Mental Healthcare Provider Perceptions of Race and Racial Disparity in the Care of Black and White Clients.

Black-white disparities in mental healthcare persist, despite efforts to eliminate them via culturally competent care. To gain insight into how providers implement culturally competent care practices, interviews were conducted with mental healthcare providers' about their self-reported behaviors with black and white clients and their perceptions of how race affects the treatment they provide. Thematic analysis was used to analyze 12 semi-structured interviews with providers from a Veterans Affairs healthcare system. Three sets of themes emerged: providers' general beliefs and behaviors (discomfort discussing race; belief that socioeconomic differences explained disparities; and use of coded language for race groups), providers' clinical beliefs and behaviors (race-matching enhances care and recognition of intersecting cultural identities), and providers' professional beliefs and behaviors (participation in passive racism facilitated by provider-provider alliance). Mental healthcare providers showed good awareness of intersectionality and subtle racism but held limiting beliefs that led to avoidance of discussions of race.

Disparities in Treatment and Service Utilization Among Hispanics and Non-Hispanic Whites with Bipolar Disorder.

OBJECTIVES: Due to the serious and recurrent nature of bipolar disorder, continuous long-term medication treatment is typically recommended. Little is known about whether these treatment recommendations are effectively implemented for Hispanics. This study examined differences in mood stabilizer use and mental health service utilization between adult English-speaking Hispanic and non-Hispanic white respondents with bipolar disorder. METHODS: The sample included 163 participants with lifetime bipolar I and II disorders in the National Comorbidity Survey Replication. Demographics, symptom presentation, and acculturation were examined as covariates. RESULTS: None of the 26 Hispanic respondents were taking mood-stabilizing medication, compared to 21 % of non-Hispanic whites, and Hispanics were less likely to receive medications for emotional problems, see a professional for manic episodes, or attend psychotherapy. Even after accounting for differences in symptom profiles and sociodemographics, ethnicity continued to be a significant predictor of mood stabilizer use and psychotherapy attendance. There was a non-significant trend toward lower acculturation among Hispanics being associated with even poorer service utilization. CONCLUSIONS: No Hispanics were receiving minimally adequate treatment for their bipolar disorder. Future research should focus on identifying the barriers that lead to these stark ethnic disparities in treatment.

Emotion in bipolar I disorder: Implications for functional and symptom outcomes.

Despite the centrality of emotion disturbance in neurobiological models of bipolar disorder, the behavioral literature has not yet clearly identified the most central aspects of emotion disturbance in bipolar disorder. Toward this aim, we gathered a battery of emotion-related measures in 67 persons diagnosed with bipolar I disorder as assessed with the SCID and a well-matched control group of 58 persons without a history of mood disorders. Those with bipolar disorder were interviewed monthly until they achieved remission, and then tested on emotion measures. A subset of 36 participants with bipolar disorder completed symptom severity interviews at 12-month follow-up. Factor analyses indicated 4 emotion factor scores: Negative Emotion, Positive Emotion, Reappraisal, and Suppression. Bivariate analyses suggested that bipolar disorder was tied to a host of emotion disturbances, but multivariate analyses suggested that bipolar disorder was particularly tied to elevations of Negative Emotion. High Negative Emotion, low Positive Emotion, and high Suppression were conjointly related to lower functioning. Reappraisal predicted declines in depression over time for those with bipolar disorder. Findings highlight the importance of considering the overall profile of emotion disturbance in bipolar disorder. Emotion and emotion regulation appear central to a broad range of outcomes in bipolar disorder.