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Researchers examine mental health problems among minorities and the way in which mental illness affects racial and ethnic groups.

Follow-up to Surgeon General's Report on Mental Health

Researchers examine mental health problems among minorities and the way in which mental illness affects racial and ethnic groups.Words like depression and anxiety do not exist in certain American Indian languages, but the suicide rate for American Indian and Alaskan Native (AI/AN) males between the ages of 15 and 24 is two to three times higher than the national rate. The overall prevalence of mental health problems among Asian Americans and Pacific Islanders (AA/PIs) does not significantly differ from the prevalence rates for other Americans, but AA/PIs have the lowest utilization rates of mental health services among ethnic populations. Mexican Americans born outside the United States have lower prevalence rates of any lifetime disorders than Mexican Americans born in the United States, and 25% of Mexican-born immigrants show signs of mental illness or substance abuse, compared with 48% of U.S.-born Mexican Americans. Somatic symptoms are almost twice as likely to be found among African Americans than among white American populations.

There have been numerous efforts, both government- and privately-funded, to develop plans and policies to assist the mentally ill minorities in the United States. With the recent influx of immigrants to the United States from poorer countries, it is vital to address their mental health care needs.

A 2002 report from U.S. Surgeon General David Satcher, M.D., examined mental health care issues among minorities. "The cultures from which people hail affect all aspects of mental health and illness," wrote Satcher in Mental Health: Culture, Race and Ethnicity, a supplement to his 1999 Mental Health: A Report of the Surgeon General.

Culture affects the ways in which patients from a given culture communicate and manifest symptoms of mental illness, their style of coping, their family and community supports and their willingness to seek treatment, Satcher wrote. The cultures of the clinician and the service system influence diagnosis, treatment and service delivery, he added. Cultural and social influences are not the only determinants of mental illness and patterns of service use, but they do play important roles.

Two important points emerge from the supplement: there are wide disparities in the kinds of treatment available to members of ethnic minorities in the United States, and there are significant gaps in the available research about the way in which mental illness affects racial and ethnic groups.

Further, the report notes that wide differences exist within minority groups that are lumped together in statistical analyses and in many aid programs. American Indians and Alaskan Natives (AI/ANs), for example, include 561 separate tribes with some 200 languages recognized by the Bureau of Indian Affairs. Hispanic Americans come from cultures as diverse as Mexico and Cuba. Asian Americans and Pacific Islanders represent 43 separate ethnic groups from countries ranging from India to Indonesia. Fifty-three percent of African Americans live in the South and have different cultural experiences from those who live in other parts of the country. The report states:

Minorities are overrepresented among the Nation's vulnerable, high-need groups, such as homeless and incarcerated persons. These subpopulations have higher rates of mental disorders than people living in the community. Taken together, the evidence suggests that the disability burden from unmet mental health needs is disproportionately high for racial and ethnic minorities relative to whites.

The supplement consists of an overview of the collective mental health care needs of minority populations, followed by separate studies of each of four minority populations, including a historical perspective and analysis of the geographic distribution, family structure, education, income and physical health status of the group as a whole.

For example, African Americans are more likely to suffer from a broad range of physical diseases than are white Americans. Rates of heart disease, diabetes, prostate and breast cancer, infant mortality, and HIV/AIDS are all substantially greater for this group than for white Americans.

According to the report, American Indians "are five times more likely to die of alcohol-related causes than whites, but they are less likely to die from cancer and heart disease." The Pima tribe in Arizona, for example, has one of the highest rates of diabetes in the world. The incidence of end-stage renal disease, a known complication of diabetes, is higher among American Indians than for both white Americans and African Americans.

Satcher uses historical and sociocultural factors to analyze the particular mental health care needs of each minority group. Then, specific mental health care needs for both adults and children are discussed and attention is given to high-need populations and culturally-influenced syndromes within the group. Each chapter includes a discussion of the availability of care, the appropriateness of available treatments, diagnostic issues and best practices relating to the group.

Some factors relating to mental illness appear to be common to most ethnic and racial minorities. In general, according to the report, minorities "face a social and economic environment of inequality that includes greater exposure to racism, discrimination, violence and poverty. Living in poverty has the most measurable effect on the rates of mental illness. People in the lowest stratum of income...are about two to three times more likely than those in the highest stratum to have a mental disorder."

Stresses caused by racism and discrimination "place minorities at risk for mental disorders such as depression and anxiety." In addition, the report states, "The cultures of racial and ethnic minorities alter the types of mental health services they use. Cultural misunderstandings or communication problems between patients and clinicians may prevent minorities from using services and receiving appropriate care." Health care practitioners who are not attuned to racial differences may not be aware of unique physical conditions as well. For example, because of differences in their rates of drug metabolism, some AA/PIs may require lower doses of certain drugs than those prescribed for white Americans. African Americans also are found to metabolize antidepressants more slowly than white Americans and may experience serious side effects from inappropriate dosages.