Differences in mental health resiliency in young African Americans.
Abstract: Introduction

Historically people of color, especially African Americans, have been mistreated, undertreated, misdiagnosed or incorrectly diagnosed with mental disorders, and have had their race and ethnicity used against them in the name of mental health research. The current study examines the differences in mental health resiliency in young African-Americans.

Methods

A secondary data analysis was conducted using the 2003 Youth Risk Resiliency Survey (YRRS) among high school students. A subset of 1,500 African American youth (between 15-18 years of age) was selected for analysis. Individual characteristics measured were age, gender, grades in school, and level of education. Outcome variables were mindset (education), spirituality, and community connectedness.

Results

Results showed females had significantly weaker opinions with regard to mindset (2.6 [+ or -] 0.57 vs. 4.9 [+ or -] 0.59; p < 0.05). No differences were detected for gender for spirituality. Students who were 18 years of age had significantly higher spiritual scores than participants who were seventeen, sixteen, and fifteen years of age (5.9 [+ or -] 0.94 vs. 5.0 [+ or -] 1.2 vs. 4.2 [+ or -] 1.20 vs. 4.1 [+ or -] 0.31, respectively; p < 0.05). Students who were 12th grade seniors had more positive feelings of community connectedness compared to youth who were in the 11th grade and 10th grade (6.8 [+ or -] 8.5 vs. 6.1 [+ or -] 2.5 vs. 5.9 [+ or -] 1.5, respectively; p < 0.05).

Conclusions

As the minority population continues to grow clinicians, researchers, and public health professionals will need to understand that African Americans differ in their resilience as it relates to mental health. The idea of people of color being resilient to prevent mental illness is a relatively new phenomenon that needs to be explored. What is now needed is a comprehensive look at how race and racism affect mental health.
Article Type: Report
Subject: Mental illness (Care and treatment)
Mental illness (Risk factors)
Mental illness (Demographic aspects)
Social economics (Comparative analysis)
Social economics (Influence)
Social economics (Psychological aspects)
Mental health (Research)
Author: Wallace, Edward V.
Pub Date: 01/01/2012
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Wntr, 2012 Source Volume: 27 Source Issue: 1
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 307184649
Full Text: INTRODUCTION

It is well documented that people of color are more mistrustful of the mental health system than other groups and have a long and damaging relationship with mental health researchers, practitioners, and policymakers (Brandon et al, 2005). Availability, access, coercion, and stigmatization of mental health care can play a significant role in the treatment of mental illness in African Americans. African Americans are less likely to obtain psychiatric care than Whites, more likely to receive health care in outpatient hospitals and emergency departments, and more likely to seek mental health services in emergency care settings (U.S. Department of Health and Human Services, 2001). These facilities by definition are often not organized or designed to provide long-term follow-up care for their patients. According to Holzer, Goldsmith, and Ciarlo (1998) among those who are trained mental health professionals in an emergency center, 2% are psychiatrists, 2% are psychologists, and 4% are social workers.

Socioeconomic differences in the United States also play a role in African Americans ability to access treatment for mental health conditions. In 2005, 21% of the African American population was uninsured compared with 13% of the White population (Henry J. Kaiser Family Foundation & Garfield, 2007). African Americans, as well as other minority groups, are less likely than their White counterparts to receive standard routine care in one localized setting and are more likely to receive care through low-income plans such as Medicaid and other public providers. These barriers to availability of care are often associated with mental illness. However, socioeconomic inequities do not fully explain the differences in service use.

African American often act upon mental health problems in contexts that may promote or hinder engagement in formal mental health services. Jackson and colleagues (2007) found that there were differences in Blacks' and Whites' use of formal mental health services. African Americans are often coerced into mental health treatment through the judicial or educational system. Many judges and others are not exempt from racial bias when making decisions as to whether an individual should be referred for treatment versus punishment. Such bias results in African Americans being coerced into systems that are inappropriate for their mental health needs. Additionally, the burden of the stigma associated with mental health issues is overwhelming and extremely high in the African American community (Bell, 2001).

Despite the historic mistrust, socioeconomic hardships, stigma, and coercion that accompany mental health issues for African Americans, many African Americans in the United States have survived and lead productive and socially engaged lives through sheer determination, strength, and perseverance. The often-repeated musical words by Gene McFadden and John Whitehead "Aint No Stopping Us Now" resonate with many African Americans and denote the notion of strength in the African American community. Resilience, then, becomes an important tool for preventing mental health conditions. The literature suggests that knowledge about resilience should be included in research and be identified for people with mental illness (Edward et al, 2009). The literature suggests that there is not a moment to lose in promoting mental health efforts in this country (Power, 2010). There is a need and a growing call for mental health research to promote individual, family, and community resilience. Finding ways to explore how people of color display this resiliency emerges as an important area of study in mental health research. Therefore, the aim of our study was to explore mental health resiliency in young African-Americans.

