Mental Health Disparities Among College Students of Color.

PURPOSE: Understanding the mental health needs of students of color is a growing priority on college and university campuses nationwide. This study aims to capture the state of mental health among students of color, including the prevalence of mental health problems and treatment utilization. METHODS: The sample is comprised of 43,375 undergraduate and graduate students at 60 institutions that participated in the survey-based Healthy Minds Study from 2012 to 2015. These data include over 13,000 students of color; we look separately at African-American, Latinx, Asian/Asian American, and Arab/Arab American students. Data are analyzed at the individual level using bivariate and multivariate modeling to elucidate variations across race/ethnicity. We examine symptom prevalence (measured by validated screens such as the Patient Health Questionnaire-9 for depression), help-seeking behaviors, and related factors (including knowledge and stigma). RESULTS: Across race/ethnicity, we find modest variation in symptom prevalence and larger variation in service utilization. Overall, treatment use is lower among students of color relative to white students, even when controlling for other variables in regression models. Asian/Asian American students have the lowest prevalence of treatment, at only 20% among those with apparent mental health conditions. Attitudes related to mental health treatment also vary significantly and help to explain the primary findings. CONCLUSIONS: College students of color represent a disparities population based on greater levels of unmet mental health needs relative to white students. This paper takes an important step toward understanding these needs and points to implications for future research and practice.

Spirituality and religious coping in African American youth with depressive illness.

The research team completed a secondary data analysis of primary data from a 2 phase depression treatment engagement behavioral trial to assess African American adolescents reported experiences of spiritual and religious coping when dealing with depression. The team utilized data collected from twenty-eight youth who participated in focus groups or individual interviews. Qualitative data were analyzed using thematic techniques for transcript-based analysis to identify the key patterns and elements of the study participants' accounts and to extract 6 primary themes. The main themes are reported in this manuscript and include; "Religion as Treatment Incentive", "Prayer & Agency", "Mixed Emotions", "Doesn't Hurt, Might Help", "Finding Support in the Church", and "Prayer and Church: Barriers to Treatment?" Overall, the data suggested that religion and spirituality play a key role in African American adolescents' experiences of depression. As well, it is surmised that these factors may be important for improving treatment seeking behaviors and reducing racial mental health disparities in this population of youth.

The Significance of Strategic Community Engagement in Recruiting African American Youth & Families for Clinical Research.

We present baseline data and describe the utility of a community engaged, culturally relevant approach to recruiting African American youth and families for phase I of The AAKOMA Project. The AAKOMA Project is a two phase treatment development study to improve mental health service use among depressed African American youth. We completed capacity building activities using a community engaged framework and Community Based Participatory Research (CBPR) methods. Replicating the (Alvarez et al. in West J Nurs Res 28:541-560, 2006) model of systematic community out-reach enhanced our ability to effectively recruit partners and evaluate outreach efforts as demonstrated by our Recruitment Success Factor (RSF-i.e. 'an adjusted ratio of eligible participant yield to contacts made'). Using the chi-square goodness-of-fit statistic; we compared the RSFs of the various modes of participant study entry to determine which was most effective. Our target enrollment was 56 persons. We recruited 130 and enrolled 57. Our baseline data is drawn from a gender balanced and socioeconomically diverse sample who participated in youth focus groups and individual interviews and adult focus groups. We identified 3 study participant referral modes (self-referral, provider referral and participant-to-participant referral) with multiple sources per mode and an overall RSF of 0.41. Study findings support the effectiveness of assiduous and systematic community interaction, reflective review of recruitment efforts and the importance of disseminating information on strategic recruitment processes for engaging diverse populations in clinical research.

Community and treatment engagement for depressed African American youth: the AAKOMA FLOA pilot.

This manuscript focuses on the recruitment efforts and pilot testing of a culturally tailored motivational interviewing intervention associated with the AAKOMA Project, a 2-phase treatment engagement intervention trial for depressed African American adolescents and families. The research team used strategic community engagement as reported in other research derived from AAKOMA. For the pilot study, the research team recruited 23 youth, enrolled 17 youth and randomized 16 of those youth to either the intervention or a delayed control group. Findings indicated that success in recruiting and retaining African American youth was sustained from earlier strategic engagement during Phase I of the project and that schools and self referrals were the largest referral sources. Pilot intervention findings highlight the preliminary utility of the intervention (100% of youth completing the intervention initiated depression treatment compared to 75% of the delayed control group) and factors that support the recruitment and engagement of a typically difficult to reach population (depressed African American youth and families). Overall, findings set the stage for further intervention development and testing in larger samples.

