Ethno-racial differences in anxiety and depression impairment among emerging adults in higher education

Background

Despite having higher exposure to stressors, many ethno-racial groups report similar or lower prevalence of clinical depression and anxiety compared to their White counterparts, despite experiencing greater psychosocial risk factors for poor mental health outcomes, thus presenting an epidemiological paradox. Ethno-racial differences in impairment, a diagnostic criterion, may in part explain this paradox.

Methods

We analyzed data from the Healthy Minds Study (2020-2021) and using survey-weighted linear mixed effects models, we tested whether there were ethno-racial differences in impairment across multiple ethno-racial groups at various levels of severity for anxiety and depression.

Results

Black students reported lower mean impairment scores relative to White students at moderate and severe anxiety. Hispanic/Latine students only reported lower impairment relative to White students at severe anxiety. Asian students reported relatively lower mean impairment than White students at mild anxiety, and this difference continued to grow as anxiety severity increased. Similar trends were observed for depression. Black and Hispanic/Latino students reported lower mean impairment scores at moderate to severe depression. Asian students reported lower mean impairment scores beginning at mild depression to severe depression.

Conclusion

Self-reported anxiety and depression related impairment varies by ethno-racial group, with Black, Hispanic/Latinx, and Asian students reporting lower impairment compared to White students at higher levels of symptom severity. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some of the racial paradox.

Effects of sleep on brain perivascular space in a cognitively healthy population

The magnetic resonance imaging (MRI) visible perivascular space (PVS) reportedly clears amyloid-β and metabolic waste during sleep. Previous studies reported an association between sleep and the PVS in small vessel disease, traumatic brain injury, and Alzheimer's disease. However, this relationship in a healthy cohort is still unclear. Here, we used the Human Connectome Project Aging dataset to analyze the relationship between sleep and the PVS in cognitively healthy adults across the aging continuum. We measured sleep parameters using the self-reported Pittsburgh Sleep Quality Index questionnaire. We found that older adults who had better sleep quality and sleep efficiency presented with a larger PVS volume fraction in the basal ganglia (BG). However, sleep measures were not associated with PVS volume fraction in the centrum semiovale (CSO). In addition, we found that body mass index (BMI) influenced the BG-PVS across middle-aged and older participants. In the entire cognitively healthy cohort, the effect of sleep quality on PVS volume fraction was mediated by BMI. However, BMI did not influence this effect in the older cohort. Furthermore, there are significant differences in PVS volume fraction across racial/ethnic cohorts. In summary, the effect of sleep on the PVS volume alteration was different in the middle-aged adults and older adults.

Depression impairment among young adult college students: exploring the racial paradox

BACKGROUND

Studies suggest Black Americans have a lower prevalence of depression than White Americans despite greater exposure to risk factors for depression across the life course. We examined whether this paradox exists among students in higher education, and whether the paradox may be partly explained by racial differences in reports of impairment from depression, which is a required criterion for clinical diagnosis.

METHODS

We analyzed data from the Healthy Minds Study (2020-2021), restricting the sample to young adults (18-29) who identified as either Black or White. Using modified Poisson regression models to estimate risk ratios, we examined associations between race and depression impairment across five levels of depression severity, adjusting for age and gender.

RESULTS

Approximately 23% of Black students reported depression impairment, which is significantly lower than the 28% of White students who reported depression impairment. For all students, greater depression severity was associated with greater probability of impairment; however, the relationship was more modest among Black students. At severe, moderately severe, and moderate depression levels, Black students had lower risk of depression impairment compared with White students.

CONCLUSION

White students may be more likely than Black students to report significant impairment at high levels of depression. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some the racial depression paradox.

Race, Ethnicity, and Age Differences in Social Relationships and Obesity: Findings From the National Survey of American Life

ObjectiveThe purpose of this study was to examine race, ethnicity, and age differences in the association between social relationships and body weight in a nationally representative sample of African American, Caribbean Black, and non-Hispanic White adults. Methods: Data were drawn from the 2001-2003 National Survey of American Life (N = 5684). Multiple linear regressions were conducted to examine the links between race, ethnicity, and age with social relationships and weight. Results: Although African American respondents had higher BMI than non-Hispanic White respondents, Caribbean Black respondents did not differ from White respondents in BMI. Emotional support from family members was both positively and negatively associated with weight depending on age, race, and ethnicity. Discussion: Social relationships are an important contributing factor to obesity and obesity-related risks in adults. Study findings demonstrate the intersection of race, ethnicity, and age and how these complex relationships influence the association between social relationships and body weight.

Religious Involvement and Sleep Among Older African Americans

Objective: This study sought to determine whether religious involvement is associated with sleep quality in a nationally representative sample of older African Americans. Methods: The analytic sample included African American respondents aged 55+ from the National Survey of American Life-Reinterview (N = 459). Religious involvement variables included service attendance, reading religious texts, watching religious television programs, listening to religious radio programs, prayer, and subjective religiosity. Sleep outcomes were restless sleep and sleep satisfaction. Multiple linear regression analysis was used. Results: Watching religious television programs was associated with more restless sleep. Respondents who attended religious services less than once a year, at least once a week, or nearly every day reported greater sleep satisfaction than respondents who never attended religious services. Subjective religiosity was associated with lower sleep satisfaction. Discussion: The findings demonstrate the importance of examining a variety of religious involvement domains, which could point to different explanatory pathways between religious involvement and sleep.

