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Sex and gender are regarded as critical structural determinants of mental health and mental illness. Mental illness is a complex phenomenon, and risky behaviour and substance use commonly occur simultaneously or subsequent to one another. A gendered vulnerability in biological, environmental, and behavioural risk factors has been registered in the development and escalation of mental illness. Studies have found that women who use drugs experience greater physical and mental health repercussions than men. Women who use drugs present higher rates of depression and anxiety, suicidal tendencies, isolation and general psychological distress. This chapter addresses the most common mental illnesses associated with women who use drugs: depression, anxiety, trauma-related disorders, and eating disorders.

This study investigated disparities in dual diagnosis (comorbid substance use and depressive/anxiety disorders) among US adults by nativity and racial–ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.

The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial–ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance use or psychiatric disorder; substance use disorder only; depressive/anxiety disorder only; and dual diagnosis. The data were analyzed using multinomial logistic regression.

The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial–ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.

The limitations included measures of immigrant status, race–ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.

This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.

This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial–ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).

Purpose – The purpose of this chapter is to provide a comprehensive overview of the substance use disparities among American Indian/Alaska Native (AI/AN) youth, the contributing factors to these disparities, proven and promising approaches through strengths-based methods, barriers to implementation of prevention and treatment efforts, and future recommendations for effective programs and research.

Approach – We have conducted a thorough literature review of relevant research studies, as well as a review of government, tribal, and community-based curricula and resources. This review of programs is not exhaustive but provides several examples of best practices in the field and suggestions for future directions.

Social implications – We strongly advocate that to accurately explore the true etiology of substance abuse and to respond to the concerns that AI/AN have prioritized, it is necessary to utilize a strengths-based approach and draw upon traditional AI/AN perspectives and values, and active community participation in the process. More specifically, prevention and treatment programs should use methods that incorporate elders or intergenerational approaches; foster individual and family skills-building; promote traditional healing methods to recognize and treat historical, cultural, and intergenerational and personal trauma; focus on early intervention; and tailor efforts to each Native nation or community.

Value – Ultimately, to reduce substance abuse disparities in AI/AN youth, we must find better ways to merge traditional Native practices with western behavioral health to ensure cultural competency, as well as to develop mechanisms to effect system- and policy-level changes that reduce barriers to care and promote the well-being of AI/AN youth, families, and communities.

Mental illness, in its various forms, is common in the United States. Tens of millions of Americans are afflicted by an episode of mental illness every year. Estimates of the 12-month prevalence of mental disorders in the U.S. (including alcohol and substance abuse or dependence) indicate that 22–30 persons per 100 in the adult population are afflicted each year.¹ An episode of a psychiatric disorder, like a physical disorder, is debilitating – often disrupting the ability of the afflicted to carry on normal personal, social, and work activities. Mental illness also commonly results in large medical expenses. In addition, a number of recent papers have found that mental illness imposes large labor market losses on the ill, decreasing the likelihood of employment and limiting earnings for the employed.² In particular, research by two of the authors indicates that depressive disorders cause significant reductions in the labor force participation of women and the earnings of both men and women.³

Purpose – To examine potential sex differences among American Indian and Alaska Native peoples (AIANs) in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs within the Indian Health Services (IHS).

Methodology/Approach – Data were drawn from the IHS Improving Healthcare Delivery Data Project with 437,608 persons in our analytical sample. We described sex and age differences in diabetes, comorbidities, healthcare utilization, and treatment costs among the adults with diabetes. We evaluated the statistical differences between men and women using confidence intervals calculated at the 95% level, with nonoverlapping confidence intervals indicating statistical significance.

Findings – The prevalence of diabetes among females was somewhat higher than that of males (10.82 vs 9.16%, respectively, p < 0.05). Among adults with diabetes, males had statistically higher prevalence of hypertension, cardiovascular disease, and substance use disorders and fewer mental health disorders compared to females. Although males had overall lower average cost of services than females, males had higher utilization for hospital inpatient services than females, and females used more outpatient services.

Research limitations/implications – We are limited to one fiscal year of data and thus cannot predict the influence of healthcare utilization patterns on the overall health of this population. Although a large sample, the findings are only generalizable to the active users of the participating IHS Service Units.

Originality/Value of Paper – This study fills a major gap in our knowledge of sex differences in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs among AIANs. Differences in the comorbidities that characterized the AIAN adult males and females with diabetes in this sample have important implications for mortality and cost of care. Diabetes management that addresses such gender-specific comorbidities, particularly substance use disorders among men and mental health disorders among women, promises to reduce these comorbidities and related complications.

Resource constraints at all levels of the criminal justice system as well as the lack of a widely accepted, validated screening scale have made it difficult to screen adequately for serious mental illnesses (SMI) in offender populations. This study examined the use of the K6 scale, a recently developed and validated screening tool for SMI, using a sample of past-year arrestees. Among the main findings were that 18% of the sample screened positive for SMI. In contrast, commonly used screening questions misidentified a large proportion of arrestees with SMI. Based on these findings, we recommend the use of K6 scale to more accurately identify offenders with SMI.

The NCS was based on multistage area probability sample of people age 15–54 in the non-institutionalized civilian population of the coterminous U.S., with a supplemental sample of students living in campus group housing (Kessler et al., 1994). The survey was carried out face-to-face in the homes of respondents by professional interviewers employed by the Survey Research Center (SRC) at the University of Michigan. The survey was carried out between September 1990 and February 1992. The response rate was 82.6%, with a total of 8,098 respondents participating in the survey. A supplemental non-response survey was carried out to adjust for non-response bias, with a random sample of initial non-respondents offered a financial incentive to complete a short form of the diagnostic interview. A non-response adjustment weight was constructed for the main survey data to compensate for elevated rates of disorders found among the initial non-respondents in this non-response survey. Significance tests were made using design-based methods because of this weighting and clustering of the data (Kish & Frankel, 1970; Koch & Lemeshow, 1972; Woodruff & Causey, 1976). More details about design and weighting procedures are reported elsewhere (Kessler, Little et al., 1995).

This chapter depicts the burden of suicidal behavior among African American males. It describes the public health approach to preventing suicidal behavior among African American males. This approach includes assessing and describing the problem; identifying causes or risk and protective factors; developing and evaluating programs and policies; and implementing and disseminating findings and activities. The chapter provides a review of the epidemiology of fatal and non-fatal suicidal behavior; a summary of what is known about the risk and protective factors of the problem; and a descriptive analysis of the circumstances associated with suicides among young African American males is presented. Lastly, the authors give a summary of evidenced-based prevention programs which could be applied in preventing male suicidal behavior.

This study is a radical interactionist analysis of family conflict. Drawing on both a negotiated order perspective and Athen's theory of complex dominative encounters, this study analyzes the role that domination plays in conflicts among intimates. As the family engages in repeated conflicts over roles, the family also engages in negotiations over the family order, what role each party should play, interpretations of past events, and plans for the future. These conflicts take place against a backdrop of patriarchy that asymmetrically distributes power in the family to determine the family order. The data from this study come from a content analysis of mothers with substance use problems as depicted in the reality television show Intervention. The conflicts in these families reveal that these families develop a grinding family order in which families engaged in repeated conflict but also continued to operate as and identify as a family. These conflicts are shaped by and reinforce patriarchal expectations that mothers are central to family operation. The intervention at the end of each episode offered an opportunity for the family to engage in a concerted campaign to try to force the mother into treatment and reestablish the family order.