Solitary Confinement and Risk of Self-Harm Among Jail Inmates

Objectives. We sought to better understand acts of self-harm among inmates in correctional institutions.Methods. We analyzed data from medical records on 244 699 incarcerations in the New York City jail system from January 1, 2010, through January 31, 2013.Results. In 1303 (0.05%) of these incarcerations, 2182 acts of self-harm were committed, (103 potentially fatal and 7 fatal). Although only 7.3% of admissions included any solitary confinement, 53.3% of acts of self-harm and 45.0% of acts of potentially fatal self-harm occurred within this group. After we controlled for gender, age, race/ethnicity, serious mental illness, and length of stay, we found self-harm to be associated significantly with being in solitary confinement at least once, serious mental illness, being aged 18 years or younger, and being Latino or White, regardless of gender.Conclusions. These self-harm predictors are consistent with our clinical impressions as jail health service managers. Because of this concern, the New York City jail system has modified its practices to direct inmates with mental illness who violate jail rules to more clinical settings and eliminate solitary confinement for those with serious mental illness.Self-harm is a prevalent and dangerous occurrence within correctional settings.1 Inmates in jails and prisons attempt to harm themselves in many ways, resulting in outcomes ranging from trivial to fatal. Suicide is a leading cause of death among the incarcerated; however, suicide and suicide attempt represent a small share of all acts of self-harm.2 The motivations of inmates who harm themselves are complex and often difficult to discern.3 Inmates often arrive in correctional settings with significant pre-existing mental illness and histories of self-harm, but they may also be influenced by environmental stressors within correctional settings or aim to avoid certain situations or punishments.4Approximately one third of those admitted to the jail in New York City (NYC) receive care for mental health services during their incarceration, a proportion that has been increasing over time. Inmates who harm themselves become patients in the mental health service. Those who harm themselves while in solitary confinement may be diverted from that punitive setting to a therapeutic setting outside solitary confinement, which may provide an incentive for self-harm. The purpose of this analysis was to better understand the complex risk factors associated with self-harm and consider whether patients might be better served with innovative approaches to their behavioral issues.     

Chronic Medical Conditions among Jail Detainees in Residential Psychiatric Treatment: A Latent Class Analysis

Studies of incarcerates with serious mental illnesses have found elevated rates of chronic medical conditions such as asthma and diabetes, and of infectious diseases such as tuberculosis compared with general population rates. This study explored the pattern of chronic medical conditions in a sample of adult detainees in psychiatric treatment in a large urban jail to develop a clinical profile encompassing the full range of medical conditions. A total of 431 male and female detainees were sampled with certainty from admissions to a residential psychiatric treatment program (overall recruitment rate = 67%). Interviews used the World Mental Health version of the Composite International Diagnostic Interview to assess psychiatric and substance use disorders per DSM-IV criteria and chronic medical conditions. Latent class analysis was conducted using 17 medical conditions as class indicators, yielding a 3-class model composed of: a latent class with a high to intermediate probability of multiple medical conditions (HMC; 12.5% of the sample); an intermediate class with a lower probability of having a smaller number of medical conditions (MMC; 43.2%); and a class with a low probability of any medical condition (44.3%). Those in the HMC class were more likely to report respiratory problems, severe headaches, musculoskeletal pain, hypertension, and arthritis, have greater functional impairment, and have a higher number of co-occurring psychiatric disorders. Being older (50+ years) and female were associated with higher odds of being in the HMC or MMC classes. The policy implications for providing medical care to incarcerates with complex mixtures of medical conditions and psychiatric disorders are considered.     

