Social adversity is commonly associated with increased risk for psychiatric disorders (Dohrenwend, 2000). However, community studies in the United States have not found elevated point prevalence of psychiatric disorders among disadvantaged racial and ethnic minority groups (Kessler et al., 1994; Somervell et al., 1989), despite higher levels of social adversity experienced by these groups (Clark et al., 1999; Turner & Lloyd, 2004; Williams, 1999). In the National Comorbidity Survey (NCS), the first nationally representative survey of psychiatric disorders conducted in the US, we showed that the lower than expected point prevalence of DSM-III mental disorders among racial-ethnic minorities was attributable exclusively to differences in lifetime risk of these disorders as opposed to course of illness. Indeed, the course of illness tended to be more persistent among minorities than Non-Hispanic Whites in that study (Breslau et al., 2005). Thus, understanding reasons for the lower risk of ever developing a mental disorder appears to be the key to understanding the lower than expected prevalence of mental disorders among disadvantaged racial and ethnic minority groups in the US.

In this report we take the next step towards identifying causes of race-ethnic differences in lifetime risk of psychiatric disorders by specifying these differences in greater detail with respect to clinical and sociodemographic characteristics. Using data from a recent national survey, the National Comorbidity Survey Replication, we investigate variation in race-ethnic differences across 1) individual DSM-IV disorders, 2) age of onset of disorder, 3) birth cohorts, and 4) educational attainment. Results of these comparisons will help guide the investigation of potential protective factors that result in lower lifetime risk among race-ethnic minorities.

Our previous report considered race/ethnic differences in 3 broad classes of disorder: mood, anxiety and substance use disorders. However, it is important to know whether the differences we observed are consistent across disorders within these classes, implicating protective factors with generalized effects, or whether they are attributable to differences in a small number of disorders, implicating factors with disorder specific effects (Aneshensel et al., 1991). In this analysis we test for variation in race/ethnic differences across individual disorders within each class of disorders. In addition, we examine an additional class of disorders, impulse control disorders, that was not included in the earlier survey.

Specifying race-ethnic differences in early vs. late age of onset of disorder can help identify the developmental periods during which protective factors exert their influence. If, for instance, reduced risk of psychiatric disorder begins with early onset disorders, we should consider protective factors present in childhood environments rather than adult social experiences. It has been suggested that stressors associated with minority race-ethnicity vary across the lifespan; minority children may be sheltered from the negative impact that discrimination in labor markets and other areas of adult life has on mental health in adults (Gore & Aseltine, 2003). This hypothesis predicts that the lower risk among minorities will be stronger for early than for late onset disorders.

Specification of race/ethnic differences with respect to birth cohorts can help identify causal factors by locating the differences historically. This is of interest because the social conditions affecting minorities in the US have changed in recent decades in ways that influence the experience of social adversity, such as income (Levy, 1998) and educational attainment (Kao & Thompson, 2003). However, studies using distress scales have found that race/ethnic differences have not varied from the 1950s through the 1990s despite these changes (Thomas & Hughes, 1986). We do not know the extent to which the same is true for lifetime risk of psychiatric disorders. Continuity in race/ethnic differences across birth cohorts would point to factors that are transmitted across generations despite historical changes in social conditions.

The association of disadvantaged minority status with lower lifetime risk of disorders suggests that the relationship between socioeconomic status and risk of onset may vary across race/ethnic groups (Williams, 1997; Williams et al., 1992). Two theories of such variation have been suggested. First, the ‘double jeopardy’ theory suggests that morbidity will be particularly elevated among low SES members of disadvantaged minority groups. This theory was supported by studies using distress scales that found higher levels of distress among Non-Hispanic Blacks relative to Non-Hispanic Whites only among those with low SES (Kessler & Neighbors, 1986; McLeod & Owens, 2004). Second, the ‘declining returns’ theory predicts the opposite pattern, with higher morbidity among minority groups at higher levels of SES. This theory, suggested by studies which found that minorities have lower economic returns to investment in educational credentials (Chiswick, 1988), has been supported in research on indicators of general physical health (Farmer & Ferraro, 2005). With respect to mental health the ‘declining returns’ pattern is also consistent with the suggestion that social stressors are most severe for middle class minorities who have the highest expectations but also face the most severe competition in labor markets (Cole & Omari, 2003; Jackson & Stewart, 2003; Neckerman et al., 1999; Parker & Kleiner, 1966).

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Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample.

