The role of subjective, interpersonal, and structural social isolation in 12-month and lifetime anxiety disorders.

BACKGROUND: Anxiety disorders are among the most prevalent psychiatric conditions worldwide, and the incidence of anxiety disorders among adults in the U.S. have increased over the last decade. Anxiety disorders can have debilitating effects on multiple areas of functioning and quality of life. Recently, social isolation has emerged as an important public health problem associated with worse health and well-being outcomes. Research on the connection between social isolation and mental health has found that multiple dimensions of social isolation may negatively impact mental health, but few inquiries have focused on the association between social isolation and anxiety. This study examined the relationships between multiple dimensions of social isolation and anxiety disorders in a nationally representative sample of adults aged 18 and older. METHODS: The sample includes 6082 individuals from the National Survey of American Life. This study examined whether three different dimensions of social isolation-subjective, interpersonal, and structural-were associated with 12-month and lifetime anxiety disorders (any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were used to test the associations between the three social isolation variables and the anxiety outcomes. RESULTS: This study found that of the three dimensions of social isolation, subjective isolation was most consistently related to both lifetime and 12-month anxiety disorders. Those who were subjectively isolated had increased odds of meeting criteria for any anxiety disorder, PTSD, GAD, PD, and AG over the past 12 months and throughout their lifetimes. Structural isolation was negatively associated with lifetime and 12-month AG. CONCLUSIONS: Public health approaches should include mental health and primary care providers and need to target social isolation, especially subjective isolation, which may be key in preventing anxiety disorders and the worsening of anxiety disorders. Future public health research is needed on how and in what ways the differing dimensions of social isolation impact mental health.

Racial/ethnic differences in the association between transgender-related U.S. state policies and self-rated health of transgender women.

BACKGROUND: Policy protections for transgender adults in the United States are consistently associated with positive health outcomes. However, studies over-represent non-Latinx White transgender people and obscure variation in policies' intended goals. This study examined racial differences in the relationship between transgender-related policies and transgender women's self-rated health. Guided by Critical Race Theory, we hypothesized that policies conferring access to resources (e.g., healthcare) would be associated with better self-rated health among all participants while policies signifying equality (e.g., nondiscrimination laws) would be associated with better self-rated health only for White participants. METHODS: Using cross-sectional data collected between March 2018-December 2020 from 1566 transgender women, we analyzed 7 state-level 'access policies,' 5 'equality policies,' and sum indices of each. Participants represented 29 states, and 54.7% were categorized as people of color. We fit a series of multilevel ordinal regression models predicting self-rated health by each policy. Multivariate models were adjusted for relevant covariates at the individual- and state-level. We then tested moderation by race/ethnicity using interaction terms and generated stratified predicted probability plots. RESULTS: In bivariate models, 4 access policies, 2 equality policies, and both indices were associated with better self-rated health, but associations did not persist in adjusted models. Results from the multivariable models including interaction terms indicated that policies concerning private insurance coverage of gender-affirming care, private insurance nondiscrimination, credit nondiscrimination, and both indices were statistically significantly associated with better self-rated health for White participants and worse self-rated health for participants of color. CONCLUSIONS: The policies included in this analysis do not mitigate racism's effects on access to resources, indicating they may be less impactful for transgender women of color than White transgender women. Future research and policy advocacy efforts promoting transgender women's health must center racial equity as well as transgender people of color's priorities.

Religious Involvement and DSM-IV Anxiety Disorders Among African-Americans.

ABSTRACT: This study examined the relationship between eight measures of religious involvement and five anxiety disorders among a nationally representative sample of African-Americans ( N = 3403). The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition , World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime prevalence for each disorder. Logistic regression indicated weekly service attendance was inversely associated with 12-month and lifetime panic disorder, lifetime agoraphobia, and 12-month and lifetime posttraumatic stress disorder (PTSD). Prayer was inversely associated with 12-month agoraphobia, 12-month social phobia, and lifetime PTSD. Listening to religious radio and looking to God for strength were also inversely related to, respectively, 12-month and lifetime panic disorder. Conversely, reading religious materials was positively associated with 12-month panic disorder, 12-month agoraphobia, lifetime PTSD, and lifetime generalized anxiety disorder. The results are discussed in light of conceptual models that specify multiple and sometimes divergent pathways through which religion impacts health, and suggestions for clinicians addressing anxiety disorders are delineated.

