Major depressive disorder in a population of urban, African-American young adults: prevalence, correlates, comorbidity and unmet mental health service need.

BACKGROUND: The U.S. Surgeon General recently highlighted the relative dearth of research on the mental health of minority populations in the U.S. The present report describes the prevalence of major depressive disorder (MDD) in an epidemiologically-defined population of 1197, predominately poor, African-American 19-22-year-olds, living in the greater Baltimore, MD metropolitan area. METHODS: The prevalence and correlates of MDD, its comorbidity with other mental and substance disorders, and unmet mental health service need were assessed via a structured clinical interview administered by lay interviewers. RESULTS: Using DSM-IV criteria, the overall prevalence of lifetime MDD for the study population was 9.4%, whereas the last year and last month prevalences were 6.2 and 2.7%, respectively. Females were approximately 1.6 times more likely to report a lifetime episode of MDD than males. MDD was highly comorbid with substance disorders. Just under 10% of those who had experienced an episode of MDD within the last year reported receiving mental health specialty services within the last year. LIMITATIONS: A major limitation was the reliance on a single interview conducted by a lay interviewer as opposed to a comprehensive psychiatric assessment carried out by a highly trained clinician, integrating information on symptoms and functioning from multiple sources. CONCLUSIONS: The lifetime prevalence of MDD found in the present study suggests that it is a significant mental health problem in the African-American young adults studied, particularly amongst women. Moreover, most episodes of MDD went untreated.

Negative caregiver strategies and psychopathology in urban, African-American young adults.

OBJECTIVE: There were three aims: (1). assess the prevalence of reported exposure to negative caregiver strategies in a community-based African-American population, (2). examine the sources of variation in caregiver parenting strategies, including demographic variables and child characteristics, (3). investigate whether mental disorders in young adulthood may differ based on reported degree of exposure to negative strategies. METHOD: The participants were 1197 African-Americans involved in a 1999-2001 young adult follow-up (age M=19.6, SD=.6) of an evaluation of school-based interventions in the Baltimore, MD metropolitan area. Measures included teacher-report of child aggression in first grade, parent-report of demographic variables in first and sixth grade, and young adult self-report of symptomatology, suicidal behaviors, and childhood caregiver discipline strategies. RESULTS: Fifty-four percent of the sample reported some use of physical discipline by caregivers. Lower family income and younger caregiver age, as well as teacher reports of child aggression, were related to reports of caregiver's high use of negative strategies. In addition, young adults who reported a high rate of negative caregiver strategies had a significantly increased risk for psychopathology and were over twice as likely to have experienced a history of suicidal ideation than those reporting low exposure. CONCLUSIONS: The results demonstrate the importance of examining variation in this population, with the poorest and the youngest using negative parenting strategies more frequently. In addition, the present study replicated previous findings of the link between negative caregiver discipline strategies and psychopathology. This association appears robust across diverse populations. The implications for preventive interventions are discussed.

Suicidal behavior among urban, African American young adults.

The objectives of the present study were four-fold. First, to determine the lifetime, last year, and 6-month prevalence and demographic correlates of suicidal behavior in a defined population of urban, African American young adults. Second, to determine the degree of mental health service utilization among attempters. Third, to study the comorbidity between mental disorders and suicidal behavior, along with the variation in the numbers and types of psychiatric disorders associated with attempts versus ideation only. Fourth, to examine gender differences in the psychiatric diagnoses associated with attempts and ideation. Data relevant to each of these objectives were gathered through structured interviews of 1,157 economically disadvantaged, African American young adults. Lifetime, last year, and 6-month prevalence rates for attempts were 5.3%, 1.2%, and 0.4%, respectively, whereas the lifetime and 6-month prevalence of ideation were 14% and 1.9%, respectively. Approximately two thirds of those who reported lifetime ideation, and a similar proportion of those who reported lifetime attempts, had a history of at least one lifetime psychiatric disorder. There were no gender differences in terms of the degree of risk for suicidal behavior (ideation or attempts) associated with any of the comorbid psychiatric diagnoses assessed. Despite the severity of most attempts, few attempters received mental health services in their lifetime or at the time of their most recent attempt.