Religiosity,spirituality, and help‐seeking among Filipino Americans: Religious clergy or mental health professionals?

Data from structured interviews with 2,285 respondents for the Filipino American Community Epidemiological Survey (FACES) were used to examine help‐seeking for emotional distress among Filipino Americans. The influence of religious affiliation, religiosity, and spirituality upon help‐seeking from religious clergy and mental health professionals was assessed after controlling for need (e.g., negative life events, SCL‐90R scores, and somatic symptoms), demographic (e.g., age, gender, marital status, education, county of residence, generational status, and insurance coverage), and cultural variables (e.g., loss of face and language abilities). Rates of help‐seeking from religious clergy versus mental health professionals were comparable (2.5% vs. 2.9%). High religiosity was associated with more help‐seeking from religious clergy but not less help‐seeking from mental health professionals, whereas high spirituality was associated with less mental health help‐seeking. Implications for understanding how religious variables affect help‐seeking were explored. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 675–689, 2004.     

Renal disease disparities in Asian and Pacific-based populations in Hawai'i

The prevalence of end-stage renal disease (ESRD) in the United States is expected to double over the next 10 years. The identification of ethnic differences in the prevalence, treatment, morbidity, and mortality related to chronic kidney disease (CKD) is of great concern. Asian Americans comprise a rapidly expanding sector of the U.S. population and are reported to have ESRD growth rates that are approximately 50% higher than caucasians. Hawai'i has a large, well-established Asian and Pacific-based population that facilitates the examination of disparities in renal disease among the state's diverse ethnic groups. The prevalence of ESRD in Hawai'i has continued to rise due, in part, to high rates of diabetes, glomerulonephritis, and hypertension reported in Asian Americans and Pacific-based populations. ESRD patients in Hawai'i have a two-fold higher prevalence of glomerulonephritis, compared with the general ESRD population in the United States. Other potential sources of renal disparities-such as cultural factors, language barriers, and health access factors-among Hawaii's major ethnic groups are assessed. However, few studies have examined the relative contribution of these potential factors. Consequently, efforts to reduce and eventually eliminate renal disease disparities will require a better understanding of the major sources of health disparities, such as timely medical care, a diverse health workforce, and cultural/social barriers, that affect optimal health care practices in Asian and Pacific-based populations.     

Barriers to mental health care utilization for U.S. Cambodian refugees

Asian Americans encounter barriers to mental health care, some of which are structural, whereas others may be cultural. Using data from a probability sample (N = 490) drawn from the largest Cambodian refugee community in the United States, the authors assessed the extent to which structural and cultural barriers were experienced. Surprisingly, a relatively small proportion endorsed commonly cited cultural barriers such as distrust of Western care (4%) and greater confidence in alternative care (5%), whereas most endorsed structural barriers such as high cost (80%) and language (66%). Among those with a probable diagnosis, a similar pattern was found. Findings suggest that structural, not culturally based, barriers are the most critical obstacles to care in this U.S. Cambodian refugee community.     

Community mental health services for ethnic minority groups: a test of the cultural responsiveness hypothesis

This study investigated services received, length of treatment, and outcomes of thousands of Asian-American, African-American, Mexican-American, and White clients using outpatient services in the Los Angeles County mental health system. It tested the hypothesis that therapist-client matches in ethnicity and language are beneficial to clients. Results indicate that Asian Americans and Mexican Americans underutilized, whereas African Americans overutilized, services. African Americans also exhibited less positive treatment outcomes. Furthermore, ethnic match was related to length of treatment for all groups. It was associated with treatment outcomes for Mexican Americans. Among clients who did not speak English as a primary language, ethnic and language match was a predictor of length and outcome of treatment. Thus, the cultural responsiveness hypothesis was partially supported.     

Culturally-Competent Treatments for Asian Americans: The Relevance of Mindfulness and Acceptance-Based Psychotherapies

The development of effective treatments for Asian Americans is important because treatment disparities continue to exist for this population. Because of their theoretical grounding in East Asian philosophies, mindfulness and acceptance-based psychotherapies appear to constitute promising ways to provide culturally responsive mental health care to Asian Americans. However, in practice these approaches often reflect conceptions of mental health that are more consistent with Western world views. We review points of intersection and divergence between Western-based mindfulness and acceptance psychotherapies and Asian American cultural values. We then propose a culturally syntonic approach that accentuates certain components of mindfulness and acceptance psychotherapies and adapts other components of these approaches to be more consistent with Asian American cultural values.     

