Cultural humility and racial microaggressions in counseling.

Racial microaggressions may contribute to poor counseling outcomes in racial/ethnic minority clients. The present study examined the occurrence of racial microaggressions in counseling using a large and diverse sample and explored the association between perceived cultural humility of the counselor and racial microaggressions. Racial/ethnic minority participants (N = 2,212) answered questions about the frequency and impact of racial microaggressions in counseling and the characteristics of their counselor. The majority of clients (81%) reported experiencing at least 1 racial microaggression in counseling. Participants most commonly reported racial microaggressions involving denial or lack of awareness of stereotypes and bias and avoidance of discussing cultural issues. There were few differences in racial microaggression frequency or impact based on client race/ethnicity and counselor race/ethnicity. Racially matched clients viewed racial microaggressions as more impactful than did clients who were not racially matched. Client-perceived cultural humility of the counselor was associated with fewer microaggressions experienced in counseling. We conclude by discussing limitations, areas for future research, and implications for counseling.

Cultural humility: measuring openness to culturally diverse clients.

Building on recent theory stressing multicultural orientation, as well as the development of virtues and dispositions associated with multicultural values, we introduce the construct of cultural humility, defined as having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual's cultural background and experience. In 4 studies, we provide evidence for the estimated reliability and construct validity of a client-rated measure of a therapist's cultural humility, and we demonstrate that client perceptions of their therapist's cultural humility are positively associated with developing a strong working alliance. Furthermore, client perceptions of their therapist's cultural humility were positively associated with improvement in therapy, and this relationship was mediated by a strong working alliance. We consider implications for research, practice, and training.

A Nominal Group Technique Study of Patients Who Identify as Black or African American and Access to Renal Transplantation.

Introduction: Completion of the renal transplant evaluation has been associated with several barriers for patients who identify as Black or African American. This study sought to prioritize barriers to and motivators of completing the renal transplant evaluation. Methods/Approach: Semi-structured interviews and focus groups with a nominal group technique were used to generate priority scores. Transplant professionals (N = 23) were recruited from 9 transplant centers in the Mid-Atlantic, Mid-Western, and Southeastern parts of the United States. Black or African American identifying renal patients (N = 30) diagnosed with end-stage kidney disease were recruited from 1 transplant center in the Mid-Atlantic region. Findings: Priority scores were created to assess the quantitative data of participant rankings of top barriers and motivators. The most significant barriers identified by both patients and transplant professionals comprised financial constraints, insurance issues, difficulty navigating the healthcare system, transportation difficulties, and multiple health problems. Facilitators consisted of family/social support, transplant education, patient navigators, comprehensive insurance, and physician repertoire and investment. A qualitative description of the ranked factors resulted in themes classified as intrapersonal, health, socioeconomic, transplant-specific healthcare, and general healthcare. Conclusion: These findings provided vital information to transplant centers nationwide about assessing the influences of renal transplant evaluation completion. Achieving equity in access to transplantation for Black or African American renal patients requires multilayered approaches.

"Could Be Even Worse in College": Social Factors, Anxiety, and Depressive Symptoms Among Black Men on a College Campus.

Understanding mental health risks among Black men is a step forward in reducing health and educational disparities that are persistent in today's society. Semi-structured focus groups were conducted with 20 Black male undergraduate students from a college campus in the Southeast. The aim was to identify and understand the social and contextual factors impacting their risk of experiencing anxiety and depressive symptoms. A thematic analysis, theoretically grounded in the social-ecological model (SEM), was conducted, revealing three overarching themes: 1) what is known or felt about mental health 2) causes of stressors and 3) signs as symptoms. Discussions with men offered insight into their perspectives and personal experiences related to mental health issues and perceived risk factors. Themes suggest that the college transition, academic workload, perceived financial distress, and their desire and need to conform to ideals of masculinity were significant risk factors and stressors. Men offered descriptions of specific symptoms and health behaviors associated with such stress, including social isolation, anger, irritability, and changes in their own personal behaviors. Key findings paint a picture of college mental health experiences for some Black male college students. Moving forward, more research is needed to expand on this study's findings and improve mental health risk among this underserved population. Future directions are discussed alongside the results presented in this paper.