"Mama just won't accept this": adult perspectives on engaging depressed African American teens in clinical research and treatment.

This manuscript focuses on qualitative data collected for AAKOMA Project, a 2-phase treatment engagement intervention trial for depressed African American adolescents and families. Data are presented from our phase I study of adult perspectives on African American adolescent depression, depression treatment, and research engagement. The research team conducted four focus groups (N = 24) and generated major themes from the data including ideas regarding the manifestations of depression in African American youth and psychosocial barriers to participation in depression research and treatment. Findings indicate that success in recruiting and retaining African American youth in depression research and treatment may include using innovative means to overcome the culturally embedded attributions of depression to non-biological causes, beliefs about the cultural insensitivity of treatments and challenges in the logistics of obtaining care. Adults report that encouraging youth and familial involvement in treatments and research should include targeted, community-partnered activities involving diverse staff in leadership roles and including community members as equal partners.

Juvenile mental health courts for adjudicated youth: role implications for child and adolescent psychiatric mental health nurses.

TOPIC: Juvenile mental health courts for adjudicated youth. PURPOSE: To describe the role of psychiatric nurses in reducing mental health disparities for adjudicated youth via juvenile mental health courts. SOURCES: ISI Web of Knowledge; Sage Journals Online; HighWire; PubMed; Google Scholar and Wiley Online Library and websites for psychiatric nursing organizations. Years included: 2000-2010. CONCLUSIONS: Juvenile mental health courts may provide a positive and effective alternative to incarceration for youth with mental health problems with psychiatric nurses playing a key role in program implementation.

Pathways to success for psychologists in academic health centers: from early career to emeritus.

Careers in academic health centers (AHCs) come with a unique set of challenges and rewards. Building a stable and rewarding career as a psychologist in an AHC requires the efforts of a whole team of players and coaches. This paper outlines the characteristics of AHCs and the general skills psychologists need to thrive in this type of setting. Advice specific to each stage of career development (early, mid, and late) is offered, highlighting the themes of coaching and teamwork that are critical to success in an AHC.

Engaging depressed African American adolescents in treatment: lessons from the AAKOMA PROJECT.

The authors describe and illustrate means of engaging depressed African American adolescents in treatment. Twenty-eight youth participated in focus groups or individual interviews. Using grounded theory and transcript based analysis, they derived 5 themes describing African American adolescents' experience of depression and suggested mechanisms for improving African American youth treatment engagement. Practitioners can educate African American youth about depression as a medical disorder, build trust, and apply innovative approaches to recognizing differential manifestations of depression in African American youth.

Family first: the development of an evidence-based family intervention for increasing participation in psychiatric clinical care and research in depressed African American adolescents.

Researchers have documented health disparities for African American and other youth of color in the area of mental health. In accordance with calls for the development of innovative methods for use in reducing these disparities, the purpose of this article is to describe the development of an evidence-based intervention targeting the use of psychiatric clinical care by African American families. The authors summarize current research in the areas of perceived and demonstrated bias in the provision of mental health services, the significance of the problem of low African American participation in psychiatric clinical research and care, and evidence-based approaches to conducting family-oriented research to address adolescent mental illness in this population. This discussion is followed by a description of the development of an intervention to improve familial treatment engagement and plans to test the intervention. The article is provided as a foundation for carefully defined plans to address the unmet mental health needs of depressed African American adolescents within a culturally relevant familial context.

Use of psychotropic medications by youths in therapeutic foster care and group homes.

This article examines the use of psychotropic medications among youths in residential community-based placements. Data are from a study funded by the National Institute of Mental Health of therapeutic foster care (June 1999 through May 2001) and group homes (January through June 2001). Data were collected from staff by means of in-person interviews. Many youths in both settings received psychotropic medications, and approximately one-half were taking multiple psychotropic medications. After the authors controlled for demographic and clinical factors, the youths in group homes were nearly twice as likely as the youths in therapeutic foster care to receive medication. However, residential setting was not related to polypharmacology. Additional work is needed to study the appropriateness of use and implications of such patterns for research on intervention outcomes.