Gender Differences Among Children with Externalising Behaviour Disorders in a Clinic Population

The objective of this study was to compare the referral patterns for males and females with externalising disorders who were admitted for specialised psychiatric treatment. The study was based on the total population of children receiving specialised mental treatment in Norway in 2001. From the total patient population of 28,571 children and adolescents aged 0-17 years, a sample was drawn of boys and girls who were referred for externalising behaviour disorders. The sample comprised a total 9729 children, of whom 2218 were females and 7511 were males. Males and females were compared with regard to age at referral, referring agents, secondary reasons for referral as indicated by referring agency, and diagnostic status. The analyses revealed several gender differences in referral patterns. A statistically significant larger proportion of males than females were referred at ages between 6 and 12 years (67.3% and 57.1%, respectively; p < 0.001 ), whereas relatively more females than males were referred at ages above 12 years (32.4% and 21.7%, respectively; p < 0.001 ). Males were more frequently referred from the school sector than females (31.2% and 21.8%, respectively; p < 0.001 ), and exhibited more externalising symptoms than females as indicated by their secondary reason for referral (47.8% and 31.5%, respectively; p < 0.001 ). Co-occurring internalising symptoms were relatively more frequent in females than in males (21.9% and 16.9%, respectively; p < 0.001 ). Furthermore, results showed statistically significant differences in diagnostic status between males and females. Among males 37.7% was assigned an ICD-10 axis I diagnosis of hyperkinetic disorders or conduct disorders; the corresponding number for females was 24.0% ( p < 0.001 ). The results may reflect the true prevalence in the child and adolescent population, or alternatively indicate a gender-related bias in the referral process of children.     

Health Behind Bars: Utilization and Evaluation of Medical Care among Jail Inmates

Jail and prison inmates experience disproportionately high levels of chronic and acute physical health problems, resulting in increased utilization of health services in correctional institutions. Variations in both health status and health care utilization are likely, although several important factors have been under-researched. Gender, in particular, is presumed to influence health outcomes and use of medical care in correctional facilities. The current study explores the physical health status of a systematic sample of 198 male and female inmates incarcerated in a large county jail located in a medium-sized Southern city. Using multiple regression analysis, predictors of physical health status, utilization of medical care, and inmates' evaluations of the accessibility and quality of health care are identified. The results indicate that gender and age are the most consistent demographic predictors of health status and medical care utilization, with females and older inmates reporting higher morbidity and concomitantly higher numbers of medical encounters. The experience of incarceration also appears to influence the physical health of inmates, as self-reported health problems increase with inmates' duration of incarceration. Evaluations of jail medical care differ significantly by gender, with female inmates reporting more difficulty accessing health services, yet higher satisfaction with the quality of services received. The results suggest a need for medical care in correctional settings to adapt to the medical needs of older inmates and women, in addition to improving treatment for chronic conditions and preventive services.     

Gender Differences in Perceived Unmet Treatment Needs Among Persons With and Without Co-occurring Disorders

This study examined gender differences in perceived unmet treatment needs among persons with and without co-occurring substance use disorders and serious mental health conditions. Data were drawn from the 2008–2013 National Survey on Drug Use and Health (unweighted N?=?37,187) to test the hypothesis that the relationships between diagnosis and perceived unmet treatment needs differ as a function of gender. Compared to individuals with a substance use disorder or severe mental illness, those with co-occurring disorders were more likely to report perceived unmet needs for substance abuse and mental health treatment. Gender significantly moderated the relationship between diagnosis and unmet needs, suggesting that men with co-occurring disorders might be more adversely affected. Findings highlight the need for better understanding of gender-diagnosis differences with respect to unmet needs for substance abuse and mental health care.     

