The role of religious coping and race in Alzheimer's disease caregiving.

Alzheimer's disease (AD) and other dementias are one of the most critical public health problems in elderly population. Using baseline data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II study, this study examined the relationship between religious coping, burden appraisal, depression, and race among 211 African American, 220 White, and 211 Hispanic caregivers, using structural equation modeling (SEM). Caregiver burden appraisal mediated the effect of religious coping on depression with higher religious coping resulting in lowering caregiver burden appraisal and thereby reducing depression. The results also showed that religious coping mediation model was best supported by African Americans. Greater understanding of religious coping and its role in the caregiving process helps researchers discover better ways to assist racially diverse caregivers in dealing with burdens of AD caregiving.

Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults.

OBJECTIVE: Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services. METHOD: A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data. RESULTS: Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans; (2) Barriers to Seeking Treatment for Older African-Americans; and (3) Cultural Coping Strategies for Depressed African-American Older Adults. CONCLUSION: Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors, which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.

Mental health treatment seeking among older adults with depression: the impact of stigma and race.

OBJECTIVE: Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment-seeking attitudes and behaviors among older adults with depression. METHOD: Random digit dialing was utilized to identify a representative sample of 248 African American and white older adults (older than 60 years) with depression (symptoms assessed by the Patient Health Questionnaire-9). Telephone-based surveys were conducted to assess their treatment-seeking attitudes and behaviors and the factors that impacted these behaviors. RESULTS: Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in or did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their white counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment. CONCLUSION: Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.

Racial differences in attitudes toward professional mental health treatment: the mediating effect of stigma.

Stigma associated with mental illness continues to be a pervasive barrier to mental health treatment, leading to negative attitudes about treatment and deterring appropriate care seeking. Empirical research suggests that the stigma of mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental illness, particularly African Americans. However, little research has examined the impact of stigma on racial differences in attitudes toward seeking mental health treatment. This study examined the hypothesis that stigma partially mediates the relationship between race and attitudes towards mental health treatment in a community-based sample of 101 African American and White older adults. Multiple regression analyses and classic path analysis was utilized to test the partial mediation model. Controlling for socio-demographic factors, African American older adults were more likely to have negative attitudes toward mental health treatment, and they also reported more public and internalized stigma than their White counterparts. As hypothesized, the relationship between race and attitudes toward mental health treatment was partially mediated by internalized stigma, suggesting that internalized stigma may cause older adults to develop negative attitudes about mental health treatment. The partial mediation model was not significant for public stigma, however. Implications for social work research and practice are discussed.

The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth.

This study hypothesized that gender-role nonconformity is associated with suicidality, and bullying mediates this relationship. Gay males retrospectively answered questions pertaining to elementary, middle, and high school. Support for the hypotheses was found. Results can help screen gay youth for suicidality and support the need for policies prohibiting harassment based on sexual orientation.

Gender-based salary inequity in social work: mediators of gender's effect on salary.

This study examined the direct effect of gender, controlling for years of experience, job role, and other variables, in a sample of 359 Pennsylvania social workers. Men social workers received significantly more yearly salary (an estimated 3,665 dollars more) than women social workers. A path analysis suggested that the salary advantage for men that was attributable to their acquiring more experience and management positions was slightly larger than the direct effect of gender. The ability of merit variables to explain salary was somewhat greater for men than women. Other variables that mediated the effect of gender on salary were MSW specialization, working in a social work or a related area, and practice area (children and youths, health, mental health, or other area). The results suggest that substantial gender disparity continues to exist in social worker salaries.

Mental health case management as a locus for HIV prevention: results from case-manager focus groups.

HIV infection among people with severe mental illness (SMI) is a growing concern, and interventions have been designed to address HIV prevention among these individuals. However, little is known about the preparedness of mental health providers to support these interventions. This study concentrated on mental health case management as a locus for HIV-prevention services. Focus groups of case managers were conducted to learn participants' motivation to adopt HIV-prevention services and barriers/facilitators to such adoption. Participants reported they would be motivated to offer HIV prevention if services were to be presented in the context of existing client relationships and case-management tasks. Barriers and facilitators were discussed at client, provider, and community levels, and recommendations for training were offered. Findings have implications for diffusion of HIV-prevention services in case management, and the line of questioning in focus groups provides a basis for learning about other behavioral health service contexts as loci for disease prevention.

Acculturation, stress, and depressive symptoms among Korean immigrants in the United States.

A sample of 157 Korean immigrants responded to measures of acculturation level, stress from acculturation, and depressive symptoms. The authors hypothesized that adaptive acculturation would depend on assimilation regarding social interactions and the host culture's language as well as on retention of a core identity, including values and traditions of the culture of origin. Consistent with the mediation hypothesis, acculturation, based on a factor representing language use and social relationships, was related to lower acculturative stress and, in turn, lower depression. However, there was no direct support for the integrative, or bicultural, strategy of acculturation. Stress did not mediate the effect of a 2nd acculturation factor, identity and tradition-based acculturation. Rather, this measure of acculturation was directly related to higher depression (i.e., immigrants reporting abandonment of Korean identity, traditions, and values scored higher for depression).

Therapist and case manager perceptions of client barriers to treatment participation and use of engagement strategies.

This study of 33 mental health therapists and 30 case managers examined the relationship between practitioners' assessments of the importance of potential treatment barriers and their use of engagement strategies to overcome those barriers and improve treatment participation. Results confirmed the hypothesis that workers who viewed treatment barriers as more important were significantly more active in their reported efforts to engage clients (r = .28, p < .05). Although no significant differences between the two groups were found in overall use of engagement strategies, we found a significant interaction effect between position and types of strategies used, with therapists employing more discussion strategies while case managers were more likely to employ practical engagement strategies (F = 35.79, p < .001). Findings suggest the desirability of enhancing mental health workers' sensitivity to the range of barriers that clients may experience, and expanding the repertoire of engagement strategies they use to encourage client retention.