(Re)humanizing Blackness: Integrating BlackCrit in the Mental Health Counseling of Black Clients

<i>Special Report:</i> Racism and Inequities in Health Care for Black Americans

The frequent police killings during the COVID-19 pandemic forced a reckoning among Americans from all backgrounds and propelled the Black Lives Matter movement into a global force. This manuscript addresses major issues to aid practitioners in the effective treatment of African Americans via the lens of Critical Race Theory and the Bioecological Model. We place the impacts of racism on Black families in historical context and outline the sources of Black family resilience. We critique structural racism embedded in all aspects of psychology and allied fields. We provide an overview of racial socialization and related issues affecting the parenting decisions in Black families, as well as a detailed overview of impacts of structural racism on couple dynamics. Recommendations are made for engaging racial issues in therapy, providing emotional support and validation to couples and families experiencing discrimination and racial trauma, and using Black cultural strengths as therapeutic resources.

Mental health care among marginalized populations in the United States

BackgroundGreat Britain has been experiencing a cost-of-living crisis since late 2021, with the cost of everyday essentials rising more quickly than the average household income. This study provides up-to-date information on levels of subjective and objective financial hardship during this crisis, differences across population subgroups, and associations with psychological distress. MethodsWe used data from a representative cross-sectional survey of adults (≥16y) in Great Britain (n=7,027) conducted January-March 2023. Subjective financial hardship was defined as reporting finding it quite/very difficult to manage financially these days and objective financial hardship as reporting having been in rent/mortgage arrears in the past 12 months. Past-30-day psychological distress was assessed with the K6 and categorised as no/low (scores ≤4), moderate (5-12), and severe distress (≥13). Covariates included sociodemographic characteristics, mental health history, smoking status, and alcohol consumption. ResultsOverall, 12.9% [95%CI=12.0-13.8%] reported subjective financial hardship and 6.5% [5.8-7.2%] objective financial hardship. Groups experiencing more hardship included non-binary people, ethnic minority groups, less advantaged social grades, those living in private rented or social housing, unemployed and seeking work or not in paid work for other reasons, those with more children in the household, those with a history of ≥1 mental health conditions, those who currently smoked and those who drank not at all or at very high levels. Subjective/objective financial hardship was associated with greater odds of experiencing moderate (ORadj=1.96 [1.59-2.42]/ORadj=1.86 [1.40-2.47]) or severe psychological distress (ORadj=4.11 [3.07-5.50]/ORadj=2.23 [1.52-3.29]). These associations between financial hardship and psychological distress were similar across all sociodemographic, mental health, smoking, and alcohol characteristics. ConclusionsIn the first quarter of 2023, around one in eight adults in Great Britain reported finding it difficult to manage financially and one in fifteen reported having been in rent or mortgage arrears in the past 12 months, with higher rates of financial hardship among disadvantaged groups. However, disadvantage did not appear to compound the psychological impact of financial hardship: people experiencing financial hardship were substantially more likely to report moderate or severe psychological distress regardless of their sociodemographic characteristics.

818-P: Mental Health History and DECIDE Self-Management Support Program Outcomes in an African American Sample with T2DM

Experts Shine Spotlight on Racial Differences in Illness

Disproportionate Use of Psychiatric Emergency Services by African Americans

“As a Black woman with a chronic mental health illness, racism and lack of cultural competency in health care scares me. Sometimes I am faced with huge barriers when trying to get the support that I need, and I am tired of it…”, tweeted Jasmin Pierre, an American mental health advocate and app developer in early February 2022. Her sentiments are echoed by many Black Americans, according to recent data. Results from the 2020 Survey On Race And Health, a nationally representative survey of US adults by American non-profit Kaiser Family Foundation and digital platform The Undefeated, revealed that one in five Black adults said that they had personally experienced race-based discrimination in the past year.

