Professional service use among older African Americans, Black Caribbeans, and Non-Hispanic Whites for serious health and emotional problems.

This study examined racial and ethnic differences in professional service use by older African Americans, Black Caribbeans, and Non-Hispanic Whites in response to a serious personal problem. The analytic sample (N = 862) was drawn from the National Survey of American Life. Findings indicated that African Americans and Black Caribbeans were less likely to use services than Whites. Type and race of providers seen varied by respondents' race and ethnicity. Among respondents who did not seek professional help, reasons for not seeking help varied by ethnicity. Study findings are discussed in relation to practice implications.

Factors associated with the use of social workers for assistance with lifetime and 12-month behavioral health disorders.

This study examined the use of social workers for assistance with a behavioral health disorder. Data were from the Collaborative Psychiatric Epidemiology Surveys. The analytic sample included respondents who reported using professional services for assistance with a behavioral health disorder during their lifetime (n = 5,585). Logistic regression was used to examine the use of a social worker during the respondent's lifetime or 12 months prior to the interview. Ten percent of respondents visited a social worker for help with a behavioral health disorder during their lifetime and 3% did so in the 12 months prior to the interview. Women were less likely than men to report using a social worker. Those who visited a social worker tended to also use other professionals for a behavioral health disorder although overall respondents reported visiting social workers less frequently for this reason than other types of professionals.

Use of Complementary and Alternative Medicine among Older Adults: Differences between Baby Boomers and Pre-Boomers.

OBJECTIVES: To compare use of complementary and alternative medicine (CAM) across age cohorts. DESIGN: Secondary analysis of data from the Collaborative Psychiatric Epidemiology Surveys. PARTICIPANTS: Adults born in 1964 or earlier (N = 11,371). Over half (61.3%) are baby boomers and 53% are female. Seventy-five percent of the sample is white, 10.2% African American, 0.6% black Caribbean, 9.35% Latino, and 4.1% Asian. MEASUREMENTS: The dependent variable is a dichotomous variable indicating use of any CAM. The main predictor of interest is age cohort categorized as pre-boomers (those born in 1945 or earlier) and baby boomers (those born between 1946 and 1964). Covariates include the use of traditional service providers in the past 12 months and 12-month levels of mood, anxiety, and substance disorder. Disorders were assessed with the Diagnostic and Statistical Manual World Mental Health Composite International Diagnostic Interview. Logistic regression was used to test the association between use of CAM and age cohort. RESULTS: Baby boomers were more likely than pre-boomers to report using CAM for a mental disorder. Among identified CAM users, a higher proportion of baby boomers reported using most individual CAM modalities. Prayer and spiritual practices was the only CAM used by more pre-boomers. CONCLUSIONS: Age cohort plays a significant role in shaping individual healthcare behaviors and service use and may influence future trends in the use of CAM for behavioral health. Healthcare providers need to be aware of patient use of CAM and communicate with them about the pros and cons of alternative therapies.

Social support from church and family members and depressive symptoms among older African Americans.

OBJECTIVE: This study examined the influence of church- and family-based social support on depressive symptoms and serious psychological distress among older African Americans. METHODS: The analysis is based on the National Survey of American Life. Church- and family-based informal social support correlates of depressive symptoms (CES-D) and serious psychological distress (K6) were examined. Data from 686 African Americans aged 55 years or older who attend religious services at least a few times a year are used in this analysis. RESULTS: Multivariate analysis found that social support from church members was significantly and inversely associated with depressive symptoms and psychological distress. Frequency of negative interactions with church members was positively associated with depressive symptoms and psychological distress. Social support from church members remained significant but negative interaction from church members did not remain significant when controlling for indicators of family social support. Among this sample of churchgoers, emotional support from family was a protective factor and negative interaction with family was a risk factor for depressive symptoms and psychological distress. CONCLUSION: This is the first investigation of the relationship between church- and family-based social support and depressive symptoms and psychological distress among a national sample of older African Americans. Overall, the findings indicate that social support from church networks was protective against depressive symptoms and psychological distress. This finding remained significant when controlling for indicators of family social support.

The Medicare Part D coverage gap: implications for non-dually eligible older adults with a mental illness.