Allergies, infections, and psychiatric disorders among Black Americans: findings from the National Survey of American Life

Objectives: An emerging body of literature shows that allergies and infections are associated with psychiatric disorders, though there is little research to confirm these associations among Black Americans in the United States.Design: We analyzed data from the National Survey of American Life, and used multivariable logistic regression models to examine the associations between past 12-month allergies/infections and past 12-month psychiatric disorders, adjusting for socio-demographic characteristics, tobacco use, lifetime diabetes, and body mass index.Results: We found that allergies/infections were associated with mood, anxiety, and eating disorders, but not alcohol or substance use disorders. We detected effect modification by ethnicity, with stronger odds for mood, anxiety disorders, and alcohol use disorders, with no significant associations for substance use or eating disorders among Caribbean Blacks.Conclusions: Our findings underscore the importance of screening for psychiatric disorders among Black individuals complaining of allergies/infections, and the need to also treat allergies/infections among people with psychiatric disorders.

The Moderating Role of Race and Ethnicity in the Relationship Between Negative Family Interactions and Mental Health Among Older Adults

BACKGROUND AND OBJECTIVES

Studies generally show that negative social interactions are detrimental to mental health for older adults. Further, empirical evidence suggests that negative interactions may function differently in relation to mental health across racial/ethnic groups given their unique life circumstances and social conditions. This study examines whether the association between negative family interactions and mental health outcomes varies by race and ethnicity.

RESEARCH DESIGN AND METHODS

Samples of older African Americans, Caribbean Blacks, and non-Latino Whites aged 55 and older were drawn from the National Survey of American Life (N=1439). Mental health variables included depressive symptoms, any lifetime DSM-IV disorder, and number of lifetime DSM-IV disorders. Regression models were used to test the study aim.

RESULTS

Analyses indicated that negative interactions with family were positively associated with all three mental health outcomes. Several racial/ethnic differences emerged. The association between negative family interactions and depressive symptoms was stronger among Whites than African Americans. While negative family interactions were positively associated with number of disorders among Caribbean Blacks, negative interactions were unrelated to number of disorders among African Americans.

DISCUSSION AND IMPLICATIONS

This study demonstrates the racial and ethnic differences in diverse aging populations and the importance of recognizing the heterogeneity of Black American population in minority research. Clinical practice should focus on reducing negative family interactions, and future research should examine whether psychosocial resources (e.g., stress appraisals, neighborhood social cohesion, and religious practices) can attenuate the association between negative family interactions and mental health for older African Americans.

Profiles of sleep and depression risk among Caribbean Blacks

Objectives: Sleep problems are associated with a host of psychiatric disorders and have been attributed to race disparities in health and wellness. Studies of sleep and mental health do not typically consider within-group differences among Blacks. Thus, our understanding of how the sleep-mental health relationship among Caribbean Blacks is limited. This study identified sleep profiles among Caribbean-born Blacks who reside in the United States.Design: Latent class analysis and data from the National Survey of American Life Re-interview study were used to identify and compare the associations between 'sleep quality classes,' sociodemographic factors, stress, and depression risk among Caribbean Blacks.Results: Two sleep quality classes were identified - 'good sleep quality' and 'poor sleep quality' - with each class demonstrating a complex pattern of sleep experiences, and illuminating the association between sleep and depression risk.Conclusions: Findings provide insight into the influence of sociodemographic factors and social stressors on the sleep experience of Caribbean Blacks and the importance of considering within-group differences to better understand risk and resilience among Caribbean Blacks living in the United States. Findings also highlight the importance of screening for sleep problems in an effort to reduce the burden of depression experienced by this population.

Fundamental causes of barriers to participation in Alzheimer's clinical research among African Americans

Objectives: African Americans have a significantly higher risk than Whites for developing Alzheimer's disease (AD), but show lower participation in AD clinical trials. Studies of African Americans' involvement in clinical research have identified fear and mistrust of research as barriers to participation. Historical occurrences of unethical research practices are often cited as the source of these attitudes, but underlying factors such as African Americans' experiences of racism and discrimination remain unexplored. The goal of this study was to examine the roles of race and culture in the attitudes and beliefs of African Americans about participating in clinical research.Design: Five focus groups were conducted with 44 African American men and women (aged 50 and over) in a western U.S. state. Participants were asked scripted questions regarding their knowledge and beliefs about AD and their feelings about participating in clinical research. A taxonomy was created to organize results based on participant responses.Results: Four major thematic clusters emerged that influence African Americans beliefs about and participation in clinical research: (a) experiences of unequal treatment and racism, (b) cultural trauma due to historical events and contemporary experiences, (c) racial identity and cultural norms, and (d) the importance of cultural competency and racial congruence in recruitment and research studies.Conclusions: Understanding, acknowledging, and addressing the factors that underlie mistrust and fear of research is important to build trust and to develop culturally appropriate outreach, education, and recruitment strategies that will increase African Americans' participation in clinical research.

Neighborhood Characteristics and Inflammation among Older Black Americans: The Moderating Effects of Hopelessness and Pessimism

BACKGROUND

Research documents the adverse health effects of systemic inflammation. Overall, older Black Americans tend to have higher inflammation than older non-Hispanic white adults. Given that inflammation is related to a range of chronic health problems that disproportionately affect Blacks compared to whites, this racial disparity in inflammation may contribute to racial disparities in particular chronic health problems. Thus, a better understanding of its determinants in the older Black population is of critical importance. This analysis examined the association between neighborhood characteristics and inflammation in a national sample of older non-Hispanic Black Americans. An additional aim of this study was to determine whether hopelessness and pessimism moderates the association between neighborhood characteristics and inflammation.

