Showing papers on "Mental health published in 2005"

Implementation research: a synthesis of the literature.

Abstract: In the past few years several major reports highlighted the gap between our knowledge of effective treatments and services currently being received by consumers. These reports agree that we know much about interventions that are effective but make little use of them to help achieve important behavioral health outcomes for children families and adults nationally. This theme is repeated in reports by the Surgeon General (United States Department of Health and Human Services 1999; 2001) the National Institute of Mental Health [NIMH] National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment (2001) Bernfeld Farrington & Leschied (2001) Institute of Medicine (2001) and the Presidents New Freedom Commission on Mental Health (2003). The authors call for applied research to better understand service delivery processes and contextual factors to improve the efficiency and effectiveness of program implementation at local state and national levels. Our understanding of how to develop and evaluate evidence-based intervention programs has been furthered by on-going efforts to research and refine programs and practices to define "evidence bases" and to designate and catalogue "evidence-based programs or practices". However the factors involved in successful implementation of these programs are not as well understood. Current views of implementation are based on the scholarly foundations prepared by Pressman & Wildavskys (1973) study of policy implementation Havelock & Havelocks (1973) classic curriculum for training change agents and Rogers (1983; 1995) series of analyses of factors influencing decisions to choose a given innovation. These foundations were tested and further informed by the experience base generated by pioneering attempts to implement Fairweather Lodges and National Follow-Through education models among others. Petersilia (1990) concluded that "The ideas embodied in innovative social programs are not self-executing." Instead what is needed is an "implementation perspective on innovation--an approach that views postadoption events as crucial and focuses on the actions of those who convert it into practice as the key to success or failure". (excerpt)

Twelve-Month Use of Mental Health Services in the United States Results From the National Comorbidity Survey Replication

Abstract: Background Dramatic changes have occurred in mental health treatments during the past decade. Data on recent treatment patterns are needed to estimate the unmet need for services. Objective To provide data on patterns and predictors of 12-month mental health treatment in the United States from the recently completed National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey using a fully structured diagnostic interview, the World Health Organization’s World Mental Health Survey Initiative version of the Composite International Diagnostic Interview, carried out between February 5, 2001, and April 7, 2003. Participants A total of 9282 English-speaking respondents 18 years and older. Main Outcome Measures Proportions of respondents with 12-monthDSM-IVanxiety, mood, impulse control, and substance disorders who received treatment in the 12 months before the interview in any of 4 service sectors (specialty mental health, general medical, human services, and complementary and alternative medicine). Number of visits and proportion of patients who received minimally adequate treatment were also assessed. Results Of 12-month cases, 41.1% received some treatment in the past 12 months, including 12.3% treated by a psychiatrist, 16.0% treated by a nonpsychiatrist mental health specialist, 22.8% treated by a general medical provider, 8.1% treated by a human services provider, and 6.8% treated by a complementary and alternative medical provider (treatment could be received by >1 source). Overall, cases treated in the mental health specialty sector received more visits (median, 7.4) than those treated in the general medical sector (median, 1.7). More patients in specialty than general medical treatment also received treatment that exceeded a minimal threshold of adequacy (48.3% vs 12.7%). Unmet need for treatment is greatest in traditionally underserved groups, including elderly persons, racial-ethnic minorities, those with low incomes, those without insurance, and residents of rural areas. Conclusions Most people with mental disorders in the United States remain either untreated or poorly treated. Interventions are needed to enhance treatment initiation and quality.

Exercise and well-being: a review of mental and physical health benefits associated with physical activity.

Abstract: Purpose of reviewThis review highlights recent work evaluating the relationship between exercise, physical activity and physical and mental health. Both cross-sectional and longitudinal studies, as well as randomized clinical trials, are included. Special attention is given to physical conditions, i

Mental illness and/or mental health? Investigating axioms of the complete state model of health.

