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Purpose – The purposes of this chapter are to describe both the within-group and between-group variance in Black Americans’ (Blacks’) prevalence of mental illness. This chapter also comments on the impact that poorer mental health has on this group's subsequent social mobility and explores recommendations for the reduction of these inequities.

Methodology/approach – This chapter reviews Black's history in America. It also outlines the influence of this history and related factors on Black Americans' current rates of illness and subsequently vulnerable upward mobility.

Research implications – The history of Blacks in America is tumultuous and has contributed to their vulnerable state. Blacks, on average, are poorer and sicker than Whites, and Blacks’ higher rates of illness are due to a number of factors. As a result, Blacks’ social mobility is precarious. Future research should continue to explore mental health care programs that are specifically designed to address Blacks’ unique culture and worldview.

Social implications – In addition to culturally competent and culturally responsive health care, future initiatives should focus on improving the accessibility and quality of health care, and alleviating socioeconomic disparities, racism, and racism-related stress. These initiatives, in conjunction, are the best approach to improving Blacks’ rates of mental illness.

COVID-19 has had remarkable impacts in rural America. Although the onset of the pandemic was in urban areas, it quickly spread to rural areas and ultimately resulted in higher mortality rates for rural populations. Due to this and other associated impacts, the pandemic has resulted in mental health issues across rural America. In this chapter, the authors first describe the state of rural America pre-pandemic, then detail the overall and mental health impacts of the pandemic on rural people. Following this, the authors report results of a case study on COVID-19 in the rural America West and conclude with recommended steps for addressing the unfolding crisis. Many of the steps the authors can take to improve rural mental health following the pandemic have long-been necessary. However, given the impacts of COVID-19, they are now needed more than ever.

The “Social Determinants of Health” construct is well-entrenched in the way that both health care providers and researchers think about the effects of social conditions on health. Although there are a number of theories that fall under this rubric for the social production of health and illness, the core of this construct is the idea that social stratification leads to health disparity. In this chapter we show how such a mechanism might work for relating social stratification and job stress.

We used the pooled 2002, 2006, 2010 Quality of Work Life modules of the General Social Survey to test a model of the relationships between gender, age, education, and nativity with “bad jobs” and indicators of health status.

Findings show that social status is positively associated with job quality and with health in turn. Lower social status characteristics are related to bad jobs and poorer health.

Health disparities are thus “explained” by the consequences of social status for occupation and job quality, thereby depicting exactly how health disparities arise in normal social life. The theory and results underscore the importance of explicitly modeling social status factors in explanations of health disparities.

It is common to relate health disparities to social status but it is not common to show the mechanisms whereby social status actually produces health disparities. Addressing health disparities means addressing the consequences of social inequalities for normal activities of social life such as work. Improving job quality would be a health “treatment” that addresses health disparities.

This chapter demonstrates the value of explicitly tracing the consequences of status differences on differences in social context such as work conditions and then health. In the study of health disparities this is not often done. In this chapter we show how social inequality leads to occupational and job quality differences that, in turn, lead to health differences.

Well-documented ethnic disparities exist in the identification and provision of quality services among children receiving community-based mental health services. These disparities extend to parent treatment engagement, an important component of effective mental health services. Currently, little is known about differences in how providers support parents’ participation in treatment and the degree to which parents actively participate in it. The purpose of this paper is to examine potential differences in both provider and parent in-session participation behaviours.

Participants included 17 providers providing standard community-based mental health treatment for 18 parent-child dyads, with 44 per cent of the dyads self-identifying as Hispanic/Latino. In-session participation was measured with the parent participation engagement in child psychotherapy and therapist alliance, collaboration, and empowerment strategies observational coding systems.

Overall, results indicate significantly lower levels of parent participation behaviours among Hispanic/Latino families compared to their Non-Hispanic/Non-Latino counterparts. No significant differences were seen in providers’ in-session behaviours to support parent participation across Hispanic/Latino and Non-Hispanic/Non-Latino families.

These findings contribute to the literature on ethnic differences in parent treatment engagement by utilising measures of in-session provider and parent behaviours and suggest that further investigation is warranted to documenting and understanding ethnic disparities in parents’ participation in community-based child mental health treatment.

This paper contributes to the evaluation of differences in parent treatment engagement through demonstrating the utility of an in-session observational coding system as a measure of treatment engagement.

The role of implicit provider bias in mental health care is an important issue that continues to be of concern in the twenty-first century for the Black/African American community. Access to mental health and quality care remains elusive as members of this social group lack access to mental health screening, diagnosis, and attention due to institutional and cultural barriers. Supporting the position that implicit and explicit provider bias exists in the mental health profession, this chapter will explore how implicit provider bias is an intractable institutional barrier that prevents Black/African Americans from accessing mental health and quality care. A review of the implications related to mental health outcomes with Black/African American clients will also be explored.

A brief overview of the Black/African American cultural responses to implicit provider bias will be discussed later in this chapter. There will be an exploration of the ways to help identify, address, and eliminate implicit provider bias using evidence-based personal and community engagement strategies that promote mental health wellness within the Black/African American community. Implications for best practices in Black/African American mental health will also be addressed to eradicate the risk of unethical or medical malpractice with Black/African American clients, reduce the mental health disparity experienced by Blacks/African Americans, and create mental health equity for this population.

To examine aging Puerto Ricans’ experiences with and perceptions of depression treatment.

In-depth analysis of eight exemplary cases from ethnographic interviews with a subsample of 16 aging Puerto Ricans in the Boston area who are part of the Boston Puerto Rican Health Study.