METHODS

A sample of older non-Hispanic Black Americans aged 60+ were drawn from the Health and Retirement Study (N=1,004). Neighborhood characteristics included neighborhood physical disadvantage and neighborhood social cohesion. Inflammation was assessed by C-reactive protein (CRP).

RESULTS

The analyses indicated that neighborhood physical disadvantage and social cohesion were not associated with CRP. Hopelessness and pessimism moderated the association between neighborhood physical disadvantage and CRP.

CONCLUSIONS

Knowledge regarding the role of hopelessness and pessimism as moderator in the neighborhood-inflammation association can inform cognitive-behavioral interventions targeted at changes in cognition patterns.

Biopsychosocial Risk Profiles among African American and Non-Hispanic White Adults: Findings from The Health and Retirement Study

BACKGROUND

Compared to Whites, African Americans have elevated risk for earlier onset fatal and non-fatal chronic conditions and accelerated aging. Despite these persistent race disparities, the causes remain poorly understood. The purpose of this study was to define a biopsychosocial risk typology that might explain accelerated aging in African Americans.

METHODS

Analyses were based on the African American and White subsample of the Health and Retirement Study (N=8,269). Latent class analysis was used to identify risk types. Chronic health conditions, salivary telomere length (STL), emotional support from family, negative interaction with family, early life adversities, and discrimination were used as class indicators. Latent class multinomial logistic regression was used to identify racial and demographic differences in risk type membership.

RESULTS

Three distinct risk types were identified: high risk, health risk, and psychosocial risk. African Americans were more likely than Whites to be assigned to the high risk type characterized by chronic health conditions, shorter STL, strained social relationships and high psychosocial stress. African Americans were less likely than Whites to be assigned to the health risk type characterized by chronic health conditions, shorter STL, optimal social relationships and low psychosocial stress.

CONCLUSIONS

The biopsychosocial risk typology accounted for population heterogeneity, identified high-risk profiles and modifiable factors within risk types that can inform current clinical interventions. The risk types also revealed different patterns of risk and resilience factors and shed light on the interplay between telomere length, stress exposure, chronic disease and accelerated aging in African Americans.

Negative interactions with extended family and church members and subjective well-being among older African American women

The purpose of this study was to determine whether negative interactions with family and church members are associated with indicators of subjective well-being (SWB) in a nationally representative sample of older African American women. The analytic sample (N = 537) was drawn from the National Survey of American Life. Linear regressions were used to assess the associations between negative interactions with family and church members and happiness, life satisfaction, and self-esteem. The negative interactions with family variable was inversely associated with happiness and self-esteem. Findings underscore the importance of social relationships and the quality of these relationships in women's well-being.

Race, Obesity, and Mental Health Among Older Adults in the United States: A Literature Review

Rising rates of obesity among older adults in the United States are a serious public health concern. While the physical health consequences of obesity are well documented, the mental health consequences are less understood. This is especially the case among older adults in general and among racial and ethnic minority older adults in particular. Available studies document a link between obesity and a variety of mental health disorders. However, findings from this body of evidence are inconsistent, especially when race and ethnicity are considered. This article examines research on obesity and mental health among older adults and identifies risk factors, causal mechanisms, and methodological approaches that help clarify the equivocal nature of the literature. Promising research and future directions include studies that consider a wide array of contextual factors and population heterogeneity.

Social Relationships and Salivary Telomere Length Among Middle-Aged and Older African American and White Adults

OBJECTIVES

A common mechanism underlying premature morbidity may be accelerated biological aging as reflected by salivary telomere length (STL). This study examined the extent to which social relationships, both positive and negative, can be protective or confer risk relative to biological aging.

METHOD

Data from the Health and Retirement Study and multiple regression were used to examine cross-sectional associations between STL, self-reported social support, and negative interaction (e.g., conflict, criticism) with family in a nationally representative sample of African American and non-Hispanic White middle-aged and older adults (N = 4,080).

RESULTS

Social support from family was associated with shorter STL. Negative interaction with family had no main effect on STL but interactions characterized by high social support and more frequent negative interactions were associated with longer STL. Negative interaction with family was negatively associated with STL for African Americans and Whites but the magnitude of the effect was greater for African Americans.

DISCUSSION

Study findings highlight the role of social relationships in physiological deterioration among middle-aged and older adults and identify a potential mechanism whereby race is linked to accelerated biological aging. Findings highlight the importance of considering positive and negative aspects of social relationships to understand the consequences of social connections for cellular aging in diverse populations.

Social stress, obesity, and depression among women: clarifying the role of physical activity

Objective: This study examined the role of stress in the association among physical activity, obesity, and depression among women. The extent to which physical activity moderated these relationships was also examined. Design: Data from the National Survey of American Life (N = 3235) and multivariable regression analyses were used to examine the effects of chronic stress, material hardship, racial discrimination, and physical activity on obesity and depression among African American, Caribbean Black and White women. Results: Stress was not related to body mass index (BMI) for African American or White women, but chronic stress was associated with higher BMI for Caribbean Black women. Stress was associated with depressive symptoms, but there was variation by the type of stressor under consideration. Physical activity was associated with fewer depressive symptoms and lower BMI, but the relationships varied by type of stressor and race/ethnicity. Physical activity moderated the effect of chronic stress on depressive symptoms and BMI, but only for African American women who reported high levels of chronic stress. Among White women, physical activity moderated the effect of racial discrimination on BMI for those who reported experiencing both high and low levels of discrimination. Conclusion: This study was the first to document physical activity as a moderator in the relationship among stress, depression, and obesity using a nationally representative sample of racially/ethnically diverse women. Findings provide insight into the role of stress in relation to depression and obesity while highlighting heterogeneity among Black Americans.

