Racial and Ethnic Disparity in Major Depressive Disorder.
Shao Z, Richie WD, Bailey RK.
J Racial Ethn Health Disparities. 2016 Dec;3(4):692-705. doi: 10.1007/s40615-015-0188-6. Epub 2015 Dec 16.
Major depressive disorder (MDD) is one of the most common and disabling psychiatric disorders in the USA. Early diagnosis and appropriate treatment are extremely important to prevent disability and improve quality of life. Recent studies have demonstrated racial and ethnic disparities in the diagnosis and treatment of MDD. African Americans (AA), Hispanics, and Asian Americans were significantly less likely to receive a depression diagnosis from a health-care provider than were non-Hispanic whites. The underdiagnosis of MDD in minority groups may be due to differences in socioeconomic status (SES), care affordability, cultural beliefs about depression, help-seeking patterns, access to culturally and linguistically appropriate care, patient-physician relationship, clinical presentation of depression, etc. Meanwhile, the likelihood of both having access to and receiving adequate care for depression was significantly low for AA, Hispanics, and Asian Americans, in contrast to whites. Similar disparities also exist in treatment outcomes. Besides the reasons for MDD underdiagnosis, additional contributing factors include access barriers to preferred mode of treatment, cultural concerns about antidepressants and different metabolism of antidepressants, etc. There are many ways to address these disparities and improve MDD care in minority populations, including universal depression screening, public financial incentives to ensure access to care in low-income and minority neighborhoods, quality improvement programs, cultural competency of mental health professionals, collaborative care management, community engagement and planning, and enhanced participation of minorities in clinical research.
Cancer Statistics for Hispanics/Latinos, 2018.
Miller KD, Goding Sauer A, Ortiz AP, Fedewa SA, Pinheiro PS, Tortolero-Luna G, Martinez-Tyson D, Jemal A, Siegel RL.
CA Cancer J Clin. 2018 Nov;68(6):425-445. doi: 10.3322/caac.21494. Epub 2018 Oct 4.
Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.8% (57.5 million) of the total population in the continental United States and Hawaii in 2016. In addition, more than 3 million Hispanic Americans live in the US territory of Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanics in the United States based on data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention. For the first time, contemporary incidence and mortality rates for Puerto Rico, which has a 99% Hispanic population, are also presented. An estimated 149,100 new cancer cases and 42,700 cancer deaths will occur among Hispanics in the continental United States and Hawaii in 2018. For all cancers combined, Hispanics have 25% lower incidence and 30% lower mortality compared with non-Hispanic whites, although rates of infection-related cancers, such as liver, are up to twice as high in Hispanics. However, these aggregated data mask substantial heterogeneity within the Hispanic population because of variable cancer risk, as exemplified by the substantial differences in the cancer burden between island Puerto Ricans and other US Hispanics. For example, during 2011 to 2015, prostate cancer incidence rates in Puerto Rico (146.6 per 100,000) were 60% higher than those in other US Hispanics combined (91.6 per 100,000) and 44% higher than those in non-Hispanic whites (101.7 per 100,000). Prostate cancer is also the leading cause of cancer death among men in Puerto Rico, accounting for nearly 1 in 6 cancer deaths during 2011-2015, whereas lung cancer is the leading cause of cancer death among other US Hispanic men combined. Variations in cancer risk are driven by differences in exposure to cancer-causing infectious agents and behavioral risk factors as well as the prevalence of screening. Strategies for reducing cancer risk in Hispanic populations include targeted, culturally appropriate interventions for increasing the uptake of preventive services and reducing cancer risk factor prevalence, as well as additional funding for Puerto Rico-specific and subgroup-specific cancer research and surveillance.
Hypertension and race/ethnicity.
Deere BP, Ferdinand KC.Curr Opin Cardiol. 2020 Jul;35(4):342-350. doi: 10.1097/HCO.0000000000000742.PMID: 32398604 Review.
Purpose of review: United States racial/ethnic minorities may experience disproportionate hypertension (HTN) morbidity and mortality. This review discusses recent literature regarding the differential impact of HTN, especially among African Americans and Hispanics.
Recent findings: Although disparities in HTN prevalence, control, and outcomes persist in racial/ethnic minorities relative to non-Hispanic Whites, racial/ethnic minorities are frequently underrepresented in genetic and clinical studies. Genomics have improved our understanding of HTN, but with no clinically useful application, the role of social determinants of health in HTN disparities is increasingly recognized. Team-based approaches with targeted, multilevel interventions may overcome barriers that uniquely impact racial/ethnic minorities.
Summary: Despite extensive epidemiological research, racial/ethnic minorities remain at higher risk HTN-related morbidity and mortality. Translational efforts may address the differential impact of HTN in racial/ethnic minorities. This review highlights recent research and concepts related to HTN and race/ethnicity.
Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy. (requires PCOM login)
Finney Rutten LJ, Zhu X, Leppin AL, Ridgeway JL, Swift MD, Griffin JM, St Sauver JL, Virk A, Jacobson RM.
Mayo Clin Proc. 2021 Mar;96(3):699-707. doi: 10.1016/j.mayocp.2020.12.024. Epub 2020 Dec 30.
Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong health care system response is critical to address vaccine hesitancy.
PMID: 33673921 Free PMC article. Review.
The success of vaccination programs is contingent upon irrefutable scientific safety data combined with high rates of public acceptance and population coverage. Vaccine hesitancy, characterized by lack of confidence in vaccination and/or complacency about vaccination that may lead to delay or refusal of vaccination despite the availability of services, threatens to undermine the success of coronavirus disease 2019 (COVID-19) vaccination programs. The rapid pace of vaccine development, misinformation in popular and social media, the polarized sociopolitical environment, and the inherent complexities of large-scale vaccination efforts may undermine vaccination confidence and increase complacency about COVID-19 vaccination. Although the experience of recent lethal surges of COVID-19 infections has underscored the value of COVID-19 vaccines, ensuring population uptake of COVID-19 vaccination will require application of multilevel, evidence-based strategies to influence behavior change and address vaccine hesitancy. Recent survey research evaluating public attitudes in the United States toward the COVID-19 vaccine reveals substantial vaccine hesitancy. Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong health care system response is critical to address vaccine hesitancy. Drawing on the evidence base in social, behavioral, communication, and implementation science, we review, summarize, and encourage use of interpersonal, individual-level, and organizational interventions within clinical organizations to address this critical gap and improve population adoption of COVID-19 vaccination.
Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence. (requires PCOM login)
Chou WS, Budenz A.
Health Commun. 2020 Dec;35(14):1718-1722. doi: 10.1080/10410236.2020.1838096. Epub 2020 Oct 30.
There are opportunities to consider the role of emotion in communication efforts. In this commentary, we highlight several ways negative as well as positive emotions may be considered and leveraged.
Long-term control of the COVID-19 pandemic hinges in part on the development and uptake of a preventive vaccine. In addition to a segment of population that refuses vaccines, the novelty of the disease and concerns over safety and efficacy of the vaccine have a sizable proportion of the U.S. indicating reluctance to getting vaccinated against COVID-19. Among various efforts to address vaccine hesitancy and foster vaccine confidence, evidence-based communication strategies are critical. There are opportunities to consider the role of emotion in communication efforts. In this commentary, we highlight several ways negative as well as positive emotions may be considered and leveraged. Examples include attending to negative emotions such as fear and anxiety, raising awareness of emotional manipulations by anti-vaccine disinformation efforts, and activating positive emotions such as altruism and hope as part of vaccine education endeavors.
Public awareness about coronavirus vaccine, vaccine acceptance, and hesitancy. (requires PCOM login)
Elgendy MO, Abdelrahim MEA.
J Med Virol. 2021 Jul 13. doi: 10.1002/jmv.27199. Online ahead of print.
Measurement of the population’s general knowledge of the coronavirus vaccine is very important to improve public acceptance and decrease vaccine hesitancy in confronting the disease.
Measurement of the population’s general knowledge of the coronavirus vaccine is very important to improve public acceptance and decrease vaccine hesitancy in confronting the disease. This study aimed to evaluate the knowledge, attitude, and practices of the participants towards the coronavirus vaccine. Data were collected using an online survey, in the form of a structured questionnaire, conducted during April-May 2021 in Egypt, and subjects from all over Egypt participated. The questionnaire was divided into three parts to assess the knowledge and attitude regarding coronavirus. The first part was to assess participants’ experience about coronavirus infection (eight items), the second was to assess the health beliefs about coronavirus and vaccine (16 items) and the third was to assess general knowledge, attitude, and practices of the participants towards vaccine (28 items). A total of 871 (465 females) participants participated, 81% of them were still committed to the precautionary measures for protection. Eighty-eight percent of them accepted to take the vaccine. Eighty-three percent of the participants answered that they will encourage family, friends, and colleagues to get the vaccine. Ninety-four percent knew that the coronavirus vaccine provides immunity against infection for a period of 6-12 months. 91.9% believed that the current infection with coronavirus is one of the main contraindications to vaccination. Eighty-nine percent believed that both pregnant women and chronic disease patients can get vaccinated and also that there is no specific age for a specific type of vaccination. Ninety-four percent of them knew that subjects taking immunosuppressive drugs should be prescribed Sinopharm, not AstraZeneca vaccine. The median score of this survey was 20/22 regarding knowledge about the coronavirus vaccine. Overall, the study participants had good knowledge about the coronavirus vaccine and accepted to take the vaccine, which indicates the highly commendable efforts to confront the coronavirus.
