Post on 26-Dec-2015
Stigma of Mental Illness Stigma of Mental Illness Among Ethnic Minority Among Ethnic Minority
PopulationsPopulationsAfrican AmericansAfrican Americans
Lois Bolden, APRN, BCLois Bolden, APRN, BCJune 27, 2004June 27, 2004
This research is supported by This research is supported by The Substance Abuse and Mental Health ServicesThe Substance Abuse and Mental Health Services
Administration (SAMHSA)Administration (SAMHSA)
IntroductionIntroduction African Americans (AA) have high prevalence African Americans (AA) have high prevalence
rates of mental illnesses rates of mental illnesses
They are less likely to receive treatment when They are less likely to receive treatment when compared with other US groupscompared with other US groups
Stigma of mental illness is a barrier to Stigma of mental illness is a barrier to prompt and effective mental health treatment prompt and effective mental health treatment
Stigma influences patterns of mental health Stigma influences patterns of mental health treatment seeking behaviorstreatment seeking behaviors
Chow, J., Jaffee, K. & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792-797.
Wells, K., Klap, R., Koike, A. & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry 15, (12), 2027-2032.
Williams, D. W. & Williams-Morris, R. (2000). Racism and mental health, The African American experience. Ethnicity and Health, 5(3/4), 243-268.
U.S. Department of Health and Human Services; Substance Abuse and Mental Health Services Administration, (1999) Mental Health: A Report of the Surgeon General, Rockville, MD.
Essential ConceptsEssential Concepts
Stigma exists when individualsStigma exists when individuals
Label persons as divergentLabel persons as divergent
Use dominant cultural beliefs to connect Use dominant cultural beliefs to connect labeled person to unfavorable labeled person to unfavorable characteristicscharacteristics
Link, B. G. and. Phelan, J. A (2001). Conceptualizing stigma. Link, B. G. and. Phelan, J. A (2001). Conceptualizing stigma. Annual Review Sociology,, 27,27, 363-385. 363-385.
Essential ConceptsEssential Concepts
Place labeled person in a category that Place labeled person in a category that separates him or her from mainstream separates him or her from mainstream societysociety
Discriminate against the labeled person, Discriminate against the labeled person, leading to compromised help seeking leading to compromised help seeking behaviors and negative health outcomesbehaviors and negative health outcomes
Link, B. G. and J. A. Phelan (2001). Conceptualizing stigma. Link, B. G. and J. A. Phelan (2001). Conceptualizing stigma. Annual Review Sociology, 2727, , 363-385.363-385.
Impact of StigmaImpact of Stigma
Delay in mental health treatment seekingDelay in mental health treatment seeking
Use of primary care and emergency Use of primary care and emergency rooms servicesrooms services
Present for treatment with more severe Present for treatment with more severe symptoms; they are more likely to be symptoms; they are more likely to be diagnosed as psychotic, schizophrenic in diagnosed as psychotic, schizophrenic in particularparticular
Kales, H., Blow, F., Bingham, C. R., Copeland, L. & Mellow, A. (2000). Race and inpatient psychiatric diagnosis among elderly veterans. Psychiatric Services, 51, 795-800.
Minsky, S., William, V., Miskimen, Gara, M. & Escobar, J. (2003). Diagnostic patterns in Latino, African American and European American psychiatric patients. Archives General Psychiatry, 60, 637-644.
U.S. Department of Health and Human Services; Substance Abuse and Mental Health Services Administration, (1999) Mental Health: A Report of the Surgeon General, Rockville, MD.
PurposePurposeExplore the following questionsExplore the following questions
What are the demographic characteristics of African What are the demographic characteristics of African American people who participated in the 2001 Nationwide American people who participated in the 2001 Nationwide Inpatient Data study (NIS) and how do they compare with Inpatient Data study (NIS) and how do they compare with the other US groups?the other US groups?
Is there a difference between Length of Stay (LOS) among Is there a difference between Length of Stay (LOS) among African Americans and other US groups?African Americans and other US groups?
Is there a difference in the types of admissions of African Is there a difference in the types of admissions of African Americans and other US groups?Americans and other US groups?
What are the three most prevalent psychiatric diagnoses What are the three most prevalent psychiatric diagnoses among African Americans who presented for treatment in among African Americans who presented for treatment in emergency rooms?emergency rooms?
What are the three most prevalent psychiatric diagnoses What are the three most prevalent psychiatric diagnoses among African American males between the ages of 18-30 among African American males between the ages of 18-30 who presented for treatment in emergency rooms? who presented for treatment in emergency rooms?