Discrimination, Serious Psychological Distress, and Church-Based Emotional Support Among African American Men Across the Life Span

Objective

This study tested whether church-based social support buffers the negative effects of discrimination on serious psychological distress (SPD) among three age groups-early, middle, and late adulthood-of African American men.

Methods

Negative binominal regression analyses for discrimination and SPD were performed using data from 1,271 African American men from the National Survey of American Life.

Results

Discrimination was positively associated with SPD for all age groups. An interaction between church-based support and discrimination indicated that under conditions of high levels of support from congregants, discrimination, and SPD were positively correlated. However, discrimination and SPD were unrelated for low levels of church-based support. Further, the interaction was significant for men aged 18-34 and 55 or older but not significant for men aged 35-54.

Discussion

This is the first study to document relationships among discrimination, SPD, and church-based support in a nationally representative sample of African American men. Overall, rather than revealing a stress-buffering function, findings were consistent with the resource mobilization perspective of social support, indicating that higher levels of assistance from church networks are provided when individuals experience high levels of both discrimination and SPD.

BrainWorks: A Comparative Effectiveness Trial to Examine Alzheimer's Disease Education for Community-Dwelling African Americans

OBJECTIVES

To test a culturally tailored intervention to improve Alzheimer's disease (AD) literacy among African Americans.

DESIGN

A 3-arm randomized comparative effectiveness trial.

SETTING

Community sites in Los Angeles, CA.

PARTICIPANTS

193 African American community-dwelling adults, ages 45 to 95 years old.

INTERVENTION

All groups attended BrainWorks Live, a culturally tailored, 60-minute talk show and received standard printed educational materials on AD. From there: a) the BrainWorks Live group received no further contact until the post-test; b) one intervention group received a 1-month, culturally tailored, unidirectional, daily text-message program; and c) a second intervention group received daily text messages based on the printed educational materials that the general public would receive. AD literacy was measured at baseline and one month post intervention.

MEASUREMENTS

Alzheimer's disease literacy and demographic and health covariates.

RESULTS

At one month, participants who received culturally tailored text messages had the highest increase in AD literacy levels, followed by those in the BrainWorks Live arm. Participants who received general text messages had a lower overall increase in AD literacy levels compared to the other arms, but had higher mean AD literacy levels than the BrainWorks Live arm. There was a significantly greater increase in AD literacy levels among participants who received culturally tailored text messages compared with those who attended BrainWorks Live only. There were no other statistically significant differences between arms.

CONCLUSIONS

AD literacy among African Americans can be improved after only one month through culturally competent, economically feasible educational formats.

Extended Family Support Networks of Caribbean Black Adults in the United States

This paper investigates the extended family social support networks of Caribbean Black adults (Afro Caribbeans). Although there are several ethnographic accounts of familial ties and support exchanges among Black Caribbean immigrants, only a handful of studies utilize quantitative data. This paper utilizes data from the National Survey of American Life, which contains the first national probability sample of Caribbean Blacks in the United States. Age, gender, income, material hardship and immigration status were all associated with at least one of the four indicators of family support networks. Subjective family closeness and frequency of family contact were significantly associated with both giving and receiving informal support. A significant age and parental status interaction for receiving support indicated that older adults without children received assistance from their extended families less frequently than older adults with children. Overall, study findings affirm the importance of extended family networks for Caribbean Black adults.

Family and Friendship Networks and Obsessive-Compulsive Disorder Among African Americans and Black Caribbeans

Although there is a large literature on the influence of social support on mental health there is limited research on social support and OCD. This is especially the case for African Americans and Black Caribbeans. This study examines the relationship between family and friendship networks and the prevalence of OCD. The analysis is based on the National Survey of American Life a nationally representative sample of African Americans and Black Caribbeans. Variables included frequency of contact with family and friends, subjective closeness with family and friends, and negative interactions (conflict, criticisms) with family members. The results indicated that only negative interaction with family members was significantly associated with OCD prevalence. African Americans and Black Caribbeans with more frequent negative interactions with family members had a higher likelihood of having OCD. Subjective closeness and frequency of contact with family and friends was not protective of OCD. Overall the findings are consistent with previous work which finds that social support is an inconsistent protective factor of psychiatric disorders, but negative interactions with support network members is more consistently associated with mental health problems.

Extended family and friendship support and suicidality among African Americans

PURPOSE

This study examined the relationship between informal social support from extended family and friends and suicidality among African Americans.

METHODS

Logistic regression analysis was based on a nationally representative sample of African Americans from the National Survey of American Life (N = 3263). Subjective closeness and frequency of contact with extended family and friends and negative family interaction were examined in relation to lifetime suicide ideation and attempts.

RESULTS

Subjective closeness to family and frequency of contact with friends were negatively associated with suicide ideation and attempts. Subjective closeness to friends and negative family interaction were positively associated with suicide ideation and attempts. Significant interactions between social support and negative interaction showed that social support buffers against the harmful effects of negative interaction on suicidality.

CONCLUSIONS

Findings are discussed in relation to the functions of positive and negative social ties in suicidality.