METHODS

DATA SOURCE AND STUDY POPULATION

A secondary data analysis was conducted using the 2003 Youth Risk Resiliency Survey (YRRS) among high school students. The YRRS 2003 survey was carefully designed by a task force composed of representatives from the Center for Health Promotion and Disease Prevention (CHPDP) and other partners. Special attention was given to ensure that it was comparable to the CDC/DASH Youth Risk Behavior Survey (YRBS), which is administered in most states to obtain relevant data about school health issues. The Youth Risk Resiliency Survey differs from the Youth Risk Behavior Survey in that the questions cover not only behavioral risk factors, to which the YRBS is limited, but also resiliency factors ('assets' or 'protective factors'). A total of 10,778 students in grades nine through twelve participated in the study. Our study consisted of analysis of all the African American youth (N = 1,500) who were fifteen to eighteen years of age. Data analysis was performed using SPSS version 18.0 (Table 1). Individual characteristics measured were age, and level of education. Gender was a binary variable. Grades in school categories were Mostly A's, Mostly B's, Mostly C's, Mostly D's, and Mostly F's. Outcome variables were mindset (education), spirituality, and community connectedness.

Mindset was assessed using Likert-type response code. Each score ranges from 1 to 6, with a higher score reflecting more positive feelings about education. Examples of items included in the mindset (education) scale are: "I have an adult in my home or my community who is interested in my school work" and "At my school I have teachers or some other adult who believes that I will be a success." The Likert-scales shows good reliability (Chronbach's alpha = 0.76).

Spirituality was measured by using a subscale score ranging from 1 to 6, with a higher score reflecting having more faith and attending services. Examples of items included in the spirituality scale are: "It's important for me to have faith and talk about my problems" and "It's important for me to attend religious or spiritual services." The chronbach's alpha = 0.80.

Community connectedness was measured with scores ranging from 1 to 7. Examples of items consist of asking questions: "Outside of my home and school, there is an adult who really cares about me" and "Who tells me when I do a good job". The connectedness scale does not have subscales, and higher scores reflect more social support. The scale showed great reliability (Chronbach's alpha = 0.78)

DATA ANALYSIS

Student's t-test, analysis of variance, and Pearson's correlation were used to compare individual characteristics on Mindset (Education), Spirituality, and Community Connectedness.

RESULTS

MINDSET (EDUCATION)

Differences were detected for gender. Females had significantly lower feelings with regard to mindset (2.6 [+ or -] 0.57 vs. 4.9 [+ or -] 0.59; p < 0.05). Participants who received mostly A's had significantly higher feelings with regard to mindset (education) when compared with participants who received grades of mostly C's and D's (5.7 [+ or -] 0.61 vs. 4.7 [+ or -] 0.59 vs. 4.7 [+ or -] 061; respectively p < 0.05) (see Table 2).

SPIRITUALITY

No differences were detected for gender for spirituality. Students who were 18 years of age had significantly higher spiritual scores than participants who were seventeen, sixteen, and fifteen years of age (5.9 [+ or -] 0.94 vs. 5.0 [+ or -] 1.2 vs. 4.2 [+ or -] 1.20 vs. 4.1 [+ or -] 0.31, respectively; p < 0.05). Students who received mostly D's and F's scored higher on the spirituality scale than students who mostly received B's and A's as letter grades (5.7 [+ or -] 0.92 vs. 5.6 [+ or -] 0.44 vs. 5.2 [+ or -] 1.01 vs. 5.2 [+ or -] 0.66, respectively; p < 0.05) (see Table 2).

COMMUNITY CONNECTEDNESS

No differences were detected for gender for community connectedness. Young African American school aged youth (18 years old) had significantly higher community connectedness compared to youth (15) years of age (6.8 [+ or -] 1.20 vs. 4.2 [+ or -] 1.49; p <0.05). Students who were 12th grade seniors had more positive feelings of connectedness compared to youth who were in the 11th grade and 10th grade (6.8 [+ or -] 8.5 vs. 6.1 [+ or -] 2.5 vs. 5.9 [+ or -] 1.5, respectively; p < 0.05).

RELATIONSHIP AMONG SAMPLE CHARACTERISTICS AND COMMUNITY CONNECTEDNESS, SPIRITUALITY AND MINDSET (EDUCATION)

Significant positive correlations were found for age, Community Connectedness and Spirituality indicating a developmental process; as age increases, the importance of networking and perceptions of having more faith in a higher being to help someone handle stressful situations increases (see Table 2). As grades increased, Mindset (education) also significantly increased, most likely a reflection of having an adult in the home or community who is interested in the student's school work (see Table 2).

