US Caribbean-born Adults: The State of Mental Health and Substance

Abuse Research and Treatment

Nakia C. Brown, PhD

Rhonda R. Waller, PhD

Nycal Anthony-Townsend, MHS

Purpose

1. Provide context for discussing issues and needs of Caribbean-born populations.

2. Identify risk and protective factors for mental health (MH) and substance abuse (SA) among Caribbean-born adults living in the US

3. Discuss MH/SA interventions targeting or serving Caribbean-born adults.

4. Discuss next steps in meeting MH/SA prevention and treatment for Caribbean-born adults.

Overview

• 3rd largest immigrant group• Colluded MH/SA survey data• MH/SA Evidence-based interventions• Organizations serve or target

communities with large Caribbean-born populations

• Little has been known about this growing segment of the increasingly diverse U.S. Black population

Contextual Factors

• Acculturative and Psychosocial Stress– Social Isolation– Discrimination– Language Barriers

Demographics

• US Census Data

• Native-born:– Born in AK, DC, HI or 48 other states– Puerto Rico: (Spanish language)– St. John, St. Thomas, or St. Croix (US VI)

• Foreign-born:– Any other country or territory

• Includes Caribbean islands/countries

Who’s Who in the US

• Race and ethnicity are treated as separate concepts in the US

• Caribbean-populations are included as “Black” unless they say otherwise

US Census Options

• White: origins in Europe, Middle East, or North Africa

• Black/African American: origins in African racial group

• Native Hawaiian/Other Pacific Islander : Hawaii, Guam (a US Territory), or Samoa

• Hispanic or Latino: Origins in Cuba, Mexico, Puerto Rican (US Territory), South or Central America regardless of race

• Other race/ethnicity not captured

Official Language of Caribbean Islands-Countries

• English (n=13)– Anguilla, Antigua and Barbuda, Bahamas,

Barbados, Bermuda, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Saint Kitts and Nevis, Saint Lucia, Trinidad and Tobago, Turks and Caicos and US VI*

• Non-English (n=11)– Argentina, Aruba, Brazil, Colombia, Cuba,

Dominican Republic, Guadeloupe, Haiti, Honduras, Martinique, Puerto Rico, and Saint Barthélemy, and Saint Maarten

“Blacks” in the United States

Mental Health Research: Caribbean-born Adults

• Compared to Blacks born in US

– Higher lifetime depression rates

– Lower treatment rates

– Similar past-year ratesWilliams et al., 2007

Substance Abuse Research: Caribbean-born Adults

• Limited published research

• Failure to distinguish from Blacks

• Gender differences in prevalence– African American women > Caribbean women

Broman et al., 2008

Top 5 States: Caribbean-born Residents

• Florida• New York

– Caribbean-born comprise nearly 25% of Black population in New York City

• New Jersey• Massachusetts• California

Number of MH/SA Facilities ( within a 5-mile Radius)

• New York City Boroughs– Bronx (n=76)– Brooklyn (n=86)– Manhattan (n=144)– Queens (n=43)

MH/SA Intervention and Treatment

• Large Caribbean-born population

• Plethora of MH/SA agencies

• Best practices in MH/SA

SAMHSA’S National Registry of Evidence-Based Programs and Practices

• Searchable registry of 160+ interventions• Connect public with intervention developers

to help implement approaches

• Minimum Requirements – Positive behavioral outcomes – Experimental/quasi-experimental design – Peer-reviewed publication– Public use-ready

NRREP Search Criterion

• Age (18 years and older)

• Black (or African American)

• Non-US population

• Urban

• In-patient or Outpatient Setting

Standards for Federal Data on Race and Ethnicity

• Race and Ethnicity

• Immigration Status (optional)– Cuba and Dominican Republic

• CPS, NHIS, and NHANES

Fundamental Issue

Caribbean-born populations that we are discussing traverse multiple categories, but are not adequately captured in any.

Current State of Affairs

• Limited MH/SA Research

• No US-based MH/SA EBIs for Caribbean-born populations

• Lack of EBI evaluation on Caribbean-born populations

Points to Consider

• Heterogeneity among “Blacks”

• Heterogeneity among Caribbean

• Variation in MH/SA risk profiles

• Impact of culture and contextual factors on treatment outcomes

Points of Emphasis

• Important to understand health disparities in the US not just in terms of race/ethnicity, but also by culture

• In US, there exists axes of diversity not only among native-born, but also among foreign-born

Recommendations

• Increase self-select identification categories

• Use stakeholders to inform survey designs

• Incorporate qualitative data collection to enhance research quantitative findings

• Conduct longitudinal studies of Caribbean-born immigrants to assess the impact of immigration on MH/SA outcomes over time

Thank You