Neuropsychological impairment in racial/ethnic minorities with HIV infection and low literacy levels: effects of education and reading level in participant characterization.

Educational attainment is an important factor in the interpretation of cognitive test scores but years of education are not necessarily synonymous with educational quality among racial/ethnic minority populations. This study investigated the comparability of educational attainment with reading level and examined whether discrepancies in education and reading level accounted for differences in neuropsychological test performance between HIV+ racial/ethnic minority and nonminority participants. Study participants (N=200) were derived from the Manhattan HIV Brain Bank (MHBB) where 50% of the cohort had < or =8th grade reading level but only 5% had < or =8 years of education. Significantly lower reading ability and education was found among African Americans and Hispanics, and these participants were more likely to have discrepant reading and education levels compared to non-Hispanic Whites. Discrepancy in reading and education level was associated with worse neuropsychological performance while racial/ethnic minority status was not. As years of schooling overestimated racial/ethnic minority participants' educational quality, standard norms based on education may inflate impairment rates among racial/ethnic minorities. Identifying appropriate normative standards is and will continue to be important in the detection of cognitive impairment in racial/ethnic minorities with HIV.     

Racial/ethnic differences in 12-month prevalence and persistence of mood,anxiety, and substance use disorders: Variation by nativity and socioeconomic status

BackgroundDespite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders.MethodData were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence.ResultsNon-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels.ConclusionNativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.     

Prevalence, patterns, and correlates of co-occurring substance use and mental disorders in the United States: variations by race/ethnicity

ObjectiveThis study examines racial/ethnic differences in the prevalence, patterns, and correlates of co-occurring substance use and mental disorders (COD) among Whites, Blacks, Latinos, and Asians using data from the Collaborative Psychiatric Epidemiology Studies.MethodWe first estimated the prevalence of various combinations of different co-occurring depressive and anxiety disorders among respondents with alcohol, drug, and any substance use (alcohol or drug) disorders in each racial/ethnic group. We then estimated the prevalence of different patterns of onset and different psychosocial correlates among individuals with COD of different racial/ethnic groups. We used weighted linear and logistic regression analysis controlling for key demographics to test the effect of race/ethnicity. Tests of differences between specific racial/ethnic subgroups were only conducted if the overall test of race was significant.ResultsRates of COD varied significantly by race/ethnicity. Approximately 8.2% of Whites, 5.4% of Blacks, 5.8% of Latinos, and 2.1% of Asians met criteria for lifetime COD. Whites were more likely than persons in each of the other groups to have lifetime COD. Irrespective of race/ethnicity, most of those with COD reported that symptoms of mental disorders occurred before symptoms of substance use disorders. Only rates of unemployment and history of psychiatric hospitalization among individuals with COD were found to vary significantly by racial/ethnic group.ConclusionsOur findings underscore the need to further examine the factors underlying differences between minority and nonminority individuals with COD as well as how these differences might affect help seeking and utilization of substance abuse and mental health services.     

Reading level attenuates differences in neuropsychological test performance between African American and White elders.

The current study sought to determine if discrepancies in quality of education could explain differences in cognitive test scores between African American and White elders matched on years of education. A comprehensive neuropsychological battery was administered to a sample of African American and non-Hispanic White participants in an epidemiological study of normal aging and dementia in the Northern Manhattan community. All participants were diagnosed as nondemented by a neurologist, and had no history of Parkinson's disease, stroke, mental illness, or head injury. The Reading Recognition subtest from the Wide Range Achievement Test-Version 3 was used as an estimate of quality of education. A MANOVA revealed that African American elders obtained significantly lower scores than Whites on measures of word list learning and memory, figure memory, abstract reasoning, fluency, and visuospatial skill even though the groups were matched on years of education. However, after adjusting the scores for WRAT-3 reading score, the overall effect of race was greatly reduced and racial differences on all tests (except category fluency and a drawing measure) became nonsignificant. These findings suggest that years of education is an inadequate measure of the educational experience among multicultural elders, and that adjusting for quality of education may improve the specificity of certain neuropsychological measures.     