Abstract: A continuous assessment and a categorical diagnosis of the presence (i.e., flourishing) and the absence (i.e., languishing) of mental health were proposed and applied to the Midlife in the United States study data, a nationally representative sample of adults between the ages of 25 and 74 years (N 3,032). Confirmatory factor analyses supported the hypothesis that measures of mental health (i.e., emotional, psychological, and social well-being) and mental illness (i.e., major depressive episode, generalized anxiety, panic disorder, and alcohol dependence) constitute separate correlated unipolar dimensions. The categorical diagnosis yielded an estimate of 18.0% flourishing and, when cross-tabulated with the mental disorders, an estimate of 16.6% with complete mental health. Completely mentally healthy adults reported the fewest health limitations of activities of daily living, the fewest missed days of work, the fewest half-day work cutbacks, and the healthiest psychosocial functioning (low helplessness, clear life goals, high resilience, and high intimacy).

Psychological and physical well-being during unemployment: a meta-analytic study.

Abstract: The authors used theoretical models to organize the diverse unemployment literature, and meta-analytic techniques were used to examine the impact of unemployment on worker well-being across 104 empirical studies with 437 effect sizes. Unemployed individuals had lower psychological and physical well-being than did their employed counterparts. Unemployment duration and sample type (school leaver vs. mature unemployed) moderated the relationship between mental health and unemployment, but the current unemployment rate and the amount of unemployment benefits did not. Within unemployed samples, work-role centrality, coping resources (personal, social, financial, and time structure), cognitive appraisals, and coping strategies displayed stronger relationships with mental health than did human capital or demographic variables. The authors identify gaps in the literature and propose directions for future unemployment research.

Prevalence and Treatment of Mental Disorders, 1990 to 2003.

Abstract: Background Although the 1990s saw enormous change in the mental health care system in the United States, little is known about changes in the prevalence or rate of treatment of mental disorders. Methods We examined trends in the prevalence and rate of treatment of mental disorders among people 18 to 54 years of age during roughly the past decade. Data from the National Comorbidity Survey (NCS) were obtained in 5388 face-to-face household interviews conducted between 1990 and 1992, and data from the NCS Replication were obtained in 4319 interviews conducted between 2001 and 2003. Anxiety disorders, mood disorders, and substance-abuse disorders that were present during the 12 months before the interview were diagnosed with the use of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Treatment for emotional disorders was categorized according to the sector of mental health services: psychiatry services, other mental health services, general...

Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis.

Abstract: ContextThe global refugee crisis requires that researchers, policymakers, and clinicians comprehend the magnitude of the psychological consequences of forced displacement and the factors that moderate them. To date, no empirical synthesis of research on these issues has been undertaken.ObjectiveTo meta-analytically establish the extent of compromised mental health among refugees (including internally displaced persons, asylum seekers, and stateless persons) using a worldwide study sample. Potential moderators of mental health outcomes were examined, including enduring contextual variables (eg, postdisplacement accommodation and economic opportunity) and refugee characteristics.Data SourcesPublished studies (1959-2002) were obtained using broad searches of computerized databases (PsycINFO and PILOTS), manual searches of reference lists, and interviews with prominent authors.Study SelectionStudies were selected if they investigated a refugee group and at least 1 nonrefugee comparison group and reported 1 or more quantitative group comparison on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4% of identified reports), yielding 59 independent comparisons and including 67 294 participants (22 221 refugees and 45 073 nonrefugees).Data ExtractionData on study and report characteristics, study participant characteristics, and statistical outcomes were extracted using a coding manual and subjected to blind recoding, which indicated high reliability. Methodological quality information was coded to assess potential sources of bias.Data SynthesisEffect size estimates for the refugee-nonrefugee comparisons were averaged across psychopathology measures within studies and weighted by sample size. The weighted mean effect size was 0.41 (SD, 0.02; range, −1.36 to 2.91 [SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement conditions moderated mental health outcomes. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes. Methodological differences between studies affected effect sizes.ConclusionsThe sociopolitical context of the refugee experience is associated with refugee mental health. Humanitarian efforts that improve these conditions are likely to have positive impacts.