The factor structure of a short acculturation scale for Filipino Americans in an adult U.S.‐born sample

The influx of non‐European immigrants since 1965 ushered the development and use of acculturation measures in immigrant health studies. A Short Acculturation Scale for Filipino Americans (ASASFA) represents a validated, unidirectional ethnic‐specific measure used with first‐generation FAs. ASASFA's psychometric properties with adult U.S.‐born children—the second generation—remain unexplored. This study determined (a) the factor structure of ASASFA with adult U.S.‐born FAs and (b) the predictors of their acculturation scores. A secondary analysis was conducted on ASASFA data from a mental health survey of 116 U.S.‐born FAs. Exploratory factor and parallel analyses showed a two‐factor solution: language use and preference (Factor 1) and ethnic social relations (Factor 2). Ordinary least squares regression indicated gender and ethnic self‐identification predict Factor 1 scores; self‐identification solely predicts Factor 2 scores. Results demonstrate ASASFA's validity and parsimony, supporting its use in FA health studies when lengthy bidirectional acculturation measures become impractical.     

Alcohol Dependence and Health Care Utilization in African Americans

ObjectiveEthnic and cultural differences in patterns of alcohol use disorders must be understood in order to address improvement in prevention of such disorders and accessibility to health care services. The purpose of this study was to evaluate factors that influence the utilization of medical and mental health services among alcohol-dependent and non–alcohol-dependent African Americans.MethodA cohort of 454 African Americans was evaluated. Alcohol-dependent participants were recruited from various inpatient treatment facilities in the Washington, DC, metropolitan area and through advertisement and word of mouth. Non–alcohol-dependent participants were recruited by advertisements. Each participant was administered the Semi-Structured Assessment for the Genetics of Alcoholism to assess alcohol dependency and the Family History Assessment module to access family history of alcoholism. χ² Test and analysis of variance were used to analyze the data.ResultsAlcohol dependence was more prevalent among men, those with lower income, those with less education, and they utilized mental health counseling as opposed to medicalbased therapy. Increased reports of medical conditions such as migraine (p < .001), loss of consciousness (p = .001), and sexually transmitted diseases (p < .001) were also associated with alcohol dependency. Other factors, including visits to inpatient treatment programs, were directly related to incidence of alcohol dependency regardless of gender status (p < .001).ConclusionsThis study suggests an association exists among alcohol dependence, medical conditions, health care, and mental care utilization among African Americans. Future research may benefit from investigating if an association exists between alcohol use disorders and health care utilization for other ethnic groups.     

Healthcare practices among blacks and whites with urinary tract symptoms

CONTEXT: The reasons for African-American men to seek care for lower urinary care symptoms has not been determined due to sparse population-based data. OBJECTIVE: Our study examines the solicitation and receipt of medical care for urinary symptoms among racially oversampled elderly urban and rural cohort of African Americans and whites. DESIGN: Longitudinal analyses were conducted on five North Carolina counties through the Piedmont Health Survey of the Elderly Established Populations for the Epidemiological Study of the Elderly. In 1994, the analytic cohort included 482 African Americans and 407 whites; by 1998, 249 and 222, respectively. RESULTS: In 1994, 49.4% of African Americans presented with lower urinary tract symptoms compared to 56.8% of whites. By 1998, these percentages increased to 60.6% and 70.3%, respectively. African Americans reported more interference with activities of daily living than whites. African Americans were less likely than whites to have regular digital rectal exams (DRE) and were more likely to have never received a DRE at all. Additionally, elders with less educational attainment, those who smoked, those who delayed care quite often and those who used less-experienced physicians were less likely to receive regular DREs. CONCLUSION: Poor health behavior has the greatest impact on healthcare seeking for lower urinary tract symptoms. These health behavior risk factors are systemic of a lack of health education. Increases in health education among African Americans regarding lower urinary tract symptoms may close the racial disparity in healthcare-seeking behaviors.     

Cultural Competence and Quality of Care: Issues for Mental Health Service Delivery in Managed Care

Models of mental health service delivery in managed care have evolved without considering the needs of ethnic minorities in any systematic manner. Consequently, these new systems may pose additional barriers to access and treatment. In this article, the impact of the health care crisis on mental health service delivery to ethnic minorities in terms of access, cost, and quality of care issues in managed care systems is explored. A quality-of-care framework is used for addressing the notion of cultural competence as a critical dimension of quality of care for ethnic minority populations. Research in minority mental health and quality of care is integrated in order to explore how various structures, processes, and outcomes in managed care systems (e.g., cost containment structures for controlling the supply and demand of mental health services, utilization management and gatekeeping processes) may impact mental health service delivery to ethnic minorities. Cultural competence is conceptualized as a critical component of quality care for ethnic minority populations.     

