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Stigma of Mental Illness Among Ethnic Minority Populations African Americans. Lois Bolden, APRN, BC June 27, 2004 This research is supported by The Substance Abuse and Mental Health Services Administration (SAMHSA). Introduction.

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stigma of mental illness among ethnic minority populations african americans
Stigma of Mental Illness Among Ethnic Minority PopulationsAfrican Americans

Lois Bolden, APRN, BC

June 27, 2004

This research is supported by

The Substance Abuse and Mental Health ServicesAdministration (SAMHSA)

introduction
Introduction
  • African Americans (AA) have high prevalence rates of mental illnesses
  • They are less likely to receive treatment when compared with other US groups
  • Stigma of mental illness is a barrier to prompt and effective mental health treatment
  • Stigma influences patterns of mental health treatment 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 concepts
Essential Concepts

Stigma exists when individuals

  • Label persons as divergent
  • Use dominant cultural beliefs to connect labeled person to unfavorable characteristics

Link, B. G. and. Phelan, J. A (2001). Conceptualizing stigma. Annual Review Sociology,27, 363-385.

essential concepts4
Essential Concepts
  • Place labeled person in a category that separates him or her from mainstream society
  • Discriminate against the labeled person, leading to compromised help seeking behaviors and negative health outcomes

Link, B. G. and J. A. Phelan (2001). Conceptualizing stigma. Annual Review Sociology,27, 363-385.

impact of stigma
Impact of Stigma
  • Delay in mental health treatment seeking
  • Use of primary care and emergency rooms services
  • Present for treatment with more severe symptoms; they are more likely to be diagnosed as psychotic, schizophrenic in particular

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.

purpose
Purpose

Explore the following questions

  • What are the demographic characteristics of African American people who participated in the 2001 Nationwide Inpatient Data study (NIS) and how do they compare with the other US groups?
  • Is there a difference between Length of Stay (LOS) among African Americans and other US groups?
  • Is there a difference in the types of admissions of African Americans and other US groups?
  • What are the three most prevalent psychiatric diagnoses among African Americans who presented for treatment in emergency rooms?
  • What are the three most prevalent psychiatric diagnoses among African American males between the ages of 18-30 who presented for treatment in emergency rooms?
methods
Methods
  • Secondary analyses of Healthcare Utilization Project Nationwide Inpatient Sample, 2001
  • Setting
    • 33 states
    • 982 hospitals
    • 5-8 million inpatient stays
  • Sample
    • 547, 614 African Americans
    • Ages 18 and over
methods8
Methods
  • Exclusion Criteria:
    • Psychiatric hospitals, short term rehabilitation centers, long term healthcare centers, alcoholism and chemical dependency treatment facilities
  • Descriptive/Comparative Design
slide9

Results

*Categories for ethnic minority groups are those used in the NIS study

discussion
Discussion
  • 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.

discussion15
Discussion

Three 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.

limitations
Limitations
  • 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 research
Implications for Research
  • Future studies are needed that focus on the impact of stigma on the “stigmatized individual” in domains such as
    • Self-Esteem
    • Resilience
    • Health Outcomes
    • Family Relationship
    • Vocational Pursuits
    • Legal and Law Enforcement Policies and Practices
    • Parental 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 research18
Implications for Research
  • More research is needed to better understand the potential overlap of cultural and folklore behaviors and beliefs that could be misinterpreted as psychiatric symptoms by clinicians and researchers who may not be culturally competent
  • Exploration of the influence of culturally competent African American providers in healthcare systems and health outcomes of this population is not well researched; stigma generated beliefs and practices within AA communities should be systematically explored with 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 practice
Implications for Clinical Practice
  • 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 policy
Implications for Public Policy
  • 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.

slide21
A comprehensive health care system could help to assure a place in the community for everyone

Thank You

references
References
  • 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.
  • Corrigan, P. P., D. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54(9), 765-776.
  • Corrigan, P., Green, A. Lundin, Kubiak, M. & Penn, D. (2001). Familiarity with and social distance from people who have serious mental illness. Psychiatric Services, 52(7), 953- 958.
  • 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.
references23
References
  • 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.
  • 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.
  • Kuno, E. & Rothbard, A. (2002). Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. American Journal of Psychiatry, 159(4), 567-572.
  • Link, B., Phelan, J., Bresnahan, M., Strueve, A. & Pescosolido, B. (1999). Public conceptions of mental illness, label, causes, dangerousness, and social distance. American Journal of Public Health, 89(9), 1328-1333.
references24
References
  • Link, B. G. & Phelan, J .A. (2001). Conceptualizing stigma. Annual Review Sociology, 27, 363-385.
  • 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.
  • Mann, C. H. & Himelein, M. (2004). Factors associated with stigmatization of persons with mental illness. Psychiatric Services, 55 (2), 185-187.
  • Milligan, C., Nich, C., & Carroll, K. (2004). Ethnic differences in substance abuse treatment, compliance, and outcome from two clinical trials. Psychiatric Services, 55(2), 167-173.
  • 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.
  • Neighbors, H., Trierweiler, S., Ford, B., & Muroff, J. (2003). Racial differences in DSM diagnosis using a semi-structured instrument, The importance of clinical judgment in the diagnosis of African Americans. Journal of Health and Social Behavior, 43(September), 237- 256.
references25
References
  • Opolka, J., Rascati, K., Brown, C. & Gibson, P.J. (2004). Ethnicity and prescription patterns for haloperidol, risperidone, and olanzapine. Psychiatric Services 55(2), 151-156.
  • Perlick, D. (2001). Special section on stigma as a barrier to recovery, Introduction. Psychiatric Services, 52(12), 1613-1632.
  • Pescosolido, B., Monahan, J., Link, B.G. Stueve, A. & Kikuzawa, S. (1999). The public's view of the competence, dangerous, and need for legal coercion if persons with mental health problem. American Journal of Public Health, 89, 1339-1345.
  • Pyne, J. M., Kuc, E. J., Schroeder, P. J., Fortney, J. C., Edlund, M. & Sullivan, G. (2004). Relationship between perceived stigma and depression severity. The Journal of Nervous and Mental Disease, 192(4), 278-283.
  • Reardon, S. and Buka S. (2002). Differences in onset and persistence of substance abuse and dependence among Whites, Blacks, and Hispanics. Public Health Report ,117(3), 51-60.
  • Sirey, J. A., Bruce, M., Alexopoulos, G. S., Perlick, D., Friedman, S., & Meyers, B. (2001). Perceived stigma and patient-related severity of illness as predictors of antidepressant drug adherence. Psychiatric Service, 52(12), 1615-1620.
references26
References
  • Snowden, L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3(4), 181-187.
  • Stuart, H. A. & Arboleda-Florez, J F. (2001). A public health perspective on violent offences among persons with mental illness. Psychiatric Services, 52(5), 654-659.
  • Takeuchi, D., & Mang-King, C. (1998). Coercive and voluntary referrals, How ethnic minority adults get into mental health treatment. Ethnicity and Health, 3(3), 149-161.
  • 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.
  • Wang, P., Demier, O. & Kessler, R. (2002). Adequacy of treatment for serious mental illness in the United States. American Journal of Public Health, 92(1), 92-98.
  • 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.