A scoping review of racial/ethnic disparities in sleep

BackgroundDespite remarkable achievements in ensuring health equity, racial/ethnic disparities in sleep still persist and are emerging as a major area of concern. Accumulating evidence has not yet been well characterized from a broad perspective. We conducted a scoping review of studies on sleep disparities by race/ethnicity to summarize characteristics of existing studies and identify evidence gaps.MethodsWe searched PubMed, CINAHL, PsycINFO, and Web of Science databases for studies of racial/ethnic disparities in sleep. Studies that met inclusion criteria were retrieved and organized in a data charting form by study design, sleep measuring methods, sleep features, and racial/ethnic comparisons.ResultsOne hundred sixteen studies were included in this review. Most studies focused on disparities between Whites and Blacks. Disproportionately fewer studies examined disparities for Hispanic, Asian, and other racial/ethnic groups. Self-reported sleep was most frequently used. Sleep duration, overall sleep quality, and sleep disordered breathing were frequently studied, whereas other features including sleep efficiency, latency, continuity, and architecture were understudied, particularly in racial minority groups in the US. Current study findings on racial/ethnic disparities in most of sleep features is mixed and inconclusive.ConclusionsThis review identified significant evidence gaps in racial/ethnic disparities research on sleep. Our results suggest a need for more studies examining diverse sleep features using standardized and robust measuring methods for more valid comparisons of sleep health in diverse race/ethnicity groups.     

Ethnic Norwegian and ethnic minority adolescents in Oslo,Norway

Background Little is known about ethnic disparities in mental health during late teens. The aim of this study was to compare changes in self reported mental health between adolescents with ethnic Norwegian and ethnic minority background aged 15-16 years followed for three years. Methods The youth part of the Oslo Health Study constituted the baseline of this self-reported longitudinal study, carried out in schools in 2001 (n = 3811). The follow-up in 2004 was conducted partly in school and partly through mail. A total of 2489 (1112 boys and 1377 girls) participated in the follow-up. Twenty percent of the participants had an ethnic minority background. Mental health was measured by the Strengths and Difficulties Questionnaire (SDQ) and The Hopkins Symptom Checklist (HSCL-10). Results Ethnic minority boys and girls reported poorer mental health than ethnic Norwegians of the same sex, both at baseline and follow-up. Exceptions were hyperactivity-inattention problems and prosocial behaviours where no differences were found. Consistent changes from baseline to follow-up were; an increase in mental distress and prosocial behaviour. No ethnic disparities were found for changes in mental health from ages 15 to 18 between the two groups. There was no different effect of perceived family economy, parents’ marital status and socioeconomic region of residence in Oslo on change in mental health between ethnic Norwegian and ethnic minority boys and girls from age 15 to 18 years. Conclusions Ethnic disparities in mental health remained the same from age 15-16 and throughout teenage years. Demographic factors adjusted for had no different impact on changes in mental health between host and immigrant adolescents.     

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.     

Barriers to recruiting ethnic minorities to mental health research: a systematic review

Disparities in the prevalence of mental illness are widely reported for people from ethnic minorities. Unlike the United States, there is no legislation for clinical research in the UK to mandate the inclusion of ethnic minorities and they are underrepresented in European trials compared with those conducted in the United States. This restricts generalization of research findings. This systematic review of the barriers to the recruitment of ethnic minority participants into psychiatric research is based on a comprehensive literature search. Nine included papers explore such barriers based on the authors’ and participants’ experiences of research. These barriers are mainly categorized as: participant related, practical issues, family/community related, health service related and research process issues. This review provides a compilation of important barriers to recruitment which can facilitate future research. The barriers that were identified are not all unique to participants from ethnic minorities, although the way in which they manifest themselves is often distinct in minority groups. It is important that these barriers are considered when designing research design so that solutions to overcome such obstacles can be incorporated in research protocols from the start and appropriate resources allocated. Copyright © 2014 John Wiley & Sons, Ltd.     

Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain

Abstract Background Our aim was to examine whether variations in the prevalence of neurosis and psychosis between ethnic minorities throughout Great Britain are explained by social disadvantage. Method A total of 10,108 adult householders throughout Great Britain were assessed in a two-stage survey with the Revised Clinical Interview Schedule (CIS-R) and Psychosis Screening Questionnaire (PSQ). Respondents with a positive PSQ or who received a diagnosis of, or treatment for, psychosis were examined by a psychiatrist using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Data on respondents preferred ethnic group were collapsed into four groups: Whites, African-Caribbean or Africans, south Asians and other. Results Ethnic grouping was strongly associated with: unemployment; lone parent status; lower social class; low perceived social support; poverty (indicated by lack of car ownership) and having a primary social support group of less than three close others. All these associations applied to the group Africans and Afro-Caribbeans, but only some applied to the other groups. No ethnic group had significantly increased rates of neurosis. Only the African-Caribbean group were at significantly increased risk of a psychotic disorder (odds ratio 4.55; 95% CI: 1.13, 18.30). After adjustment for risk factors, the odds of psychosis were lower (odds ratio 2.97; 95% CI: 0.66, 13.36). Conclusions The excess of psychosis in Africans and Afro-Caribbeans in Great Britain appears to be partly explained by socio-economic disadvantage, but larger studies are needed to confirm this.     