Interethnic differences in dementia epidemiology: global and Asia-Pacific perspectives

The burden of dementia will continue to rise globally, particularly in developing countries, many of which lie in the Asia-Pacific region. It was initially thought that both prevalence and incidence of dementia showed little geographic variation. More recent work has suggested differences: migrant populations attain rates between their homelands and adopted countries, and higher rates have been found in African Americans and Hispanics compared to Caucasian Whites, and also among native Australians. The only interethnic studies in the Asia-Pacific region were performed in Singapore, which showed lower standardized prevalence among ethnic Chinese compared to ethnic Malays and Indians, independent of vascular risk factors. There was conflicting information about the relative frequencies of Alzheimer's disease and vascular dementia between ethnic groups in Singapore. More research, with careful attention to potential cultural confounders, is needed to further explore and better understand interethnic differences in dementia epidemiology.     

Racial/Ethnic Differences in the Association Between Symptoms of Depression and Self-rated Mental Health Among Older Adults

The study examined racial/ethnic differences in the association between symptoms of depression and self-rated mental health among older adults. Data came from the first wave of the National Social Life, Health, and Aging Project, a population-based study of non-institutionalized older adults aged 57 to 85. The sample consisted of non-Hispanic Whites (n = 2,110), Blacks (n = 509), and Hispanics (n = 304). The association between symptoms of depression and self-rated mental health was weaker among minority groups than that among non-Hispanic Whites. Tests of interaction effects showed that the predictability of depressive symptoms to self-rated mental health was substantially weakened among Blacks of advanced ages and Hispanics with multiple chronic conditions. The study explored potential sources of racial/ethnic differences in subjective reports of mental health and called attention to older minorities with advanced ages and cormorbid conditions in mental health services and interventions.     

Differences in mental health outcomes among Whites, African Americans, and Hispanics following a community disaster

A number of studies have assessed the association between race and ethnicity and psychological health status following exposure to a stressful event. However, some of these studies indicate racial and ethnic minorities have poorer mental health relative to Whites, while others show no differences or that minorities may actually have better psychological health. One year after the terrorist attacks on the World Trade Center, we collected data on a random sample of city residents (N = 2368). The dependent variables were posttraumatic stress disorder (PTSD), PTSD symptom severity, major depression, panic attack, and general physical and mental well-being. We categorized our respondents as Non-Hispanic White, Non-Hispanic African American, Dominican, Puerto Rican, and Other Hispanics. Bivariate results indicated racial/ethnic differences for PTSD symptom severity, depression, general physical and mental health, and panic attack. Using logistic regression and controlling for possible confounding factors, most of these associations were rendered non-significant. That is, we found no post-disaster racial/ethnic differences for PTSD, PTSD symptom severity, or physical health. African Americans and Other Hispanics were less likely to meet criteria for major depression or to be classified as unhealthy on the self-report SF-12 mental health scale compared to Whites. Only for panic attack were African Americans and Puerto Ricans more likely to meet criteria for this outcome. Thus, our study found little support for the hypothesis that Latinos or African Americans consistently suffered from poorer psychological and physical well-being in the aftermath of traumatic events, relative to Whites.     

Ethnic minority elders: are they neglected in published geriatric psychiatry literature?

ABSTRACTBackground: The population size of the elderly from ethnic minority groups in many developing countries is rapidly increasing. The authors perceived a paucity of publications in the geriatric psychiatry literature pertaining to ethnic minority elders.Methods: A study examining the proportion of research publications pertaining to ethnic minority elders in two leading geriatric psychiatry journals, International Psychogeriatrics and International Journal of Geriatric Psychiatry, was undertaken.Results: The main findings were: (1) overall only 7.6% of the publications examined ethnic minority elders; (2) only 5.1% of publications were exclusively of ethnic minority elderly groups; and, (3) only 2.5% of publications included ethnic minority elderly groups in their overall sample.Conclusions: Findings from studies, such as epidemiological studies of risk factors for mental disorders in old age and randomized controlled studies of treatment interventions, which exclude ethnic minority elders, cannot be assumed to apply to these groups. Researchers, research institutions, funding organizations and policy-makers should acknowledge the rising numbers of ethnic minority elders and recognize the importance of using ethnic minority-specific research data in the planning of culturally sensitive services and mental health promotion programs.     