DISCUSSION

This study explored the differences in mental health resiliency in young African-American students. Resilience is the ability to bounce back after having been faced with stressful events, an ability which is influenced by complex interactions of personal traits, developmental stages, and environment (Winsett, et al, 2010). The student's resiliency in preventing mental illness was characterized by mindset (education), spirituality and community connectedness. We found that males had a more positive mindset about education compared to females. At an early age boys are taught, well before starting preschool, to be prepared for what lies ahead. In a hands-on environment many boys are taught to play with building blocks, legos, cars, video games and other technology while girls are encouraged to play with dolls, and to "play house." This difference in nurturing is more likely to make girls less equipped to problem solve and less likely to be resilient when experiencing stress which can affect one's mental health. Other researchers have previously reported (Graham et al, 2011) even when females have received the same preparation as boys they tend to lack confidence and resiliency.

With regard to spirituality African American students who were older and received grades of mostly D's in their courses tended to be highly spiritual compared to students who received grades of A's and B's. The result of this question relates more to the issue of faith, where students who seem to struggle with their grades tend to have faith which makes them more optimistic about their academics. The desire to be spiritual where a person has faith could suggest that people of color may have different levels of resiliency depending on individual spiritual connectedness.

Our study showed high school students with low levels of caring and supportive relationships with parents, peers, and other adults in the home and the community had less positive feelings of connectedness. Our findings support that of Boey (1999) who suggested that feelings of connectedness and social support play a positive role in affecting people's psychological well-being, both directly and indirectly. Boey's (1999) research suggested that individuals who do not feel connected with others and rely more on themselves to deal with psychological distress tend to be less resilient. However, when individuals feel connected and seek help from others, learned helplessness is avoided opening up the possibility of their moving forward in life and remaining resilient.

These findings support the recommendation that there should be a funding mechanism for research on resiliency in mental health among African Americans (Hawkins, 2011). People of color, especially African American youth, are often viewed and generalized by the media and other outlets as "vulnerable populations" who often deal with stress and other mental illness through the use of drugs and violence (Slomka, 2008). Students in this study did not demonstrate such a view that African American youth use drugs and violence to cope with mental illness. In fact, many participants showed how African American differed in terms of being resilient as it relates to mental health.

STUDY LIMITATION

Two limitations to this study should be noted. First, all information from the Youth Risk Resiliency Survey was self-reported; therefore there is no way to guarantee the truthfulness of the participants in a survey that relies completely on self-report. Second, the overall response rate was driven down by school districts that declined to participate. This low response rate may indicate that the data only represent students that participated in the survey and not necessarily the entire student body. Yet this study has important insights that can be drawn from the findings with regard to resiliency in African American youth.

CONCLUSION

As the minority population continues to grow nearly half of the United States population will be composed of ethnically and racially diverse people formerly identified as "minorities". With this growing rate of diverse groups, clinicians, researchers, and public health professionals will need to understand that African Americans differ in their resilience as it relates to mental health and that Eurocentric views may not be relevant or adequate to address mental health needs among African American youth. There is a need to study not only the differences in resiliency among racially diverse populations, but also to study how people of color develop resiliency to avoid mental health conditions. The idea of people of color being resilient to prevent mental illness is a relatively new phenomenon that needs to be explored. What is now needed is research that takes a comprehensive look at how race and racism effect mental health.

Acknowledgements

I would like to thank Dr. Billi Johnson Professor in Africana Studies at the University of Cincinnati for her ability to pay attention to detail in helping me edit this manuscript. Dr. Billi Johnson, thank you for encouraging, supporting, and making a difference in my career.

REFERENCES

Bell, C. (2001). Multiple stigmas keep Blacks away from MH system. Psychiatric News, 36(20), 19.

Boey, K. (1999). Distressed and stress resistant nurses. Issues in Mental Health Nursing, 20(1), 33-54.

Brandon, D. T., Isaac, L. A., & LaVeist, T. A. (2005). The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? Journal National Medical Association, 97(7), 951-956

Edward, K., Welch, A., & Chater, K. (2009). The phenomenon of resilience as described by adults who have experienced mental illness. Journal of Advanced Nursing, 65(3), 587-595.

Graham, C., Burton, R. D., Little, K. E., & Wallace, T. T. (2011). Attainment of doctoral degrees by licensed physical therapists: perceptions and outcomes of graduates. Journal of Physical Therapy Education, 25(2), 8-16.

Hawkins, R. (2011). Building a race conscious research agenda. Mental Health News, 13(1), 17.

Henry J. Kaiser Family Foundation, & Garfield, R. (2007). Key facts: race, ethnicity and medical care (Publication No. 6069-02). Menlo Park, CA: Henry J. Kaiser Family Foundation.