MethodsMethods
Secondary analyses of Healthcare Utilization Secondary analyses of Healthcare Utilization Project Nationwide Inpatient Sample, 2001Project Nationwide Inpatient Sample, 2001
SettingSetting 33 states 33 states 982 hospitals 982 hospitals 5-8 million inpatient stays5-8 million inpatient stays
SampleSample 547, 614 African Americans547, 614 African Americans Ages 18 and overAges 18 and over
Methods Methods
Exclusion Criteria: Psychiatric hospitals, short term
rehabilitation centers, long term healthcare centers, alcoholism and chemical dependency treatment facilities
Descriptive/Comparative Design
Results(Table 1) Demographic Characteristics of The
Nationwide Inpatient Sample
Characteristics African Americans
Caucasians Hispanics *Asians/Pacific
Islander
Native Americans
NN 576,737576,737 3,322,6773,322,677 459,507459,507 96,48196,481 19,33019,330
AgeAge
M M SDSD
50.95 50.95 19.9719.97
60.42 60.42 20.45 20.45
45.86 45.86 21.01 21.01
52.5152.5121.61 21.61
51.33 51.33 20.16 20.16
GenderGender
Male (%)Male (%) 36.60 36.60 40.65 40.65 31.64 31.64
32.05 32.05
36.10 36.10
Female (%)Female (%) 63.40 63.40 59.35 59.35 68.36 68.36
67.95 67.95
63.90 63.90 *Categories for ethnic minority groups are those used in the NIS study
Results
(Table 2) Length of Stay for African Americans and Other US Groups
Characteristics
African America
ns
Caucasians
Hispanics
Asians/Pacific
Islanders
Native America
ns
Length of StayM SD
*5.59 7.89
4.94 6.68
4.45 6.60
5.02 8.38
4.186.28
Results(Table 3) A Comparison of Admission Types for African (Table 3) A Comparison of Admission Types for African
Americans with Other US GroupsAmericans with Other US Groups
Characteristics Characteristics African African AmericansAmericans
CaucasiansCaucasians HispanicsHispanics Asians/Asians/
PacificPacific
IslandersIslanders
Native Native AmericansAmericans
Emergency (%)
*58.82 47.58 47.53 45.57 39.72
Urgent (%) 19.5419.54 23.30 20.88 25.30 15.56
Elective (%) 21.3721.37 29.07 31.56 29.10 44.70
Results Results
Three Most Prevalent Psychiatric Diagnoses for African Americans
65%
22.20%
5.50%
Psychosis
Alcohol/Drug Dependence
Depressive Neurosis
ResultsResults
Three Most Prevalent Psychiatric Diagnoses for African American Males (ages 18-30)
78%
15%
7%
Psychosis
Alchohol/DrugDependence
Depressive Neurosis
DiscussionDiscussion
The length of stays (LOS) were longer (5.59 days) for African Americans (AA) than any other population
Perhaps they experienced delays in help seeking and are more severely ill at the time they entered the health system
Most psychiatric admissions are from the emergency room (58%)
Baker, F. & Bell C. (1999). Issues in the psychiatric treatment of African Americans. Psychiatric Services, 50, 362-368.
Chow, J., Jaffee, K. & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792-797.
Minsky, S., William, V., Miskimen, Gara, M. & Escobar, J. (2003). Diagnostic patterns in Latino, African American and European American psychiatric patients. Archives General Psychiatry, 60, 637-644.
DiscussionDiscussionThree Most Common Psychiatric Diagnoses Psychosis Substance Abuse Depressive Neurosis
These findings are consistent with the literature suggesting that AAs are more likely to be diagnosed with psychosis (67.8%) rather than depressive neurosis (5.7%)
Substance abuse is also prevalent among AA males ages 18-30, but the most frequent diagnosis in this group is PSYCHOSIS
Dixon, L., Paden-Green, L., Delahanty, J., Lucksted, A., Postrado, L., & Hall, J. (2001). Variables associated with disparities in treatment of patients with schizophrenia and comorbid mood and anxiety disorders. Psychiatric Services 52(9), 1216-1222.
Kales, H., Blow, F., Bingham, C. R., Copeland, L. & Mellow, A. (2000). Race and inpatient psychiatric diagnosis among elderly veterans.Psychiatric Services , 51, 795-800.
U.S. Department of Health and Human Services; Substance Abuse and Mental Health Services Administration, (1999) Mental Health: A Report of the Surgeon General, Rockville, MD.
