The study reported by Brent et al.
in this issue of JAACAP is an encouraging approach to potentially reducing mental health disparities. The response of Latinx youth to treatment for depression and ...anxiety in Brent and colleagues' studies is promising and can help explain why previous studies of Hispanic youth found lower rates of receiving depression care. Brent and colleagues' results of brief behavioral therapy (BBT) at 32 weeks are mostly in line with results of their original study
: BBT was superior to assisted referral to care (ARC) regarding treatment response and functioning. Like the original study, at week 32, ethnicity continued to moderate the effect of BBT on anxiety (but not depression), due to a lower response rate of Hispanics to assisted referrals to care than their non-Hispanic white counterparts. Findings demonstrated that Hispanics had a stronger response to BBT than assisted referral to outpatient care in comparison to non-Hispanic whites; however, at 32 weeks, ethnicity did not moderate BBT impact on functioning, suggesting that the treatment worked the same for non-Hispanic whites as for Hispanics. Such findings suggest that availability of services, identification of need, and easy navigation to mental health services might be some of the reasons for the persistent mental health access disparities among youth of color.
Background: There is little consensus on the extent to which psychiatric disorders or syndromes are universal or the extent to which they differ on their core definitions and constellation of ...symptoms as a result of cultural or contextual factors. This controversy continues due to the lack of biological markers, imprecise measurement and the lack of a gold standard for validating most psychiatric conditions.
Method: Empirical studies were used to present evidence in favor of or against a universalist or relativistic view of child psychiatric disorders using a model developed by Robins and Guze to determine the validity of psychiatric disorders.
Results: The prevalence of some of the most common specific disorders and syndromes as well as its risk and protective factors vary across cultures, yet comorbid patterns and response to treatments vary little across cultures. Cross‐cultural longitudinal data on outcomes is equivocal.
Conclusions: The cross‐cultural validity of child disorders may vary drastically depending on the disorder, but empirical evidence that attests for the cross‐cultural validity of diagnostic criteria for each child disorder is lacking. There is a need for studies that investigate the extent to which gene–environment interactions are related to specific disorders across cultures. Clinicians are urged to consider culture and context in determining the way in which children's psychopathology may be manifested independent of their views. Recommendations for the upcoming classificatory system are provided so that practical or theoretical considerations are addressed about how culture and ethnic issues affect the assessment or treatment of specific disorders in children.
Despite decades of research, racial and ethnic disparities in behavioral health care persist. The Affordable Care Act expanded access to behavioral health care, but many reform initiatives fail to ...consider research about racial/ethnic minorities. Mistaken assumptions that underlie the expansion of behavioral health care run the risk of replicating existing service disparities. Based on a review of relevant literature and numerous observational and field studies with minority populations, we identified the following three mistaken assumptions: Improvement in health care access alone will reduce disparities, current service planning addresses minority patients' preferences, and evidence-based interventions are readily available for diverse populations. We propose tailoring the provision of care to remove obstacles that minority patients face in accessing treatment, promoting innovative services that respond to patients' needs and preferences, and allowing flexibility in evidence-based practice and the expansion of the behavioral health workforce. These proposals should help meet the health care needs of a growing racial/ethnic minority population.
The fields of psychiatry and mental health are increasingly recognizing the importance of social determinants of health (SDOH) and their impact on mental health outcomes. In this overview, the ...authors discuss the recent research, from the past 5 years, on advances made in SDOH work. SDOH frameworks and theories have expanded to include more social conditions, from traumas associated with immigration to psychosocial and community strengths, that impact mental health and well-being. Research has consistently shown the pervasive deleterious impacts of inequitable social conditions (e.g., food insecurity, housing instability) on minoritized populations' physical and mental health. Social systems of oppression (e.g., racism, minoritization) have also been shown to confer higher risk for psychiatric and mental disorders. The COVID-19 pandemic illuminated the inequitable impact of the social determinants of health outcomes. More efforts have been made in recent years to intervene on the social determinants through interventions at the individual, community, and policy levels, which have shown promise in improving mental health outcomes in marginalized populations. However, major gaps remain. Attention should be paid to developing guiding frameworks that incorporate equity and antiracism when designing SDOH interventions and improving methodological approaches for evaluating these interventions. In addition, structural-level and policy-level SDOH efforts are critical for making long-lasting and impactful advances toward mental health equity.
This literature review examined the effects of patients' limited English proficiency and use of professional and ad hoc interpreters on the quality of psychiatric care.
PubMed, PsycINFO, and CINAHL ...(Cumulative Index to Nursing and Allied Health Literature) were systematically searched for English-language publications from inception of each database to April 2009. Reference lists were reviewed, and expert sources were consulted. Among the 321 articles identified, 26 met inclusion criteria: peer-reviewed articles reporting primary data on clinical care for psychiatric disorders among patients with limited proficiency in English or in the provider's language.
Evaluation in a patient's nonprimary language can lead to incomplete or distorted mental status assessment. Although both untrained and trained interpreters may make errors, untrained interpreters' errors may have greater clinical impact, compromising diagnostic accuracy and clinicians' detection of disordered thought or delusional content. Use of professional interpreters may improve disclosure in patient-provider communications, referral to specialty care, and patient satisfaction.
Little systematic research has addressed the impact of language proficiency or interpreter use on the quality of psychiatric care in contemporary U.S. settings. Findings are insufficient to inform evidence-based guidelines for improving quality of care among patients with limited English proficiency. Clinicians should be aware of the ways in which quality of care can be compromised when they evaluate patients in a nonprimary language or use an interpreter. Given U.S. demographic trends, future research should help guide practice and policy by addressing deficits in the evidence base.
The National Advisory Council on Minority Health and Health Disparities (NACMHD) consists of researchers, advocates, and leaders on minority health and health disparities who advise the National ...Minority Health and Health Disparities (NIMHD) director on matters related to NIMHD's mission. Thus, it was with enthusiasm that NACMHD endorsed the apropos initiative to assess the current state of the science and identify gaps, challenges, and opportunities to develop a National Institutes of Health (NIH)-wide strategic vision to advance minority health and health disparities. This AJPH special issue represents the fruits from that initiative. In 2016, the extramural community celebrated the 30th anniversary of the Report of the Secretary's Task Force on Black and Minority Health, or as it is commonly referred, the Heckler re-port. This landmark document described health disparities "as an affront both to our ideals and the ongoing genius of American medicine."1(p.ix) The report elevated minority health to the na-tional stage and was a driving force to address the significant disparities found among Blacks, Hispanics, Asians, Native Hawaiians/Pacific Islanders, and Native Americans through monumental changes in infrastructure, research, policies, programs, and legislation advancing health equity at the national, regional, state, and community levels. There are countless modern-day pioneers who have worked with racial/ ethnic and gender minorities and disparate populations to understand the factors that exacerbate health disparities and devise strategies for their reduction and elimination. Although much progress has been made, we are at a critical juncture, where we can pivot to what is urgently needed.
Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination ...into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.
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