There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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Culturally adapted mental health intervention: A meta-analytic review.

OBJECTIVE: Our objective was to review and compare, with meta-analytic methods, observational studies on the association of medically unexplained physical symptoms, anxiety, and depression with special emphasis on healthy and organically ill control groups and on different types of symptoms, measures, and illness behavior. METHODS: A search of MEDLINE and PsycLIT/PsycINFO for abstracts from 1980 to April 2001 was performed; principal investigators in the field were contacted and article reference lists were used to retrieve additional relevant articles. Two hundred forty-four studies were included on the basis of consensus ratings if they fulfilled seven of eight inclusion criteria pertaining to diagnostic accuracy and statistical appropriateness. Five hundred twenty-two studies were deferred or excluded. We focused specifically on the four functional somatic syndromes for which there were sufficient numbers for meta-analytic integration: irritable bowel syndrome (IBS), nonulcer dyspepsia (NUD), fibromyalgia(FM), and chronic fatigue syndrome (CFS). Data were extracted independently by two authors according to a prespecified coding manual with up to 70 parameters per study. RESULTS: Effect sizes for the association of the four functional somatic syndromes with depression and anxiety were of moderate magnitude but were highly significant statistically when compared with healthy persons and controls with medical disorders of known organic pathology. Moreover, this association was significant whether depression was measured with or without somatic items. Chronic fatigue syndrome is characterized by higher scores of depression, fibromyalgia by lower scores of anxiety than irritable bowel syndrome. Consulting behavior and severity of somatization is related to higher levels of anxiety and depression. CONCLUSIONS: Meta-analytic integration confirms that the four functional somatic syndromes (IBS, NUD, FM, CFS) are related to (but not fully dependent on) depression and anxiety. At present, there is only limited meta-analytic evidence for the same sort of association for medically unexplained physical symptoms in general. In view of the relative independence from depression and anxiety, classification and treatment of these symptoms and syndromes as "common mental disorders" does not seem fully appropriate.

Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review.

Meta-analytic techniques were used to estimate the effects of exposure to community violence on mental health outcomes across 114 studies. Community violence had its strongest effects on posttraumatic stress disorder (PTSD) and externalizing problems and smallest impact on other internalizing symptoms. Victimization by community violence most predicted symptomatology compared to witnessing or hearing about community violence. Witnessing community violence had a greater effect than hearing about violence on externalizing problems, but both types of exposure had an equal impact on other internalizing problems. PTSD symptoms were equally predicted by victimization, witnessing, or hearing about community violence. Compared to children, adolescents reported a stronger relationship between externalizing behaviors and exposure, whereas children exhibited greater internalizing problems than did adolescents.

Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents

Cultural competency practices have been widely adopted in the mental health field because of the disparities in the quality of services delivered to ethnic minority groups. In this review, we examine the meaning of cultural competency, positions that have been taken in favor of and against it, and the guidelines for its practice in the mental health field. Empirical research that tests the benefits of cultural competency is discussed.

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The case for cultural competency in psychotherapeutic interventions.

Stressors and child and adolescent psychopathology: Evidence of moderating and mediating effects.

This study examined exposure to community violence and depressive and post-traumatic stress disorder (PTSD) symptoms within a non-random sample of low-income, African-American male adolescents. The moderating effect of social support on these relationships was also examined. Seventy-seven African-American adolescent males were recruited from an inner-city, Midwestern high school and surveyed on exposure to violence, depression, post-traumatic stress, and social support. Regression analyses revealed that exposure to violence was significantly associated with both depressive and PTSD symptoms. However, social support was not found to moderate the relationship between exposure to community violence and psychological distress. Implications for intervention are discussed.

Psychological distress for African-American adolescent males: exposure to community violence and social support as factors.

This paper explores the impact of school-based heath centers (SBHCs) on the substance use behaviors of low-income, inner-city African American adolescents. Researchers surveyed 2,114 9th- and 11th-grade students from seven inner-city public high schools (three with SBHCs and four without SBHCs). Of the initial 2,114 students, 598 SBHC students and 598 non-SBHC students were successfully matched using ethnicity, grade, gender, and propensity scores. The results of separate grade x gender x SBHC ANOVAs indicated significant grade x SBHC interactions (i.e., such that substance use decreased in SBHC schools while increasing in non-SBHC schools) for cigarettes (p = .05) and marijuana (p < .001), but not for alcohol. These findings show that the SBHC intervention model is promising toward the prevention and reduction of substance use among high-risk African American adolescents and highlight the importance of accessible, holistic, and culturally appropriate health care.

Reducing Substance Use Among African American Adolescents: Effectiveness of School-Based Health Centers.

This study evaluated the diagnostic validity of conditions that have been labeled functional somatic syndromes. In an effort to replicate prior work in this area, latent variable models of functional somatic distress were estimated from the responses of 213 community members to a medical questionnaire. Medical questionnaire items that closely conformed to formal diagnostic criteria for the conditions were used in model estimation. Results of confirmatory factor analysis supported diagnostic distinctions between five syndromes (fibromyalgia, chronic fatigue syndrome, somatic depression, somatic anxiety, and irritable bowel syndrome). Discrete diagnostic categories of fibromyalgia and chronic fatigue syndrome were then tested using logistic regression analysis, in which the outcome involved independent diagnosis of these conditions based upon physician evaluation. Evidence for the existence of discrete diagnoses of fibromyalgia and chronic fatigue syndrome was particularly strong, since these diagnoses were cross-validated using findings from physician evaluation tailored to diagnose these conditions. Findings can assist mental health practitioners in drawing theoretical and symptom-based distinctions between different types of syndromes characterized by physical complaints.

Evaluating latent variable models of functional somatic distress in a community-based sample

Patients treated in a Department of Veterans Affairs (VA) emergency room were evaluated to delineate the differences in use of services between homeless and domiciled veterans who have mental disorders. Data were obtained and compared on DSM-III-R diagnoses, number of hospitalizations, lengths of stay, and outpatient visits in the preceding year. Homeless veterans with mental disorders were significantly more likely to have emergency visits and psychiatric admissions in the preceding 12 months than were the domiciled veterans. However, the average length of stay was shorter for the homeless group. These differences must be accounted for in the design of programs targeting homeless veterans with mental illness.

Michael E. Schoeny

Papers

Psychological distress for African-American adolescent males: exposure to community violence and social support as factors.

Reducing Substance Use Among African American Adolescents: Effectiveness of School-Based Health Centers.

Evaluating latent variable models of functional somatic distress in a community-based sample

Use of psychiatric services by homeless veterans.