Lessons Learned from 50 Years of Violence Prevention Activities in the African American Community.

PURPOSE: This article covers violence prevention (homicide and suicide) activities in the African American community for nearly 50 years. METHOD: Drawing on lived experience the works of early and recent efforts by African American physicians, the author illustrates we know a great deal about violence prevention in the African American community. RESULTS: There remains challenges of implementation and political will. Further, most physicians, like the public, are confused about the realities of homicide and suicide because of the two different presentations both are given in the media and scientific literature. CONCLUSIONS: Responses to homicide and suicides should be based on science not distorted media reports. There are violence prevention principles that, if widely implemented, could stem the tide of violence.

Rethinking funding priorities in mental health research.

Mental health research funding priorities in high-income countries must balance longer-term investment in identifying neurobiological mechanisms of disease with shorter-term funding of novel prevention and treatment strategies to alleviate the current burden of mental illness. Prioritising one area of science over others risks reduced returns on the entire scientific portfolio.

Misdiagnosis of African-Americans with Psychiatric Issues - Part I.

PURPOSE: This article highlights issues of misdiagnosis in an African-American, adult clinical population by doing point prevalence, record review study within a comprehensive community mental health center. METHOD: Psychiatric evaluations of 330 patients were reviewed and clinically identifiable variables of: a) childhood Intellectual Disability (ID), special education, Attention Deficit Hyperactive Disorder (ADHD), or Autism/Pervasive Developmental Disorder (PDD); b) head injury causing Organic Brain Syndrome (OBS) or Temporal Lobe Epilepsy (TLE); c) a history of chronic substance abuse prior to the development of psychiatric symptoms; or d) childhood trauma causing Anxiety, Depression, and Panic Disorders were tabulated. RESULTS: Two hundred and twenty patients, who were free of the four variables, had a single psychiatric diagnosis and 18 had multiple co-morbid diagnoses. More than 25% (92/330) of the patients had the four variables in their histories. Four of the 92 patients had more than one variable in their history. Of the remaining 88 cases, 42 had psychiatric issues beginning in childhood (28 had history of ID, 4 had history of learning disabilities, 3 had history of ADHD, 7 had histories of Autism/PDD); 9 had histories of OBS or TLE; 20 had histories of substance abuse; and 18 had histories of extensive childhood trauma). CONCLUSIONS: Careful attention to common issues in African-Americans can inform the psychiatric diagnostic process pointing to prevention or treatment considerations that would benefit the African-American community at large.

Misdiagnosis of African-Americans with Psychiatric Issues - Part II.

PURPOSE: The second "Misdiagnosis of African-Americans with Psychiatric Issues" article focuses on traumatic life experiences that meet a proposed criteria for Developmental Trauma Disorder (DTD).l METHOD: Psychiatric evaluations of 330 patients were reviewed and clinically identifiable variables of: a) childhood mental retardation (MR), special education, Attention Deficit Hyperactive Disorder (ADHD), or Autism/Pervasive Developmental Disorder (PDD); b) head injury causing Organic Brain Syndrome (OBS) or Temporal Lobe Epilepsy (TLE); c) a history of chronic substance abuse prior to the development of psychiatric symptoms; or d) childhood trauma causing Anxiety, Depression, and Panic Disorders were tabulated. RESULTS: In Part I,2-Reference Part I we learn that the above four variables did not influence two-thirds of the African-American patient's psychiatric diagnoses; however, excluding patients with multiple diagnoses, 26.7% of the patient's diagnoses were shaped by these variables. Of these, 20% (18 of 88 patients), or 5.5% of the total 330 patients, had diagnoses that were strongly influenced by childhood traumatic experiences. Accordingly, we present two case histories that explicate the psychopathology seen in African-Americans traumatized as children. CONCLUSIONS: This study helps to stress and confirm the importance of how understanding childhood traumatic experiences shape adult African-American psychopathology and the potential for misdiagnosis - an important factor for prevention and appropriate treatment of African-American patients with psychiatric issues.

National Institutes of Health State-of-the-Science Conference statement: preventing alzheimer disease and cognitive decline.

The National Institute on Aging and the Office of Medical Applications of Research of the National Institutes of Health convened a State-of-the-Science Conference on 26-28 April 2010 to assess the available scientific evidence on prevention of cognitive decline and Alzheimer disease. This article provides the panel's assessment of the available evidence.

"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.

Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence.

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Differences in vulnerability factors for depressive episodes in African American and European American adolescents.

