Differences in treatment attitudes between depressed African-American and Caucasian veterans in primary care

Acceptability of a mindfulness intervention for depressive symptoms among African-American women in a community health center: A qualitative study

INTRODUCTION

In this study we examined the acceptability and feasibility of a mindfulness based group intervention for socio-economically disadvantaged women in an urban community health center (M-Body).

METHOD

Women ages 18-65 with depressive symptoms who participated in an 8-week mindfulness based group intervention were invited to attend follow up focus groups about their experience. Inductive content analysis was used to identify themes from transcripts.

RESULTS

All participants were African-American (N = 27). Participants had limited past experience with mindfulness. They reported benefits included anger management, increased control of thoughts, emotions and behaviors, enhanced awareness/focus and feeling calm and relaxed. Barriers to session attendance included transportation, employment, family responsibilities and child care. Participants suggested modifications such as providing the audio in multiple formats, increasing time spent doing yoga, modifying yoga postures and providing an orientation session. They stated that the content and delivery format of the group was acceptable.

DISCUSSION

The mindfulness based intervention for depression was acceptable, reduced stress and improved coping and functioning among women in a community health center.

Perceived Need for Mental Health Care: The Intersection of Race, Ethnicity, Gender, and Socioeconomic Status

Racial/ethnic minority populations underutilize mental health services, even in the presence of psychiatric disorder, and differences in perceived need may contribute to these disparities. Using the Collaborative Psychiatric Epidemiology Surveys, we assessed how the intersections of race/ethnicity, gender, and socioeconomic status affect perceived need. We analyzed a nationally representative sample of U.S. adults (18 years or older; N=14,906), including non-Latino whites, Asian Americans, Latinos, African Americans, and Afro-Caribbeans. Logistic regressions were estimated for the total sample, a clinical need subsample (meets lifetime diagnostic criteria), and a no disorder subsample. Perceived need varies by gender and nativity, but these patterns are conditional on race/ethnicity. Men are less likely than women to have a perceived need but only among non-Latino whites and African Americans. Foreign-born immigrants have lower perceived need than U.S.-born persons, only among Asian Americans. Intersectional approaches to understanding perceived need may help uncover social processes that lead to disparities in mental health care.

Are there racial/ethnic disparities in VA PTSD treatment retention?

BACKGROUND

Chronic posttraumatic stress disorder (PTSD) can result in significant social and physical impairments. Despite the Department of Veterans Affairs' (VA) expansion of mental health services into primary care clinics to reach larger numbers of Veterans with PTSD, many do not receive sufficient treatment to clinically benefit. This study explored whether the odds of premature mental health treatment termination varies by patient race/ethnicity and, if so, whether such variation is associated with differential access to services or beliefs about mental health treatments.

METHODS

Prospective national cohort study of VA patients who were recently diagnosed with PTSD (n = 6,788). Self-administered surveys and electronic VA databases were utilized to examine mental health treatment retention across racial/ethnic groups in the 6 months following the PTSD diagnosis controlling for treatment need, access factors, age, gender, treatment beliefs, and facility factors.

RESULTS

African American and Latino Veterans were less likely to receive a minimal trial of pharmacotherapy and African American Veterans were less likely to receive a minimal trial of any treatment in the 6 months after being diagnosed with PTSD. Controlling for beliefs about mental health treatments diminished the lower odds of pharmacotherapy retention among Latino but not African American Veterans. Access factors did not contribute to treatment retention disparities.

CONCLUSIONS

Even in safety-net healthcare systems like VA, racial and ethnic disparities in mental health treatment occur. To improve treatment equity, clinicians may need to more directly address patients' treatment beliefs. More understanding is needed to address the treatment disparity for African American Veterans.

