Stigma of Mental Illness Among Ethnic Minority Populations African Americans Lois Bolden, APRN, BC June 27, 2004 This research is supported by The Substance

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.


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.



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.


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.


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



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.


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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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.

ReferencesReferences 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.

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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