Older Jail Inmates and Community Acute Care Use

Objectives. We examined older jail inmates’ predetainment acute care use (emergency department or hospitalization in the 3 months before arrest) and their plans for using acute care after release.Methods. We performed a cross-sectional study of 247 jail inmates aged 55 years or older assessing sociodemographic characteristics, health, and geriatric conditions associated with predetainment and anticipated postrelease acute care use.Results. We found that 52% of older inmates reported predetainment acute care use and 47% planned to use the emergency department after release. In modified Poisson regression, homelessness was independently associated with predetainment use (relative risk = 1.42; 95% confidence interval = 1.10, 1.83) and having a primary care provider was inversely associated with planned use (relative risk = 0.69; 95% confidence interval = 0.53, 0.89).Conclusions. The Affordable Care Act has expanded Medicaid eligibility to all persons leaving jail in an effort to decrease postrelease acute care use in this high-risk population. Jail-to-community transitional care models that address the health, geriatric, and social factors prevalent in older adults leaving jail, and that focus on linkages to housing and primary care, are needed to enhance the impact of the act on acute care use for this population.Jail has become a critical site for linking medically vulnerable older adults to community health care. Approximately 12 million Americans pass through jails each year and nearly all return to the community within 6 months where many struggle to access nonemergency medical care. Between 1996 and 2008 the number of “older” or “geriatric” inmates (aged 55 years or older) increased 278% compared with a 53% growth in the overall jail population.1,2 Now, approximately 550 000 older adults spend time in jail each year, comprising 10% of all inmates. Yet little is known about their health care and social service needs.Reducing acute care use (hospitalizations and emergency department [ED] use) and improving insurance access for former inmates is a priority in the Affordable Care Act (ACA).3 Although most inmates are without health insurance,4 those with insurance demonstrate reduced recidivism and better access to mental health and substance abuse treatment when released.5–7 The ACA expands Medicaid eligibility for low-income adults and allows eligible inmates to apply for coverage while in jail.3,8 As most persons passing through jails will be eligible for Medicaid in states participating in the expansion, an estimated 4 to 6 million jail inmates will gain new coverage by the end of 2014 through outreach and patient navigator assistance.9For community-dwelling older adults, health and social factors beyond insurance drive community acute care use, such as functional impairment, uncontrolled symptoms, and housing instability.10–12 This may also be true for older former inmates, many of whom experience “accelerated aging” because of high rates of disability and chronic disease at relatively young ages.13 Therefore, we conducted a study of older jail inmates to describe predetainment acute care use and anticipated plans for using acute care after release, and to assess the factors associated with use.     

Gender Differences in Stressors Related to Migration and Acculturation in Patients with Psychiatric Disorders and Turkish Migration Background

Migration, acculturation, and psychiatric disorders may cause stress and adaptation processes differently in men and women, but empirical research is scarce. In a retrospective study n = 62 Turkish migrants and n = 62 native German inpatients with depressive or anxiety disorders, matched for age, gender, and diagnoses, were compared using a 10-item instrument for the assessment of migration- and acculturation related stressors (MIGSTR10). Gender differences in the prevalence of stressors and in the total sum of stressors were calculated and compared between migrants and indigenous patients. Results showed a higher global stress level in migrants and in women than in men with migration background. Regarding single stressors, the perceived loss of status was significantly more prevalent and more pronounced in men than in women (P < 0.05) whereas guilt feelings were more severe in women with Turkish migration background compared to men (P < 0.05). Gender differences of perceived stress should be taken into account in migration and acculturation research.     

我国不同性别患者医疗费用支出的差异

目的:通过分析不同性别患者的医疗费用支出,反映两性卫生资源利用程度的差别。方法:利用第三次国家卫生服务调查资料对两性患者的医疗费用支出进行比较分析。结果:女性的两周卧床率高于男性,但是,男性的医疗费用支出高于女性,尤其是5岁以下儿童和65岁及以上老人更为明显。结论:女性患者的医疗费用支出较男性低,可能与女性的社会地位较低、经济保障能力较差有关。     

Prevalence of Chronic Medical Conditions among Inmates in the Texas Prison System

Given the rapid growth and aging of the US prison population in recent years, the disease profile and health care needs of inmates portend to have far-reaching public health implications. Although numerous studies have examined infectious disease prevalence and treatment in incarcerated populations, little is known about the prevalence of non-infectious chronic medical conditions in US prison populations. The purpose of this study was to estimate the prevalence of selected non-infectious chronic medical conditions among inmates in the Texas prison system. The study population consisted of the total census of inmates who were incarcerated in the Texas Department of Criminal Justice for any duration from September 1, 2006 through August 31, 2007 (N = 234,031). Information on medical diagnoses was obtained from a system-wide electronic medical record system. Overall crude prevalence estimates for the selected conditions were as follows: hypertension, 18.8%; asthma, 5.4%; diabetes, 4.2%; ischemic heart disease, 1.7%; chronic obstructive pulmonary disease, 0.96%; and cerebrovascular disease, 0.23%. Nearly one quarter (24.5%) of the study population had at least one of the selected conditions. Except for asthma, crude prevalence estimates of the selected conditions increased monotonically with age. Nearly two thirds (64.6%) of inmates who were ≥55 years of age had at least one of the selected conditions. Except for diabetes, crude prevalence estimates for the selected conditions were lower among Hispanic inmates than among non-Hispanic White inmates and African American inmates. Although age-standardized prevalence estimates for the selected conditions did not appear to exceed age-standardized estimates from the US general population, a large number of inmates were affected by one or more of these conditions. As the prison population continues to grow and to age, the burden of these conditions on correctional and community health care systems can be expected to increase.     

