The Mental Health of Ethnic Minority Groups: Challenges Posed by the Supplement to the Surgeon General's Report on Mental Health

In contrast to the conclusions reached by the Supplement to the Surgeon General's report on mental health, there is evidence that the various ethnic minority groups may exhibit significant differences in the prevalence of mental disorder. These differences cannot be fully explained by disparities or inequities in mental health services. African Americans appear to have relatively low prevalence rates despite a history of prejudice, discrimination, and the resulting stress. Ethnic differences are also revealed by findings that acculturation is negatively related to mental health for Mexican Americans and positively related to mental health for Asian Americans. Implications of these findings are discussed.     

Including Ethnic Minorities in Mental Health Intervention Research: A Practical Approach to a Long-Standing Problem

This paper examines a controversy that arose while developing a supplement to Mental Health: A Report of the Surgeon General that was focused on ethnic minority mental health. The controversy involved whether and how to make recommendations about ethnic minorities seeking mental health care. We found that few studies provided information on outcomes of mental health care for ethnic minorities. In this paper, we discuss outcomes of mental health care for ethnic minorities and how to proceed in developing an evidence base for understanding mental health care and minorities. We conclude that entering representative (based on population) numbers of ethnic minorities in efficacy trials is unlikely to produce useful information on outcomes of care because the numbers will be too small to produce reliable findings. We also conclude that while conducting randomized efficacy trials for all mental health interventions for each ethnic group would be impractical, innovative and theoretically informed studies that focus on specific cultural groups are needed to advance the knowledge base. We call for theory-driven research focused on mental health disparities that has the potential for understanding disparities and improving outcomes for ethnic minority populations.     

Challenges to Consensus in Preparing the Supplement to the Surgeon General's Report on Mental Health

Preparing the Supplement to the Surgeon General's Report on Mental Health proved controversial because the assignment, by its nature, challenged several forms of consensus that typically remain unexamined. They included disciplinary assumptions about theory and methods, sociopolitical assumptions about the relevance of history to contemporary circumstances of ethnic minority groups in America, the rigor and usefulness of cultural formulation, and whether the burden of proof rested with those who took for granted that sociocultural differences exist in theories of behavior, or those who took for granted the existence of universals. Preparation of the Supplement illustrates the uncertainty and tension that arise when unexamined boundaries and perspectives lose their capacity to serve as guides to scientific judgment and discourse.     

Extending the Boundaries,Bridging the Gaps: Crafting Mental Health: Culture,Race, and Ethnicity,a Supplement to the Surgeon General's Report on Mental Health

The August 2001 issuance of Mental Health: Culture, Race, and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General, represents a landmark in the dialogue--political and scientific--regarding health disparities in the United States. This paper offers a critical appraisal of the process and structure of generating these reports, paying particular attention to issues that marked serious epistemological tensions among the participants. These issues revolved around the relative emphasis placed on (1) mental illness and mental health; (2) risk, etiology, and treatment versus prevention and promotion; (3) large-scale, population-based surveys and randomized clinical trials as the standard bearers of scientific evidence; (4) variation related to gender, social class, and culture; (5) ethnicity and culture as dispositional variables or individual glosses as opposed to dynamic, collective phenomena; and (6) the historical forces that shaped the contemporary context for much of this discussion. It describes the sometimes subtle, other times stark differences in assumptions and experience that sprang from disciplinary orientations, investigative methods, institutional affiliations, and personal histories and agendas.     

What to Do with Race? Changing Notions of Race in the Social Sciences

The Supplement to the Surgeon General's Report on Mental Health documents that race, ethnicity, and culture are linked to the use of mental health services and the receipt of quality mental health care. The Supplement provides an elaborate discussion on how culture affects mental health care without a corresponding level of discourse on race. How race is handled in the Supplement suggests that it is still a sensitive topic and one that is difficult to address in a public report. This sensitivity parallels the difficulties that the social sciences have had in investigating issues of race. In this paper, we highlight some perspectives that have influenced the way race has been studied in the past and how these views reflect the general political climates of the eras that produced them.     