Financial Strain, Negative Interactions, and Mastery: Pathways to Mental Health Among Older African Americans

This study examines the impact of financial strain, social support, and negative interactions on depressive symptoms among African Americans and the role of mastery as a mediator in these relationships. Structural equation modeling and baseline data from the Americans' Changing Lives Study were used to test these relationships among a sample of African Americans aged 50 to 96 years (N = 583). Findings illustrate the mechanistic pathways whereby financial strain is associated with depressive symptoms. Moreover, the study findings give further credence to the notion that positive and negative aspects of social relationships are distinctive with respect to social status factors, financial strain, and their relationship to depressive symptoms. This research suggests that mastery is an important mechanism linking negative interaction to mental health. The collection of findings provide a number of provocative departures from research conducted primarily using White samples and identifies important areas of intervention with older African Americans.

Discrimination, mental health, and leukocyte telomere length among African American men

African American men in the US experience disparities across multiple health outcomes. A common mechanism underlying premature declines in health may be accelerated biological aging, as reflected by leukocyte telomere length (LTL). Racial discrimination, a qualitatively unique source of social stress reported by African American men, in tandem with poor mental health, may negatively impact LTL in this population. The current study examined cross-sectional associations between LTL, self-reported racial discrimination, and symptoms of depression and anxiety among 92 African American men 30-50 years of age. LTL was measured in kilobase pairs using quantitative polymerase chain reaction assay. Controlling for sociodemographic factors, greater anxiety symptoms were associated with shorter LTL (b=-0.029, standard error [SE]=0.014; p<0.05). There were no main effects of racial discrimination or depressive symptoms on LTL, but we found evidence for a significant interaction between the two (b=0.011, SE=0.005; p<0.05). Racial discrimination was associated with shorter LTL among those with lower levels of depressive symptoms. Findings from this study highlight the role of social stressors and individual-level psychological factors for physiologic deterioration among African American men. Consistent with research on other populations, greater anxiety may reflect elevated stress associated with shorter LTL. Racial discrimination may represent an additional source of social stress among African American men that has detrimental consequences for cellular aging among those with lower levels of depression.

Race and socioeconomic differences in obesity and depression among Black and non-Hispanic White Americans

Obesity and depression often co-occur; however, the association between these conditions is poorly understood, especially among racial/ethnic minority groups. Using multinomial logistic regression and data from the National Survey of American Life, the relationships between race, ethnicity, and sociodemographic factors to the joint classification of body mass index categories and depression among African Americans, Caribbean Blacks, and non-Hispanic Whites were examined. Differential risk for the combination of obesity and depression by sociodemographic status was found. Being African American, female, young, married, or having low income or education increases the risk for obesity without depression. Risk factors for obesity with depression include being female, young, married and having a low income. Race was not a significant predictor of obesity with depression relative to normal weight without depression status. However, racial differences were observed among the non-depressed. Non-depressed African Americans were more likely than non-depressed Whites or Caribbean Blacks to be obese.

Correlates of Emotional Support and Negative Interaction Among African Americans and Caribbean Blacks

This study explores the relationship of family and demographic factors to the frequency of receiving emotional support and the frequency of engaging in negative interactions with family members (i.e., criticism, burden, and being taken advantage of). The study uses the ambivalence framework and data from the National Survey of American Life, a national sample of African Americans and Caribbean Blacks (Caribbean Blacks). Overall, no significant differences were found between African Americans and Caribbean Blacks in the frequency of emotional support or negative interaction; several significant correlates (e.g., age, family closeness) were found for both groups. However, a number of unique associations were also demonstrated (e.g., marital status, frequency of family contact), indicating differences in the ways that these variables operate within the two populations. These and other findings are discussed in relation to the ambivalence framework and subgroup differences in family phenomena within the Black population.

DSM-IV 12-month and lifetime major depressive disorder and romantic relationships among African Americans

BACKGROUND

This brief report examines the association between marital and relationship status and 12-month and lifetime prevalence of major depressive disorder (MDD) among African Americans. Previous work has found that adults with major depressive disorder are less likely to be married or in a cohabiting relationship. This report extends previous research by investigating whether unmarried, non-cohabiting African Americans with depression are also less likely to be involved in a romantic relationship.

METHODS

Data are from the African American sub-sample (n=3570) of the National Survey of American Life (NSAL; 2001-2003). The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime MDD. Weighted logistic regression was used.

RESULTS

The findings indicate that for both 12-month and lifetime major depressive disorder, African Americans who are depressed are not only less likely to be married; they are also significantly less likely to be involved in a romantic relationship. This is particularly the case for 12-month depression.

LIMITATIONS

Due to limitations in the number of cohabiting respondents, currently married and cohabiting respondents were combined into a single category.

CONCLUSION

The findings of this brief report highlight the importance of changes in marital and relationship circumstances of the U.S. population for research and practice on depression and other psychiatric disorders. Our study provides evidence for a more nuanced approach in which examining marital and romantic relationship status together promotes a better understanding of the impact of major depression on romantic unions.

Demographic correlates of DSM-IV major depressive disorder among older African Americans, Black Caribbeans, and non-Hispanic Whites: results from the National Survey of American Life

OBJECTIVES

To examine the demographic correlates of lifetime and 12-month prevalence of major depressive disorder (MDD) among older African Americans, Black Caribbeans, and non-Hispanic Whites.

METHODS

Data are from adults aged 55 years and older (n = 1439) recruited to the National Survey of American Life (NSAL; 2001-2003). The Diagnostic and Statistical Manual Version IV World Mental Health Composite International Diagnostic Interview was used to assess the 12-month and lifetime MDD. Weighted logistic regression was used to model demographic correlates of MDD.