Gender Differences in Acculturation, Stress, and Salivary Cortisol Response Among Former Soviet Immigrants

Post-immigration adaptation is characterized by chronic and acute acculturative stressors. Salivary cortisol is a commonly used hormonal marker of stress, but few studies have investigated its use as an indicator of acculturative stress and adjustment in immigrants. The purpose of this study was to examine relationships among predictors of adjustment (environmental and language mastery), self-reported stress outcomes (depressive symptoms, perceived stress, alienation), and salivary cortisol response in immigrants from the former Soviet Union. The sample included 137 married men and women aged 42–80 who lived in the U.S. for 1–13 years. Results indicated that while men and women had similar values for cortisol response, relationships among adjustment measures, stress outcomes, and cortisol differed by gender. Among men, environmental mastery significantly reduced depressive symptoms, perceived stress, and cortisol response. Among women, environmental mastery also reduced depressive symptoms, perceived stress, and alienation, but language mastery increased cortisol response and decreased alienation.     

Gender Differences in Condom Usage Among Rural Crack-Using Men and Women

SUMMARY

Consistent condom use is an important aspect of decreasing HIV transmission risk in heterosexual crack cocaine using populations. This study explores gender differences in attitudes and motivations to use condoms within a rural, economically disadvantaged sample. Qualitative data analysis identified recurrent themes regarding condom use and assessed how themes varied among men and women. Analyses showed that men and women exhibit different rationales for condom use, while both reported inconsistencies between their knowledge about safe sex, receptivity to condom use, and applications in practice. The findings suggest that prevention programs should be tailored to increase consistent condom use among main partners of crack smokers at risk for HIV.     

Gender Differences in Demographic and Clinical Correlates among Veterans with Musculoskeletal Disorders

BackgroundStudies suggest that women may be at greater risk for developing chronic pain and pain-related disability.MethodsBecause musculoskeletal disorders (MSD) are the most frequently endorsed painful conditions among veterans, we sought to characterize gender differences in sociodemographic and clinical correlates among veterans upon entry into Veterans Health Administration's Musculoskeletal Disorders Cohort (n = 4,128,008).ResultsWomen were more likely to be younger, Black, unmarried, and veterans of recent conflicts. In analyses adjusted for gender differences in sociodemographics, women were more likely to have diagnoses of fibromyalgia, temporomandibular disorders, and neck pain. Almost one in five women (19.4%) had more than one MSD diagnosis, compared with 15.7% of men; this higher risk of MSD multimorbidity remained in adjusted analyses. Adjusting for sociodemographics, women with MSD were more likely to have migraine headache and depressive, anxiety, and bipolar disorders. Women had lower odds of cardiovascular diseases, substance use disorders, and several MSDs, including back pain conditions. Men were more likely to report “no pain” on the pain intensity Numeric Rating Scale, whereas more women (41%) than men (34%) reported moderate to severe pain (Numeric Rating Scale 4+).ConclusionsBecause women veterans are more likely to have conditions such as fibromyalgia and mental health conditions, along with greater pain intensity in the setting of MSD, women-specific pain services may be needed.     