The relationship between job satisfaction and health: a meta-analysis

Abstract: Background: A vast number of published studies have suggested a link between job satisfaction levels and health. The sizes of the relationships reported vary widely. Narrative overviews of this relationship have been published, but no systematic meta-analysis review has been conducted. Methods: A systematic review and meta-analysis of 485 studies with a combined sample size of 267 995 individuals was conducted, evaluating the research evidence linking self-report measures of job satisfaction to measures of physical and mental wellbeing. Results: The overall correlation combined across all health measures was r = 0.312 (0.370 after Schmidt- Hunter adjustment). Job satisfaction was most strongly associated with mental/psychological problems; strongest relationships were found for burnout (corrected r = 0.478), self-esteem(r = 0.429), depression (r = 0.428), and anxiety(r = 0.420). The correlation with subjective physical illness was more modest (r = 0.287). Conclusions: Correlations in excess of 0.3 are rare in this context. The relationships found suggest that job satisfaction level is an important factor influencing the health of workers. Organisations should include the development of stress management policies to identify and eradicate work practices that cause most job dissatisfaction as part of any exercise aimed at improving employee health. Occupational health clinicians should consider counselling employees diagnosed as having psychological problems to critically evaluate their work—and help them to explore ways of gaining greater satisfaction from this important aspect of their life.

Religious coping and psychological adjustment to stress: a meta-analysis.

Abstract: A growing body of literature suggests that people often turn to religion when coping with stressful events. However, studies on the efficacy of religious coping for people dealing with stressful situations have yielded mixed results. No published studies to date have attempted to quantitatively synthesize the research on religious coping and psychological adjustment to stress. The purpose of the current study was to synthesize the research on situation-specific religious coping methods and quantitatively determine their efficacy for people dealing with stressful situations. A meta-analysis of 49 relevant studies with a total of 105 effect sizes was conducted in order to quantitatively examine the relationship between religious coping and psychological adjustment to stress. Four types of relationships were investigated: positive religious coping with positive psychological adjustment, positive religious coping with negative psychological adjustment, negative religious coping with positive psychological adjustment, and negative religious coping with negative psychological adjustment. The results of the study generally supported the hypotheses that positive and negative forms of religious coping are related to positive and negative psychological adjustment to stress, respectively. Implications of the findings and their limitations are discussed.

Failure and Delay in Initial Treatment Contact After First Onset of Mental Disorders in the National Comorbidity Survey Replication

Abstract: Context An understudied crucial step in the help-seeking process is making prompt initial contact with a treatment provider after first onset of a mental disorder. Objective To provide data on patterns and predictors of failure and delay in making initial treatment contact after first onset of a mental disorder in the United States from the recently completed National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey carried out between February 2001 and April 2003. Participants A total of 9282 respondents aged 18 years and older. Main Outcome Measures LifetimeDSM-IVdisorders were assessed with the World Mental Health (WMH) Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured interview designed to be administered by trained lay interviewers. Information about age of first professional treatment contact for each lifetimeDSM-IV/WMH-CIDI disorder assessed in the survey was collected and compared with age at onset of the disorder to study typical duration of delay. Results Cumulative lifetime probability curves show that the vast majority of people with lifetime disorders eventually make treatment contact, although more so for mood (88.1%-94.2%) disorders than for anxiety (27.3%-95.3%), impulse control (33.9%-51.8%), or substance (52.7%-76.9%) disorders. Delay among those who eventually make treatment contact ranges from 6 to 8 years for mood disorders and 9 to 23 years for anxiety disorders. Failure to make initial treatment contact and delay among those who eventually make treatment contact are both associated with early age of onset, being in an older cohort, and a number of socio-demographic characteristics (male, married, poorly educated, racial/ethnic minority). Conclusions Failure to make prompt initial treatment contact is a pervasive aspect of unmet need for mental health care in the United States. Interventions to speed initial treatment contact are likely to reduce the burdens and hazards of untreated mental disorder.