RESULTS

The population prevalence of lifetime and 12-month MDD were 11.2% and 4.1%, respectively. Bivariate analyses revealed that younger respondents and those with greater disability had a higher prevalence of both lifetime and 12-month MDD compared with those who were older and who had lower disability. Multivariable logistic regressions controlling for demographic characteristics revealed that non-Hispanic Whites had the greatest odds of lifetime MDD (OR = 2.27, 95% CI = 1.32, 3.93). Women had significantly greater odds of lifetime MDD compared with men (OR = 2.49, 95% CI = 1.14, 5.41); there were no gender differences in 12-month MDD. Other significant predictors of MDD were marital status and region of residence.

CONCLUSIONS

The distribution, correlates, and nature of associations with MDD vary as a function of whether we examined lifetime vs. 12-month MDD. Future work should account for within group differences among older adults with depression. Understanding MDD correlates and the nature of intergroup diversity can inform the identification of particularly vulnerable subgroups as well as appropriate treatment approaches.

Prevalence of lifetime DSM-IV affective disorders among older African Americans, Black Caribbeans, Latinos, Asians and non-Hispanic White people

OBJECTIVES

The purpose of this study is to estimate lifetime prevalence of seven psychiatric affective disorders for older non-Hispanic White people, African Americans, Caribbean Black people, Latinos, and Asian Americans and examine demographic, socioeconomic, and immigration correlates of those disorders.

DESIGN

Data are taken from the older sub-sample of the Collaborative Psychiatric Epidemiology Surveys. Selected measures of lifetime DSM-IV psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder, major depressive disorder, and dysthymia).

SETTING

Community epidemiologic survey.

PARTICIPANTS

Nationally representative sample of adults 55 years and older (n = 3046).

MEASUREMENTS

Disorders were assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview.

RESULTS

Major depressive disorder and social phobia were the two most prevalent disorders among the seven psychiatric conditions. Overall, non-Hispanic White people and Latinos consistently had higher prevalence rates of disorders, African Americans had lower prevalence of major depression and dysthymia, and Asian Americans were typically less likely to report affective disorders than those of their counterparts. There is variation across groups in the association of demographic, socioeconomic, and immigration variables with disorders.

CONCLUSIONS

This study furthers our understanding of the racial and ethnic differences in the prevalence of DSM-IV disorders among older adults and the correlates of those disorders. It highlights the importance of examining both between-group and within-group differences in disorders and the complexity of the mechanisms associated with differences across groups. Findings from this study underscore the need for future research that more clearly delineates subgroup differences and similarities.

Emotional support, negative interaction and major depressive disorder among African Americans and Caribbean Blacks: findings from the National Survey of American Life

OBJECTIVES

Few studies have examined the association between social support, negative interaction, and major depressive disorder among representative samples of racial and ethnic minority groups. This study investigates the relationship between emotional support and negative interaction with family members on lifetime major depressive disorder among African Americans and Caribbean Blacks.

METHOD

Cross-sectional epidemiologic data from the National Survey of American Life and multivariable logistic regression analyses were used to predict lifetime history of major depressive disorder and to examine the effect of perceived emotional support and negative interaction on major depressive disorder among 3,570 African Americans and 1,621 Caribbean Blacks aged 18 and older.

RESULTS

Multivariate analyses found that perceived emotional support was associated with lower odds of MDD for African Americans and Caribbean Blacks. Negative interaction with family was associated with greater odds of MDD for African Americans and Caribbean Blacks. Emotional support moderated the impact of negative interaction on MDD for Caribbean Blacks, but not for African Americans.

DISCUSSION

This is the first study to investigate the relationships between emotional support, negative interaction with family members and depressive disorder among African Americans and Caribbean Blacks. Negative interaction was a risk factor for depression and emotional support was a protective factor.

Racial discrimination, mood disorders, and cardiovascular disease among black americans

PURPOSE

To examine associations between racial discrimination, mood disorders, and cardiovascular disease (CVD) among Black Americans.

METHODS

Weighted logistic regression analyses were performed on a nationally representative sample of Black Americans (n = 5022) in the National Survey of American Life (NSAL; 2001-2003). Racial discrimination and CVD were assessed via self-report. Mood disorder was measured with the World Health Organization Composite International Diagnostic Interview.

RESULTS

Model-adjusted risk ratios (RRs) revealed that participants with a history of mood disorder had greater risk of CVD (RR, 1.28; 95% confidence interval (CI), 1.12-1.45). This relationship was found specifically among those younger than 50 years of age (RR, 1.56; 95% CI, 1.27-1.91). There was a significant interaction between racial discrimination and mood disorder in predicting CVD in the total (F = 2.86, 3 df, p = .047) and younger sample (F = 2.98, 3 df, p = .047). Participants with a history of mood disorder who reported high levels of racial discrimination had the greatest risk of CVD.

CONCLUSIONS

The association between racial discrimination and CVD is moderated by history of mood disorder. Future studies may examine pathways through which racial discrimination and mood disorders impact CVD risk among Black Americans.

Discrimination, attribution, and racial group identification: implications for psychological distress among Black Americans in the National Survey of American Life (2001-2003)

There is increasing evidence that experiencing discrimination may contribute to poor mental health among Black Americans. However, few studies have distinguished between discrimination attributed to race versus other forms of discrimination or have compared differences in their psychological implications. Using nationally representative data on 5,191 Black Americans in the National Survey of American Life (NSAL; 2001-2003), this study examined serious psychological distress (SPD) in relation to discrimination attributed to racial versus nonracial causes and also investigated whether racial group identification may be a buffer. We found that discrimination was associated with greater odds of SPD, regardless of attribution. Racial attributions were associated with higher odds of SPD compared with attributions to nonracial causes for each level of discrimination. High racial group identification buffered the negative effect of moderate levels of both racially and nonracially attributed discrimination. Our results provide evidence for the negative influence of discrimination on SPD among Black Americans and indicate that high racial group identification may somewhat mitigate their negative mental health effects. Our study suggests that discrimination and racial group identification should be addressed to protect against psychological distress among Black Americans.