Gender Differences in Substance Use Among Mexican American School-Age Children

ABSTRACT: This study identified differences in gender between and among fourth, fifth, and sixth grade Mexican American students for use of four specific "minor" substances: cigarettes, beer, wine/liquor, and marijuana. Minor substances are believed to serve as a "gateway" to more intense and frequent use of minor and major substances. Students (N = 2,216; males 52% and females 48%) were surveyed to ascertain information pertaining to their substance use. The chi-square statistic found significant gender differences at the fourth and fifth grade for use of minor substances. Patterns of initiation of minor substance use by gender and grade are discussed in the context of substance use stage theory. Overall, results support the need for further research emphasizing within group variations in the substance use of singular ethnic groups. (J Sch Health. 1993;63(9):397–401)     

Gender Differences in Dating Aggression Among Multiethnic High School Students

PURPOSE: (1) To assess prevalence of physical dating aggression and victimization among high school students; (2) to assess prevalence of mutual and exclusive aggression; (3) to determine whether aggression differs across ethnic groups and relationship type; and (4) to ascertain the likelihood of injury and breakup in individuals who reported that they were the recipients of physical aggression. METHODS: Students (N = 2363) from seven multiethnic high schools participated. Because males in high school date females younger than they and the reverse for females, and because males and females may underreport aggression, only within gender comparisons were conducted. RESULTS: More females reported engaging in physical aggression (40%) than reported being victims of aggression (30%). Fewer males reported engaging in physical aggression (24%) than reported being victims of physical aggression (31%). If physical aggression occurred, typically both partners were aggressive. For females, exclusive engagement in physical aggression (perpetration) was reported at higher rates than exclusively being the recipient of physical aggression (victimization) and vice versa for males. Dating aggression was less prevalent among male Asian students than other ethnic groups. Engaged males and females reported the highest rates of physical aggression. Injury was reported by over 25% of males and females who reported being the recipients of physical aggression. CONCLUSIONS: Dating aggression intervention programs should address physical aggression of both males and females. Because approximately 30% of the high school males and females reported being the recipients of physical aggression by their partners, primary prevention efforts should occur before high school.     

Discrimination and Substance Use Disorders Among Latinos: The Role of Gender,Nativity, and Ethnicity