Holzer, C. E., Goldsmith, H. F., & Ciarlo, J. A. (1998). Effects of rural-urban county type on the availability of health and mental health care professionals. In R.W. Manderscheid & M.J. Henderson (Eds), Mental Health, United States (pp.204-213). Rockville, MD: Center for Mental Health Services.

Jackson, J. S., Neighbors, H.W., Torres, M., Martin, L. A., Williams, D. R., & Baser, R. (2007). Use of mental health services and subjective satisfaction with treatment among Black Caribbean immigrants: Results from the national survey of American life. American Journal of Public Health, 97 (1), 60-70

Power, A. (2010). Transforming the Nation's Health: next steps in mental health promotion. American Journal of Public Health, 100(12), 2343-2346.

Slomka, J., Ratliff, E., McCurdy, S., Timpson, S., & Williams, M. (2008). Decisions to participate I research: views of underserved minority drug users with or at risk for HIV. AIDS Care, 20(10), 1224-1232.

U.S. Department of Health and Human Services. (2001). Mental health: Culture, race and ethnicity: A supplement to mental health: A report of the surgeon general (Report No.0-16-050892-4). Rockville, MD: U.S. Department of Health and human services, Public Health Service, Office of the Surgeon General.

Edward V. Wallace, PhD, MPH, Assistant Professor, University of Cincinnati, Department of Africana Studies, 3609 French Hall, Cincinnati, OH 45221, Phone: (513) 556-3841, Fax: (513) 556-0350, Edward.Wallace@uc.edu
Table 1. Demographic Profile of the
Sample (N = 1500)

Variable       Percent   (N)

Age

15 years old    17.3     (260)
16 years old    45.3     (680)
17 years old    22.6     (339)
18 years old    13.8     (207)

Sex

Male            46.2     (693)
Female          53.8     (807)

Grades in school

Mostly A's      26.5     (398)
Mostly B's      35.3     (530)
Mostly C's      22.3     (335)
Mostly D's       4.9     (74)
Mostly F's       2.3     (35)
None of          1.5     (23)
  these
  grades
Not sure         7.2     (108)

Education

9th Grade       29.9     (449)
10th Grade      25.3     (380)
11th grade      21.4     (321)
12th Grade      22.3     (335)
Ungraded or      0.9     (14)
  other
  grade

Table 2. Mindset (Education), Spirituality, and Connectedness
Outcomes (N = 1500)

Variable       Mindset (Education)      Spirituality
                 (Range 1 to 6)        (Range 1 to 6)

Age

15 years old    4.1 [+ or -] 1.10     4.1 [+ or -] 0.31
16 years old    4.1 [+ or -] 1.20     4.2 [+ or -] 1.20
17 years old    4.2 [+ or -] 0.94     5.0 [+ or -] 1.2
18 years old    4.1 [+ or -] 0.85     5.9 [+ or -] 0.94 *

Gender

Female          2.6 [+ or -] 0.57 *   4.77 [+ or -] 0.74
Male            4.9 [+ or -] 0.59     4.8 [+ or -] 0.85

Education

9th grade       4.6 [+ or -] 0.57     4.5 [+ or -] 1.09
10th grade      4.4 [+ or -] 1.10     4.3 [+ or -] 1.20
11th grade      4.4 [+ or -] 1.20     4.5 [+ or -] 1.04
12th grade      4.5 [+ or -] 1.04     4.4 [+ or -] 1.10

Grades in
School

Mostly A's      5.7 [+ or -] 0.61 *    5.2 [+ or -] 0.66
Mostly B's      5.6 [+ or -] 0.60 *    5.2 [+ or -] 1.01
Mostly C's      4.7 [+ or -] 0.59      5.0 [+ or -] 1.2
Mostly D's      4.7 [+ or -] 0.61      5.7 [+ or -] 0.92 *
Mostly F's      4.6 [+ or -] 0.59      5.6 [+ or -] 0.44 *

Variable            Community
                  Connectedness
                 (Range 1 to 7)

Age

15 years old    4.2 [+ or -] 1.49
16 years old    6.7 [+ or -] 0.76
17 years old    6.7 [+ or -] 0.79
18 years old    6.8 [+ or -] 1.20 *

Gender

Female          4.5 [+ or -] 1.09
Male            4.3 [+ or -] 1.20

Education

9th grade       5.9 [+ or -] 0.89
10th grade      5.9 [+ or -] 1.5
11th grade      6.1 [+ or -] 2.5
12th grade      6.8 [+ or -] 8.5 *

Grades in
School

Mostly A's      5.4 [+ or -] 1.34
Mostly B's      5.5 [+ or -] 0.94
Mostly C's      5.5 [+ or -] 1.01
Mostly D's      5.5 [+ or -] 1.20
Mostly F's      5.4 [+ or -] 0.81

* p < 0.05 between groups
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