BACKGROUND: Although intervention tailoring could lower the burden of adolescent depression, few studies have examined differences in vulnerability factors between African American and European American youth. METHODS: We determined and compared the prevalence, relative risk, and population-attributable risk (PAR) of baseline vulnerability factors predicting depressive episodes at 1-year follow-up in a nationally representative sample of African American and European American adolescents. RESULTS: The leading (highest PAR) vulnerability factors for African American adolescents were demographics, while the top vulnerability factors for European American youth were current depressed affect and low perceived family connectedness. Unique vulnerability factors for African American youth were (1) neither parent finished high school, (2) believing oneself unintelligent, and (3) running away from home. Avoidant problem solving, divorce, poor residential father relationship, sexual relationships, and delinquent behaviors did not predict depressive episodes in African American adolescents but did in European American. Low family and peer connectedness were important common vulnerability factors for both groups. CONCLUSIONS: Differing patterns of vulnerability suggest that alternative strategies may be better suited to preventing depression among African American youth. A first step may lie in understanding what mediates the effect of low parental educational status on future depression risk.

American Association of Community Psychiatrists' views on general features of DSM-IV.

OBJECTIVE: The authors report on a survey of the American Association of Community Psychiatrists (AACP) about improving DSM-IV. METHODS: An anonymous survey was sent to 600 psychiatrists of the AACP via Survey Monkey technology. RESULTS: Respondents (N=152) answered questionnaires regarding the general features of DSM-IV. Reliable interclinician communication was valued most highly. A majority of respondents (92%) reported using axis 1, 75% used axes 2 and 3, and approximately 50% used axes 4 and 5. AACP members were less keen on using the tool to inform patient management planning. Least valued were usefulness for a national statistical base or to indicate prognosis. CONCLUSIONS: AACP respondents' views suggest modification to the DSM system to improve clinical utility. Most favored fewer than 100 diagnostic categories. Many were concerned about the current systems' cultural sensitivity and accessibility to patients. These considerations should guide DSM-V deliberations.

Building protective factors to offset sexually risky behaviors among black youths: a randomized control trial.

OBJECTIVES: To test the effectiveness of the CHAMP among black South Africans in KwaZulu-Natal, South Africa. METHODS: A randomized control trial was conducted in KwaDedangendlale, South Africa, among youths (ages 9-13) and their families (245 intervention families rearing 281 children and 233 control families rearing 298 children). The CHAMPSA intervention targeted HIV risk behaviors by strengthening family relationship processes as well as targeting peer influences through enhancing social problem solving and peer negotiation skills for youths. RESULTS: Among caregivers in the control and experimental conditions, significant intervention group differences were revealed regarding HIV transmission knowledge, less stigma toward HIV-infected people, caregiver monitoring-family rules, caregiver communication comfort, caregiver communication frequency and social networks. Among youths, data revealed that control and experimental groups were significantly different for children in AIDS transmission knowledge and less stigma toward HIV-infected people. CONCLUSIONS: CHAMPSA enhances a significant number individual, family and community protective factors that can help youths avoid risky behaviors leading to HIV-positive status.

Development and process evaluation of a primary care internet-based intervention to prevent depression in emerging adults.

BACKGROUND: Primary care is a potential setting for implementation of depression prevention interventions using cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT). The purpose of this study was to develop and conduct a process evaluation of a primary care/ Internet-based intervention that addresses key dissemination barriers in a community setting. METHOD: We used an interdisciplinary team of investigators in a multistep intervention development process among a sample of primary care patients (aged 18 to 24 years). The intervention included an initial primary care motivational interview to engage the participant, 11 Internet-based modules based on CBT (to counter pessimistic thinking) and IPT (to activate social networks and strengthen relationship skills), and a follow-up motivational interview in primary care to enhance behavior change. Each component of the intervention was rated with regard to dissemination barriers of (1) fidelity, (2) motivation, (3) dose, (4) perceived helpfulness (rated on a Likert scale), and (5) potential costs. The study was conducted from April through June of 2004. RESULTS: Fidelity checklist and serial reviews were satisfactory (100% core concepts translated into intervention). Key motivations for participation included (1) risk reduction, (2) intervention effectiveness, (3) "resiliency," and (4) altruism. In terms of dose, 13 of 14 participants engaged the Internet-based components, completing a mean of 7.2 modules (SD = 3.9). The 2 primary care interviews and the self-assessment and resiliency modules received the highest helpfulness ratings. The duration of the 2 motivational interviews was approximately 17-18 minutes, which is similar to a typical primary care visit. CONCLUSIONS: By using multidisciplinary teams and incorporating the opinions of potential users, complex preventive mental health interventions can be translated into primary care settings with adequate fidelity, motivation, dose, and perceived helpfulness, and at a reasonably low cost.

Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence.

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Correlates of Participation in a Family-Based HIV Prevention Program: Exploring African-American Women's Motivations and Understanding of the Program.

This study examines the relationship between contextual factors and attendance in a family-based HIV prevention program for low-income, urban, African-American women and their children. Participants' motivations to become involved, their concerns about discussing sex-related issues with their children, recruiters' perceptions of respondents' understanding of the program, and environmental stressors were examined. Participants' level of motivation and recruiters' success in improving respondents' understanding of the program were significant correlates of attendance. Stressors experienced by the family and concerns around talking with children about sex were not significantly associated with participation. Recommendations to enhance involvement in family-based HIV prevention programs are made.

Substance Use and Risky Sexual Behaviors Among Young Men Working at a Rural Roadside Market in Malawi.

Using an ecological model, we describe substance use and sexual risk behaviors of young male laborers at a roadside market in Malawi. Data included observations and interviews with 18 key market leaders and 15 laborers (ages 18-25 years). Alcohol, marijuana, and commercial sex workers (CSWs) were widely available. We identified three patterns of substance use: 6 young men currently used, 6 formerly used, and 3 never used. Substance use was linked to risky sex, including sex with CSWs. The market supported risky behaviors through availability of resources; supportive norms, including beliefs that substance use enhanced strength; and lack of restraints. Community-level poverty, cultural support for alcohol, interpersonal family/peer influences, early substance use, and school dropout also contributed to risky behaviors. Parental guidance was protective but not often reported. Local programs addressing substance use and risky sex simultaneously and better national substance use policies and mental health services are needed.

Mediating social representations using a cartoon narrative in the context of HIV/AIDS: the AmaQhawe Family Project in South Africa.

Using findings from the formative evaluation of the adaptation of the Collaborative HIV/AIDS Adolescent Mental Health Programme (CHAMP) family-based intervention in South Africa, known as the 'AmaQhawe Family Project', the potential role of 'micro-media' using a cartoon narrative for promoting health-enhancing behaviour change is explored. In particular, the cartoon narrative was found to be a useful medium for informing the development and diffusion of health-enhancing social representations that shape the potential for health-related behaviour change.

Prevalence of neurodevelopmental disorders among low-income African Americans at a clinic on Chicago's south side.

OBJECTIVE: This study examined the point prevalence of neurodevelopmental disorders among predominantly low-income, African-American psychiatric patients at Jackson Park Hospital's Family Medicine Clinic on Chicago's South Side. METHODS: Using active case ascertainment methodology, the authors assessed the records of 611 psychiatric patients visiting the clinic between May 23, 2013, and January 14, 2014, to identify those with DSM-5 neurodevelopmental disorders. RESULTS: A total of 297 patients (49%) met criteria for a neurodevelopmental disorder during childhood. Moreover, 237 (39%) had clinical profiles consistent with neurobehavioral disorder associated with prenatal alcohol exposure, and 53 (9%) had other neurodevelopmental disorders. The authors disagreed on the specific type of neurodevelopmental disorder of seven (1% of 611) of the 297 patients with neurodevelopmental disorders. CONCLUSIONS: A high prevalence of neurodevelopmental disorders was found among low-income predominantly African-American psychiatric patients on Chicago's South Side. If replicated, these findings should bring about substantial changes in medical practice with African-American patients.

Psychosocial intervention development for the prevention and treatment of depression: promoting innovation and increasing access.

Great strides have been made in developing psychosocial interventions for the treatment of depression and bipolar disorder over the last three decades, but more remains to be done. The National Institute of Mental Health Psychosocial Intervention Development Workgroup recommends three priorities for future innovation: 1) development of new and more effective interventions that address both symptom change and functional capacity, 2) development of interventions that prevent onset and recurrence of clinical episodes in at-risk populations, and 3) development of user-friendly interventions and nontraditional delivery methods to increase access to evidence-based interventions. In each of these areas, the Workgroup recommends systematic study of the mediating mechanisms that drive the process of change and the moderators that influence their effects. This information will highlight the elements of psychosocial interventions that most contribute to the prevention and treatment of mood disorders across diagnostic groups, populations served, and community settings. The process of developing innovative interventions should have as its goal a mental health service delivery system that prevents the onset and recurrence of the mood disorders, furnishes increasingly effective treatment for those who seek it, and provides access to evidence-based psychosocial interventions via all feasible means.