Objectives. We examined the relationship between discrimination and substance use disorders among a diverse sample of Latinos. We also investigated whether the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity.Methods. Our analyses focused on 6294 Latinos who participated in the National Epidemiologic Survey on Alcohol and Related Conditions from 2004 to 2005. We used multinomial logistic regression to examine the association between discrimination and substance use disorders.Results. Discrimination was significantly associated with increased odds of alcohol and drug use disorders among Latinos. However, the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity. Discrimination was associated with increased odds of alcohol and drug use disorders for certain groups, such as women, US-born Latinos, and Mexicans, but this relationship did not follow the same pattern for other subgroups.Conclusions. It is important to determine which subgroups among Latinos may be particularly vulnerable to the negative effects of discrimination to address their needs.Latinos are the largest ethnic or racial minority group in the United States1 and the fastest growing group entering substance abuse treatment programs.2 Although Latinos are disproportionately affected by substance abuse,3 they have been understudied.4 Previous research shows that high levels of poverty, minority status, and residential concentration in areas with widespread drug and alcohol distribution have been considered to be factors that may put Latinos at risk for substance use disorders.5 More recently, discrimination has also been considered to be a risk factor.6,7 As studies aim toward filling the gap in the literature, the heterogeneity of Latinos must also be considered.Discrimination has been associated with alcohol and drug use8–13 and substance use disorders among Latinos.6,7 Stress-coping frameworks and the minority stress model have been applied to hypothesize that individuals belonging to various marginalized groups respond to experiences of discrimination with unhealthy coping behaviors, such as substance use.14,15 Moreover, discrimination may lead to underemployment, lower wages, and limited access to health services and other resources that can affect health outcomes.16 In this way, discrimination operates at both the interpersonal and institutional levels simultaneously to situate individuals on different health trajectories, fostering and reinforcing poor health behaviors and outcomes.16,17The association between discrimination and substance use has been previously documented for Latinos and other groups. However, reviews of the literature have called for more granular analysis of specific risk patterns. One specific area needing analysis is whether some subgroups of Latinos are at higher risk of substance use related to discrimination than others. The identification of subgroups is an important first step toward the development of targeted population-level approaches and tailored interventions.In the present study, we focused on subgroups based on gender, nativity, and ethnicity (country of origin or heritage country). These subgroups were based on ascribed characteristics that refer to immutable characteristics (vs achieved characteristics, such as education) that are given status value.18,19 The status value placed on these characteristics can drive discrimination; for example, when men are considered more valuable than women and when US-born individuals are considered more valuable than immigrants.18,19 At the same time, these characteristics (gender, nativity, and ethnicity) are also associated with substance use disorders.Gender differences in substance use disorders are not unique to Latinos. Across racial/ethnic groups, men consistently have higher prevalence of substance use disorders. Using data from the National Latino and Asian American Study, the lifetime prevalence of alcohol use disorders was 16.7% for Latino men and 4.3% for Latina women.20 Research also shows that Latino men generally reported higher levels of discrimination compared with Latina women.13,21 Data from the National Latino and Asian American Study showed that 39% of Latino men, compared with 29% of Latina women, reported discrimination.22 These authors suggested that these patterns might be the result of minority men being more exposed and vulnerable to racial bias from social institutions. These higher rates of substance use and discrimination among men also appeared to be jointly related. A recent study found that discrimination was associated with increased risk of drug abuse among Latino men, but not Latina women.6 This interaction might occur because of greater cultural acceptability among men overall to use substances to cope with stress compared with women. In contrast, women were found to rely on social support and to turn to food to cope with stress.23–25 Other specific factors, such as abuse history,26 were found to be more central in predicting risk of substance use disorders among Latina women. Thus, we expected that discrimination would have a stronger relationship with substance use disorders among Latino men than Latina women.Similar to health differences by gender, differences by nativity are not unique to Latinos. Overall, foreign-born individuals tend to be healthier than their US-born counterparts. Lifetime rates of substance use disorders were higher among US-born than foreign-born Latinos (19.6% vs 5.5%, respectively).20 Previous studies also found greater reporting of discrimination among US-born Latinos; 47% of US-born compared with 25% of foreign-born Latinos reported discrimination.22 However, discrimination might be more harmful to foreign-born Latinos because they are less likely to enjoy citizenship rights (e.g., voting privileges, access to educational scholarships) that might help temper some of the stressful effects of discrimination. From this perspective, we expected that discrimination would have a stronger relationship with substance use disorders among foreign-born than US-born Latinos.Finally, it is also important to consider ethnicity. There is some indication of variation in rates of substance use across these groups. Cubans were found to have lower odds of substance use disorders compared with Puerto Ricans.27 In addition, there was good evidence for variation in reporting of discrimination.28 For example, 40% of Puerto Ricans reported discrimination compared with 34% of Mexicans and 16% of Cubans.22 This variation might be attributed to gradations based on socioeconomic resources that differ by Latino ethnicity.29 Gradations based on socioeconomic resources could dictate the risks and resources individuals have exposure and access to, affecting coping mechanisms. Thus, we expected the relationship between discrimination and substance use disorders to vary by ethnicity as well.In sum, based on this literature, we hypothesized that discrimination would be associated with increased risk of substance use disorders among Latinos overall, and that the relationship between discrimination and substance use disorders would vary by ascribed characteristics. Specifically, we theorized that the relationship between discrimination and substance use disorders would be stronger among men compared with women, among foreign-born Latinos compared with US-born Latinos, and among Mexicans and Puerto Ricans compared with Cubans.     