Racial/Ethnic Differences in Parental Endorsement of Barriers to Mental Health Services for Youth

The present study investigated parental endorsement of barriers to care in a racially/ethnically diverse, at-risk sample of youth with mental health needs by testing the following hypotheses: (1) African American, Asian/Pacific Islander American, and Latino youth would have higher levels of unmet need compared to Non-Hispanic Whites (NHWs); (2) Parents of ethnic minority youth would report a greater number of barriers to mental health services for their children than would parents of NHWs; (3) The pattern of greater barrier endorsement by parents of ethnic minorities compared to parents of NHWs would persist across different barrier types; (4) Barrier endorsement would be related to unmet need for mental health services. As hypothesized, ethnic minority youth had higher levels of unmet need as compared to NHWs. However, despite this finding, parents of ethnic minority youth reported fewer barriers than did parents of NHWs, and this pattern generally persisted across barrier types. Furthermore, barrier endorsement was unrelated to unmet need. Post hoc analyses suggest the influence of cultural factors upon barrier endorsement, indicating the importance of taking such influences into account in future research on barriers to care.     

Relationship between discourse and Western Aphasia Battery performance in African Americans with aphasia

Background: There is a need for discourse research with African Americans who have aphasia, highlighted by ethnic group differences in stroke prevalence, and potential ethnic group differences in dialect. Identification of ethnic dialect is critical to differentiate communication changes associated with pathology from normal communicative differences associated with ethnicity. Also, preliminary research on adults with aphasia indicates an uncertain relationship between discourse performance and standardised test performance. Aims: This study was designed to assess: (1) the relationship between performance on a standardised language measure and discourse performance, and (2) the use of ethnic dialect and discourse features, in the narrative productions of African-American adults with moderate aphasia on a variety of discourse tasks. Methods & Procedures: We investigated the discourse of 12 African Americans with scores in the moderate severity range on the Western Aphasia Battery, Aphasia Quotient (WAB-AQ). Each subject produced a fable retell, a story derived from a picture sequence, two stories derived from single pictures, and a topic-elicited personal narrative of a frightening experience. Analysis consisted of ratings of discourse quality (coherence, reference, and emplotment); a measure of discourse quantity (number of propositions); and a tally of the presence or absence of ethnic dialect and discourse features. Outcomes & Results: The correlation between WAB-AQ and discourse quality was statistically significant on the picture sequence task and one single-picture task, but not on the other discourse tasks. There was a significant relationship between WAB-AQ and overall quality ratings of coherence, reference, and emplotment. The correlation between WAB-AQ and discourse quantity was not significant for any task, and discourse quality was not significantly correlated with discourse quantity. Ethnic features appeared most often on one single-picture task and the personal narrative. No ethnic dialect features occurred on the fable retell. Conclusions : These findings suggest the need to supplement standardised assessment of aphasia with assessment of discourse performance, using less structured discourse tasks, such as a personal narrative task. Less structured discourse tasks may also be optimal for eliciting natural ethnic patterns of communication. The lack of relationship between narrative quantity and narrative quality may not generalise to individuals with aphasia that is severe or mild. This study contributes towards development of a discourse assessment tool for culturally and linguistically diverse populations that may supplement information provided by standardised testing.     

Differential effects of perceived discrimination on the diurnal cortisol rhythm of African Americans and Whites

The current study considered the influence of perceived discrimination on the diurnal cortisol rhythm of 50 African American older adults and a matched comparison groups of 100 Whites (M(age)=56.6; 58% female). The role of socioeconomic status (SES) as a moderator of the effects of discrimination on the diurnal decline was also considered for each group. In support of the idea that perceptions of unfair treatment take on a unique meaning for stigmatized minority groups, results suggest that perceived discrimination is associated with a flatter (less healthy) diurnal slope among Whites but a steeper (more healthy) diurnal slope among African Americans. Perceived discrimination was also found to be more strongly associated with a steepening of the diurnal slope among lower SES African Americans than higher SES African Americans.     