Fictive Kin Networks among African Americans, Black Caribbeans, and Non-Latino Whites.

Using data from the National Survey of American Life, we investigated the social and demographic correlates of fictive kin network involvement among African Americans, Black Caribbeans, and non-Latino Whites. Specifically, we examined the factors shaping whether respondents have fictive kin, the number of fictive present kin in their networks, and the frequency with which they received support from fictive kin. Eighty-seven percent of respondents had a fictive kin relationship, the average network size was 7.5, and 61% of participants routinely received fictive kin support. Affective closeness and contact with family, friends, and church members were positively associated with fictive kin relations. Age, region, income and marital and parental status were related to fictive kin network involvement, though these associations varied by race/ethnicity. Collectively, findings indicate that fictive kin ties extend beyond marginalized communities, and they operate as a means to strengthen family bonds, rather than substitute for family deficits.

Correlates of Obsessive-Compulsive Symptoms Among Black Caribbean Americans.

Despite the rapid growth of the Black Caribbean population in the United States, we know little about the presentation and prevalence of obsessive-compulsive disorder (OCD) among these groups. This study examines the demographic correlates and the effect of racial discrimination on OCD symptoms among a nationally-representative sample of Black Caribbean and African American adults (n = 5,191). Drawing on the Composite International Diagnostic Interview Short Form (CIDI-SF) for OCD, we examine two types of obsessions (harm and contamination) and four types of compulsions (repeating, washing, ordering, and counting). There we no significant differences between Black Caribbeans and African Americans in obsessions and compulsions. Analysis among Black Caribbeans found that compared with Jamaican and Trinidadian Americans, Haitian American individuals reported the fewest number of obsessions and compulsions. We show that Black Caribbean Americans with lower income, lower self-rated physical and mental health, and more experiences with racial discrimination report higher levels of OCD. More specifically, racial discrimination was associated with contamination and harm obsessions, as well as washing and repeating compulsions. Our findings highlight the need to consider specific domains of OCD relative to Black Caribbeans, and the relationship between social and demographic variables on symptomology.

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.

Prevalence and correlates of everyday discrimination among black Caribbeans in the United States: the impact of nativity and country of origin.

OBJECTIVES: Black Caribbeans in the United States have been the victims of major discrimination (e.g. unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S. DESIGN: This analysis used the black Caribbean sub-sample (n = 1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores. RESULTS: Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race. CONCLUSION: To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health.

A Person-Centered Approach to the Study of Black Adolescent Religiosity, Racial Identity, and Sexual Initiation.

Decreasing the number of adolescents who have never had sexual intercourse is one way to address sexual health disparities. We used intersectionality to explore the joint effects of religiosity and racial identity on Black adolescent sexual initiation. Data originated from the National Survey of American Life-Adolescent (n = 1,170), a nationally representative study of Black adolescents. Latent profile analysis and survival analysis were used to evaluate study hypotheses. Results showed four distinct profiles of religiosity and racial identity. These profiles explained 19% of the variability in sexual initiation. Additional analyses revealed sociodemographic differences in profile membership. Findings contribute to understanding ethnic heterogeneity among Black adolescents and racial identity and religiosity as sociocultural factors that influence sexual initiation; and support reconceptualizing Black adolescent religiosity.

Church support networks of African Americans: The impact of gender and religious involvement.

We examined the sociodemographic and religious involvement correlates of church support networks in a nationally representative sample of African Americans across the adult life span. Data from the National Survey of American Life was used for analysis. Ordinary least squares regression was conducted to identify correlates of frequency of contact, subjective closeness, provision and receipt of overall support, receipt of emotional support, and negative interactions with church members. We also investigated differences in church support networks separately for men and women. Religious involvement was positively associated with church support network indicators (i.e., frequency of contact). Church support network indicators also varied by age, gender, education, family income, marital status, and region. The findings indicate that for many African Americans, church members are an integral component of their support networks and underscore the importance of social integration in church networks for social support exchanges. Moreover, these church support network characteristics are patterned by sociodemographic characteristics.

