Perceived discrimination, mental health help-seeking attitudes, and suicide ideation, planning, and attempts among black young adults.

BACKGROUND: Developing an understanding of the negative impact of discrimination is critical when examining the suicidality of Black young adults in the US. Suicide rates among Black young adults have increased at alarming rates. One of the reasons for this increase is the disparities related to access to mental health services, which has long-term health consequences. This study addresses a significant gap in the literature by examining associations between experiences of everyday discrimination, attitudes towards mental health help-seeking attitudes, on the outcomes suicide ideation, planning to die by suicide, and suicide attempts. METHODS: The data came from a national study of the experiences of Black young adults regarding mental, physical, and sexual health. Participants were recruited from across the Midwestern region of the United States through Qualtrics Panels, an online survey delivery service used to recruit study participants. The total sample for this study was N = 362, and the average age of the sample was 21 (SD: 1.96). We used a logistic regression analysis to examine the role of everyday discrimination, mental health support-seeking attitudes, and covariates on the outcomes: suicide ideation, planning to die by committing suicide, and suicide attempts. RESULTS: Black young adults with positive mental health help-seeking attitudes were 34% less likely to attempt suicide (OR = 0.66; 95% CI: 0.46, 0.96) and 35% less likely to experience suicide ideation (OR = 0.65; 95% CI: 0.47, 0.89). However, those young adults who experienced discrimination daily were more likely to report having attempted suicide (OR = 1.70; 95% CI: 1.34, 2.15). CONCLUSIONS: Our findings offer valuable insights into the complex interplay between experiences of discrimination, attitudes toward seeking mental health support, and suicidal behaviors. However, our research also underscores how experiences of discrimination can significantly exacerbate feelings of isolation, hopelessness, and inadequacy, further contributing to suicidal behaviors in this population. By promoting positive mental health help-seeking behaviors, actively addressing discrimination, and applying an intersectional approach to suicide prevention efforts, we can take significant strides towards building a more supportive and inclusive society. This approach aims to empower individuals to seek help, reduce the risk of suicidal behaviors, and create a more welcoming environment for all members of our community.

Identifying disparities in patient-centered care experiences between non-Latino white and black men: results from the 2008-2016 Medical Expenditure Panel Survey.

BACKGROUND: Patient-centered healthcare in the context of a medical home (PCMH) is an important pathway to reducing healthcare inequities. To date, no work has examined the prevalence of care experiences associated with PCMH among non-elderly Black males. METHODS: We analyzed data, on 22 indicators representative of six healthcare domains associated with PCMH experiences, from non-Latino White (NLW) and Black males aged 18-64 from the 2008-2016 Medical Expenditure Panel Survey (n = 47,405). We used generalized linear models to test whether Behavioral Model factors attenuate any differences in access to these domains between NLW and Black males, and decomposition techniques to examine the contribution of these factors to reported differences. RESULTS: Black males reported 1) lower access to personal primary care providers, 2) poorer quality communication with providers, and 3) lower levels of care comprehensiveness (all p < 0.05). Differences between groups were attenuated but not eliminated by accounting for the Behavioral Model factors particularly through enabling and predisposing factors. Group health characteristics were not a primary driver of racial differences in care experiences across all the considered domains. CONCLUSIONS: Black men, in the U.S, continue to face barriers to accessing high quality, patient-centered care, specifically as it relates to accessing specialty care, medical tests, and patient-provider communication.

Characterizing Mobility Limitations Among Older African American Men.

This study represents an effort to contribute to the limited body of research on biopsychosocial contextual factors that influence or contribute to mobility limitations for older African American men. Specifically, we were interested in examining associations between socio-demographic, physical and emotional health experiences with mobility limitations. A secondary analysis of 1666 older African American men was performed to investigate socio-demographic, mental and physical health correlates to a specific measures of mobility limitation. In the final model, difficulty with self-care, severe pain interference, and problems with usual activities were most strongly associated with mobility limitations. Men who were married were significantly less likely to experience mobility limitations. Findings highlighted the relationship between mobility limitations and difficulty performing activities of daily living. Additional research should examine the impact of poor emotional health and the buffering effects of marriage on mobility for older African American men, a population at high risk of experiencing disparate health outcomes.

Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth.