Mental health disorder symptom prevalence and rates of help-seeking among University-Enrolled, emerging adults.

Objective. Examine mental health symptom prevalence and rates of campus services utilization among Black male, White male and Black female college students. Participants. 2500 students from an ongoing, student survey at a public university; launched in 2011. Methods. Measures included data for anxiety and depressive symptoms and utilization of campus health services (counseling center, health services, etc.). Descriptive analyses determined prevalence and utilization rates. Mann Whitney U tests compared prevalence. Chi-squared tests compared utilization rates. Results. Anxiety prevalence: greater than 60% of students from each ethnic group reported symptoms; reporting rates decreased significantly for Black men (49.6%); p < 0.001. Depression prevalence: greater than 80% reported symptoms; there were significant differences in reporting between Black men and Black women (72.7% vs. 87.1%, p < 0.001). Utilization: Black men utilized counseling services less than White men (20.4% vs. 37.8%, p = 0.024). Conclusion. Black men report depressive and anxiety symptoms but underutilize campus health resources.

Risk, Protective, and Associated Factors of Anxiety and Depressive Symptoms and Campus Health Services Utilization Among Black Men on a College Campus.

OBJECTIVE: The aim of this study is to analyze relationships among social and environmental determinants serving as risk, protective, and important covariate factors for mental health risk and help-seeking among Black men on a college campus. METHODS: A secondary data analysis was conducted utilizing an ongoing, campus-wide survey at a large, urban, public university. Measures included depressive and anxiety symptoms; campus service utilization; risk factors (e.g., financial status); protective factors (social support/religiosity); and additional covariates (substance use/GPA). Multiple linear regressions were conducted to examine relationships between these factors, symptoms and help-seeking. RESULTS: Data is included for 681 students. Findings indicated that stressful life events were associated with higher levels of anxiety symptoms (B = 0.39, p < 0.001) and depressive symptoms (B = 0.33, p = 0.013). Cannabis use (B = 1.14, p = .020) was also associated with higher levels of depressive symptoms. We found that financial status (B = 0.21, p = 0.041) was positively associated with higher levels of depressive symptoms and endorsement of religiosity was associated with lower levels anxiety (B = - 0.23, p = 0.019) and depressive symptoms (B = - 0.32, p = 0.035). Religiosity predicted lower utilization of campus health services. CONCLUSIONS: The key findings indicated that Black men's mental health is negatively influenced by stressful live events and cannabis use. As religiosity was associated with lower levels of symptoms and utilization, it may be beneficial to assess this in future work. Further research is needed to address and improve mental health and help-seeking among these men.

Cultural perceptions in cancer care among African-American and Caucasian patients.

PURPOSE: This exploratory study examined perceptions and beliefs of African Americans and Caucasians related to cancer care. Understanding belief systems and cultures optimizes cancer treatment and care delivery to ethnic minority individuals. PATIENTS AND METHODS: Focus groups were conducted with 39 African-American and Caucasian cancer patients. Data analysis included whole group analysis with a team of five researchers. RESULTS: Regardless of ethnicity, cancer patients share many of the same emotions and experiences, and want complete information and quality care. Differences were also apparent. African-American participants were more likely to report increased religious behaviors, believe that healthcare providers demonstrate care with simple actions and provision of practical assistance, and use church and community information sources. Caucasian participants were more likely to report spiritual but not overtly religious changes, and depend on healthcare providers for information. CONCLUSION: Understanding how culture colors perceptions, communication and information requirements is critical to providing effective care to ethnically diverse cancer patients. Findings have implications for professionals understanding ways patients seek information, the role of spirituality and religion in care, and ways healthcare providers demonstrate care.

Heart rate variability as a physiological moderator of the relationship between race-related stress and psychological distress in African Americans.