Help‐seeking behavior of west African Migrants

In this article, the authors present essential aspects of the help‐seeking behavior with regard to mental health problems of Ghanaian migrants in the Netherlands. Samples of citizens in the general population (n=97) and outpatients treated in mental health care facilities (n=36) were included. Data were acquired by administering a semi‐structured interview. Quantified data were analysed using hierarchical multiple regression analyses and direct (standard) logistic analyses. Help‐seeking pathways are multi‐determined. Being involved in Dutch society may determine an individual's attitude toward health care and the time before taking action. Particularly, socio‐demographic variables (e.g., age, unemployment, urbanicity) and acculturative demands (integrative skills, normative orientation) shape the help‐seeking orientation and service utilization in multiethnic settings. A liaison between mental health services, traditional healers, religious leaders and self‐help groups might therefore benefit patients. By identifying and emphasizing the specific social and acculturation components that facilitate or deter health behaviours, we are better able to implement health care interventions among different ethnic and cultural communities. © 2008 Wiley Periodicals, Inc.     

Differences between Asian and White Americans' help seeking and utilization patterns in the Los Angeles area

This study examines help seeking and utilization patterns of 161 Asian or Pacific Islander Americans and 1332 White Americans randomly selected in the Los Angeles area, based on the first wave of the Epidemiological Catchment Area (ECA) study. Logistic regression analyses are performed to detect ethnic differences in disclosing mental health problems and utilizing mental health services. Results show that Asian Americans are more reticent than White Americans about mental distress regardless of whether they speak with professionals or family and friends, and that they are unwilling to use mental health services of any type. However, contrary to common assumptions, Asian Americans claim somatic discomfort as frequently as White Americans do, and the somatic discomfort is independent of Asian Americans' unwillingness to talk about mental health problems. © 1998 John Wiley & Sons, Inc.     

Cultural and practical barriers to seeking mental health treatment for Chinese Americans

Based on a sample of 1747 from the Chinese American Psychiatric Epidemiological Study, this report examined perceived barriers to mental health treatment. Two factors emerged, namely practical barriers, which included cost of treatment, time, knowledge of access, and language, and cultural barriers consisting of credibility of treatment, recognition of need, and fear of loss of face. Average ratings of all practical barrier items were higher than cultural barrier items, demonstrating the importance of pragmatic considerations for this population. In a novel attempt, this study examined the empirical link between these perceived barriers and actual mental health service use. The practical barrier factor showed significance in predicting service use for both the whole sample and a subsample of individuals with at least one lifetime mental disorder. Cultural barriers, however, did not attain significance. Practice and research implications of the findings are discussed. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 27–43, 2004.     

Sociocultural factors and health care-seeking behavior among black Americans

This study investigates the health care-seeking behavior of black Americans in the Detroit Metropolitan area. Analyses of 176 semistructured interviews and 27 life history profiles obtained from participants, nonparticipants, clinic coordinators, community leaders, and health care professionals at local screening clinics suggest that black Americans follow a culturally specific health care-seeking pattern, and that such behavior is significantly influenced by sociocultural factors. This information should be particularly useful for health care professionals and educators, because it can help them plan and implement special intervention strategies for the black community.     

Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway

Background

Internationally, depression is a common psychological disorder whose treatment depends upon its identification by treating professionals as well as patient utilization of mental health care systems; the latter often being hampered by cultural differences between patients and health professionals.

Method

The current study used vignettes of depressed patients which varied the culture and/or social circumstances of the patient to assess whether these variables influenced the conceptualization of depression and its treatment. Participants (N = 722) included mental health professionals, lay people, immigrants, and refugees in Norway.

Results

We found that immigrants and refugees, particularly those of non-western origin, endorsed different types of depression treatments from native Norwegians and mental health professionals, and judged who deserved treatment and who was overreacting based on the patient's culture and social circumstances, while native Norwegians did not.

Limitations

While widely used cross-culturally, vignette methodology is limited in its generalizability to real clinical situations. Acculturation was not evaluated, which may have influenced the results.

Conclusions

Findings support the integration of cultural competency ideals not only into treatment, but also into public health promotions of mental health services for lay people.     

Building a durable response to HIV/AIDS: implications for health systems

The remarkable rise in investments for HIV control programs in 2003-2010 enabled an unprecedented expansion of access to HIV services in low-income and middle-income countries. By the end of 2010, more than 5.2 million people were receiving antiretroviral therapy (ART), which transformed HIV infection, once a death sentence, into a long-term illness. The rapid expansion in the number of persons receiving ART means that health systems must continue to provide acute life-saving care for those with advanced HIV/AIDS although also providing chronic care services to expanding cohorts of more stable patients who are doing well on ART. This expansion also means a transition from an emergency response to the epidemic, characterized by a public health approach, to a more integrated and durable approach to HIV prevention, care, and treatment services that fosters individualized care for those requiring long-term antiretroviral treatment. Yet most low-income and middle-income countries, which have weak health systems, are poorly prepared to make this transition. In this article, we highlight the challenges health systems face in developing a sustained and durable response to HIV/AIDS. The article analyses the readiness of health systems to combine rapid expansion of ART access with long-term treatment and continuity of care for a growing cohort of patients. We argue that effective management of a transition from an emergency AIDS response to long-term programatic strategies will require a paradigm shift that enables leveraging investments in HIV to build sustainable health systems for managing large cohorts of patients receiving ART although meeting the immediate needs of those who remain without access to HIV treatment and care.     