Disentangling the effects of race and SES on arthritis-related symptoms, coping, and well-being in African American and White women

This study examined both unique and interactive effects of race and socioeconomic status (SES) on arthritis-related symptoms, coping, and well-being in African American and White women. Participants included 77 African American and 98 White women, aged 45 to 90, who completed structured, face-to-face interviews. A series of 2 x 2 MANCOVAs examined race (African American, White) and SES (high/low education or high/low occupational status) differences in arthritis-related symptoms, coping, and well-being. African Americans used more religious coping, wishful-thinking, seeking social support, and emotional expression than Whites. Individuals with low SES reported worse arthritis-related symptoms, poorer well-being, and greater use of coping strategies that tend to be maladaptive. Race x SES interactions revealed higher depressive symptoms in African Americans with low versus high education and coping differences in African Americans with low versus high occupational status; however differences in depressive symptoms and coping based on SES were not evident for Whites. Results demonstrate unique and interactive race and SES differences for arthritis-related symptoms, coping, and well-being showing the complexity of race and SES in the realm of physical and mental health.     

Psychological well-being in Black Caribbean,Black African,and White adolescents in the UK Medical Research Council DASH study

BACKGROUND: It is not known if adolescents from diverse groups of Black African origin experience similar or different psychological well-being. AIMS: To examine adolescent self-report of psychological well-being among Black African and White UK origin groups and to assess the extent to which family type and social deprivation influence any ethnic differences. METHOD: The 25-item Strengths and Difficulties Questionnaire (SDQ) was used to assess psychological well-being in a study of 6,632 11-13 year-olds in 51 schools in London. RESULTS: Overall, family type (but not material deprivation) was an important independent correlate of psychological well-being. Nigerian/Ghanaian boys reported the lowest mean Total Difficulties Score (TDS) compared to White boys (regression coefficient (95% CI) -2.09 (-2.83, -1.35) p < 0.001). They also had significantly higher mean pro-social behaviour score, and were at reduced risk of a high (i.e., likely psychological distress) TDS score. TDS was also significantly lower than Whites for other African boys and girls. Other African and mixed ethnicities were protective factors against risk of psychological distress for girls. CONCLUSIONS: Black African boys and other African boys and girls reported the most favourable psychological well-being scores. The influence of family type on mental health may operate differently for girls compared to boys and for Africans compared to other ethnic groups.     

Ethnic identity in college students from four ethnic groups

Research on adolescent identity development within Erikson's (1968) framework has not included ethnicity. This study examined ethnic identity search and commitment, the importance of ethnicity as an identity issue, and relationship of ethnic identity to self-esteem among college students. Questionnaires were given to 196 male and female urban college students from three minority groups (Asian-American, Black, and Mexican-American) and a comparison White group. Exploration of ethnic identity issues was significantly higher among minority group, compared to majority group, college students. Ethnicity was considered to be as important as two other traditionally studied areas of identity and was rated as significantly more important by minorities than by Whites. Self-esteem, especially for minority subjects was related to the extent that subjects had thought about and resolved issues involving their ethnicity.     

Letter cancellation performance across the adult life span

Letter cancellation tasks are paper and pencil tests widely used in clinical and research settings as quick measures of attention/concentration, visual-spatial scanning abilities, and visual-spatial dysfunctions such as spatial neglect. Despite their popularity, only a few studies have investigated effects of age on letter cancellation performance and no comprehensive large-scale adult life-span norms are available for any of the letter cancellation tasks. We have developed a letter cancellation test, and we report a normative data obtained from a partially stratified sample of 351 healthy adults between 18 and 91 years of age. The results show the expected large age-related decline in the speed of letter cancellation performance and no age-related differences in spatial distribution of cancellation errors. We also provide various equations for precise predictions of Cancel H test performance. The results of correlational analyses show high reliability and provide evidence for both convergent and divergent validity of our letter cancellation task.     

Racial differences in the frequency of depressive symptoms among community dwelling elders: the role of socioeconomic factors

In a biracial sample of community dwelling elders (n=4162, the Duke EPESE), African-Americans endorsed more items than Whites on a standardized depression scale, the CES-D, in unadjusted, cross-sectional analyses. However, indices of socioeconomic status (e.g., education and problems meeting needs) were found to mediate the relationship between race and depression. When these socioeconomic variables were included in cross-sectional analyses, the association between depressive symptoms and race reversed such that Whites were significantly more likely to endorse depressive symptoms than African-Americans. Further, whereas in unadjusted, longitudinal analyses, race was unrelated to changes in depressive symptoms over time, with the inclusion of the socioeconomic variables Whites were found to endorse more depressive symptoms than African-Americans. We conclude that socioeconomic variables influence the size and direction of racial differences in the endorsement of depressive symptoms in community dwelling elders.     

