Introduction Does living in poverty increase the risks of mental illness? Is there a difference between race/ethnicity among the poor and those seeking mental health services? Racial/ethnic disparities in mental health issues have received an increase in attention. Recent studies indicate that people with mental illness and members of minority racial/ethnic populations are disproportionately concentrated in high poverty areas (Chung-Chung Chow, Jaffee & Snowdwn, 2003). Previous studies have indicated that African Americans with mental illness do not seek mental health services (Schnittker, 2000).Several reasons are the lack of mental health services in poverty areas and the mistrust of White physicians. However, the research article used for this research review indicates the opposite. According to Diala (2001), African Americans are more likely to accept and seek mental health issues than Whites.
Costello, Keeler and Angold (2001) compared Black and White children living in poverty and those living in non-poor areas. White children living in poverty had more emotional disorders, particularly depression, more oppositional defiant disorders and conduct disorders than African American children.The use of mental health services by a community is applicable to community nursing. A part of nursing is education and it appears there needs to be more mental health education available in high poverty areas.
Public awareness is the key to getting information out to those who do not know where to get help. Child services are needed in high poverty areas, because children are vulnerable to mental health problems due to living in poor conditions and high levels of violence in their neighborhoods, they experience chronic distress symptoms and behavioral problems (Chun-Chung Chow et.al. , 2001).Nurses can help organize and set up programs to encourage those living in high poverty areas to seek mental health services. The research article by Chun-Chung Chow et.
al. (2001) mentions several important implications that can be used. First, mental health services should be tailored to meet the needs of minorities within different community settings. Second, the community needs to minimize disparities in service access and use. Finally, priority should be given to programs that specifically target minorities and immigrant children.Nurses can help in all these areas through practice, education and research. Research article one The research article titled, Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas, examines racial/ethnic disparities in mental health service access and their use in different poverty areas. The researchers looked at the Surgeon General reports on mental health, other literature reviews on this subject, recent studies, safety-net providers, public hospitals, and mental health centers as the base of their study.
Chun-Chung Chow et. al. (2003) state that “another reason that racial disparities between minorities and Whites may be less within high-poverty neighborhoods than elsewhere is predicted by social selection theory”. This theory assumes that Whites have a greater tendency to avoid living in poverty communities because they are more likely to enjoy social and economic advantages. The quantitative design of this study was to see how racial/ethnic disparities correlate with the use of mental health services in poverty areas by collecting statistical data.
Extraneous variables were used within the study such as: a survey conducted by the New York Office of Mental Health, which included demographic (e. g. , race/ethnicity, gender, age), clinical (primary diagnosis), and service use information (insurance status, prior services, type of service received, and referral source) on each client visit over a seven day period during autumn 1995. Also, data used from the 1990 US Census of Population and Housing was used as an indicator of poverty neighborhoods.From the survey they obtained from the New York Offices, they had each client’s zip code, which helped them match with the census data to locate those living in poverty areas. The matching procedure yielded a sample of 78,085 individuals who had a valid New York City zip code and received mental health services during the seven-day period. The final sample included 33,278 Whites, 23,683 Blacks, 19,849 Hispanics and 1,275 Asians. Excluded were other racial/ethnic groups, which represented less than 1% of the services used.
The study showed that racial/ethnic disparities in the use of mental health services not only persist, but also were more prevalent in low poverty areas than in high poverty areas. In low poverty areas mental health services were promoted more compared to high poverty areas. Furthermore, the use of emergency and inpatient hospitalization was more frequently used for minority groups than White clients. When studying the tables with results you will notice that those living in high poverty areas (n= 29,102) shows that Hispanics (41. 6%) used more mental health services than the Blacks (39.8%), Whites (17. 3%) and the Asians (1.
2%).This shows that minorities do seek mental health services, but when you look at the low poverty areas, Whites represent 57. 6% of mental health services used. There were some noted differences in demographic and clinical characteristics of public mental health service users among each race/ethnic group. For example, Asians are diagnosed with more frequently with schizophrenia, Blacks used more inpatient and emergency services, and Hispanics and Blacks were referred to mental health services by the criminal justice department.
One piece of data that was not mentioned in this study was the education level and employment status of each client. It would be interesting to see if there is a higher correlation between the two and mental illness. Since there was no weakness identified within the study the additional data was suggested out of curiosity.The strength of the study was the methods used to collect the data through extraneous variables from the New York Office of Mental Health, which included demographic (e. g., race/ethnicity, gender, age), clinical (primary diagnosis), and service use information (insurance status, prior services, type of service received, and referral source) on each client visit over a seven day period during autumn 1995. In addition, data used from the 1990 US Census of Population and Housing as an indicator of poverty neighborhoods.Research article two Diala, Muntaner, Walrath, Nickerson, LaVeist and Leaf (2001) research article titled, Racial/Ethnic Differences in Attitudes Toward Seeking Professional Mental Health Services, examines the differences between African Americans and Whites in seeking mental health services.
Previous studies indicate that African Americans have a higher prevalence of mental illness because they tend to be poorer than Whites and have prior negative attitudes towards seeking services. The goal of this current study was to determine who had more negative attitudes towards seeking mental health services. The method used was structured psychiatric diagnostic interviews conducted by the National Comorbidity Survey. A total of 8098 respondents participated with a response rate of 82.