The present article presents a review of identity status-based theory and research with adolescents and emerging adults, with some coverage of related approaches such as narrative identity and identity style. In the first section, we review Erikson's theory of identity and early identity status research examining differences in personality and cognitive variables across statuses. We then review two contemporary identity models that extend identity status theory and explicitly frame identity development as a dynamic and iterative process. We also review work that has focused on specific domains of identity. The second section of the article discusses mental and physical health correlates of identity processes and statuses. The article concludes with recommen- dations for future identity research with adolescent and emerging adult populations. Identity is a fundamental psychosocial task for young people. Beginning in their early teens, adolescents start to ask questions such as ''Who am I?'' ''What am I doing in my life?'' ''What kind of relationships do I want?'' ''What kind of work do I want to do?'' and ''What are my beliefs?''(Archer, 1982). The con- sideration of alternative possibilities often coincides with the advent of formal operational thought during adolescence (Kret- tenauer, 2005). As young people develop the ability to consider an abstract idea such as who and what they could be, they may begin to imagine new and different possibilities for themselves. Accordingly, the purpose of this article is to review what is known about identity in young people—with particular atten- tion to work conducted since 2000. We begin with an overview of what identity is (from a developmental perspective), how it functions, and how the task of developing a sense of identity has changed in the past 40-50 years due to technological advances and associated social changes. We attend to research and theory that is rooted in the pioneering work of Erikson (1950), who was one of the first ''grand theorists'' to character- ize identity as a fundamental task of adolescence and of the transition to adulthood. We then review a number of prominent neo-Eriksonian identity theories and some of the content domains in which identity processes operate. We focus partic- ularly on Marcia's identity status model, which was one of the first empirical operationalizations of Erikson's work and has generated more than 45 years of theoretical and empirical work. We also review two other prominent neo-Eriksonian approaches, identity style and narrative identity. We then review research linking identity processes and domains with psychosocial and health outcomes. Finally, we suggest future directions for identity research.

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Identity in emerging adulthood: Reviewing the field and looking forward

Background: The relationship between religiosity/spirituality and physical health has been the subject of growing interest in epidemiological research. We systematically reviewed pr

Religiosity/spirituality and mortality. A systematic quantitative review.

Introduction. There is reliable evidence that racial/ethnic minorities suffer disproportionately from unrelieved pain compared with Whites. Several factors may contribute to disparities in pain management. Understanding how these factors influence effective pain management among racial/ethnic minority populations would be helpful for developing tailored interventions designed to eliminate racial/ethnic disparities in pain management. We conducted a review of the literature to explore the interaction between race/ethnicity, cultural influences; pain perception, assessment, and communication; provider and patient characteristics; and health system factors and how they might contribute to racial/ethnic disparities in receipt of effective pain management. Methods. The published literature from 1990–2008 was searched for articles with data on racial/ethnic patterns of pain management as well as racially, ethnically, and culturally-specific attitudes toward pain, pain assessment, and communication; provider prescribing patterns; community access to pain medications; and pain coping strategies among U.S. adults. Results. The literature suggests that racial/ethnic disparities in pain management may operate through limited access to health care and appropriate analgesics; patient access to or utilization of pain specialists; miscommunication and/or misperceptions about the presence and/or severity of pain; patient attitudes, beliefs, and behaviors that influence the acceptance of appropriate analgesics and analgesic doses; and provider attitudes, knowledge and beliefs about patient pain.

Race, ethnicity, and pain among the U.S. adult population.

Levels of spirituality and religious beliefs and behaviour are relatively high in Australia, although lower than those in the United States. There is mounting scientific evidence of a positive association between religious involvement and multiple indicators of health. The strongest evidence exists for the association between religious attendance and mortality, with higher levels of attendance predictive of a strong, consistent and often graded reduction in mortality risk. Negative effects of religion on health have also been documented for some aspects of religious beliefs and behaviour and under certain conditions. Health practices and social ties are important pathways by which religion can affect health. Other potential pathways include the provision of systems of meaning and feelings of strength to cope with stress and adversity.

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Spirituality, religion and health: evidence and research directions

The study of the relationship between religion and health has grown substantially in the past decade. There is little doubt that religion plays an important role in many people's lives and that this has an impact on their health. The question is how researchers and clinicians can best evaluate the available information and how we can improve upon the current findings. In this essay we review the cur- rent knowledge regarding religion and health and also critically re- view issues pertaining to methodology, findings, and interpretation of these studies. It is important to maintain a rigorous perspective with regard to such studies and also to recognize inherent limitations and suggest constructive ways in which to advance this field of study. In the end, such an approach can provide new information that will improve our understanding of the overall relationship between reli- gion and health.

Religion and health: a review and critical analysis

. With the rapidly expanding field of neuroscience research exploring religious and spiritual phenomena, there have been many perspectives as to the validity, importance, relevance, and need for such research. In this essay we review the studies that have contributed to our current understanding of the neuropsychology of religious phenomena. We focus on methodological issues to determine which areas have been weaknesses and strengths in the current studies. This area of research also poses important theological and epistemological questions that require careful consideration if both the religious and scientific elements are to be appropriately respected. The best way to evaluate this field is to determine the methodological issues that currently affect the field and explore how best to address such issues so that future investigations can be as robust as possible and can become more mainstream in both the religious and the scientific arenas.

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Andrew B. Newberg

Papers

Religion and health: a review and critical analysis

The neuroscientific study of religious and spiritual phenomena: or why god doesn't use biostatistics