The Role of Religious Socialization and Religiosity in African American and Caribbean Black Adolescents' Sexual Initiation.

This study determined the nature of the associations between religious socialization, religiosity, and adolescent sexual initiation. Data originated from the National Survey of American Life-Adolescent (n = 1170), a nationally representative study of black adolescents. Factor analysis, structural equation modeling, and logistic regression were used to evaluate hypotheses. Results indicated that as black adolescents received more messages about religious beliefs and practices, their religiosity was greater and, in turn, they were less likely to report sexual initiation; findings varied by ethnicity, gender, and age. Findings contribute to understanding religious socialization and its association with sexual initiation.

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.

Discrimination and psychiatric disorders among older African Americans.

OBJECTIVES: This study examined the impact of everyday discrimination (both racial and non-racial) on the mental health of older African Americans. METHODS: This analysis is based on the older African American subsample of the National Survey of American Life (NSAL) (n = 773). We examined the associations between everyday discrimination and both general distress and psychiatric disorders as measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Six dependent variables were examined: lifetime mood disorders, lifetime anxiety disorders, any lifetime disorder, number of lifetime disorders, depressive symptoms as measured by the 12-item Center for Epidemiological Scale of Depression (CES-D), and serious psychological distress as measured by the Kessler 6 (K6). RESULTS: Overall, racial and non-racial everyday discrimination were consistently associated with worse mental health for older African Americans. Older African Americans who experienced higher levels of overall everyday discrimination had higher odds of any psychiatric disorder, any lifetime mood disorder, any lifetime anxiety disorder, and more lifetime DSM-IV disorders, in addition to elevated levels of depressive symptoms and serious psychological distress. These findings were similar for both racial discrimination and non-racial discrimination. CONCLUSIONS: This study documents the harmful association of not only racial discrimination, but also non-racial (and overall) discrimination with the mental health of older African Americans. Specifically, discrimination is negatively associated with mood and anxiety disorders as well as depressive symptoms and psychological distress. Copyright © 2016 John Wiley & Sons, Ltd.

Extended family and friendship support and suicidality among African Americans.

PURPOSE: This study examined the relationship between informal social support from extended family and friends and suicidality among African Americans. METHODS: Logistic regression analysis was based on a nationally representative sample of African Americans from the National Survey of American Life (N = 3263). Subjective closeness and frequency of contact with extended family and friends and negative family interaction were examined in relation to lifetime suicide ideation and attempts. RESULTS: Subjective closeness to family and frequency of contact with friends were negatively associated with suicide ideation and attempts. Subjective closeness to friends and negative family interaction were positively associated with suicide ideation and attempts. Significant interactions between social support and negative interaction showed that social support buffers against the harmful effects of negative interaction on suicidality. CONCLUSIONS: Findings are discussed in relation to the functions of positive and negative social ties in suicidality.

Extended Family Support Networks of Caribbean Black Adults in the United States.

This paper investigates the extended family social support networks of Caribbean Black adults (Afro Caribbeans). Although there are several ethnographic accounts of familial ties and support exchanges among Black Caribbean immigrants, only a handful of studies utilize quantitative data. This paper utilizes data from the National Survey of American Life, which contains the first national probability sample of Caribbean Blacks in the United States. Age, gender, income, material hardship and immigration status were all associated with at least one of the four indicators of family support networks. Subjective family closeness and frequency of family contact were significantly associated with both giving and receiving informal support. A significant age and parental status interaction for receiving support indicated that older adults without children received assistance from their extended families less frequently than older adults with children. Overall, study findings affirm the importance of extended family networks for Caribbean Black adults.

African American and Black Caribbean Feelings of Closeness to Africans.