This study examines how the Medicare Part D coverage gap impacts non-dually eligible older adults with a mental illness. Qualitative, semistructured interviews were conducted with 11 case managers from community-based agencies serving persons, age 55 and over, with a mental disorder. Five themes illustrating the central difficulties associated with the Part D gap emerged: medication affordability, beneficiary understanding, administrative barriers, Low-Income Subsidy income and asset guidelines, and medication compliance. Although the Patient Protection and Affordable Care Act gradually reduces cost sharing within the gap, findings suggest that medication access and adherence may continue to be impacted by the benefit's structure.

Prevalence of lifetime DSM-IV affective disorders among older African Americans, Black Caribbeans, Latinos, Asians and non-Hispanic White people.

OBJECTIVES: The purpose of this study is to estimate lifetime prevalence of seven psychiatric affective disorders for older non-Hispanic White people, African Americans, Caribbean Black people, Latinos, and Asian Americans and examine demographic, socioeconomic, and immigration correlates of those disorders. DESIGN: Data are taken from the older sub-sample of the Collaborative Psychiatric Epidemiology Surveys. Selected measures of lifetime DSM-IV psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder, major depressive disorder, and dysthymia). SETTING: Community epidemiologic survey. PARTICIPANTS: Nationally representative sample of adults 55 years and older (n = 3046). MEASUREMENTS: Disorders were assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. RESULTS: Major depressive disorder and social phobia were the two most prevalent disorders among the seven psychiatric conditions. Overall, non-Hispanic White people and Latinos consistently had higher prevalence rates of disorders, African Americans had lower prevalence of major depression and dysthymia, and Asian Americans were typically less likely to report affective disorders than those of their counterparts. There is variation across groups in the association of demographic, socioeconomic, and immigration variables with disorders. CONCLUSIONS: This study furthers our understanding of the racial and ethnic differences in the prevalence of DSM-IV disorders among older adults and the correlates of those disorders. It highlights the importance of examining both between-group and within-group differences in disorders and the complexity of the mechanisms associated with differences across groups. Findings from this study underscore the need for future research that more clearly delineates subgroup differences and similarities.

Demographic correlates of DSM-IV major depressive disorder among older African Americans, Black Caribbeans, and non-Hispanic Whites: results from the National Survey of American Life.

OBJECTIVES: To examine the demographic correlates of lifetime and 12-month prevalence of major depressive disorder (MDD) among older African Americans, Black Caribbeans, and non-Hispanic Whites. METHODS: Data are from adults aged 55 years and older (n = 1439) recruited to the National Survey of American Life (NSAL; 2001-2003). The Diagnostic and Statistical Manual Version IV World Mental Health Composite International Diagnostic Interview was used to assess the 12-month and lifetime MDD. Weighted logistic regression was used to model demographic correlates of MDD. RESULTS: The population prevalence of lifetime and 12-month MDD were 11.2% and 4.1%, respectively. Bivariate analyses revealed that younger respondents and those with greater disability had a higher prevalence of both lifetime and 12-month MDD compared with those who were older and who had lower disability. Multivariable logistic regressions controlling for demographic characteristics revealed that non-Hispanic Whites had the greatest odds of lifetime MDD (OR = 2.27, 95% CI = 1.32, 3.93). Women had significantly greater odds of lifetime MDD compared with men (OR = 2.49, 95% CI = 1.14, 5.41); there were no gender differences in 12-month MDD. Other significant predictors of MDD were marital status and region of residence. CONCLUSIONS: The distribution, correlates, and nature of associations with MDD vary as a function of whether we examined lifetime vs. 12-month MDD. Future work should account for within group differences among older adults with depression. Understanding MDD correlates and the nature of intergroup diversity can inform the identification of particularly vulnerable subgroups as well as appropriate treatment approaches.

Use of Professional and Informal Support by Black Men with Mental Disorders.

This study utilized data from the National Survey of American Life to investigate the use of professional services and informal support among African American and Caribbean black men with a lifetime mood, anxiety, or substance use disorder. Thirty-three percent used both professional services and informal support, 14% relied on professional services only, 24% used informal support only, and 29% did not seek help. African American men were more likely than to rely on informal support alone. Having co-occurring mental and substance disorders, experiencing an episode in the past 12 months, and having more people in the informal network increased the likelihood of using professional services and informal supports. Marital status, age, and socioeconomic status were also significantly related to help-seeking. The results suggests potential unmet need. However, the reliance on informal support also suggests a strong protective role that informal networks play in the lives of black men.