Migration,ethnicity and psychoses: evidence,models and future directions

There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio‐developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.     

The Quality of Mental Health Care for African Americans

In response to the Surgeon General's request for more research on racial disparities in mental health care, especially research that includes high-need populations (e.g., the homeless, incarcerated, children in foster care, and substance abusers), we examined racial disparities in the provision of mental health counseling, psychotherapy, and pharmacotherapy in hospital outpatient settings using nationally representative data from the 1997 National Hospital Ambulatory Medical Care Survey (NHAMCS). After controlling for diagnosis and other factors, we found that African Americans were less likely than whites to receive mental health counseling and psychotherapy, but more likely than whites to receive pharmacotherapy. We also found that substance abuse clinics were more likely than primary care and specialty mental health clinics to provide mental health counseling and psychotherapy. However, specialty mental health clinics were the only clinics to provide pharmacotherapy. Future research should examine racial disparities in a variety of settings, controlling for diagnosis as well as other factors.     

Investigating the Relationship between Ethnic Consciousness,Racial Discrimination and Self-Rated Health in New Zealand

In this study, we examine race/ethnic consciousness and its associations with experiences of racial discrimination and health in New Zealand. Racism is an important determinant of health and cause of ethnic inequities. However, conceptualising the mechanisms by which racism impacts on health requires racism to be contextualised within the broader social environment. Race/ethnic consciousness (how often people think about their race or ethnicity) is understood as part of a broader assessment of the ‘racial climate’. Higher race/ethnic consciousness has been demonstrated among non-dominant racial/ethnic groups and linked to adverse health outcomes in a limited number of studies. We analysed data from the 2006/07 New Zealand Health Survey, a national population-based survey of New Zealand adults, to examine the distribution of ethnic consciousness by ethnicity, and its association with individual experiences of racial discrimination and self-rated health. Findings showed that European respondents were least likely to report thinking about their ethnicity, with people from non-European ethnic groupings all reporting relatively higher ethnic consciousness. Higher ethnic consciousness was associated with an increased likelihood of reporting experience of racial discrimination for all ethnic groupings and was also associated with fair/poor self-rated health after adjusting for age, sex and ethnicity. However, this difference in health was no longer evident after further adjustment for socioeconomic position and individual experience of racial discrimination. Our study suggests different experiences of racialised social environments by ethnicity in New Zealand and that, at an individual level, ethnic consciousness is related to experiences of racial discrimination. However, the relationship with health is less clear and needs further investigation with research to better understand the racialised social relations that create and maintain ethnic inequities in health in attempts to better address the impacts of racism on health.     

Racial and ethnic differences in perceptions of discrimination among Muslim Americans

I use data from the 2011 Pew Survey (N?=?1,033) to examine the prevalence and correlates of perceived discrimination across Muslim American racial/ethnic groups. Asian Muslims report the lowest frequency of perceived discrimination than other Muslim racial/ethnic groups. Nearly, all Muslim racial/ethnic groups have a few times higher odds of reporting one or more types of perceived discrimination than white Muslims. After controlling for socio-demographic characteristics, the observed relationships persist for Hispanic Muslims but disappear for black and other/mixed race Muslims. Women are less likely than men to report several forms of discrimination. Older Muslims report lower rates of perceived discrimination than younger Muslims. White Muslim men are more likely to report experiencing discrimination than white, black and Asian Muslim women. The findings highlight varying degrees of perceived discrimination among Muslim American racial/ethnic groups and suggest examining negative implications for Muslims who are at the greatest risk of mistreatment.     