Correlates of Psychological Distress and Major Depressive Disorder Among African American Men

This study examines the demographic correlates of depressive symptoms, serious psychological distress (SPD), and major depressive disorder (MDD; 12-month and lifetime prevalence) among a national sample of African American men. Analysis of the National Survey of American Life (NSAL) data set provides first-time substantiation of important demographic differences in depressive symptoms (measured by the Center for Epidemiological Studies Depression scale [CES-D]), SPD (measured by the K6), and 12-month and lifetime MDD among African American men. Findings illuminate the heterogeneity within the African American male population. Findings also demonstrate the need for additional research focusing on within-group differences and a comprehensive research and mental health promotion agenda that recognizes the importance of improving access to education and employment and promoting healthy coping behaviors, while acknowledging the larger social context in which African American men live.

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.

Do experiences of racial discrimination predict cardiovascular disease among African American men? The moderating role of internalized negative racial group attitudes

Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001-2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive racial group identity may help to improve cardiovascular health among African American men.

Emotional support, negative interaction and DSM IV lifetime disorders among older African Americans: findings from the National Survey of American Life (NSAL)

OBJECTIVES

Both emotional support and negative interaction with family members have been linked to mental health. However, few studies have examined the associations between emotional support and negative interaction and psychiatric disorders in late life. This study investigated the relationship between emotional support and negative interaction on lifetime prevalence of mood and anxiety disorders among older African Americans.

DESIGN

The analyses utilized the National Survey of American Life.

METHODS

Logistic regression and negative binomial regression analyses were used to examine the effect of emotional support and negative interaction with family members on the prevalence of lifetime DSM-IV mood and anxiety disorders.

PARTICIPANTS

Data from 786 African Americans aged 55 years and older were used.

MEASUREMENT

The DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to assess mental disorders. Three dependent variables were investigated: the prevalence of lifetime mood disorders, the prevalence of lifetime anxiety.

RESULTS

Multivariate analysis found that emotional support was not associated with any of the three dependent variables. Negative interaction was significantly and positively associated with the odds of having a lifetime mood disorder, a lifetime anxiety disorder and the number of lifetime mood and anxiety disorders.

CONCLUSIONS

This is the first study to investigate the relationships among emotional support, negative interaction with family members and psychiatric disorders among older African Americans. Negative interaction was a risk factor for mood and anxiety disorders among older African Americans, whereas emotional support was not significant.

Variation in the trajectories of depressive symptoms: results from the Americans' Changing Lives Study

This study examines the association between race and depressive symptoms over a 16-year study period. The analysis is based on the responses of 3485 African-American and White respondents from four waves of the Americans' Changing Lives Panel Study. Growth mixture modeling was used to identify latent trajectory classes based on the reported levels of depressive symptoms over 16 years. Four latent trajectory classes were identified: two "high-risk" groups and two "low-risk" groups. Findings show the heterogeneity among and within racial groups in their trajectories of depressive symptoms and the distinct demographic and social relationship predictors for symptom trajectories.

Demographic Correlates of Psychological Well-Being and Distress Among Older African Americans and Caribbean Black Adults

This study examines the demographic correlates of psychological distress and psychological well-being among older African American and black Caribbean adults. Analysis of the National Survey of American Life revealed that psychological well-being and psychological distress are distinct concepts. Findings also identify distinct correlates of psychological well-being (e.g., happiness, life satisfaction, self-rated mental health) and psychological distress (e.g., depressive symptoms, serious psychological distress) across and within racial and ethnic groups. Findings demonstrate the heterogeneity within the older black American population and provide a rare detailed examination of the differences between the correlates of psychological well-being and psychological distress among older adults. Practice implications highlight the need for targeted interventions that more precisely identify groups at elevated risk for poor mental health and lower psychological well-being, increased research focusing on within-group differences, and attention to the impact of immigration on social work training and interventions with individuals, families, and communities.

Discriminatory Experiences and Depressive Symptoms among African American Women: Do Skin Tone and Mastery Matter?

We apply structural equation modeling techniques to data from the National Survey of American Life to investigate the relationship between perceived discrimination and depressive symptoms among African American women ages 18-98 years (N=2,299). In addition, we evaluate whether or not personal mastery accounts for the intensity of African American women's psychological response to discrimination and whether or not exposure to discrimination varies by skin complexion. Findings reveal that discrimination is a major threat to African American women's mental health. They are vulnerable to discrimination, in part, because discrimination undermines their beliefs in mastery making them less psychologically resilient. Experiences of discrimination do not differ by complexion. We conclude that complexion does not matter, but mastery does.

Personality, Negative Interactions, and Mental Health

Research suggests that an individual's personality traits may mediate the relationship between social support and mental health. This study uses two national data sets to test a conceptual model that integrates personality, social support, negative interactions, and psychological distress. Results suggest that, beyond the influence of personality, social support is negatively associated with psychological distress, and negative interactions are positively associated with such distress. The findings also suggest that personality has direct and indirect effects, through social support and negative interactions, on psychological distress. Findings specify how positive and negative facets of relationships and personality influence mental health outcomes.