10-Year Research Update Review: The Epidemiology of Child and Adolescent Psychiatric Disorders: I. Methods and Public Health Burden

Abstract: Objective To review recent progress in child and adolescent psychiatric epidemiology in the area of prevalence and burden. Method The literature published in the past decade was reviewed under two headings: methods and findings. Results Methods for assessing the prevalence and community burden of child and adolescent psychiatric disorders have improved dramatically in the past decade. There are now available a broad range of interviews that generate DSM and ICD diagnoses with good reliability and validity. Clinicians and researchers can choose among interview styles (respondent based, interviewer based, best estimate) and methods of data collection (paper and pencil, computer assisted, interviewer or self-completion) that best meet their needs. Work is also in progress to develop brief screens to identify children in need of more detailed assessment, for use by teachers, pediatricians, and other professionals. The median prevalence estimate of functionally impairing child and adolescent psychiatric disorders is 12%, although the range of estimates is wide. Disorders that often appear first in childhood or adolescence are among those ranked highest in the World Health Organization's estimates of the global burden of disease. Conclusions There is mounting evidence that many, if not most, lifetime psychiatric disorders will first appear in childhood or adolescence. Methods are now available to monitor youths and to make early intervention feasible.

Young people’s help-seeking for mental health problems

Abstract: This paper summarises an ambitious research agenda aiming to uncover the factors that affect help-seeking among young people for mental health problems. The research set out to consider why young people, and particularly young males, do not seek help when they are in psychological distress or suicidal; how professional services be made more accessible and attractive to young people; the factors that inhibit and facilitate help-seeking; and how community gatekeepers can support young people to access services to help with personal and emotional problems. A range of studies was undertaken in New South Wales, Queensland and the ACT, using both qualitative and quantitative approaches. Data from a total of 2721 young people aged 14-24 years were gathered, as well as information from some of the community gatekeepers to young people’s mental health care. Help-seeking was measured in all the studies using the General Help Seeking Questionnaire (Wilson, Deane, Ciarrochi & Rickwood, 2005), which measures future help-seeking intentions and, through supplementary questions, can also assess prior help-seeking experience. Many of the studies also measured recent help-seeking behaviour using the Actual Help Seeking Questionnaire. The types of mental health problems examined varied across the studies and included depressive symptoms, personal-emotional problems, and suicidal thoughts. The help-seeking process was conceptualised using a framework developed during the research program. This framework maintains that help-seeking is a process of translating the very personal domain of psychological distress to the interpersonal domain of seeking help. Factors that were expected to facilitate or inhibit this translation process were investigated. These included factors that determine awareness of the personal domain of psychological distress and that affect the ability to articulate or express this personal domain to others, as well as willingness to disclose mental health issues to other people. The results are reported in terms of: patterns of help-seeking across adolescence and young adulthood; the relationship of help-seeking intentions to behaviour; barriers to seeking help—lack of emotional competence, the help-negation effect related to suicidal thoughts, negative attitudes and beliefs about helpseeking and fear of stigma; and facilitators of seeking help—emotional competence, positive past experience, mental health literacy, and supportive social influences. The paper considers the implications of the findings for the development of interventions to encourage young people to seek help for their mental health problems, and concludes by identifying gaps in the help-seeking research and literature and suggesting future directions.

Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood

Abstract: Background: This paper seeks to extend research into the adult sequelae of childhood conduct problems by investigating the associations between conduct problems in middle childhood and psychosocial outcomes in adulthood. Method: Data were gathered during the course of a 25-year longitudinal study of a birth cohort of New Zealand young people. Information was collected on: a) parent and teacher reports of child conduct problems at ages 7, 8 and 9 years; b) measures of crime, substance use, mental health, sexual/partner relationships, education/employment; c) confounding factors, including childhood, family and educational characteristics. Results: There were statistically significant associations between childhood conduct problems from 7–9 years and risks of adverse outcomes across all domains of functioning. After control for confounding factors the associations between conduct problems and education/employment outcomes became statistically non-significant. Associations persisted for other outcomes (crime, substance dependence, mental health and sexual/partner relationships). Children in the most disturbed 5% of the cohort had rates of these outcomes that were between 1.5 and 19 times higher than rates for the least disturbed 50% of the cohort. The associations between conduct problems and adult outcomes were similar for males and females. Conclusions: Childhood conduct problems were associated with a wide range of adverse psychosocial outcomes (crime, substance use, mental health, sexual/partner relationships) even after control for confounding factors. The results reinforce the need for greater investment into interventions to address these problems.

The mental and physical health outcomes of green exercise.