The results show that respondents were resistant to accepting pharmacological treatment for their depression, and they often characterized antidepressants as “dope.” Moreover, they claimed that in addition to their health problems, social stressors such as financial strain, lack of jobs, housing problems, and social isolation are triggering or contributing to their depression. Because of this, they express reluctance in accepting clinical treatment only, and suggest that broader social issues and other health needs ought to be addressed as part of an effective treatment. For many, pharmacological treatment is acceptable only in the more severe forms of depression.

These results have important implications for improving the quality of depression treatment and reducing health disparities for mainland Puerto Ricans.

Even though recent studies continue to show a high frequency of depression among Puerto Ricans, issues of treatment quality are still understudied and ethnographic accounts are especially lacking. Our study offers an exploratory investigation of this unresolved research issue.

Crises can weigh heavily on individuals' mental health. COVID-19 is a crisis that has shaken humanity, plunging it into a great wave of fear, ambiguity and uncertainty, due to its novelty and rapid spread, as well as lethality. Mental health disparities between women and men have widened as a result of this pandemic. Stress factors have multiplied, especially among working women, making them more psychologically vulnerable than they were before this pandemic and easy prey to psychological distress. This emphasized the importance of having integrated care interventions that take into consideration the organizational context, with gendered lenses. This paper discusses the relationship between COVID-19 and psychological distress among women in the workforce. It presents the main sources of stress and addresses integrated care interventions that can help to prevent psychological distress among women.

This paper is a viewpoint and critique of the recent literature.

Interventions based on a partnership between employers, employees, and government, including health and social services are needed to prevent mental health problems among women in the workplace that can result from crises. In this case, a gendered approach as well as an optimization of the use of new technologies should be favored.

There is little focus on the development of integrated care approaches to address psychological distress among working women in times of crisis and beyond. This paper helps to expand the scope of integrated care to work-related mental health research by exploring the impact of an unprecedented health crisis on a vulnerable group that suffers from disparities in mental health. It also provides insights into preventive interventions, built upon an integrated care approach, based on a tripartite partnership between working women, employing organizations, and governmental institutions, facilitated by the integration of new technologies. By doing this, the author aims to contribute to the prevention of mental health issues that can result from this crisis.

The COVID-19 pandemic imposed significant and abrupt lifestyle changes on the pediatric population. Major lifestyle changes that occur during children’s and adolescents’ vital developmental years have the potential to introduce stressors, which have both immediate and long-term effects on physical and mental health. The aspects of the COVID-19 pandemic that impacted pediatric mental health included school closures, quarantine, increases in screen time, changes to Labor & Delivery unit COVID-19 policies, and changes to the delivery of clinical mental health care, including telehealth. In addition, pediatric mental health was deeply impacted by the ongoing challenges to health equity associated with health disparities and racism as a health crisis. Pediatric mental health declined since the start of the pandemic, school closures and quarantine affected rates of food insecurity and physical activity levels, and the COVID-19 pandemic exacerbated pre-existing health disparities and mental health conditions among the pediatric population. Recommendations for building more resilient public health systems are explored.

This paper aims to investigate research activity on barriers for minority and underserved groups to access and use mental health services.

Using Scopus, relevant articles published from 1993 to 2022 were collected. The final list included 122 articles.

Research hotspots included cultural and ethnic barriers, obstacles encountered by LGBTQ+ individuals, challenges faced by refugees and immigrants, limited access in rural areas and barriers affecting special populations. The top 10 cited articles focused on language barriers, cultural stigma, gender-specific challenges and systemic obstacles. New research avenues included the role of technology in overcoming barriers to access mental health services.

Policymakers and practitioners can use this knowledge to develop targeted interventions, enhance cultural competence, reduce stigma, improve rural access and provide LGBTQ+-affirming care, ultimately promoting equitable mental health care.

This research underscores the importance of addressing mental health service barriers for equity and social justice. Neglecting these disparities can worsen mental health, increase health-care costs, reduce productivity and lead to higher social welfare expenses, perpetuating disadvantages.

This paper's uniqueness lies in its comprehensive analysis of barriers and facilitators to mental health service utilization among minority and underserved groups. It serves as a basis for developing evidence-based strategies to improve service accessibility and enhance the well-being of marginalized communities.

Health disparities affecting lesbian, gay, bisexual, transgender and queer (LGBTQ) populations have been reported in many countries. For Singapore, no large quantitative studies on mental health and well-being in the local LGBTQ community have been published. The authors conducted a community-based survey (National LGBT Census Singapore, 2013; NLCS2013) that covered a comprehensive set of demographic, social and health indicators. Here, the authors investigated mental health status and its correlates in 2,350 LGBTQ individuals within the NLCS2013 sample.

The NLCS2013 was an anonymous online survey conducted amongst self-identified LGBTQ adults (aged ≥ 21 years) residing in Singapore. The survey included the World Health Organisation Well-being Index (WHO-5) as a measure of mental well-being, with low WHO 5 scores (<13/25) indicating poor mental well-being. The authors analysed relationships between low WHO-5 score and a range of respondent characteristics using multivariate logistic regression.

Strikingly, 40.9% of 2,350 respondents analysed had low WHO-5 scores, indicating poor mental well-being. Parental non-acceptance, experience of conflict at home and bullying/discrimination in the workplace or educational environments were all significantly associated with poor mental well-being. Conversely, community participation appeared protective for mental well-being, as respondents who participated in LGBTQ community organisations or events were less likely to have poor mental well-being than non-participants.

The NLCS2013 represents one of the first broad-based efforts to comprehensively and quantitatively capture the sociodemographic and health profile, including mental health status, within Singapore’s resident LGBTQ population. These findings affirm the need to address the mental health needs of LGBTQ individuals in Singapore and to foster safe spaces and allyship.