This study examined the moderator effects of heart rate variability, a physiological marker of stress vulnerability, on the relationship between race-related stress and psychological distress in African Americans (N = 215). Participants were administered the Index of Race-Related Stress-Brief and the Brief Symptom Inventory-18. Resting heart rate was recorded using the Polar 810s heart rate monitor. Findings indicated that heart rate variability moderated the relationship between institutional race-related stress and psychological distress for men, but not women. These findings suggest that higher levels of resting heart rate variability may buffer African Americans from the deleterious effects of race-related stress.

Culturally prescribed beliefs about mental illness among the Akan of Ghana.

Mental illness is a culturally laden phenomenon, and different cultures have unique ways of constructing mental illness. In this study, conceptions of mental illness were explored among 30 participants of Akan descent in Ghana through individual and group interviews. Participants demonstrated a wide range of knowledge on mental illness indicating that poor self-care, deficits in social functioning, and disordered behaviors are the cardinal features of mental illness. The data revealed that Akan cultural beliefs influenced notions of etiology of mental illness and care of the mentally ill. While participants recognized the role of multiple factors such as genetics, substance abuse, daily hassles (for example, concerns about basic needs such as food, clothing, and shelter), and trauma in the cause of mental illness, the predominant belief was that mental illness is a retributive and/or a spiritual illness. This belief encourages pluralistic health-seeking behaviors: use of hospitals, prayer camps, herbalists, and traditional healers. The implications of these findings for public health education on mental illness, and clinical training and practice are discussed.

Moderator effects of cognitive ability and social support on the relation between race-related stress and quality of life in a community sample of black Americans.

The current study examined the combined moderating effects of cognitive ability and social support on the relation between race-related stress and quality of life in a sample of Black Americans. Participants (N = 323) were administered the Wonderlic Personnel Test (WPT; E. F. Wonderlic Associates, Inc., 1983), the Multidimensional Social Support Scale (MDSS; Winefield, Winefield, & Tiggemann, 1992), the Index of Race-Related Stress-Brief (Utsey, 1999), and the WHOQOL-BREF (The WHO Group, 1998). The findings indicated that cognitive ability and social support, conjointly, moderated the relation between individual and cultural race-related stress and quality of life for Black Americans in the current sample. The paper concludes by discussing the study's findings, limitations, and by offering recommendations for future research related to this area of inquiry.

Do sociocultural factors predict suicidality among persons of African descent living in the U.S.?

Given that researchers have found increased risk for suicidality and other psychiatric problems among acculturated individuals, we predicted similar results for African-descended people living in the U.S. We surveyed a community sample of 423 adult men and women of African descent to determine acculturation's relationship to Black suicide. Participants completed the African American Acculturation Scale, the Multi-Dimensional Support Scale, and a subscale of the Spiritual Well-Being Scale. Suicidal ideation and history of suicide attempt were defined as a "yes" response to the questions, "have you ever considered taking your own life?" and "have you ever attempted to take your own life?" We found that religious well-being (not acculturation) was predictive of both suicidal ideation and history of suicide attempt.

Effect of ethnic group membership on ethnic identity, race-related stress, and quality of life.

This study examined the effect of ethnic group membership on ethnic identity, race-related stress, and quality of life (QOL). The Multigroup Ethnic Identity Measure, the Index of Race Related Stress--Brief Version, and the World Health Organization Quality of Life--Brief Version were administered to 160 male and female participants from 3 ethnic groups (African American, Asian American, and Latino American). Results indicated that African American participants had significantly higher race-related stress, ethnic identity, and psychological QOL scores than did Asian and Latino American participants. A stepwise multiple regression analysis revealed that ethnic identity and cultural racism were significant predictors of QOL and accounted for 16% of the total variance for the entire sample.

Race-related stress, quality of life indicators, and life satisfaction among elderly African Americans.