Abstract: Both physical activity and exposure to nature are known separately to have positive effects on physical and mental health. We have investigated whether there is a synergistic benefit in adopting ph...

Social capital and mental illness: a systematic review

Abstract: Study objective: The concept of social capital has influenced mental health policies of nations and international organisations despite its limited evidence base. This papers aims to systematically review quantitative studies examining the association between social capital and mental illness. Design and setting: Twenty electronic databases and the reference sections of papers were searched to identify published studies. Authors of papers were contacted for unpublished work. Anonymised papers were reviewed by the authors of this paper. Papers with a validated mental illness outcome and an exposure variable agreed as measuring social capital were included. No limitations were put on date or language of publication. Main results: Twenty one studies met the inclusion criteria for the review. Fourteen measured social capital at the individual level and seven at an ecological level. The former offered evidence for an inverse relation between cognitive social capital and common mental disorders. There was moderate evidence for an inverse relation between cognitive social capital and child mental illness, and combined measures of social capital and common mental disorders. The seven ecological studies were diverse in methodology, populations investigated, and mental illness outcomes, making them difficult to summarise. Conclusions: Individual and ecological social capital may measure different aspects of the social environment. Current evidence is inadequate to inform the development of specific social capital interventions to combat mental illness.

Depression: management of depression in primary and secondary care

Abstract: The National Institute for Clinical Excellence and the National Collaborating Centre for Mental Health have published a guideline for the NHS in England and Wales on the management of depression in primary and secondary care.

Medical Student Distress: Causes, Consequences, and Proposed Solutions

Abstract: The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students' mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to cynicism and subsequently may affect students' care of patients, relationship with faculty, and ultimately the culture of the medical profession. In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress.

Contingencies of Self-Worth

Abstract: We argue that the importance of self-esteem lies in what people believe they need to be or do to have worth as a person. These contingencies of self-worth are both sources of motivation and areas of psychological vulnerability. In domains of contingent self-worth, people pursue self-esteem by attempting to validate their abilities and qualities. This pursuit of self-esteem, we argue, has costs to learning, relationships, autonomy, self-regulation, and mental and physical health. We suggest alternatives to this costly pursuit of self-esteem.

Subthreshold Depression in Adolescence and Mental Health Outcomes in Adulthood

Abstract: Background There is increasing interest in the extent to which individuals with subthreshold depression face increased risks of subsequent major depression and other disorders. Objective To examine linkages between the extent of depressive symptoms (asymptomatic, subthreshold, major depression) at ages 17 to 18 years and mental health outcomes up to age 25 years in a New Zealand birth cohort. Design Data were gathered during the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of 1265 New Zealand children (635 males, 630 females). Setting General community sample. Participants The analysis was based on 1006 participants who represented 80% of the original cohort. Main Outcome Measures Diagnostic and Statistical Manual of Mental Disorders, Fourth Editionsymptom criteria for major depression and anxiety disorder, treatment-seeking, suicidal ideation, and suicide attempt. Results There were significant associations (P Conclusions Findings suggest that sample members with subthreshold depression are a group with elevated risks of later depression and suicidal behaviors. Current diagnostic procedures, which classify people with subthreshold depression into complex discrete groups, might obscure the fact that depressive symptoms are dimensional and range from none to severe.

Nonsuicidal Self-Harm Among Community Adolescents: Understanding the “Whats” and “Whys” of Self-Harm

Abstract: This study examines self-harm in a community sample of adolescents. More specifically, the study identifies the prevalence and types of self-harm, elucidates the nature and underlying function of self-harm, and evaluates the relation of psychological adjustment, sociodemographic, and health-risk variables to self-harm. Self-report questionnaires assessing self-harm, adjustment, health behaviors, suicide history, and social desirability were completed by 424 school-based adolescents. Overall, 15% of the adolescents reported engaging in self-harm behavior. Analyses revealed gender differences across behaviors and motivations. Adolescents who indicated harming themselves reported significantly increased antisocial behavior, emotional distress, anger problems, health risk behaviors, and decreased self-esteem. Results provide support for the coping or affect regulation model of self-harm. Findings suggest that self-harm is associated with maladjustment, suicide, and other health behaviors indicative of risk for negative developmental trajectories.

