Stigma,Discrimination, or Symptomatology Differences in Self-Reported Mental Health Between US-Born and Somalia-Born Black Americans

Objectives. We examined differences in self-reported mental health (SRMH) between US-born and Somalia-born Black Americans compared with White Americans. We tested how SRMH was affected by stigma toward seeing a mental health provider, discrimination in the health care setting, or symptoms of depression.Methods. Data were from a 2008 survey of adults in Minnesota and were limited to US-born and Somalia-born Black and White Americans (n = 938).Results. Somalia-born adults were more likely to report better SRMH than either US-born Black or White Americans. They also reported lower levels of discrimination (18.6%) than US-born Black Americans (33.4%), higher levels of stigma (23.6% vs 4.7%), and lower levels of depressive symptoms (9.1% vs 31.6%). Controlling for stigma, discrimination, and symptomatology, Somalia-born Black Americans reported better SRMH than White and Black Americans (odds ratio = 4.76).Conclusions. Mental health programming and health care providers who focus on Black Americans’ mental health might be missing important sources of heterogeneity. It is essential to consider the role of race and ethnicity, but also of nativity, in mental health policy and programming.Black Americans are at lower risk than White Americans for common mental disorders, such as anxiety and mood disorders, and substance use.1 Evidence is less clear that there are differences for rates of psychological distress or depressive symptoms,2 with some research indicating that Black Americans may fare worse on these measures,3,4 and other studies showing that they may do better.5 Recent research examined diversity within the Black American population and highlighted important differences in mental health outcomes by nativity.5 For example, Williams et al.,6 using data from the National Survey of American Life, found that Caribbean-born Black males had higher risk of 12-month psychiatric disorders than did US-born Black men, whereas the opposite pattern held for women. The study by Williams7 in 1986 described the historical development of epidemiological studies of mental illness in this population. Using data from the National Institute of Mental Health Epidemiological Catchment Area study, he concluded that there was a paucity of studies that documented the variation in mental illness among Black Americans of different backgrounds.7These studies illustrated the need for research to differentiate between the experiences of US-born and foreign-born Black individuals. To date, no large studies have focused exclusively on immigrants from Africa, who made up about 4% of the total foreign-born population and 49% of the foreign-born Black population in the United States in 2010.8 This study provided an opportunity to examine mental health among Somalia-born Black adults compared with US-born Black and White adults. Data were from a representative sample of adults enrolled in public health care programs in Minnesota, thereby focusing on primarily low-income adults.Studies generally found that foreign-born adults had lower rates of mental illness and psychological distress than US-born adults.5,9 One explanation was that having strong social ties and a strong sense of belonging to a particular ethnic group might protect against mental illness.10 An alternative explanation was that healthy people were more likely to take on the challenge of immigrating (the “healthy migrant” effect).11Although most research on the healthy immigrant paradox has focused on Hispanic or Latino populations, important differences exist between such populations and the Somalia-born population. Most Somalia-born individuals immigrated in the midst of civil war. In their study of Somali and Oromo (Ethiopian) immigrants to the United States, Jaranson et al.12 found that 25% to 69% had experienced torture before immigrating. Because exposure to conflict leads to vulnerability toward mental health problems, Somalia-born individuals might be expected to report worse mental health than their US-born counterparts. Specifically, exposure to trauma and stress that accompany leaving conflict zones could be expected to predict higher rates of posttraumatic stress disorder and depression. Many refugee populations do exhibit higher rates of such disorders.12,13Some studies indicated that foreign-born Black immigrants had better mental and physical health than their US-born counterparts.14,15 Furthermore, foreign-born Black adults demonstrated lower rates of chronic disease16 and fewer risk factors than US-born Black adults.17 However, these studies largely focused on Caribbean-born Black immigrants and not their Somalia-born counterparts, who might have markedly different immigration experiences. Additionally, these populations might hold different attitudes toward mental illness and have different experiences within the health care arena. To better understand differences between groups, we investigated the role of stigma, discrimination, and symptomatology.Stigma can lead to understated self-reports of mental illness and might prevent people with mental illness from seeking, engaging in, or following through with treatment.18,19 Previous work suggested that Black Americans in the United States hold less stigmatized attitudes toward mental health care than do White Americans,20 but research has not explored this issue in as much depth in the immigrant population. Qualitative research suggested that some Somali immigrants might be reluctant to admit to mental health problems and might experience shame, guilt, or even suicidal ideation in response to experiencing mental illness.21 Such stigma and reticence to admit to mental illness might manifest itself as embarrassment to see a mental health provider.22Although the mental health of Somalia-born individuals might be closely tied to immigration and acculturation, US-born Black adults face prolonged exposure to racism that negatively affects mental health.23 The link between discrimination toward US-born Black Americans and physical and mental health outcomes has been well documented,24 including myriad studies that documented the association between self-reports of discrimination and mental health.25 Yet, there is a paucity of research that has sought to understand the role that discrimination plays in the mental health of foreign-born Black immigrants.23International studies suggested that African immigrant populations outside of the United States experience social exclusion, which might contribute to poor mental health. Although UK and US ethnic minority groups have different cultural and social contexts and histories of migration, they share experiences of social exclusion that can potentially contribute to mental disorders. There are also similarities in the pattern of interaction and experiences of mental health services by ethnic minority groups in the United Kingdom and the United States.26–28 For example, the existence of inequalities in diagnosis and treatment of Afro-Caribbeans in the United Kingdom is well-established. Studies found that perceptions of discriminatory treatment by health services deterred Afro-Caribbeans from accessing such services.29,30In the United States, there is evidence that foreign-born Black adults report experiencing less discrimination than their counterparts born in the United States. A 2009 study, for example, found that of pregnant US-born and foreign-born Black Americans, the US-born cohort was significantly more likely to report experiencing racial discrimination.31 In addition to discrimination and racism generally, it is important to understand the role of unfair treatment within the health care setting. If individuals do not feel that they are given fair treatment, it may lead to reticence to seek help or follow treatment recommendations.An alternative explanation for differences in self-reported mental health (SRMH) is that groups experience different symptoms of mental illness and that SRMH is an accurate reflection of mental health status. The Patient Health Questionnaire-2 (PHQ-2) has proved effective in detecting mental illness symptomatology in clinical settings32,33 and can be compared with SRMH to gain a more complete picture of mental health status. Some research found that despite experiencing discrimination, Black Americans demonstrated lower rates of many common mental illnesses than did White Americans.25 The healthy immigrant paradox found that, despite low socioeconomic and social standing, some immigrants had better health outcomes than more advantaged groups.14,15 However, much of this research focused on this effect among Hispanic populations.34 Research among Somalia-born immigrants found that mental illness was often somaticized, with symptoms of physical, rather than mental, ailments.21This article addressed the following research questions. (1) Do US-born and Somalia-born Black Americans differ from White Americans in SRMH? (2) Do stigma, discrimination in a health care setting, and symptoms of mental illness explain differences in SRMH? (3) Do interactions between race or nativity and stigma, discrimination, and symptomatology mediate these relationships? Answering these questions will allow us to develop a richer understanding of the mental health experiences of these populations while gaining a better understanding of how stigma around mental health and experiences within the health care system might affect individuals’ perceptions of their mental health.     