Recent findings from the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network's 2020 prevalence report indicate that disparities in autism diagnoses between Black and White youth have narrowed, reflecting improved screening, awareness, and access to services (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). Claims of reducing disparities beyond prevalence rates, however, are not fully supported, as indicated by the reality that Black youth whose screenings indicate autistic traits are still not being referred for full evaluation or early intervention services at the same rate as their White peers (Major et al., 2020. Autism, 24, 1629-1638; Smith et al., 2020. Pediatrics, 145, S35-S46.). Black 8-year-olds identified as autistic still experience disparate educational placements (Waitoller et al., 2010. The Journal of Special Education. 44, 29-49.) where services may not be autism-specific or have Individual Education Plan goals only focused on "behavior problems" (Severini et al., 2018. Journal of Autism and Developmental Disorders, 48, 3261-3272.), are served in the most restrictive environments (Skiba et al., 2006. Exceptional Children, 72, 411-424.) and lack consistent augmentative and alternative communication support (Pope et al., 2022. American Journal of Speech-Language Pathology, 31, 2159-2174.). Additionally, ADMM researchers report consistent disparities in the identification of co-occurring intellectual disability where Black autistic children have significantly more co-occurrences than White autistic children. The purpose of this commentary is to first examine the assertion that the narrowed gap indicates, "…improved…access to services among historically underserved groups," (p. 9) (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). We will then recommend strategies to address the ongoing disparities.

Perspective: The role of diversity advisory boards in autism research.

LAY ABSTRACT: This article argues that using groups of individuals that specifically focus on addressing issues with diversity in autism research and autism intervention development are key in ensuring that a greater amount of racial, ethnic, and gender diverse autistic individuals are included in the research and that the research is addressing the needs of these individuals and groups. We call these groups a diversity advisory board. A diversity advisory board will help improve diversity in autism research and intervention development by making sure that autism researchers (1) are intentional about addressing issues of diversity in their research and (2) are able to recruit a greater number of autistic individuals with diverse identities, and (3) by giving greater consideration to the context of diverse autistic individuals which will help autism-focused interventions work better in community settings. We give a short description of these arguments and ideas for how to form and use a diversity advisory board.

Virtual Interview Training Among BIPOC Autistic Transition-Age Youth: A Secondary Analysis of an Initial Effectiveness RCT.

Black, Indigenous, and Persons of Color (BIPOC) autistic transition-aged youth (TAY) report lower rates of competitive employment compared to White autistic TAY and even greater deficits with social skills associated with positive job interviewing. A virtual job interviewing program was adapted to support and improve the job interviewing skills of autistic TAY. The current study evaluates the effectiveness of an efficacious virtual interview training program on the job interview skills, interview anxiety, and likeliness to be hired, for a subsample of 32 BIPOC autistic TAY, ages 17-26 years old from a previous randomized control trial of the program. Bivariate analyses were used to evaluate between-group differences at pre-test related to background characteristics, and whether Virtual Interview Training for Transition-Age Youth (VIT-TAY) was associated with changes between pre-test and post-test measures of job interview skills. Additionally, a Firth logistic regression was conducted to examine the relationship between VIT-TAY and competitive integrative employment at 6 months, covarying for fluid cognition, having ever had a job interview, and baseline employment status. Participants receiving pre-employment services (Pre-ETS) and virtual interview training had better job interview skills (F = 12.7, [Formula: see text] < .01; [Formula: see text] = .32), lower job interview anxiety (F = .3.96, [Formula: see text] < .05; [Formula: see text] = .12), and a higher likeliness of receiving employment (F = 4.34, [Formula: see text] < .05; [Formula: see text] = .13 at the 6-month follow up compared to participants that only had Pre-ETS. Findings from this study suggest that virtual interview training for TAY is effective for BIPOC autistic TAY in improving their interview skills to gain competitive employment and lower their job interview anxiety.

An Exploratory Case Study of the Types of Resources Black Boys Use to Support Their Mental Health.

Black adolescent boys experience mental health challenges because of their exposure to a greater frequency and severity of psychosocial stressors. This study used a sample of Black boys at a high school in southeastern Michigan as a case study to understand the types of resources Black boys might use to support their mental health. After conducting a rigorous analysis of the study data using a rapid and an accelerated data reduction technique, four themes helped us answer the question: What kinds of mental health support resources are Black boys using? Four themes emerged from our analysis: online resources, community and trusted individuals, self-reliance, and additional needs. This case study is a springboard for further work to tailor a mental health education and support intervention, such as the YBMen Project, for Black boys and for building additional support amid the multiple crises occurring that impact their mental health and safety. Findings have implications for future research, practice, and policy to improve the mental health of Black boys in high school.

The Mental Health of Black Youth Affected by Community Violence: Family and School Context as Pathways to Resilience.

