The Multi-Ethnic Study of Atherosclerosis was initiated in July 2000 to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in a population-based sample of 6,500 men and women aged 45-84 years. The cohort will be selected from six US field centers. Approximately 38% of the cohort will be White, 28% African-American, 23% Hispanic, and 11% Asian (of Chinese descent). Baseline measurements will include measurement of coronary calcium using computed tomography; measurement of ventricular mass and function using cardiac magnetic resonance imaging; measurement of flow-mediated brachial artery endothelial vasodilation, carotid intimal-medial wall thickness, and distensibility of the carotid arteries using ultrasonography; measurement of peripheral vascular disease using ankle and brachial blood pressures; electrocardiography; and assessments of microalbuminuria, standard CVD risk factors, sociodemographic factors, life habits, and psychosocial factors. Blood samples will be assayed for putative biochemical risk factors and stored for use in nested case-control studies. DNA will be extracted and lymphocytes will be immortalized for genetic studies. Measurement of selected subclinical disease indicators and risk factors will be repeated for the study of progression over 7 years. Participants will be followed through 2008 for identification and characterization of CVD events, including acute myocardial infarction and other coronary heart disease, stroke, peripheral vascular disease, and congestive heart failure; therapeutic interventions for CVD; and mortality.

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Multi-Ethnic Study of Atherosclerosis: Objectives and Design

: A measure of social support, the Social Support Questionnaire (SSQ), is described and four empirical studies employing it are described. The SSQ yields scores for (a) number of social supports, and (b) satisfaction with social support that is available. Three of the studies deal with the SSQ's psychometric properties, its correations with measures of personality and adjustment, and the relationship of the SSQ to positive and negative life changes. The fourth study was an experimental investigation of the relationship between social support and persistence in working on a complex, frustrating task. The research reported suggests that the SSQ is a reliable instrument, and that social support is (1) more strongly related to positive than negative life changes, (2) more related in a negative direction to psychological discomfort among women than men, and (3) an asset in enabling a person to persist at a task under frustrating conditions. Research and clinical implications are discussed. (Author)

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Assessing Social Support: The Social Support Questionnaire.

Building on Kahn’ s (1990) ethnographic work, a e eld study in a U.S. Midwestern insurance company explored the determinants and mediating effects of three psychological conditions ‐ meaningfulness, safety and availability ‐ on employees’ engagement in their work. Results from the revised theoretical framework revealed that all three psychological conditions exhibited signie cant positive relations with engagement. Meaningfulness displayed the strongest relation. Job enrichment and work role e t were positively linked to psychological meaningfulness. Rewarding co-worker and supportive supervisor relations were positively associated with psychological safety, whereas adherence to co-worker norms and self-consciousness were negatively associated. Psychological availability was positively related to resources available and negatively related to participation in outside activities. Finally, the relations of job enrichment and work role e t with engagement were both fully mediated by the psychological condition of meaningfulness. The association between adherence to co-worker norms and engagement was partially mediated by psychological safety. Theoretical and practical implications related to psychological engagement at work are discussed. To explore the challenge to the human soul in organizations is to build a bridge between the world of the personal, subjective, and even unconscious elements of individual experience and the world of organizations that demand rationality, efficiency, and personal sacrifice . . . we must be willing to shift our viewpoint back and forth between what organizations want of people and what constitutes human complexity: the contradictory nature of human needs, desires, and experience. (Briskin, 1998, p. xii.) This quote from Briskin (1998), an organizational consultant, reflects the challenges that managers and researchers of organizations face as they seek to understand and

The psychological conditions of meaningfulness, safety and availability and the engagement of the human spirit at work

Social Psychology of Organizations

Mental health is fundamental to health, according to Mental Health: A Report of the Surgeon General, the first Surgeon General’s report ever to focus exclusively on mental health. That report of two years ago urged Americans to view mental health as paramount to personal well-being, family relationships, and successful contributions to society. It documented the disabling nature of mental illnesses, showcased the strong science base behind effective treatments, and recommended that people seek help for mental health problems or disorders. The first mental health report also acknowledged that all Americans do not share equally in the hope for recovery from mental illnesses. This is especially true of members of racial and ethnic minority groups. That awareness galvanized me to ask for a supplemental report on the nature and extent of disparities in mental health care for racial and ethnic minorities and on promising directions for the elimination of these disparities. This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best available research, however, indicates that these groups have less access to and avail-ability of care, and tend to receive poorer quality mental health services. These disparities leave minority communities with a greater disability burden from unmet mental health needs. A hallmark of this Supplement is its emphasis on the role that cultural factors play in mental health. The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek, what symptoms and concerns they bring to clinical attention, and what types of coping styles and social supports they possess. Likewise, the cultures of clinicians and service systems influence the nature of mental health services.

Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General

Objectives. This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. Methods. We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. Results. Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. Conclusions. Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services.

Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas

National data on psychiatric hospitalization point to marked ethnic-related differences. Blacks and Native Americans are considerably more likely than Whites to be hospitalized; Blacks are more likely than Whites to be admitted as schizophrenic and less likely to be diagnosed as having an affective disorder; Asian Americans/Pacific Islanders are less likely than Whites to be admitted, but remain for a lengthier stay, at least in state and county mental hospitals. These differences are clear-cut, but they ignore a major source of care: psychiatric hospitalization in placements other than psychiatric units and hospitals. Explanations for observed minority-White differences in hospitalization can be evaluated only partially or not at all: Such explanations include ethnic-related differences in socioeconomic standing and in the prevalence of major psychopathology; differential stigma, or capacity to tolerate or support a dysfunctional significant other; access and use of alternative services; and bias in the behavior of gatekeepers, especially practitioners assigning diagnostic labels and making involuntary commitment decisions. More research is needed to help explain these striking differences in utilization.

Use of inpatient mental health services by members of ethnic minority groups.

Many African Americans—especially the most marginal—suffer from mental health problems and would benefit from timely access to appropriate forms of care. However, few seek treatment from outpatient providers in the specialty mental health sector and those who do are at risk of dropping out. African Americans visit providers in the general medical sector, although they use another hypothesized alternative to specialty care, voluntary support networks, less than other groups. These help-seeking tendencies may reflect characteristic coping styles and stigma, as well as a lack of resources and opportunities for treatment. More should be learned about differences in need according to location, social standing, and cultural orientation so as to identify treatments and programs that are especially beneficial to African Americans.

Barriers to effective mental health services for African Americans.

A recent surgeon general's report and various studies document racial and ethnic disparities in mental health care, including gaps in access, questionable diagnostic practices, and limited provision of optimum treatments. Bias is a little studied but viable explanation for these disparities. It is important to isolate bias from other barriers to high-quality mental health care and to understand bias at several levels (practitioner, practice network or program, and community). More research is needed that directly evaluates the contribution of particular forms of bias to disparities in the area of mental health care.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.93.2.239

Bias in Mental Health Assessment and Intervention: Theory and Evidence

Background
Limited English proficiency (LEP) may contribute to mental health care disparities, yet empirical data are limited.

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Lonnie R. Snowden

Papers

Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas

Use of inpatient mental health services by members of ethnic minority groups.

Barriers to effective mental health services for African Americans.

Bias in Mental Health Assessment and Intervention: Theory and Evidence

Access to Mental Health Treatment by English Language Proficiency and Race/Ethnicity