Development of emotional autonomy from adolescence to young adulthood in Spain

The main objective of this study was to learn whether emotional autonomy is truly part of a developmental stage for Spanish adolescents and young adults or if it is an indicator of difficult family relationships. Using a longitudinal design, a sample of ninety young people was followed for ten years, from their initial adolescence until their first years of adulthood. At four observation points, the participants completed various questionnaires to evaluate their emotional autonomy, the cohesion in their family relationships and their life satisfaction. There were no gender differences in the development of emotional autonomy. Family cohesion and life satisfaction showed significant negative associations with emotional autonomy and these associations became more pronounced as participants moved from adolescence into adulthood. Based on our results, emotional autonomy from parents does not seem to be a developmental stage taking place during adolescence, but rather, an indicator of difficult family relationships.     

A cross-sectional population-based study of elder self-neglect and psychological,health, and social factors in a biracial community

Objective: Elder self-neglect is an important public health issue; however, its association with psychological, health, and social factors remains unclear. This study aimed to (1) examine the associations between self-neglect severity and psychological, health, and social factors (2) examine the racial/ethnic differences in these associations.

Methods: We conducted a biracial population-based study in a geographically defined community in Chicago: Chicago Health Aging Project. We identified 1094 persons who had been identified by social services agency as suspected elder self-neglect from 1993 to 2005. Self-neglect severity was assessed on a 0–45 scale. The psychological, health, and social factors were assessed using Center for Epidemiological Studies of Depression (CESD), poor mental health, health status, unhealthy days, poor physical health, days away from usual activities, social network, and social engagement. Linear regression was used to assess associations between self-neglect and psychological, health, and social factors. Interaction terms (Self-neglect × Race) were used to assess the black (non-Hispanic black) and white (non-Hispanic white) differences in these associations.

Results: There were significant associations between self-neglect severity with health and social factors. After adjusting for confounders, greater self-neglect severity was associated with lower health status (PE = 0.001, p = 0.002), higher unhealthy days (PE = 0.139, p < 0.001), poor physical health (PE = 0.141, p < 0.001), and more days away from usual activities (PE = 0.120, p = 0.030). Interaction term (Self-Neglect × Race) indicates black compared with white older adults, had more days away from usual activities (PE = 0.321, p = 0.045) and lower social engagement (PE = ?0.04, p = 0.003).

Conclusion: Greater self-neglect severity is associated with lower levels of health and social wellbeing. These associations may be stronger for black than white older adults.     

Racial/Ethnic Disparities in Parent Perception of Child Need for Mental Health Care Following School Disciplinary Events

Disciplinary problems at school potentially affect parent perception of child need for mental health care. This article explores effects of a child's first school suspension or expulsion on parent perception of child need for services in three racial-ethnic subgroups. Subjects were mothers participating in a national longitudinal study and their children. First-time school suspension or expulsion positively affected service use and parent-reported service need among white non-Hispanic children, but had little or no effect for African American and Hispanic children. These results suggest that information on child behavior provided to parents by teachers and school administrators can influence parent perception of child service need, but that racial-ethnic differences may exist in parent interpretation of and response to this information. Culturally appropriate approaches to relaying information to parents about child service need may help reduce these differences.     

Racial disparities in bipolar disorder treatment and research: a call to action

Objectives

Health disparities between individuals of African and European ancestry are well documented. The disparities in bipolar disorder may be driven by racial bias superimposed on established factors contributing to misdiagnosis, including: evolving empirically based diagnostic criteria (International Classification of Diseases [ICD], Research Diagnostic Criteria [RDC] and Diagnostic and Statistical Manual [DSM]), multiple symptom domains (i.e. mania, depression and psychosis), and multimodal medical and additional psychiatric comorbidity.

Methods

For this paper, we reviewed the phenomenological differences between bipolar individuals of African and European ancestry in the context of diagnostic criteria and clinical factors that may contribute to a potential racial bias.

Results

Published data show that bipolar persons of African ancestry, compared with bipolar persons of non‐African ancestry, are more often misdiagnosed with a disease other than bipolar disorder (i.e. schizophrenia). Additionally, studies show that there are disparities in recruiting patients of African ancestry to participate in important genomic studies. This gap in biological research in this underrepresented minority may represent a missed opportunity to address potential racial differences in the risk and course of bipolar illness.

Conclusion

A concerted effort by the research community to increase inclusion of diverse persons in studies of bipolar disorder through community engagement may facilitate fully addressing these diagnostic and treatment disparities in bipolar individuals of African ancestry.     