The Epidemiologic Vocabulary of the West and the Former Soviet Union: Different Sides of the Same Science

Objective

The purpose of this project was to develop an English-Russian Epidemiology Dictionary, which is needed for improved international collaboration in public health surveillance.

Introduction

As part of the US Department of Defense strategy to counter biological threats, the Defense Threat Reduction Agency’s Cooperative Biological Engagement Program is enhancing the capabilities of countries in the former Soviet Union (FSU) to detect, diagnose, and report endemic and epidemic, man-made or natural cases of especially dangerous pathogens. During these engagements, it was noted that Western-trained and Soviet-trained epidemiologists have difficulty, beyond that of simple translation, in exchanging ideas.The Soviet public health system and epidemiology developed independently of that of other nations. Whereas epidemiology in the West is thought of in terms of disease determinants in populations and relies on statistics to make inferences, classical Soviet epidemiology is founded on a more ecological view with the main focus on infectious diseases’ spread theory. Consequently many fundamental Soviet terms and concepts lack simple correlates in English and other languages outside the Soviet sphere; the same is true when attempting to translate from English to Russian and other languages of the FSU. Systematic review of the differences in FSU and Western epidemiologic concepts and terminology is therefore needed for strengthening understanding and collaboration in disease surveillance, pandemic preparedness, response to biological terrorism, etc.

Methods

Following an extensive search of the Russian and English literature by a working group of Western and FSU epidemiologists, we created a matrix containing English and Russian definitions of key epidemiologic terms found in FSU and Western epidemiology manuals and dictionaries, such as A Dictionary of Epidemiology (1), Epidemiology Manual (2) and many other sources. Particular emphasis was placed on terms relating to infectious disease surveillance, analysis of surveillance data, and outbreak investigation. In order to compare the definitions of each term and to elucidate differences in usage and existing gaps, all definitions were translated into English and Russian so that the definitions could be compared side by side and discussed by the working group.

Results

Six hundred and thirty one terms from 27 English and 51 Russian sources were chosen for inclusion based on their importance in applied epidemiology in either the West or the FSU. Review of the definitions showed that many terms within biosurveillance and infectious disease public health practice are used differently, and some concepts are lacking altogether in the Russian or English literature. Significant gaps in FSU epidemiology are in the areas of biostatistics and epidemiologic study designs. There are distinctive differences in FSU and Western epidemiology in the conceptualization and classification of disease transmission, surveillance practices, and control measures.