African Americans' and Black Caribbeans' Religious Coping for Psychiatric Disorders.

This study investigates the use of religious coping among African Americans and Black Caribbeans with 12-month DSM-IV psychiatric disorders. Data from the National Survey of American Life is used to examine three indicators of religious coping: 1) using prayer and other spiritual practices for mental health problems, 2) the importance of prayer in stressful situations, and 3) looking to God for strength. Three out of four respondents who had a mental health problem reported using prayer as a source of coping. Agoraphobia and drug abuse disorder were associated with the importance of prayer during stress. Individuals with generalized anxiety disorder were more likely to report that prayer was important during stressful experiences and that they looked to God for strength. These findings contribute to the limited, but growing body of research on the ways that African Americans and Black Caribbeans cope with psychiatric disorders.

Emotional support, negative interaction and DSM IV lifetime disorders among older African Americans: findings from the National Survey of American Life (NSAL).

OBJECTIVES: Both emotional support and negative interaction with family members have been linked to mental health. However, few studies have examined the associations between emotional support and negative interaction and psychiatric disorders in late life. This study investigated the relationship between emotional support and negative interaction on lifetime prevalence of mood and anxiety disorders among older African Americans. DESIGN: The analyses utilized the National Survey of American Life. METHODS: Logistic regression and negative binomial regression analyses were used to examine the effect of emotional support and negative interaction with family members on the prevalence of lifetime DSM-IV mood and anxiety disorders. PARTICIPANTS: Data from 786 African Americans aged 55 years and older were used. MEASUREMENT: The DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to assess mental disorders. Three dependent variables were investigated: the prevalence of lifetime mood disorders, the prevalence of lifetime anxiety. RESULTS: Multivariate analysis found that emotional support was not associated with any of the three dependent variables. Negative interaction was significantly and positively associated with the odds of having a lifetime mood disorder, a lifetime anxiety disorder and the number of lifetime mood and anxiety disorders. CONCLUSIONS: This is the first study to investigate the relationships among emotional support, negative interaction with family members and psychiatric disorders among older African Americans. Negative interaction was a risk factor for mood and anxiety disorders among older African Americans, whereas emotional support was not significant.

Religious participation and DSM-IV disorders among older African Americans: findings from the National Survey of American Life.

OBJECTIVES: This study examined the religious correlates of psychiatric disorders. DESIGN: The analysis is based on the National Survey of American Life (NSAL). The African American sample of the NSAL is a national representative sample of households with at least one African American adult 18 years or over. This study uses the older African American subsample (N = 837). METHODS: Religious correlates of selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress, major depressive disorder, dysthymia, bipolar I & II disorders, alcohol abuse/dependence, and drug abuse/dependence) were examined. PARTICIPANTS: Data from 837 African Americans aged 55 years or older are used in this analysis. MEASUREMENT: The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess mental disorders. Measures of functional status (i.e., mobility and self-care) were assessed using the World Health Organization Disability Assessment Schedule-Second Version. Measures of organizational, nonorganizational and subjective religious involvement, number of doctor diagnosed physical health conditions, and demographic factors were assessed. RESULTS: Multivariate analysis found that religious service attendance was significantly and inversely associated with the odds of having a lifetime mood disorder. CONCLUSIONS: This is the first study to investigate the relationship between religious participation and serious mental disorders among a national sample of older African Americans. The inverse relationship between religious service attendance and mood disorders is discussed. Implications for mental health treatment underscore the importance of assessing religious orientations to render more culturally sensitive care.

Mental health service use among older African Americans: the National Survey of American Life.