Depression and Risk Perceptions in Older African Americans With Diabetes

Objective. The purpose of this study is to describe the impact of depression on perceptions of risks to health, diabetes self-management practices, and glycemic control in older African Americans with type 2 diabetes. Methods. The authors analyzed data on depression, risk perceptions, diabetes self-management, and A1C in African Americans with type 2 diabetes. T-tests, χ(2), and multivariate regression were used to analyze the data. Results. The sample included 177 African Americans (68% women) whose average age was 72.8 years. Thirty-four participants (19.2%) met criteria for depression. Compared to nondepressed participants, depressed participants scored significantly higher on Personal Disease Risk (the perception of being at increased risk for various medical problems), Environmental Risk (i.e., increased risk for environmental hazards), and Composite Risk Perception (i.e., overall perceptions of increased risk); adhered less to diabetes self-management practices; and had marginally worse glycemic control. Depression and fewer years of education were independent predictors of overall perception of increased health risks. Conclusion. Almost 20% of older African Americans with type 2 diabetes in this study were depressed. Compared to nondepressed participants, they tended to have fewer years of education, perceived themselves to be at higher risk for multiple health problems, and adhered less to diabetes self-management practices. It is important for diabetes educators to recognize the impact of low education and the fatalistic perceptions that depression engenders in this population.

The role of coping in depression treatment utilization for VA primary care patients

OBJECTIVE

To examine the impact of Veterans' coping strategies on mental health treatment engagement following a positive screen for depression.

METHODS

A mixed-methods observational study using a mailed survey and semi-structured interviews. Sample included 271 Veterans who screened positive for depression during a primary care visit at one of three VA medical centers and had not received a diagnosis of depression or prescribed antidepressants 12 months prior to screening. A subsample of 23 Veterans was interviewed.

RESULTS

Logistic regression models showed that Veterans who reported more instrumental support and active coping were more likely to receive depression or other mental health treatment within three months of their positive depression screen. Those who reported emotional support or self-distraction as coping strategies were less likely to receive any treatment in the same time frame. Qualitative analyses revealed that how Veterans use these and other coping strategies can impact treatment engagement in a variety of ways.

CONCLUSIONS

The relationship between Veterans' use of coping strategies and treatment engagement for depression may not be readily apparent without in-depth exploration.

PRACTICE IMPLICATIONS

In VA primary care clinics, nurse care managers and behavioral health providers should explore how Veterans' methods of coping may impact treatment engagement.

Late-life depression in older African Americans: a comprehensive review of epidemiological and clinical data

OBJECTIVE

The population of older African Americans is expected to triple by 2050, highlighting the public health importance of understanding their mental health needs. Despite evidence of the negative impact of late-life depression, less is known of how this disorder affects the lives of older African Americans. Lack of studies focusing on how depression presents in older African Americans and their subsequent treatment needs lead to a gap in epidemiologic and clinical knowledge for this population. In this review, we aim to present a concise report of prevalence, correlates, course, outcomes, symptom recognition, and treatment of depression for these individuals.

METHOD

We performed a literature review of English-language articles identified from PubMed and Medline published between January 1990 and June 2012. Studies included older adults and contained the key words 'geriatric depression in African Americans', 'geriatric depression in Blacks', and 'geriatric depression in minorities'.

RESULTS

Although in most studies, older African Americans had higher or equivalence prevalence of depression compared with Caucasian Americans, we also found lower rates of recognition of depression and treatment. Many studies reported worse outcomes associated for depression among older African Americans compared with older Caucasians.

CONCLUSIONS

Serious racial and ethnic disparities persist in the management of older African Americans with depression. Understanding their unmet needs and improving depression care for these individuals is necessary to reduce these disparities.

Preliminary findings exploring the social determinants of Black males' lay health perspectives

The unequal discussion of Black males' health is a pressing social problem. This study addressed Black males' lay perspectives regarding their health, illness, and mortality, with attention to the determinants of men's health, prevention, lifestyle, and opportunities for health promotion using an exploratory/qualitative research methodology. Participants were 68 Black males aged 15 to 68 years, with an average age of 44 years (SD = 14.5). The narratives represented a complex interplay of biopsychosocial factors, ranging from intrapersonal attitudes, interpersonal experiences to discussions about community and public policy injustices. Five prominent themes emerged: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic-medical settings, (d) hyperactive masculinity fatigue, and (e) the gay-straight divide. The term Tired Black Male Health syndrome was coined in the forum. Implications of these findings are discussed in the context of culturally relevant strategies for improving Black male community health engagement.