Marital Satisfaction Among African Americans and Black Caribbeans: Findings From the National Survey of American Life

This study examines the correlates of marital satisfaction using data from a national probability sample of African Americans (N = 962) and Black Caribbeans (N = 560). Findings reveal differences between African Americans and Black Caribbeans, and men and women within those groups, in the predictors of marital satisfaction. Black Caribbean women reported overall higher levels of marital satisfaction than African American women. The findings amply demonstrate the significance of ethnic diversity within the Black population in the United States. Difficulties with finances (budgeting, credit issues, and debt management) are one of the key issues that generate conflict in marriages; stress generated as a result of financial problems can lower marital satisfaction. Because these issues are salient for couples at any given time in the family life cycle, counseling at critical points in the marriage (birth of children, launching of children from home, and retirement) may be helpful.

Romantic Relationships Among Unmarried African Americans and Caribbean Blacks: Findings From the National Survey of American Life

This study investigated the correlates of relationship satisfaction, marriage expectations, and relationship longevity among unmarried African American and Black Caribbean (Caribbean Black) adults who are in a romantic relationship. The study used data from the National Survey of American Life, a national representative sample of African Americans and Caribbean Blacks in the United States. The findings indicated that the correlates of relationship satisfaction, expectations of marriage, and relationship longevity were different for African Americans and Black Caribbeans. For Black Caribbeans, indicators of socioeconomic status were particularly important correlates of relationship satisfaction. For African Americans, indicators of parental status were important for relationship longevity. Policy and practice implications for nonmarital unions are discussed.

Religious Coping Among African Americans, Caribbean Blacks and Non-Hispanic Whites

This study examined demographic predictors of attitudes regarding religious coping (i.e., prayer during stressful times and look to God for support, strength and guidance) within a national sample of African American, Caribbean Blacks and non-Hispanic Whites (National Survey of American Life). The findings demonstrate significant Black-White differences in attitudes regarding religious coping with higher endorsements of religious coping among African Americans and Black Caribbeans (Caribbean Blacks). Comparisons of African Americans and Black Caribbeans revealed both similar and divergent patterns of demographic effects. For both African Americans and Black Caribbeans, women were more likely to utilize religious coping than men and married respondents were more likely than never married respondents to report utilizing prayer when dealing with a stressful situation. Further, for both groups, higher levels of education were associated with lower endorsements of the importance of prayer in dealing with stressful situations. Among African Americans only, Southerners were more likely than respondents who resided in other regions to endorse religious coping. Among Black Caribbeans, those who emigrated from Haiti were more likely than Jamaicans to utilize religious coping when dealing with a stressful episode.

Social Support, Traumatic Events, and Depressive Symptoms Among African Americans

Structural equation modeling was used to examine the relationships among stress, social support, negative interaction, and mental health in a sample of African American men and women between ages 18 and 54 (N = 591) from the National Comorbidity Study. The study findings indicated that social support decreased the number of depressive symptoms, did not mitigate the effects of stress, and was reduced in response to financial strain. Financial strain and traumatic events were associated with increased negative interaction with relatives and depressive symptoms. The findings verify that stressful and traumatic events have direct influences on levels of depressive symptoms and affect the quality of social interactions and suggest how social interaction processes contribute to mental health.

Correlates of emotional support and negative interaction among older Black Americans

OBJECTIVES

The study investigates the social and demographic, personality and social contact correlates of emotional support and negative interaction among older Black Americans.

METHODS

The present analyses are based on the responses of 519 older African American respondents (55-96 years old) from the Americans' Changing Lives Survey. Structural equation modeling (e.g., LISREL) was used to estimate the direct and indirect effects of sociodemographic variables (i.e., age, gender, education, income, marital status, and presence of children), social contact factors (i.e., frequency of face-to-face and telephone contact), and personality (i.e., extraversion and neuroticism) on emotional support and negative interaction with relatives and friends.

RESULTS

Gender, marital status, and extraversion were significantly associated with emotional support. Age, education, marital status, having a child, and neuroticism were identified as correlates of negative interaction.

DISCUSSION

The majority of older Black adults in this sample participated in emotionally supportive relations with relatives and friends, whereas negative social interactions were reported with less frequency. The distinctive group of predictors explaining emotional support and negative interaction suggests that they are different social occurrences. This analysis particularly underscores the role of personality factors in these processes.

Social Support, Negative Social Interactions, and Psychological Well-Being

Research examining the relationship between social support and psychological well-being has largely ignored the negative side of social interactions. However, empirical evidence suggests that negative interactions can potentially be more harmful than social support is helpful. This article critically reviews the literature investigating the relationship between social support and negative social interactions and their simultaneous effect on psychological well-being. A review of 28 studies revealed that there are conceptual, theoretical, and methodological limitations associated with this body of research. In order to unravel some of these limitations, studies are grouped according to three conceptual models: the additive effects model, the moderator model, and the domain-specific model. Finally, the article discusses directions social work practice research should take to tackle and fully appreciate the complexities of the relationship between social support and psychological well-being.

Mental health services in faith communities: the role of clergy in black churches

A small but growing literature recognizes the varied roles that clergy play in identifying and addressing mental health needs in their congregations. Although the role of the clergy in mental health services delivery has not been studied extensively, a few investigations have attempted a systematic examination of this area. This article examines the research, highlighting available information with regard to the process by which mental health needs are identified and addressed by faith communities. Areas and issues where additional information is needed also are discussed. Other topics addressed include client characteristics and factors associated with the use of ministers for personal problems, the role of ministers in mental health services delivery, factors related to the development of church-based programs and service delivery systems, and models that link churches and formal services agencies. A concluding section describes barriers to and constraints against effective partnerships between churches, formal services agencies, and the broader practice of social work.