Black youth who experience community violence occupy multiple environments with varying levels of influence on how they display resiliency to prevent adverse mental health outcomes. Considering the recent rise of mental health concerns (i.e., increase in suicidal outcomes) among Black youth, along with the abundance of research illustrating the detrimental impact of community violence, more research is needed to examine how different environmental factors (e.g., family and school) shape how youth protect their mental health while displaying resiliency navigating community violence. The purpose of this study was to examine how family and school contexts predict Black youths' ability to display resiliency to navigate community violence and prevent adverse mental health outcomes. This study utilized a path analysis to examine the associations between parent relationships, parent bonding, school climate, resilience to adverse community experiences, community violence, and mental health among 548 Black adolescents in Chicago. Findings highlight that parent relationships, parent bonding, and school climate influence the association between resilience to community violence and mental health outcomes among Black youth. Implications for mental health practice and policy among Black youth are discussed.

Decoding the Role of Companions in Supporting the Health Communication of Older African-American Men With Cancer.

The objective of this study was to systematically characterize the content and patterning of companion's communicative behavior during oncology consultations for older African-American male patients. Companions and family members often play an important role in patient-centered communication for patients with cancer. Despite their disproportionate cancer burden, little is known about how companions facilitate patient-provider communication for older African-American men with cancer. This study represents a secondary qualitative analysis of 14 video-recorded doctor patient-companion medical visits for African-American male patients with cancer. Videos were captured with consent and institutional review board approval at a Midwest comprehensive cancer center between 2002 and 2006. These medical visits were transcribed, deidentified, and analyzed for the content, frequency, co-occurrence, and thematic clustering of companions' active participation behaviors during the interaction. Results were well aligned with existing studies on accompanied oncology visits. Patients were on average, 60.14 years old and all but one of the 16 companions was a woman. A total 782 companion behaviors were coded across 14 medical interactions. While companions communicated directly with providers (eg, asking questions, providing medical history) and directly with patients (eg, clarifying information, giving advice), there was a lack of triadic communication. This study clarifies the role of mainly spousal companions as important intermediaries in the patient-provider communication dynamic for older African-American men with cancer.

An Online Behavioral Health Intervention Promoting Mental Health, Manhood, and Social Support for Young Black Men: The YBMen Project.

Conventional definitions of mental health, manhood, and social support create barriers to accessing behavioral health care for Black men ages 18 to 30. Targeted behavioral health interventions sensitive to culture, social norms, and gender that circumvent these barriers are desperately needed to improve access and integrated care for this group. This article reports mixed methods findings from the 2017 iteration of the Young Black Men, Masculinities, and Mental Health (YBMen) project, a social media-based, psychoeducational program that promotes mental health, progressive definitions of manhood, and sustainable social support for Black men. Young Black men (n = 350) across two universities in the Midwest completed baseline surveys on their mental health, definitions of manhood, and social support. Forty of the men participated in the YBMen intervention and at postintervention reported experiencing fewer depressive symptoms on the Patient Health Questionnaire (PHQ-9, Z = -2.05, p < .01) and the Gotland Male Depression Scale (GMDS; Z = -1.76, p < .05). There were also changes on the Conformity to Masculine Norms Inventory (CMNI) for Self-Reliance (Z = -0.34, p = .26) and Heterosexual Self-Presentation (Z = -0.18, p = .59), though these changes were not statistically significant. A qualitative review of postintervention interviews revealed participants' appreciation of the YBMen project and its influence on their mental health, manhood, and social support. Programmatic efforts that support the behavioral health, positive development, and social relationships of Black men translate into positive families, communities, and experiences as they live, learn, love, and work over the life course.

"You Have to Be Part of the Process": A Qualitative Analysis of Older African American Men's Primary Care Communication and Participation.

The objective of the current study was to understand older African American men's perceptions of and experiences with patient-provider communication during primary care medical visits. Fifteen African American men age 50 and older participated in individual semistructured interviews. Open-ended questions focused on their primary care therapeutic alliance, preferences for decision-making, self-efficacy, patient satisfaction, communication, and companion participation during primary care medical visits. Emergent themes included the perception of rushed and inattentive care related to low socioeconomic status, inadequate information exchange about medical testing and follow-up care, welcoming the help of highly engaged companions, and proactively preparing for medical visits. Participants' assertiveness, confidence, and persistence with health providers regarding agenda setting for their care were most prevalent and contradict extant literature portraying African American men as less engaged or informed patients. Older African American men, particularly those with low socioeconomic status, may benefit from additional support and advocacy to consistently receive patient centered care and communication.