This article examined the relationships among race-related stress, quality of life indicators, and life satisfaction among elderly African Americans. A sample of 127 elderly African Americans, consisting of 87 women and 26 men (and 14 missing values), were administered the Index of Race-Related Stress, the Satisfaction With Life Scale, and the 36-item Short-Form Health Survey. Results indicated that elderly African American men and women differed significantly with regard to institutional and collective racism-related stress. In addition, the authors found that institutional racism-related stress was a significant predictor of psychological health in this sample of elderly African Americans.

Self-concealment, social self-efficacy, acculturative stress, and depression in African, Asian, and Latin American international college students.

The primary purpose of this exploratory investigation was to examine self-concealment behaviors and social self-efficacy skills as potential mediators in the relationship between acculturative stress and depression in a sample of 320 African, Asian, and Latin American international college students. The authors found several differences by demography with regard to the study's variables. After controlling for regional group membership, sex, and English language fluency, they found that self-concealment and social self-efficacy did not serve as mediators in the relationship between African, Asian, and Latin American international students' acculturative stress experiences and depressive symptomatology. Implications of the findings are discussed.

White public regard: associations among eating disorder symptomatology, guilt, and White guilt in young adult women.

OBJECTIVE: As a novel investigation of the role of White racial identity, the current study explored the link between White guilt and disordered eating. PARTICIPANTS: Young adult women (N=375), 200 of whom self-identified as White. METHODS: Measures assessed disordered eating, trait guilt, White guilt, and affect. RESULTS: White guilt is interrelated with disordered eating, particularly bulimic symptomatology. Distress tolerance and tendency to experience negative affect moderated the relation between White guilt and several disordered eating variables. CONCLUSIONS: Exploration of White guilt in clinical and research settings can inform understanding and treatment of disordered eating.

A re-examination of cultural factors that mitigate risk and promote resilience in relation to African American suicide: a review of the literature and recommendations for future research.

Suicide among African Americans has been acknowledged by the U.S. Surgeon General as a growing crisis. However, suicide remains understudied in this population. In this article, the authors examine the literature related to cultural protective factors that buffer African Americans from suicide risk. They present an overview of suicide among African Americans, review the culture and world-view of African Americans, and examine the degree to which these cultural variables protect against suicide risk. Finally, they discuss the limitations of the extant research on African American suicide, set an agenda for future research, and discuss its implications for clinical practice and public policy.

A confirmatory test of the underlying factor structure of scores on the collective self-esteem scale in two independent samples of Black Americans.

In this study, we examined the factor structure of the Collective Self-Esteem Scale (CSES; Luhtanen & Crocker, 1992) across 2 separate samples of Black Americans. The CSES was administered to a sample of Black American adolescents (n = 538) and a community sample of Black American adults (n = 313). Results of confirmatory factor analyses (CFAs), however, did not support the original 4-factor model identified by Luhtanen and Crocker (1992) as providing an adequate fit to the data for these samples. Furthermore, an exploratory CFA procedure failed to find a CSES factor structure that could be replicated across the 2 samples of Black Americans. We present and discuss implications of the findings.

Religiosity, refusal efficacy, and substance use among African-American adolescents and young adults.

Research points toward multiple pathways (i.e., psychosocial domains) through which religiosity influences substance use behaviors. This study examined whether refusal efficacy mediated the relationship between religiosity and substance use in African-American adolescents and young adults. Four hundred thirty-five urban and rural African-Americans, aged between 12 and 25, completed measures of private and public religiosity, refusal efficacy, and substance use (i.e., tobacco, alcohol, marijuana, and other illicit drug use). Tests for mediation were computed with private and public religiosity as independent variables, drug refusal efficacy as mediator, and substance use as the criterion. Results show that drug refusal efficacy mediated the relationship between private religiosity and tobacco, marijuana, and other illicit drug use, but not for alcohol use. Refusal efficacy also mediated the relationship between public religiosity and alcohol use, but not for other licit and illicit substances. The findings provide support for the unique impact of public religiosity when considering its role in preventive intervention. Future research should consider examining other psychosocial domains which may mediate the effect of religiosity on substance use behaviors among African-American adolescents.