Participatory destigmatization strategies among Palestinian citizens,Ethiopian Jews and Mizrahi Jews in Israel

Abstract

This study examines how members of minority groups in Israel cope with stigmatization in everyday life. It focuses on working-class members of three minority groups: Palestinian Arabs or Palestinian citizens of Israel, Mizrahim (Jews of Middle Eastern and North African origin) and Ethiopian Jews. It reveals the use of racial, ethnic and national markers in daily processes of social inclusion and exclusion in one sociopolitical context. Palestinians, a group with a fixed external identity and a limited sphere of participation, were found to use the language of race and racism when describing stigmatizing encounters. Ethiopian Jews, the most phenotypically marked group, strictly avoided this language. For their part, Mizrahi Jews perceived the very discussion of stigmatization as stigmatizing, while often using ‘contingent detachment’ to distance themselves from negative group identities. Despite differences between the communities and the powerful role of the state in establishing symbolic and social boundaries, members of all three groups expressed their intention to achieve or retain avenues for participation in the larger society.     

Racialized national identity construction in the ancestral homeland: Japanese American migrants in Japan

This article examines Japanese Americans in Japan to illuminate how ‘Japanese American’ – an ethnic minority identity in the US – is reconstructed in Japan as a racialized national identity. Based on fifty interviews with American citizens of Japanese ancestry conducted between 2004 and 2007, I demonstrate how interactions with Japanese in Japan shape Japanese Americans’ racial and national understandings of themselves. After laying out a theoretical framework for understanding the shifting intersection of race, ethnicity, and nationality, I explore the interactive process of racial categorization and ethnic identity assertion for Japanese American transnationals in Japan. This process leads to what I call racialized national identities – the intersection of racial and national identities in an international context – and suggests that US racial minority identities are constructed not only within the US, but abroad as well.     

The social determinants of mental health and disorder: evidence,prevention and recommendations

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.     

The A's, G's, C's, and T's of health disparities

In order to eliminate health disparities in the United States, more efforts are needed to address the breadth of social issues directly contributing to the healthy divide observed across racial and ethnic groups. Socioeconomic status, education, and the environment are intimately linked to health outcomes. However, with the tremendous advances in technology and increased investigation into human genetic variation, genomics is poised to play a valuable role in bolstering efforts to find new treatments and preventions for chronic conditions and diseases that disparately affect certain ethnic groups. Promising studies focused on understanding the genetic underpinnings of diseases such as prostate cancer or beta-blocker treatments for heart failure are illustrative of the positive contribution that genomics can have on improving minority health.     

Defining difference: the role of immigrant generation and race in American and British immigration studies

Abstract

This article reviews the ways in which Britain and the USA classify and analyse the integration of immigrants and their descendants. While both societies recognize racial differences in their official statistics and in the academic analyses of change over time, the USA tends to classify immigrants and their descendants by immigrant generation much more than Britain does. The importance of the concept of generation in American immigration research is highlighted and it is suggested that studies built on the importance of generation can illuminate social processes of integration in Britain. The complexities of defining and measuring immigrant generation are reviewed, including new developments in the measurement of generation that take into account age at migration, and historical period and cohort effects. Racial and ethnic minority groups formed through immigration may have very different characteristics depending on the average distance of their members from immigration – including the possibility of ‘ethnic leakage’, as more assimilated, later-generation individuals no longer identify with the group.     

Ethnic differences in atherosclerosis, cardiovascular disease and lipid metabolism