LimitationsLimitations Data were obtained from a large dataset with
numerous researchers and clinicians involved in the data collection process; issues regarding cultural competence among researchers and clinicians were not addressed
Potential for variability of data collection and interpretation across sites
Inconsistencies regarding criteria for psychiatric diagnoses; different criteria for classifying psychosis used by International Classification of Diseases (ICD) and the Diagnostic Related Groups (DRG)
Cultural competence was not addressed in the study as it relates to African Americans and mental health and illness
Implications for ResearchImplications for Research
Future studies are needed that focus Future studies are needed that focus on the impact of stigma on the on the impact of stigma on the “stigmatized individual” in domains “stigmatized individual” in domains such as such as Self-EsteemSelf-Esteem ResilienceResilience Health OutcomesHealth Outcomes Family RelationshipFamily Relationship Vocational PursuitsVocational Pursuits Legal and Law Enforcement Policies and PracticesLegal and Law Enforcement Policies and Practices Parental Rights and ResponsibilitiesParental Rights and Responsibilities
Link, B. G., Struening, E., Neese-Todd, S., Asmussen, S.& Phelan, J.A. (2001). The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Service, 52(12), 1621-1626.
U.S. Department of Health and Human Services; Substance Abuse and Mental Health Services Administration, (1999) Mental Health: A Report of the Surgeon General, Rockville, MD.
Implications for ResearchImplications for Research
More research is needed to better understand More research is needed to better understand the potential overlap of cultural and folklore the potential overlap of cultural and folklore behaviors and beliefs that could be behaviors and beliefs that could be misinterpreted as psychiatric symptoms by misinterpreted as psychiatric symptoms by clinicians and researchers who may not be clinicians and researchers who may not be culturally competentculturally competent
Exploration of the influence of culturally Exploration of the influence of culturally competent African American providers in competent African American providers in healthcare systems and health outcomes of this healthcare systems and health outcomes of this population is not well researched; stigma population is not well researched; stigma generated beliefs and practices within AA generated beliefs and practices within AA communities should be systematically explored communities should be systematically explored with appropriate interventions and evaluationswith appropriate interventions and evaluations
U.S. Department of Health and Human Services; Substance Abuse and Mental Health Services Administration, (1999) Mental Health: A Report of the Surgeon General, Rockville, MD.
Williams, D. W. & Williams-Morris, R. (2000). Racism and mental health, The African American experience. Ethnicity and Health, 5(3/4), 243-268.
Implications for Clinical Implications for Clinical PracticePractice
It is imperative that clinicians are educated and trained in cultural competence and the multitude of ways that mental illness is expressed among different groups
Cultural diversity should be a major component of education and continuing education for practitioners and educators
More research is needed from the perspective of the “stigmatized individual” and his/her sense of satisfaction with treatment
Diala, C., Muntaner, C., Walrath, C., Nickerson, K., LaVeist, T., & Leaf, P. (2001). Racial/ethnic differences in attitudes toward seeking professional mental health services. American Journal of Public Health, 91(5), 805-807.
Institute of Medicine (2001). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.
Implications for Public Implications for Public PolicyPolicy
Public Policy should address The impact of stigma related to
Housing Education Employment Opportunities Homelessness Abandonment of Patient by the Family Abandonment of Patient by the Practitioner Patient in Clinical Research Trials Continuity of Care Aging and long term care
Corrigan, P., Thompson, V., Lambert, D. ,Sangster, Y., Noel, J., & Campbell, J. (2003). Perceptions of discrimination among persons with serious mental illness. Psychiatric Services, 54(8), 1105-1110.
Hocking, B. (2003). Reducing mental illness stigma and discrimination-everybody's business. Medical Journal of Australia, 178(supplemental 5), 47-48.
A comprehensive health care system could help to assure a place in the community for everyone
Thank You
ReferencesReferences
Baker, F. & Bell, C. (1999). Issues in the psychiatric treatment of African Americans. Psychiatric Services, 50(3), 362-368.
Chow, J., Jaffee, K. & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792-797.
Copeland, L., Zeber, J., Valenstien, M., & Blow, F. (2003). Racial disparity in the use of atypical antipsychotic medications among veterans. American Journal of Psychiatry, 160(10), 1817-1822.
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Racial/ethnic differences in attitudes toward seeking professional mental health services. American Journal of Public Health, 91(5), 805-807.
Dixon, L., Paden-Green, L., Delahanty, J., Lucksted, A., Postrado, L., & Hall, J. (2001). Variables associated with disparities in treatment of patients with schizophrenia and comorbid mood and anxiety disorders. Psychiatric Services, 52(9), 1216-1222.
Hocking, B. (2003). Reducing mental illness stigma and discrimination-everybody's business. Medical Journal of Australia, 178(supplemental 5), 47-48.
Institute of Medicine (2001). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.
Kales, H., Blow, F., Bingham, C. , Copeland, L. & Mellow, A. (2000). Race and inpatient psychiatric diagnosis among elderly veterans. Psychiatric Services, 51, 795-800.
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