Factorial validity of the multidimensional health locus of control scales for three American ethnic groups

This study examined the psychometric properties (specifically, the factorial invariance) of the Multidimensional Health Locus of Control scales in a multicultural sample of college students. The original 18-item MHLC was administered, along with measures of ethnicity-related variables, to 1845 college students from three ethnic groups (Caucasian Americans, Filipino Americans and Latino Americans). Confirmatory factor analysis failed to confirm a three-factor structure for any of the three groups. Subsequent exploratory principal components analysis supported a cross-ethnic-group three-factor structure that had reduced numbers of items loading adequately on each factor. Shortened scales were created, and internal consistency reliability for each scale was acceptable for each ethnic group. Filipino Americans scored higher on all three scales. Regression analyses predicting MHLC scales from demographic and sociocultural variables revealed few predictive relationships.     

Enhancing Mental Health Service Delivery to Ethnically Diverse Populations: Introduction to the Special Series

The American Psychological Association's adoption of guidelines for providing psychological services to diverse populations and the enactment by the National Institutes of Health (NIH) of regulations that required the representation of women and ethnic minorities in NIH-funded research projects called attention to the need to improve mental health services for ethnically diverse populations. This special series illustrates the relevance of cultural and ethnic factors in addressing contemporary mental health needs and the role of these factors in the work of clinicians who serve ethnically diverse clinical populations. The articles comprising the series examine the mental health dimensions of five contemporary clinical practice issues: HIV/AIDS, eating disorders, hate crimes, folk healing, and youth at high risk for drug abuse.     

Race and mental health diagnosis are risk factors for highly active antiretroviral therapy failure in a military cohort despite equal access to care

BACKGROUND: Data suggest that African Americans have lower rates of virologic suppression using highly active antiretroviral therapy (HAART), possibly because of socioeconomic status and access to care. In a US Military clinic, where beneficiaries have ready access to no-cost health care, the impact of several variables (including race) on HIV virologic suppression were examined. METHODS: Retrospective analysis of antiretroviral-naive patients who began HAART between 1997 and 2003. Demographics, viral loads, CD4 cell counts, and mental health diagnoses were analyzed. RESULTS: The charts of 129 individuals who initiated their first antiretroviral regimen during the period of observation were evaluated. The overall efficacy of reaching viral suppression was 71% at 12 months and 56% at 24 months. HIV suppression was achieved at 12 months by 63% of African Americans and 92% of whites (P = 0.001). Mental health diagnosis was associated with failure at 24 months (38 vs. 61%; P = 0.034). Being white (odds ratio = 3.5, 95% confidence interval [CI]: 1.2 to 10.3; P = 0.022) and lacking a mental health diagnosis (odds ratio = 8.7, 95% CI: 2.4 to 32.1; P = 0.001) were both associated with increased efficacy at 24 months by multivariate analysis. CONCLUSIONS: African-American race and the presence of a mental health diagnoses were independently associated with antiretroviral failure. Equal access to care yields high efficacy rates with HAART but does not fully equilibrate racial differences in virologic failure.     

Changes in attitudes toward seeking mental health services: A 40-year cross-temporal meta-analysis

Although rates of treatment seeking for mental health problems are increasing, this increase is driven primarily by antidepressant medication use, and a majority of individuals with mental health problems remain untreated. Helpseeking attitudes are thought to be a key barrier to mental health service use, although little is known about whether such attitudes have changed over time. Research on this topic is mixed with respect to whether helpseeking attitudes have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on Fischer and Turner's (1970) helpseeking attitude measure among university students (N = 6796) from 1968 to 2008. Results indicated that attitudes have become increasingly negative over time, r(44) = − 0.53, p < 0.01, with even stronger negative results when the data are weighted (w) for sample size and study variance, r(44) = − 0.63, p < .001. This disconcerting finding may reflect the greater emphasis of Fischer and Turner's scale toward helpseeking for psychotherapy. Such attitudes may be increasingly negative as a result of the unintended negative effects of efforts in recent decades to reduce stigma and market biological therapies by medicalizing mental health problems.