PURPOSE OF REVIEW: Comparison of risk factors and cardiovascular disease among racial and ethnic groups is a powerful approach to study genetics and lifestyle, or environmental interactions. RECENT FINDINGS: Most, mean or median, cardiovascular risk factor levels are similar among black and white people. There are much greater differences in the distribution of risk factor level within a specific race and ethnic group than between US populations. There are also very large differences in levels of risk factors for coronary heart disease between specific ethnic migrant populations such as comparing black people in Africa with those in the US, or Japanese people in Japan with those in Hawaii and California. Differences in distribution of risk factors and disease between race and ethnic group are a function of the frequency of specific genotypes and interaction with environmental factors. Several of the most important differences between racial groups are higher blood pressure, lower triglycerides and higher HDL cholesterol among blacks, higher prevalence of diabetes and insulin resistance among Mexican Americans and American Indians, and higher triglyceride levels among the Japanese. SUMMARY: Further studies of racial and ethnic differences should focus on unique phenotypes and genotypic differences, international and migrant studies and large enough sample sizes to provide robust results. The sprinkling of a percentage of minority participants in each study is worthless. The study of racial and ethnic differences in disease and detection of risk factor levels must be based on solid hypotheses that can evaluate the interaction of lifestyle and possible genetic attributes. Many of the reported ethnic differences in risk factors and disease in US populations are primarily a function of differences in education, socioeconomic variations, and utilization of preventive and clinical treatments.     

Ethnicity,the search for rapists and the press

Media reporting of rape continues to provoke concern. This article focuses on the press reporting of the discovery and search for alleged rapists. On examining nine British newspapers for one complete year (1992), a serious distortion in the media reporting of ethnicity emerges at this early stage of the criminal process. While there is an over‐representation of minority ethnic men accused of rape coming to the notice of the police, the cases identified as involving minority ethnic (particularly black) men as assailants, are much more likely to be reported widely. The distortion is then intensified by associating minority ethnic (and again particularly, black men) with certain types of rape. However, there are important differences between newspapers in their coverage. Furthermore, while media coverage of the search for rapists is a matter of concern, it also needs to be seen as part of the wider process of the social construction of rapists. Nevertheless, the conclusion is that the media coverage of rape tends to distort in ways which may well exacerbate hostility against minority ethnic groups.     

The Influence of Antismoking Television Advertisements on Cessation by Race/Ethnicity,Socioeconomic Status,and Mental Health Status

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State’s antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.     

Racialized political shock: Arab American racial formation and the impact of political events

This article explores significant factors influencing the process of Arab American racial formation. I bring into conversation theories of racial formation and ‘political shock’ in social movement scholarship to develop the notion of ‘racialized political shock’ as an important factor in how racial and ethnic groups mobilize and organize. Many moments of political shock are highly racialized and have the potential to reorder the racial and ethnic landscape in ways that can open opportunities or introduce constraints to mobilizations around racial formation. Drawing on existing studies of Arab Americans, this paper highlights how Arab American racial formation has been galvanized during moments of racialized political shock. In the Arab American case, these moments have led to a call for recognition outside the category of white. I conclude by outlining ways forward in the study of Arab Americans, who have been overlooked in studies of race and ethnicity in the US.     

Perceived discrimination and diurnal cortisol: examining relations among Mexican American adolescents

Perceived discrimination remains a salient and significant environmental stressor for ethnic and racial minority youth. Although many studies have examined the impact of racial/ethnic discrimination on mental health symptomatology and physical health, little is known of the potential physiological processes underlying such experiences, especially during adolescence. In an attempt to understand how varying perceptions of discrimination relate to functioning of the hypothalamic-pituitary-adrenal axis (HPA axis), the current study examined the relation between Mexican American adolescents' (N = 100, M(age) = 15.3 years old) perceptions of discrimination and aspects of their diurnal cortisol profiles. Three salivary samples (wakeup, +30 waking, bedtime) were collected across 3 days (total of 9 samples). Utilizing multi-level modeling, results revealed that adolescents' perceived discrimination related to greater overall cortisol output (area under the curve; AUC) after controlling for other life stressors, depressive symptoms, family income, acculturation level, daily stress levels and daily behaviors. Findings also revealed that perceived discrimination was marginally related to a steeper cortisol awakening response (CAR). Together, these findings suggest that perceived discrimination is a salient and impactful stressor for Mexican American adolescents. Understanding the physiological correlates of discrimination can provide insight into larger health disparities among ethnic and racial minority individuals.