OBJECTIVES: The objective of this study was to examine mental health services utilization of older African Americans using data from the National Survey of American Life. METHODS: A subsample of African American respondents aged 55 years or older (N = 837) was used for this study. Thirteen mental disorders, including mood, anxiety, and substance disorders, were assessed using the Diagnostic Statistical Manual-IV World Mental Health Composite International Diagnostic Interview. Seventy-four respondents (9.6%) met criteria for a disorder. Self-reported service use included psychiatric and nonpsychiatric mental health services, general medical care, and nonhealth care (e.g., human services and complementary-alternative medicine). RESULTS: Overall, 46.5% (N = 30) of older African Americans with any one 12-month disorder used some form of services in the last year; 47.2% (N = 12) with two or more disorders used any services. Those reporting any mood disorder had higher service use in every sector compared with those with any anxiety or any substance disorder. Age was significantly related with each service sector except for nonhealth care. There were no significant gender or work status differences, and marital status was only significant in nonhealth care use. Those aged 55-64, married, and not residing in the south were more likely to report any service use than their respective counterparts. CONCLUSIONS: These findings reveal that a significant proportion of African American older adults with mental health disorders do not receive professional help. Future research on system, provider, and patient factors is needed to clarify and explain underutilization of mental health services.

Church-Based Exchanges of Informal Social Support among African Americans.

This study examines the correlates of the types of instrumental support exchanges that occur between church members among African Americans. Exchanges of four types of instrumental support are examined: transportation assistance, help with chores, financial assistance and help during illness. Data for this study are from the National Survey of American Life Re-Interview, the follow-up survey to the National Survey of American Life which is a nationally representative sample of the African American population. We found that African Americans were more likely to both give and receive support in situations involving illness, followed by transportation, financial assistance, and help with chores. For each of the four types of instrumental support, respondents indicate that they provide more assistance to others than they receive. For all eight dependent variables, those with lower levels of education were more actively engaged in receiving and providing support than their higher educated counterparts. Higher levels of religious service attendance were associated with higher levels of support, which underscores the importance of involvement in faith communities for assistance. Overall, our findings confirm the importance of church-based informal social support between African Americans and documents within group diversity as both recipients and providers of assistance.

Differences between African Americans and Non-Hispanic Whites Utilization of Clergy for Counseling with Serious Personal Problems.

There is a paradox in research on African Americans and non-Hispanic whites in the utilization of clergy. Research finds that African Americans have higher levels of religious service attendance and higher levels of contact with clergy. Research also finds that despite this, African Americans are less likely than non-Hispanic whites to seek out assistance from clergy for psychiatric disorders including depression and anxiety. The goal of this paper was to investigate race differences in the use of clergy for counseling for serious personal problems. It uses the National Survey of American Life. We find that non-Hispanic whites were more likely than African Americans to use clergy for a serious personal problem. The significant difference between African Americans and non-Hispanic whites appeared to be mediated by the fact that African Americans were more likely to have seen clergy in a religious setting and non-Hispanic whites were more likely to have seen clergy in other settings including hospitals.

Professional Service Use for a Serious Personal Problem: Comparing Older African Americans, Black Caribbeans, and Non-Hispanic Whites Using the National Survey of American Life.

OBJECTIVES: Examines combinations of professionals visited for a serious personal problem. METHOD: The sample includes those aged 55 and above (N = 862) from the National Survey of American Life (NSAL). Latent class analysis was used to identify groups of respondents based on types of professionals visited. Multinomial logistic regression was used to identify factors associated with group membership. RESULTS: Classes included health provider plus clergy, physician plus mental health provider, and limited provider use. Whites were more likely than African Americans to fall into the health provider plus clergy and physician plus mental health provider classes. Those with physical and emotional problems were more likely to be in the health provider plus clergy and physician plus mental health provider classes, respectively. DISCUSSION: Most respondents were in the limited provider use class suggesting that for many problems, minimal professional help is utilized. Physicians and clergy were important across all three classes.

A latent class analysis of age differences in choosing service providers to treat mental and substance use disorders.

