization of clergy. Research finds that African Americans have higher levels of religious service attendance and higher levels of contact with clergy. Research also finds that despite this, African Americans are less likely than non-Hispanic whites to seek out assistance from clergy for psychiatric disorders including depression and anxiety. The goal of this paper was to investigate race differences in the use of clergy for counseling for serious personal problems. It uses the National Survey of American Life. We find that non-Hispanic whites were more likely than African Americans to use clergy for a serious personal problem. The significant difference between African Americans and non-Hispanic whites appeared to be mediated by the fact that African Americans were more likely to have seen clergy in a religious setting and non-Hispanic whites were more likely to have seen clergy in other settings including hospitals.

The Role of Faith-Based Organizations in the Depression Care of African Americans and Hispanics in Los Angeles

OBJECTIVE

This study examined use of depression care provided by faith-based organizations (FBOs) by African Americans and Hispanics and factors associated with the receipt of such care, including mental illness severity and use of traditional mental health services.

METHODS

The study used baseline data from the Community Partners in Care study, a group-randomized trial comparing a community-partnered approach with a technical-assistance approach to improving depression care in underresourced communities in Los Angeles. A sample of 947 individuals (48% African American, 27% non-U.S.-born Hispanic, 15% U.S.-born Hispanic, and 10% non-Hispanic white) were surveyed about recent visits to a religious or spiritual place and receipt of FBO depression care. Descriptive analyses compared racial-ethnic, sociodemographic, and health service use variables for three groups: those who did not attend a religious place, those who attended a religious place and did not receive FBO depression services, and those who received FBO depression services. Multinomial logistic regression was used to identify predictors of receipt of FBO depression care.

RESULTS

A larger proportion of African Americans and non-U.S.-born Hispanics received FBO faith-based depression services compared with non-Hispanic whites and with U.S.-born Hispanics. Receipt of FBO depression services was associated with younger age, lifetime diagnosis of mania, use of primary care depression services, and receipt of a mental health service from a substance abuse agency.

CONCLUSIONS

FBO depression services were used in the community, especially by persons from racial-ethnic minority groups. Collaborative efforts between FBOs and traditional health services may increase access to depression services for African Americans and Latinos.

African-American Congregational Care and Counseling: Transcending Universal and Culturally-Specific Barriers

This article addresses two major African-American congregational care needs: (1) helping suffering people to access sustained mental health care, particularly in a large/mega-church; and (2) helping suffering people with multi-layered challenges to access appropriate, skilled care that transcends traditional barriers and is consistent with their faith. One model of congregational care is presented with concrete examples of how cultural, theological, and strategic concerns are discussed, with broad implications for diverse faith communities.

Impact of lifetime evaluated need on mental health service use among African American emerging adults

OBJECTIVE

This study investigated the association between evaluated need and mental health service use among African-American emerging adults, when controlling for other predictor variables.

METHOD

Secondary analysis of data from the National Survey of American Life (2001-2003) was conducted. A nationally representative sample of African-American emerging adults, ages 18 to 29 years (N = 806), was assessed with the Composite International Diagnostic Interview. The sample included females and males with a mean age of 23 years. Evaluated need was determined by endorsement of mood, anxiety, substance use, or impulse control diagnoses. Respondents who reported ever voluntarily using mental health or general medical services to address these problems were considered to have used services.

RESULTS

Forty-seven percent of the sample demonstrated an evaluated need for services, whereas a quarter of the sample used services in their lifetime. Respondents who were females, had received religious/spiritual support, and who had an evaluated need for services were significantly more likely to have used services in their lifetime compared with males, those who had not received religious/spiritual support, and those without a need for services.

CONCLUSIONS

Literature indicates that evaluated need is a strong predictor of mental health service use, yet research examining its impact on service use among African American emerging adults is limited. This study found that along with having an evaluated need, this population was more likely to use services when supported by a religious/spiritual leader. Mental health outreach and education that incorporates the informal support systems identified by African American emerging adults, particularly males, is needed.

Religiosity and Mental Health Service Utilization Among African-Americans

African-Americans are approximately half as likely as their white counterparts to use professional mental health services. High levels of religiosity among African-Americans may lend to a greater reliance on religious counseling and coping when facing a mental health problem. This study investigates the relationship between three dimensions of religiosity and professional mental health service utilization among a large (n = 3570), nationally representative sample of African-American adults. African-American adults who reported high levels of organizational and subjective religiosity were less likely than those with lower levels of religiosity to use professional mental health services. This inverse relationship was generally consistent across individuals with and without a diagnosable Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, anxiety, mood, or substance use disorder. No association was found between nonorganizational religiosity and professional mental health service use. Seeking professional mental health care may clash with sociocultural religious norms and values among African-Americans. Strategic efforts should be made to engage African-American clergy and religious communities in the conceptualization and delivery of mental health services.

Licensed Professional Counselors' Perceptions of Pastoral Counseling in the African American Community

This study utilized a phenomenological theory to evaluate the perceptions held by licensed professional counselors regarding pastoral counseling conducted in African American communities in the southeastern United States. The study was designed to build a deeper understanding of how licensed professional counselors conceptualized the African American pastor's role. To evaluate those perceptions, the researcher analyzed data collected from face-to-face interviews. The findings from this qualitative data analysis study revealed that the licensed professional counselor's perceptions of pastoral counseling are jaded by several factors that divide the two professions: lack of training, poor communications, and misconception of the level of professionalism in the church. These are just some of the results from the study. Moreover, the results of this study (a) can offer direction to pastors in selecting individual professional development goals to better prepare themselves and (b) can add perspective to the design of collaboration programs between counselors and pastors.