(© 2021 Wiley Periodicals LLC.)
Kim PY, Park IJ. Testing a multiple mediation model of Asian American college students’ willingness to see a counselor. Cultur Divers Ethnic Minor Psychol. 2009 Jul;15(3):295-302. doi: 10.1037/a0014396. PMID: 19594258.
Adapting the theory of reasoned action, the present study examined help-seeking beliefs, attitudes, and intent among Asian American college students (N = 110). A multiple mediation model was tested to see if the relation between Asian values and willingness to see a counselor was mediated by attitudes toward seeking professional psychological help and subjective norm. A bootstrapping procedure was used to test the multiple mediation model. Results indicated that subjective norm was the sole significant mediator of the effect of Asian values on willingness to see a counselor. The findings highlight the importance of social influences on help-seeking intent among Asian American college students.
Cheng HL, Kwan KL, Sevig T. Racial and ethnic minority college students’ stigma associated with seeking psychological help: Examining psychocultural correlates. J Couns Psychol. 2013 Jan;60(1):98-111. doi: 10.1037/a0031169. PMID: 23356468.
Many college students underuse professional psychological help for mental health difficulties. The stigma associated with seeking such help appears to be one of the reasons for this underuse. Levels of psychological distress and past use of counseling/psychotherapy have been found to be important correlates of stigma associated with seeking psychological help (Obasi & Leong, 2009; Vogel, Wade, & Haake, 2006). For racial and ethnic minorities, the hindering effects of self-stigma and perceived stigmatization by others on treatment seeking may further be compounded by their relationships with their own ethnic groups, with other ethnic groups, and with the dominant society. This study used structural equation modeling (SEM) to test a model that explored the effects of psychological distress and psychocultural variables (i.e., ethnic identity, other-group orientation, perceived discrimination) on perceived stigmatization by others and self-stigma for seeking psychological help, controlling for past use of counseling/psychotherapy. The sample consisted of 260 African American, 166 Asian American, and 183 Latino American students. SEM multigroup analyses indicated measurement invariance, but partial structural invariance, across racial/ethnic groups. Across all 3 groups, higher levels of psychological distress and perceived racial/ethnic discrimination, respectively, predicted higher levels of perceived stigmatization by others for seeking psychological help, which, in turn, predicted greater self-stigma for seeking psychological help. Higher levels of other-group orientation predicted lower levels of self-stigma of seeking psychological help across groups. Higher levels of ethnic identity predicted lower levels of self-stigma of seeking psychological help only for African Americans. Implications for research and practice are discussed.
Miller MJ, Yang M, Hui K, Choi NY, Lim RH. Acculturation, enculturation, and Asian American college students’ mental health and attitudes toward seeking professional psychological help. J Couns Psychol. 2011 Jul;58(3):346-57. doi: https://doi.org/10.1037/a0023636. PMID: 21574693.
In the present study, we tested a theoretically and empirically derived partially indirect effects acculturation and enculturation model of Asian American college students’ mental health and attitudes toward seeking professional psychological help. Latent variable path analysis with 296 self-identified Asian American college students supported the partially indirect effects model and demonstrated the ways in which behavioral acculturation, behavioral enculturation, values acculturation, values enculturation, and acculturation gap family conflict related to mental health and attitudes toward seeking professional psychological help directly and indirectly through acculturative stress. We also tested a generational status moderator hypothesis to determine whether differences in model-implied relationships emerged across U.S.- (n = 185) and foreign-born (n = 107) participants. Consistent with this hypothesis, statistically significant differences in structural coefficients emerged across generational status. Limitations, future directions for research, and counseling implications are discussed.
Cary Wu, Yue Qian & Rima Wilkes (2021) Anti-Asian discrimination and the Asian-white mental health gap during COVID-19, Ethnic and Racial Studies, 44:5, 819-835, DOI: https://doi.org/10.1080/01419870.2020.1851739
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In this article, we consider how, due to a spike in anti-Asian hate crimes, Asians might face a disproportionate mental health impact of the COVID-19 pandemic. Analyzing data from the University of Southern California’s Center for Economic and Social Research Understanding Coronavirus in America survey, we report several findings. First, since the onset of the pandemic, Asians (Asian Americans in particular) have experienced higher levels of mental disorders than whites. Second, Asian Americans and Asian immigrants are about twice as likely as whites to report having encountered instances of COVID-19-related acute discrimination. Third, experiences of COVID-19-related discrimination increase mental disorders for all Americans. Finally, COVID-19-related discrimination partially explains the disproportionate mental health impact of the pandemic on Asians. In conclusion, we highlight the importance of tackling hate, violence, and discrimination so as to address the disproportionate mental health impacts of COVID-19 on minority populations.