Responses to Discrimination and Psychiatric Disorders Among Black,Hispanic, Female,and Lesbian,Gay, and Bisexual Individuals

Objectives. We examined associations between perceived discrimination due to race/ethnicity, sexual orientation, or gender; responses to discrimination experiences; and psychiatric disorders.Methods. The sample included respondents in the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions (n = 34 653). We analyzed the associations between self-reported past-year discrimination and past-year psychiatric disorders as assessed with structured diagnostic interviews among Black (n = 6587); Hispanic (n = 6359); lesbian, gay, and bisexual (LGB; n = 577); and female (n = 20 089) respondents.Results. Black respondents reported the highest levels of past-year discrimination, followed by LGB, Hispanic, and female respondents. Across groups, discrimination was associated with 12-month mood (odds ratio [ORs] = 2.1–3.1), anxiety (ORs = 1.8–3.3), and substance use (ORs = 1.6–3.5) disorders. Respondents who reported not accepting discrimination and not discussing it with others had higher odds of psychiatric disorders (ORs = 2.9–3.9) than did those who did not accept discrimination but did discuss it with others. Black respondents and women who accepted discrimination and did not talk about it with others had elevated rates of mood and anxiety disorders, respectively.Conclusions. Psychiatric disorders are more prevalent among individuals reporting past-year discrimination experiences. Certain responses to discrimination, particularly not disclosing it, are associated with psychiatric morbidity.The role of discrimination as a health determinant has increasingly become a focus of scholarly inquiry. Accumulating evidence points to the deleterious consequences of discrimination experiences on health.^1–6 The damaging effects of discrimination on mental health, in particular, are increasingly evident.^6–9 Experiences of discrimination, whether based on race/ethnicity, sexual orientation, or gender, have been linked to elevations in psychological distress and symptoms of psychopathology.^1,8,10–13 Although the relation between discrimination and psychiatric disorders has been studied less frequently, significant associations with major depression,^9,13 generalized anxiety disorder (GAD),⁹ early initiation of substance abuse,¹⁴ and a composite index of psychiatric morbidity¹⁵ have been reported.This research provides empirical documentation of the role of discrimination in shaping the distribution of adverse mental health outcomes at a population level, but numerous questions regarding these associations remain. Despite widespread exposure to discrimination, most members of stigmatized groups do not ultimately develop psychiatric disorders, which suggests the presence of factors that buffer some individuals against the negative mental health consequences of discrimination. How an individual responds to and copes with discrimination is one factor that may help to identify those most vulnerable to the development of psychiatric disorders after exposure to discrimination. Although several studies have examined coping strategies that members of stigmatized groups use in response to status-based discrimination,^16,17 few studies have considered the impact of these strategies on psychiatric disorders. Previous research has reported associations between responses to discrimination and blood pressure,^3,5 self-esteem, and psychological distress,^6,16 which suggest that such responses may have implications for psychiatric morbidity.Two dimensions of discrimination responses relevant to health outcomes are acceptance and disclosure. Previous research has suggested that these responses interact in complex ways. Among individuals who accept discrimination, disclosing the experience is associated with elevated blood pressure among Black men, whereas not disclosing the experience predicts higher blood pressure among Black women.³ Aside from that study, however, the extent to which responses to discrimination and their associations with health outcomes vary across stigmatized groups has rarely been examined empirically. Given the heterogeneity across groups in experiences of discrimination,^18–20 it is likely that members of stigmatized groups have developed divergent social norms or beliefs regarding appropriate responses to discriminatory actions. Consequently, it remains unclear (1) whether members of different stigmatized groups respond differently to discrimination, and (2) wct 6 whether these variations in responses translate into differential vulnerability to psychiatric disorders when discrimination is experienced. Such information may help to more effectively target preventive interventions, an important public health priority given group-based disparities in psychiatric morbidity.²¹In the present study, we addressed these gaps in the literature by examining whether psychiatric disorders were associated with perceived discrimination due to race/ethnicity, sexual orientation, or gender and with responses to discrimination experiences. We first examined the prevalence of past-year self-reported discrimination experiences based on race/ethnicity, sexual orientation, or gender in a US national sample. Second, we estimated the associations between discrimination experiences and the prevalence of psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV),²² including mood, anxiety, and substance use disorders, thus providing the first such estimates across a range of disorders. Third, we examined the distribution of responses to discrimination across 2 domains (acceptance–nonacceptance and disclosure–nondisclosure). Finally, we estimated the associations between responses to discrimination and psychiatric disorders among individuals exposed to past-year discrimination.