OBJECTIVE This study investigated choice of service provider for treatment of a mental or substance use disorder and its association with consumers' age. METHODS Data were from the Collaborative Psychiatric Epidemiology Surveys. Service users born between 1946 and 1964 were compared with those born in 1945 or earlier (N=4,082). Latent class analysis was used to identify groups of service users according to nine dichotomous items reflecting lifetime visits with different types of professionals. Multinomial logistic regression was used to analyze factors predicting latent class membership, with particular focus on both the direct and moderating effects of age. Analyses controlled for sociodemographic characteristics and disorder-related variables. RESULTS Five classes of service user were identified. Class 1 (10.8%) included individuals who visited six of the nine types of providers (multiple providers visited). Class 2 (21.9%) had low probability of visiting most providers (limited providers visited). Class 3 (24.1%) visited a psychiatrist (primarily psychiatrist). Class 4 (28.1%) visited a family physician or other physician (primarily family physician). Class 5 (15.1%) visited a psychologist (primarily psychologist). A higher proportion of service users born before 1946 were in the primarily family physician class. Although 21% of service users born later also fell into this class, overall they were more evenly distributed across the five classes. CONCLUSIONS Family physicians played a significant role in behavioral health treatment for both age groups. However, findings suggest that younger adults may rely on more complex combinations of service providers that will require greater coordination between the behavioral and general health care systems in the future.

Use of ministers for a serious personal problem among African Americans: findings from the national survey of American life.

This study examined use of ministers for assistance with a serious personal problem within a nationally representative sample of African Americans (National Survey of American Life-2001-2003). Different perspectives on the use of ministers-social stratification, religious socialization, and problem-oriented approach-were proposed and tested using logistic regression analyses with demographic, religious involvement, and problem type factors as predictors. Study findings supported religious socialization and problem-oriented explanations indicating that persons who are heavily invested in religious pursuits and organizations (i.e., women, frequent attenders) are more likely than their counterparts to use ministerial assistance. Contrary to expectations from the social stratification perspective, positive income and education effects indicated that higher status individuals were more likely to report use of ministers. Finally, problems involving bereavement are especially suited for assistance from ministers owing to their inherent nature (e.g., questions of ultimate meaning) and the extensive array of ministerial support and church resources that are available to address the issue.

Characteristics of users of consumer-run drop-in centers versus clubhouses.

Clubhouses and consumer-run drop-in centers (CRDIs) are two of the most widely implemented models of consumer-centered services for persons with serious mental illness. Differences in structure and goals suggest that they may be useful to different types of consumers. Information on what types of consumers use which programs would be useful in service planning. This study analyzes data from the authors' NIMH-funded research on 31 geographically matched pairs of clubhouses and CRDIs involving more than 1,800 consumers to address the following question: are there significant differences in the characteristics and outcomes of members of clubhouses versus CRDIs? Results from multilevel analyses indicated that clubhouse members were more likely to be female, to receive SSI/SSDI, to report having a diagnosis of schizophrenia, and to live in dependent care; and they reported both a greater number of lifetime hospitalizations and current receipt of higher intensity traditional MH services. Controlling for differences in demographic characteristics, psychiatric history, and mental health service receipt, clubhouse members also reported higher quality of life and were more likely to report being in recovery. CRDI consumers were more likely to have substance abuse histories. Possible reasons for the differences are discussed. The results suggest that CRDIs are a viable alternative to more traditional mental health services for individuals who might not otherwise receive mental health services.

Prevalence and burden of general medical conditions among adults with bipolar I disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To examine the prevalence and burden of general medical conditions (GMCs) among a nationally representative sample of adults with bipolar I disorder. METHOD: Data for this study were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093), which included US adults aged 18 years and older. This study focused on the subsample of adults with DSM-IV-diagnosed bipolar I disorder (n = 1,548). The past-year prevalence of 11 GMCs was examined. Associations between GMCs, bipolar I disorder, and disability measures (12-Item Short-Form Health Survey) were tested using multivariate regression analyses. RESULTS: Approximately 32.4% of adults with bipolar I disorder had 1 or more GMCs. In the general population, diagnosis with bipolar I disorder was a significant risk factor for 7 of 11 GMCs in adjusted analyses. Among adults with bipolar I disorder, those with 1 or more GMCs evidenced significantly greater disability across all disability measures compared to those without a GMC. Individual GMCs were significantly associated with physical, mental, and psychosocial disability in adjusted analyses and predicted specific patterns of disability. CONCLUSIONS: GMCs were found disproportionately among persons with bipolar I disorder and associated with significant impairments in health and psychosocial functioning. Health care providers should screen for and treat GMCs in service populations including persons with bipolar disorder, given the heightened rates of morbidity, mortality, and disability that attend untreated GMCs in this client group. Integrated and collaborative treatment approaches could significantly improve overall functioning and quality of life for persons with this treatable disorder.