Professional Service Use for a Serious Personal Problem: Comparing Older African Americans, Black Caribbeans, and Non-Hispanic Whites Using the National Survey of American Life

OBJECTIVES

Examines combinations of professionals visited for a serious personal problem.

METHOD

The sample includes those aged 55 and above (N = 862) from the National Survey of American Life (NSAL). Latent class analysis was used to identify groups of respondents based on types of professionals visited. Multinomial logistic regression was used to identify factors associated with group membership.

RESULTS

Classes included health provider plus clergy, physician plus mental health provider, and limited provider use. Whites were more likely than African Americans to fall into the health provider plus clergy and physician plus mental health provider classes. Those with physical and emotional problems were more likely to be in the health provider plus clergy and physician plus mental health provider classes, respectively.

DISCUSSION

Most respondents were in the limited provider use class suggesting that for many problems, minimal professional help is utilized. Physicians and clergy were important across all three classes.

Engaging Faith-Based Resources to Initiate and Support Diabetes Self-Management Among African Americans

Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network.

The influence of secular and theological education on pastors' depression intervention decisions

Will a pastor refer to a mental health center? If they feel qualified to intervene themselves, they may not. Because pastors often provide grief counseling, it is important to understand the decisions they make when intervening with depressed individuals. A random sample of 204 Protestant pastors completed surveys about their treatment practices for depression. Fisher's exact analyses revealed that more pastors with some secular education yet no degree felt that they were the best person to treat depression than pastors who had no secular education or pastors who had at least a secular bachelor's degree. However, the level of theological education did not influence beliefs about the pastor being the best person to treat depression. In addition, neither secular nor theological education level influenced pastors' views on referring people to mental health centers for depression treatment. Based on findings, this paper discusses implications for best practices in training pastors on depression and other mental health topics.

Major depressive disorder among older African Americans, Caribbean blacks, and non-Hispanic whites: secondary analysis of the National Survey of American Life

BACKGROUND

Previous epidemiological and clinical research on mental disorders has treated Blacks as a homogenous group and yet Blacks of Caribbean descent and African Americans differ with respect to ethnicity, national heritage, living circumstances, and immigration status. The purpose of this article is to examine the prevalence of major depressive disorder (MDD) among African Americans, Caribbean Blacks, and non-Hispanic whites aged 50 and older with data on psychiatric and physical comorbidity, mental illness severity, and service use.

METHODS

Secondary analysis of data from the National Survey of American Life, a national household probability sample of African Americans, Caribbean Blacks, and non-Hispanic Whites in the United States, were used (n = 1,950). The response rate was 72.3%.

RESULTS

Controlling for age, the lifetime prevalence rate of MDD was 12.1% and the 12-month rate was 5.2%. Older Whites and Caribbean Blacks had significantly higher lifetime prevalence than African Americans but 12-month rates were similar across the three groups. Rates of co-occurring psychiatric disorders and physical conditions were high and were similar for African Americans, Caribbean Blacks, and Whites. Most older adults had either moderate or severe 12-month MDD and most talked to at least one professional, most frequently a family doctor, psychiatrist, or other mental health professional.

CONCLUSION

MDD among older adults is highly prevalent, often associated with other psychiatric disorders or chronic physical conditions, and is associated with high overall mental illness severity. Differences among older Blacks highlight the need for further research on this population to ensure appropriate treatment is being provided to these groups.

Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.

Religious involvement and obsessive compulsive disorder among African Americans and Black Caribbeans

Prior research is equivocal concerning the relationships between religious involvement and obsessive-compulsive disorder (OCD). The literature indicates limited evidence of denomination differences in prevalence of OCD whereas findings regarding OCD and degree of religiosity are equivocal. This study builds on prior research by examining OCD in relation to diverse measures of religious involvement within the National Survey of American Life, a nationally representative sample of African American and Black Caribbean adults. Bivariate and multivariate analyses (logistic regression) examine the relationship between lifetime prevalence of OCD and religious denomination, service attendance, non-organizational religiosity (e.g., prayer, religious media) subjective religiosity, and religious coping. Frequent religious service attendance was negatively associated with OCD, whereas Catholic affiliation (as compared to Baptist) and religious coping (prayer when dealing with stressful situations) were both positively associated with OCD. With regard to demographic factors, persons of older age and higher education levels were significantly less likely to have OCD.

The Relationship of Social Support to African American Caregivers' Help-Seeking for Emotional Problems

This study analyzes whether social support serves as a link to or substitute for formal services among African American female caregivers seeking help with emotional problems. It also analyzes other determinants of help-seeking. It relies on data from the Black Rural and Urban Caregivers Mental Health and Functioning Study and is guided by a modified version of the behavioral model of health services use. Using hierarchical binary logistic regression, analyses reveal that only age, stress, and support from fellow church members are statistically significantly associated with the likelihood of help-seeking. These results support the linking hypothesis, suggesting that the social support received by African American women caregivers in the context of their religious organizations helps to link them to services.

Church-based social support and suicidality among African Americans and Black Caribbeans

This study explores the relationship between church-based informal social support and lifetime prevalence of suicide ideation and attempts within a representative national sample of African American and Black Caribbean adults. Characteristics of church-based social support networks, as well as emotional support and negative interaction with church members were examined in relation to lifetime suicide ideation and attempts. This study used data from the National Survey of American Life (2001-2003). Frequency of interaction with church members was positively associated with suicide attempts, while subjective closeness to church members was negatively associated with suicide ideation. Emotional support, service attendance, and negative interaction with church members were unrelated to both suicide ideation and attempts. Findings are discussed in relation to research on church-based support networks, different models linking church support and suicidality, and the mechanisms by which church-based networks deter suicide ideation and attempts.