Health literacy and functional health status among older adults.

Abstract: Background Individuals with limited health literacy have less health knowledge, worse self-management skills, lower use of preventive services, and higher hospitalization rates. We evaluated the association between health literacy, self-reported physical and mental health functioning, and health-related activity limitations among new Medicare managed care enrollees. Methods A cross-sectional survey of 2923 enrollees was conducted in Cleveland, Ohio; Houston, Tex; Tampa, Fla; and Fort Lauderdale–Miami, Fla. Health literacy was measured using the short form of the Test of Functional Health Literacy in Adults. We used outcome measures that included scores on the physical and mental health functioning subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey, difficulties with instrumental activities of daily living and activities of daily living, and limitations because of physical health and pain. Results After adjusting for the prevalence of chronic conditions, health risk behaviors, and sociodemographic characteristics, individuals with inadequate health literacy had worse physical function (67.7 vs 78.0, P P Conclusion Among community-dwelling older adults, inadequate health literacy was independently associated with poorer physical and mental health.

The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes

Abstract: The efficacy of psychological interventions for children has long been debated among mental health professionals; however, only recently has this issue received national attention, with the U.S. Public Health Service (2000) emphasizing the critical need for early intervention and empirically validated treatments tailored to children’s maturational needs. Play therapy is a developmentally responsive intervention widely used by child therapists but often criticized for lacking an adequate research base to support its growing practice. A meta-analysis of 93 controlled outcome studies (published 1953‐2000) was conducted to assess the overall efficacy of play therapy and to determine factors that might impact its effectiveness. The overall treatment effect for play therapy interventions was 0.80 standard deviations. Further analysis revealed that effects were more positive for humanistic than for nonhumanistic treatments and that using parents in play therapy produced the largest effects. Play therapy appeared equally effective across age, gender, and presenting issue.

Trauma‐informed or trauma‐denied: Principles and implementation of trauma‐informed services for women

Abstract: In this article, we attempt to bridge the gap between practice (service delivery) and philosophy (trauma theory, empowerment, and relational theory). Specifically, we identify 10 principles that define trauma-informed service, discuss the need for this type of service, and give some characteristics of trauma-informed services in eight different human service areas. The areas include outreach and engagement, screening and assessment, resource coordination and advocacy, crisis intervention, mental health and substance abuse services, trauma-specific services, parenting support, and healthcare. We draw upon the experiences of the nine sites involved in the Substance Abuse and Mental Health Service Administration's (SAMHSA) 5-year grant project, Women, Co-occurring Disorders and Violence Study (WCDVS), and include the recommendation that consumers be integrated into the design and evaluation of services. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 461–477, 2005.

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

Abstract: 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).

Systems analysis of stress and positive perceptions in mothers and fathers of pre-school children with autism.

Abstract: Systemic analyses of psychological functioning in families of children with autism have typically shown that parents report different experiences (e.g., stress) and that siblings may also be affected. The purpose of the present research was more explicitly to address relationships between child, partner, and parent variables. Parents of 48 children with autism (41 mother–father pairs) reported on child characteristics, and their own stress and mental health. Mothers were found to report both more depression and more positive perceptions than fathers. Regression analyses revealed that paternal stress and positive perceptions were predicted by maternal depression; maternal stress was predicted by their children’s behavior problems (not adaptive behavior or autism symptoms) and by their partner’s depression. The future testing of the mechanisms underlying these results is discussed. In addition, the need is emphasized for more systemic analyses to understand the psychological functioning of children with autism and their siblings and parents.

Socioeconomic Status and Mental Illness: Tests of the Social Causation and Selection Hypotheses

Abstract: This study tests several hypotheses about the underlying causal structure of the inverse correlation between socioeconomic status (SES) and mental illness. It does this through the analysis of a longitudinal statewide database on acute psychiatric hospitalization in Massachusetts for the fiscal years 1994-2000 as well as supplemental census data. The modeling strategy used techniques of structural equation modeling and found that SES impacted directly on rates of mental illness as well as indirectly through the impact of economic hardship on low and middle income groups.