4%.The survey was conducted in two parts, which included the core diagnostic interview, a brief risk factor battery, and an inventory of sociodemographic data. Part two included a more detail risk factor battery and secondary diagnosis, which was the basis of this study (Diala et.
al. , 2001). The quantitative design of this study was conducted by assessing three questions on attitudes towards seeking mental health services between African Americans and Whites. The researchers compared the results of the three attitude questions with those who also had a diagnosis of major depression and any psychiatric disorder.The three attitude questions were operationalized as dichotomous variables (e. g. definitely go vs other, very comfortable vs other, very embarrassed vs other).
The researchers used SUDAAN to account for possible survey design effects due to clustered sampling. African Americans reported more positive attitudes towards seeking care in all three questions asked than their White counterparts, both in the general population (n=5877), among those with depression (n=427) and with other psychiatric disorders (n=855).African Americans reported a greater predisposition than Whites to “definitely go” seek care if they had a serious emotional problem (OR=1. 5, P to see if there is a difference in the attitudes between the general population and those with mental disorders. Another strength was the large sample size, which increases the reliability of the study.
Research article three Costello, Keeler and Angold (2001) research article titled, Poverty, Race/Ethnicity, and Psychiatric Disorder: A Study of Rural Children, examines the effect of psychiatric disorders among rural African American and White children.The goal of this study was to compare the prevalence of psychiatric disorders in non-urban poor and non-poor Black and White children, the types and numbers of family risk factors for child psychopathology in poor and non-poor Black and White families, and to examine the effects of the interaction of poverty and minority status on child psychopathology. The study was conducted in four rural counties in North Carolina with a sample size of 922 participants between the ages nine to seventeen. Structured interviews were conducted at the participant’s homes and in separate rooms to ensure privacy.The researchers collected information about symptoms contributing to a wide range of computer generated Diagnostic and Statistical Manual of Mental Disorders, symptom scales and diagnosis based on combining symptoms from parents and children. Comparisons between racial/ethnic groups overall showed only one significant difference; the prevalence of depression was higher in the White children (OR= 8. 4, OR=1.
5). Poor White children had more emotional disorders, particularly depression, and more oppositional defiant and conduct disorders.The only difference was substance abuse, which was higher among Black children (OR= 6. 9, OR= 4. 5). Comparisons tested for differences between levels of poverty within each racial/ethnic group showed that Black children had small effects of poverty with the only significance (P= .
05) was an excess of depression in relatively poorer children. However, White children had a significantly higher risk of diagnosis than did the non-poor White children. White children in poverty were 59% more likely than Black children in poverty to have a psychiatric diagnosis.In the case of relative poverty, however, risk was still significantly higher for poorer than for non-poor White, but not Black children (P=. 001).
The overall prevalence of child psychiatric disorders was the same as that found in almost every study conducted in the United States over the past two decades. The difference that this study showed was that in non-urban areas it was not the Black children who were seriously affected by poverty, but the White children. Many other factors contributed to children having mental disorders such as multiple moves between house-to-house, family history of mental illness, and poor parenting.A weakness of this study was identified within the research and indicated that the survey was cross sectional and suited only to correlational analysis, in addition some methodological aspects of the study could have affected the results. Another weakness was that the analysis was based on the reports of parents and children alone and was limited to a single geographical area.
The lack of better measure of social capital such as job opportunities, community organizations, and mental health services was another weakness to this study.The strength to this study was the results by showing that non-urban White children are seriously affected by mental illness while living in poverty as compared to previous studies that indicate the opposite. Conclusion The three research articles show that there is a significant difference among race/ethnicity regarding mental health issues. The research showed that the use of mental health services was more prevalent in low poverty areas than high poverty areas. Hispanics used more mental health services than Blacks, Whites and Asians, which shows that minorities do seek services.
When assessing racial/ethnic differences in attitudes towards seeking mental health services, Blacks had more positive attitudes than their White counterparts. Blacks were more comfortable in seeking help from professionals and less embarrassed if friends knew of their diagnosis than Whites. The affects of poverty among rural Black and White children showed that poor White children appear to be more seriously affected. Community health nurses need to be aware of the affects of mental health issues among persons of different race/ethnicity in poverty levels.While working within a community a nurse needs to assess usage of mental health services, public awareness programs, and know the ethnic backgrounds and demographic variables within the community. Child services are needed in poverty urban and rural areas because they are vulnerable to mental health problems.
Further research needs to be conducted with children living in poverty. Previous studies have been focused in urban areas, which show Black children were affected more by mental disorders that lived in poverty. The research on rural children indicated the opposite, White children were at higher risk.
Community nurses can help through educating the community, practice, and conducting research to identify possible problems within their community. Further research needs to be conducted on why Whites are not comfortable with seeking mental health services and why the use of services are lower among Whites in poor communities. References Chun-Chung Chow, J. , Jaffee, K. , & Snowden, L. (2003).
Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792-797. Costello, E. , Keeler, G. , Angold, A. (2001).Poverty, race/ethnicity, and psychiatric disorder: a study of rural children.
American Journal of Public Health, 91(9), 1494-1498. Diala, C. , Mutaner, C. , Walrath, C. , Nickerson, K. , LaVeist, T. , & Leaf, P. (2001).
Racial/ethnic differences in attitudes toward seeking professional mental health services. American Journal of Public Health, 91(5), 805-807. Schnittker, J. (2000). Nature, nurture, neither, nor: Black-White differences in beliefs about the causes and appropriate treatment of mental illness. Social Forces: Vol. 78, 1100-1134.
Department of Sociology, Indiana University.