African American and Black Caribbean relations dominate research on interactions across black ethnic divides. Using National Survey of American Life data, we explore a different aspect of black interethnic attitudes: how close these groups feel toward Africans. African Americans and Black Caribbeans were largely similar in their feelings of closeness to Africans. For Black Caribbeans, younger and male respondents, those reporting higher levels of financial strain, living in the northeast and persons who immigrated to the United States at least 11 years ago, report feeling especially close to Africans. Being male was the only significant correlate among African Americans. The findings are discussed in relation to how race, ethnicity and national origin shape personal identities within the U.S. and their significance for intergroup perceptions. These broader issues warrant further consideration in light of assertions that race as a defining feature of American life and intergroup relations is obsolete.

Everyday Racial Discrimination, Everyday Non-racial Discrimination, and Physical Health Among African Americans.

Past research has identified a link between discrimination and health outcomes among people of color. Perceptions of the cause of discrimination (racial vs. other) seem to be important for mental health; however, this relationship has not been fully examined for physical health. Using data from the National Survey of American Life, we find that, among African Americans, racial discrimination and overall discrimination regardless of attribution are associated with negative health outcomes while non-racial discrimination is not. The results suggest that racial discrimination has a unique adverse effect on physical health for African Americans that practitioners need to better understand.

Family, friends, and 12-month PTSD among African Americans.

PURPOSE: Despite a growing literature on the influence of social support on mental health, little is known about the relationship between social support and specific psychiatric disorders for African Americans, such as PTSD. This study investigated the relationship between social support, negative interaction with family and 12-month PTSD among African Americans. METHODS: Analyses were based on a nationally representative sample of African Americans from the National Survey of American Life (n = 3315). Social support variables included emotional support from family, frequency of contact with family and friends, subjective closeness with family and friends, and negative interactions with family. RESULTS: Results indicated that emotional support from family is negatively associated with 12-month PTSD while negative interaction with family is predictive of 12-month PTSD. Additionally, a significant interaction indicated that high levels of subjective closeness to friends could offset the impact of negative family interactions on 12-month PTSD. CONCLUSIONS: Overall, study results converged with previously established findings indicating that emotional support from family is associated with 12-month PTSD, while, negative interaction with family is associated with increased risk of 12-month PTSD. The findings are discussed in relation to prior research on the unique association between social support and mental health among African Americans.

Church-Based Social Support Among Caribbean Blacks in the United States.

An emerging body of research notes the importance of church-based social support networks in the daily lives of Americans. However, few studies examine church-based support, and especially among ethnic subgroups within the U.S. Black population, such as Caribbean Blacks. This study uses data from the National Survey of American Life (NSAL) to examine demographic and religious participation (e.g., attendance, interaction) correlates of church-based social support (e.g., receipt of emotional support, receipt of general support, provision of support to others, and negative interaction) among Caribbean Blacks residing in the U.S. Multiple regression analyses indicated that religious participation was associated with all four dependent variables. Church attendance was positively associated with receiving emotional support, general social support, and providing support to others, but was not associated with negative interaction. Frequency of interaction with fellow congregants was positively associated with receiving emotional support, receiving general support, providing support to others and negative interaction. Demographic findings indicated that women provided more support to church members and experienced more negative interactions with members than did men. Education was positively associated with frequency of support; household income was negatively associated with receiving emotional support and providing social support to others. Findings are discussed in relation to the role of church-based support networks in the lives of Caribbean Black immigrants and communities.

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.

Extended family and friendship support networks are both protective and risk factors for major depressive disorder and depressive symptoms among African-Americans and black Caribbeans.

This study explores relationships between lifetime and 12-month Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) major depressive disorder (MDD), depressive symptoms, and involvement with family and friends within a national sample of African-American and Black Caribbean adults (n = 5191). MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview and depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression subscale and the K6. Findings indicated that among both populations, close supportive ties with family members and friends are associated with lower rates of depression and MDD. For African-Americans, closeness to family members was important for both 12-month and lifetime MDD, and both family and friend closeness were important for depressive symptoms. For Caribbean Blacks, family closeness had more limited associations with outcomes and was directly associated with psychological distress only. Negative interactions with family (conflict, criticisms), however, were associated with higher MDD and depressive symptoms among both African-Americans and Black Caribbeans.