Conclusions

Epidemiologic concepts and definitions significantly differed in the FSU and Western literature. To improve biosurveillance and international collaboration, recognition of these differences must occur. Detailed analysis of epidemiology terminology differences will be discussed in the presentation and paper. Major limitations of the work were scarcity of prior research on the subject and lack of bilingual epidemiologists with the good understanding of FSU and Western approaches. A bilingual reference in the form of a dictionary will greatly improve mutual comprehension and collaboration in the areas of biosurveillance and public health practice.     

NA cohort study of thyroid cancer and other thyroid diseases after the Chernobyl accident

BACKGROUND:

The Ukrainian American Cohort Study was established to evaluate the risk of thyroid disorders in a group exposed as children and adolescents to ¹³¹I by the Chernobyl accident (arithmetic mean thyroid dose, 0.79 grays). Individuals are screened by palpation and ultrasound and are referred to surgery according to fine‐needle aspiration biopsy (FNA). However, the accuracy of FNA cytology for detecting histopathologically confirmed malignancy after this level of internal exposure to radioiodines is unknown.

METHODS:

During the first screening cycle (1998‐2000), 13,243 individuals were examined, 356 individuals with thyroid nodules were referred for FNA, 288 individuals completed the procedure, 85 individuals were referred to surgery, 82 individuals underwent surgery, and preoperative cytology was available for review in 78 individuals. Cytologic interpretation for the nodule that resulted in surgical referral was correlated with final pathomorphology; discrepancies were reviewed retrospectively; and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNA cytology were calculated.

RESULTS:

All 24 cytologic interpretations that were definite for papillary thyroid cancer (PTC) were confirmed histopathologically (PPV, 100%); and, of 11 cytologic interpretations that were suspicious for PTC, 10 were confirmed (PPV, 90.9%). Ten of 41 FNAs that were interpreted as either definite or suspect for follicular neoplasm were confirmed as malignant (PPV, 24.4%), including 2 follicular thyroid cancers and 8 PTCs (all but 1 of the follicular or mixed subtypes). Depending on whether a cytologic interpretation of follicular neoplasm was considered “positive” or “negative,” the sensitivity was 100% and 77.3%, respectively; similarly, the respective specificity was 17.6% and 97.1%, the respective PPV was 61.1% and 97.1%, and the respective NPV was 100% and 76.7%.

CONCLUSIONS:

Among children and adolescents who were exposed to ¹³¹I after the Chernobyl accident and were evaluated 12 to 14 years later, thyroid cytology had a sensitivity and a predictive value similar to those reported in unexposed populations. Cancer (Cancer Cytopathol) 2009. Published 2009 by the American Cancer Society.     

Genetic and epigenetic changes in rat preneoplastic liver tissue induced by 2-acetylaminofluorene

Genotoxic carcinogens, including 2-acetylaminofluorene (2-AAF), in addition to exerting their genotoxic effects, often cause a variety of non-genotoxic alterations in cells. It is believed that these non-genotoxic effects may be indispensable events in tumorigenesis; however, there is insufficient knowledge to clarify the role of carcinogens in both the genetic and epigenetic changes in premalignant tissues and a lack of conclusive information on the link between epigenetic alterations and carcinogenic exposure. In the current study, we investigated whether or not the mechanism of 2-AAF-induced hepatocarcinogenesis consists of both genotoxic (genetic) and non-genotoxic (epigenetic) alterations. Male and female Sprague-Dawley rats were fed NIH-31 diet containing 0.02% of 2-AAF for 6, 12, 18 or 24 weeks. The levels of DNA adducts obtained from 2-AAF in liver and kidney tissues were assessed by high-performance liquid chromatography combined with electrospray tandem mass spectrometry (HPLC-ES-MS/MS). N-(Deoxyguanosine-8-yl)-2-aminofluorene was the major adduct detected at all time points in both tissues. Global DNA methylation in the livers and kidneys, as determined by an HpaII-based cytosine extension assay and by HPLC-ES-MS/MS, did not change over the 24-week period. In the livers of male rats, there was a progressive decrease of global and long interspersed nucleotide element-1-associated histone H4 lysine 20 trimethylation, as well as hypermethylation of the p16(INK4A) gene. These epigenetic changes were not observed in the livers of female rats or the kidneys of both sexes. Importantly, morphological evidence of formation and progression of neoplastic process was observed in the liver of male rats only. In conclusion, we have demonstrated that exposure of rats to genotoxic hepatocarcinogen 2-AAF, in addition to formation of 2-AAF-specific DNA lesions, resulted in substantial alterations in cellular epigenetic status.     

Synthesis and Anti-Platelet Activity of Thiosulfonate Derivatives Containing a Quinone Moiety

Thiosulfonate derivatives based on quinones were synthesized for studying “structure-activity relationship” compounds with an acylated and a free amino-group. Anti-platelet activity of the synthesized compounds was determined and the influence of substituents on the activity of the derivatives was assessed.