Education correction using years in school or reading grade-level equivalent? Comparing the accuracy of two methods in diagnosing HIV-associated neurocognitive impairment.

Neuropsychological tests generally require adjustments for years of education when determining the presence of neurocognitive impairment. However, evidence indicates that educational quality, as assessed with reading tests, may be a better reflection of educational attainment among African Americans. Thus, African Americans with poor educational quality may be incorrectly classified with neurocognitive impairment based on neuropsychological tests. We compared the accuracy of neuropsychological test scores standardized using reading grade-equivalent versus years of education in predicting neurocognitive impairment among a sample of Whites and African-American adults who were HIV+. Participants were examined by a neurologist and classified with or without HIV-associated neurocognitive disorders according to accepted criteria. Participants were also classified as impaired versus not impaired based on their neuropsychological test scores standardized by 1) self-reported education or 2) WRAT-3 reading grade-level. Cross tabulation tables were used to determine agreement of the two methods in detecting impairment. Among African-Americans, standardized scores derived from reading scores had greater specificity than those derived from years of education (84.1% vs. 77.3). Among the Whites, correction based on years of education had both greater specificity and sensitivity. The results suggest that reading tests may be a useful alternative for determining NCI among African Americans.     

Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: findings from Project EAT

OBJECTIVE: To compare weight-related concerns and behaviors across ethnicity/race among a population-based sample of adolescent boys and girls. METHODS: The study population included 4746 adolescents from urban public schools in the state of Minnesota who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers. Main outcome measures included measured body mass index (BMI), weight-related concerns (perceived weight status, weight disparity, body satisfaction and attitudes about weight control) and weight-related behaviors (general/specific weight control behaviors and binge eating). RESULTS: In comparison to White girls, African American girls tended to report fewer weight-related concerns/behaviors, while Hispanic, Asian American and Native American girls tended to report similar or more concerns/behaviors. Among boys, weight-related concerns/behaviors were equally or more prevalent among all non-Whites than among Whites. In particular, African American and Asian American boys were at greater risk for potentially harmful weight-related concerns/behaviors than White boys. CONCLUSIONS: Weight-related concerns and behaviors are prevalent among adolescents, regardless of their ethnic/racial background, indicating a need for prevention and treatment efforts that reach adolescents of different ethnic backgrounds. However, ethnic differences demonstrate a need for ensuring that the specific needs of different groups are addressed in the development of such interventions.     

Ethnicity and dementia

A large number of studies have examined both the epidemiology and neuropsychiatric manifestations of dementia among older adults. However, there is a relative dearth of studies focusing on ethnic minority elders in the United States. This article reviews the existing empiric literature in the area of ethnicity and dementia. For the purpose of this paper, the focus will be on Hispanics and black Americans, the two most prevalent ethnic minority populations in the United States. This review includes discussion of terminology issues, diagnosis, epidemiology, and clinical features, in addition to caregiver issues.     

Further Consideration of the “Cold,Sick” Husband

Abstract

A number of studies have assessed the association between race and ethnicity and psychological health status following exposure to a stressful event. However, some of these studies indicate racial and ethnic minorities have poorer mental health relative to Whites, while others show no differences or that minorities may actually have better psychological health. One year after the terrorist attacks on the World Trade Center, we collected data on a random sample of city residents (N = 2368). The dependent variables were posttraumatic stress disorder (PTSD), PTSD symptom severity, major depression, panic attack, and general physical and mental well—being. We categorized our respondents as Non—Hispanic White, Non—Hispanic African American, Dominican, Puerto Rican, and Other Hispanics. Bivariate results indicated racial/ethnic differences for PTSD symptom severity, depression, general physical and mental health, and panic attack. Using logistic regression and controlling for possible confounding factors, most of these associations were rendered non—significant. That is, we found no post-disaster racial/ethnic differences for PTSD, PTSD symptom severity, or physical health. African Americans and Other Hispanics were less likely to meet criteria for major depression or to be classified as unhealthy on the self—report SF—12 mental health scale compared to Whites. Only for panic attack were African Americans and Puerto Ricans more likely to meet criteria for this outcome. Thus, our study found little support for the hypothesis that Latinos or African Americans consistently suffered from poorer psychological and physical well—being in the aftermath of traumatic events, relative to Whites.