The brain in social context: A systematic review of substance use and social processing from adolescence to young adulthood

Substance use escalates between adolescence and young adulthood, and most experimentation occurs among peers. To understand underlying mechanisms, research has focused on neural response during relevant psychological processes. Functional magnetic resonance imaging (fMRI) research provides a wealth of information about brain activity when processing monetary rewards; however, most studies have used tasks devoid of social stimuli. Given that adolescent neurodevelopment is sculpted by the push-and-pull of peers and emotions, identifying neural substrates is important for intervention. We systematically reviewed 28 fMRI studies examining substance use and neural responses to stimuli including social reward, emotional faces, social influence, and social stressors. We found substance use was positively associated with social-reward activity (e.g., in the ventral striatum), and negatively with social-stress activity (e.g., in the amygdala). For emotion, findings were mixed with more use linked to heightened response (e.g., in amygdala), but also with decreased response (e.g., in insula). For social influence, evidence supported both positive (e.g., cannabis and nucleus accumbens during conformity) and negative (e.g., polydrug and ventromedial PFC during peers’ choices) relations between activity and use. Based on the literature, we offer recommendations for future research on the neural processing of social information to better identify risks for substance use.     

Ethnic differences in mental health service use among White, Chinese, South Asian and South East Asian populations living in Canada

Background  Health services in Canada are publicly funded. However, the use of health services, especially mental health services, by ethnic minority groups in Canada, has not been well studied. Objectives  The objectives of the study were to estimate the 12-month prevalence of mental health service use by ethnicities, overall and among those with major depression, and to identify factors associated with mental health services use in different ethnic groups in Canada. Methods  Data from the Canadian Community Health Survey (CCHS-1.1) were used. Participants included in this analysis were white who were born in Canada (n = 108,192), white immigrants (n = 10,892), Chinese (n = 1,785), South Asian (n = 1,214), and South East Asian immigrants (n = 818). Participants were selected using multiple staged, stratified random sampling procedures from household residents aged 12 years or older in ten provinces. Results  White people were more likely to have used mental health services than Chinese participants and those from South Asian and South East Asian regions. The Chinese participants appeared to be less likely to have used mental health services than those in the South Asian and South East Asian groups, in those without major depression. Conclusions  In Canada, Asian immigrants are less likely to use mental health service use than white people. More studies are needed to examine factors affecting mental health service use in Asian immigrants living in North America. JianLi Wang is supported by a New Investigator Award from the Canadian Institutes of Health Research.     

Perceived reciprocity in social exchange and health functioning in early old age: Prospective findings from the GAZEL study

Objectives: To assess prospectively the effects of perceived non-reciprocity of exchange in three different types of social engagement on health functioning in early old age.

Methods: In the frame of the prospective French GAZEL cohort study, data on reciprocity in three types of role-related social engagement (principal regular activity in everyday life, marital role relationship, trusting relationships in civic life) were collected from 8679 men and 2742 women (mean age: 60.4 years) in 2005. Two years later, health functioning was assessed using the SF-36 mental and physical component scores, as well as self-perceived health. Multivariate regressions were calculated, controlling for important confounders including baseline self-perceived health.

Results: Consistent effects of perceived non-reciprocity in all three types of social exchange on mental and physical health functioning were observed. After adjustment for relevant confounders including baseline self-perceived, health effects were attenuated, but largely remained significant.

Conclusions: Findings underline the importance of the quality of social exchange (reciprocity vs. non-reciprocity) for health functioning in early old age.     

Sickness absence and disability pension in a cohort of employees initially on long-term sick leave due to psychiatric disorders in Sweden

Background Over the last decade sickness absence and disability pension (DP) due to psychiatric disorders have increased considerably in Western countries. The scientific knowledge base about prognoses for such absences is very limited, but employers and clinicians often predict them to be very long. The aim of this study was to investigate sickness absence and disability pension in a cohort of employees who initially were on long-term sick leave due to psychiatric disorders, with regard to gender, age, socioeconomic status, and previous sickness absence. Methods The cohort included 4,891 employees in Sweden, who, in 1999 were aged 20–61 and had a new sick-leave spell >90 days with a psychiatric disorder. Retrospective and prospective registry data on sickness absence and DP for 1996–2002 were obtained. Logistic regressions were performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for having a low, intermediate, or high level of sickness absence (<17, 17–90, and 91–365 days, respectively) or DP in 2002. Results The mean number of sick-leave days per person per year 3 years prior to inclusion was low; 17 days, but had increased to 211 days by 2000. In 2002, 26% had been granted DP, significantly higher rate among men, while a higher rate of the women had long-term sickness absence. Of all 4,891 subjects, 35% had <17 sick-leave days in 2002. The OR of having low, intermediate, or long-term sickness absence decreased with age. The reverse was found for obtaining DP, for which also low socioeconomic status was an independent predictor of an increased risk (OR = 3.40, CI 2.28–5.08). Conclusions Employees with long-term sick leave due to psychiatric disorders did not have a high level of sickness absence in the 3 years prior to inclusion in the study. Also, 3 years after inclusion, only 35% had very low levels of sickness absence, whereas 26% had been granted DP. Employees who were aged 55–61 showed the lowest risk of sick leave but the highest risk of DP. Low SES was a significant predictor of DP in 2002.