Retention and attrition among African Americans in the STAR*D study: what causes research volunteers to stay or stray?

BACKGROUND: High attrition rates among African-Americans (AA) volunteers are a persistent problem that makes clinical trials less representative and complicates estimation of treatment outcomes. Many studies contrast AA with other ethnic/racial groups, but few compare the AA volunteers who remain in treatment with those who leave. Here, in addition to comparing patterns of attrition between African Americans and Whites, we identify predictors of overall and early attrition among African Americans. METHOD: Sample comprised non-Hispanic African-American (n = 673) and White (n = 2,549) participants in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Chi-square tests were used to examine racial group differences in reasons for exit. Multivariate logistic regression was used to examine predictors of overall attrition, early attrition (by level 2) and top reasons cited for attrition among African Americans. RESULTS: Both African-American and White dropouts most commonly cited noncompliance reasons for attrition during the earlier phases of the study, while citing reasons related to efficacy and medication side effects later in the study. Satisfaction with treatment strongly predicted overall attrition among African Americans independent of socioeconomic, clinical, medical or psychosocial factors. Early attrition among African American dropouts was associated with less psychiatric comorbidity, and higher perceived physical functioning but greater severity of clinician-rated depression. CONCLUSIONS: Compliance, efficacy, and side effects are important factors that vary in relative importance during the course of a clinical trial. For African Americans in such trials, retention strategies should be broadened to emphasize patient engagement and satisfaction during the critical periods immediately following enrollment and treatment initiation.

Racial and ethnic differences in willingness to participate in psychiatric genetic research.

OBJECTIVE: The National Institute of Mental Health's effort to rectify the underrepresentation of American Blacks in the genetic studies of psychiatric disorders has met with mixed success. This study was designed to understand some of the barriers to recruitment. METHODS: Men and women, who were of Black, White or Hispanic race/ethnicity, aged 18-79 years (N= 353), were recruited from clinical and community settings in New York City. Participants responded to a survey that was designed to measure willingness to participate and attitudes toward genetic research. Principal components analyses generated eight factors including perceived benefits, concerns about, and drawbacks of genetic research, and beliefs about genetic or environmental contributions to psychopathology. Analysis of variance assessed within-ethnic group differences on factor scores, as they related to willingness to participate in genetic research. RESULTS: Ethnic groups did not differ significantly in stated willingness to participate in genetic research; more than 70% in each group were willing to participate. Among Blacks and Hispanics, mistrust and wariness, and stigma were significantly increased in those unwilling to participate; for Whites, perceived benefit to society and perceived importance for knowledge/education were associated with willingness to participate. For Blacks and Hispanics, youth (aged 18-29 years) and college education reduced, but did not eliminate the association between wariness and mistrust and willingness to participate. CONCLUSION: Findings suggest that recruitment efforts aimed at increasing the representation of Blacks should be aware of the barriers among those who are less educated, and involve interactive community collaborations, to fully address the mistrust in this population.

Perceived congruence between expectations and outcomes: implications for mental health among Caribbean immigrants.

Previous research on the psychological adjustment of immigrants has cited the perceived congruence between premigratory expectations and postmigratory realities as a primary determinant of psychological well-being. Using a sample of 137 first-generation Caribbean immigrants, a measure of the perceived congruence between expectations and outcomes was developed to examine the relationship between perceived congruence in various life domains, and indexes of psychological well being, such as anxiety, depression, and life satisfaction. Overall, perceived congruence was positively associated with life satisfaction and negatively associated with depression. Factor analyses revealed the presence of two reliable domains (social and professional) in the congruence measure. Perceived congruence in both domains was positively associated with life satisfaction, and perceived congruence in the professional domain was negatively associated with depression symptoms. Implications of the findings are discussed.

Transnational ties and mental health of Caribbean immigrants.

Immigration scholars have demonstrated the increasing importance of transnational activities among contemporary immigrants. While much of the previous research has emphasized social and economic outcomes, very little attention has been paid to psychological well-being or mental health. Using a community sample of West Indian immigrants, we developed an empirical measure of the nature and frequency of transnational practices. The resulting Transnationalism Scale is examined for psychometric properties using an exploratory principal components factor analysis, and bivariate correlations with pre-existing measures of psychological well-being, perceived social support, and ethnic identity. Results reveal five factors, some of which are significantly correlated with measures of psychological well-being, social support, and ethnic identity. Findings suggest that transnationalism, as a construct, is a valid measure for this population. We argue that transnational ties shape various aspects of immigrants' lives.