Mentorship Called Key to Bringing Diversity to Psychiatric Workforce

We assess the likelihood of moderate and severe psychological distress among Black immigrants. We test the region of context framework, which states that Black immigrants from majority-Black and racially mixed regions of origin have better health outcomes than Black immigrants from majority-white contexts. We utilize data from IPUMS Health Surveys, 2000-2018. We employed partial proportional odds models to assess the likelihood of moderate and severe psychological distress among Black immigrants and U.S.-born Black Americans. All immigrant groups, except for Black Europeans, are significantly less likely to be in moderate and severe distress vis-à-vis U.S.-born Black Americans (p < 0.01). Black Africans are about 54-58% less likely to be in severe distressed compared to U.S.-born Black Americans. Black immigrants from racially mixed and majority-Black contexts (Mexico, Central America, Caribbean, South America, and Africa) are significantly less likely to be afflicted with moderate and severe distress than U.S.-born Black Americans.

10025 Background: Poverty is associated with inferior psychosocial function among parents of children with cancer. Severe parental distress during treatment predicts future poor mental health for both parents and children. It is also associated with impaired parental cognitive bandwidth and executive function, which may have implications for treatment adherence. Efforts to identify poverty-exposures amenable to intervention are essential to improving survivorship quality of life for the &gt; 90% of children with acute lymphoblastic leukemia (ALL) who will be long-term survivors. Household material hardship (HMH) is a targetable poverty exposure defined as at least 1 of 3 unmet basic needs including food, housing, or utilities. Dana-Farber Cancer Institute (DFCI) ALL Consortium trial 16-001 is the first pediatric oncology clinical trial to systematically evaluate HMH. We investigated the hypothesis that HMH exposure independently predicts severe parent psychological distress during ALL therapy. Methods: Patients with newly diagnosed ALL ages 1-17 years were enrolled on the DFCI 16-001 embedded HMH cohort study at 8 U.S. and Canadian centers. Secondary interim analyses used baseline (within 32-days of trial enrollment) and 6-mos parent-reported sociodemographic data, the Kessler-6 (K6) Psychological Distress scale, and trial-collected child and disease data. Severe psychological distress was defined as a K6 &gt; = 13. Multivariable cox regression evaluated baseline HMH-exposure and parent distress at baseline and 6-mos adjusting for child’s initial ALL risk group (Very High Risk (VHR) vs other) and marital status (single vs dual parent). Results: Among 258 families with evaluable data, 34% reported baseline HMH. Families were predominantly English-speaking (54%) dual parent households (71%). Children were a median of 5.7 years (IQR 1.0-17.99) at diagnosis and predominantly non-Hispanic white (66%) with expected disease distribution by immunophenotype (84% B-cell). HMH (odds ratio (OR) 2.18, 95% confidence interval (CI) 1.0-4.31, p = 0.025) and VHR initial risk group (OR 2.32; 95% CI 1.06-5.06, p = 0.035) were independently associated with baseline severe psychological distress. Only HMH was independently associated with 6-mos severe psychological distress (OR 4.93, 95% CI 1.80-13.48, p = 0.002). Future analyses will investigate race and ethnicity associations with parental distress pending trial accrual for statistical power. Conclusions: HMH, a modifiable poverty exposure, is significantly associated with severe parent psychological distress at diagnosis that persists 6-months into pediatric ALL therapy. These findings identify a cohort at high risk of inferior mental health outcomes, and affirm the need for HMH-targeted interventions to support children and parents during cancer treatment to reduce poverty-associated outcome disparities in survivorship.

Overrepresentation of Black Americans in Psychiatric Inpatient Care

Numerous studies have documented overrepresentation of the black population in psychiatric inpatient settings, but none have included certain important covariates or examined heterogeneity within the black population. After controlling for key social, demographic, and clinical factors, the investigators sought to determine whether blacks are overrepresented in inpatient psychiatric settings; they examined differences within the black population by separately examining the prevalence of inpatient treatment of African Americans and U.S.- and foreign-born Caribbean blacks. Secondary analysis was performed on data from two population-based household surveys, the National Survey of American Life (NSAL) and the National Comorbidity Survey Replication (NCS-R), which provided a population-based sample of 9,371 community-dwelling adults, including 3,570 African Americans, 1,621 blacks of Caribbean descent, and 4,180 non-Hispanic whites. Using logistic regression, the investigators estimated self-reported lifetime psychiatric hospitalization as a function of racial-ethnic background after controlling for sociodemographic differences and differences in lifetime counseling or therapy and psychiatric diagnosis. With controls for demographic and clinical factors, both African Americans (odds ratio [OR]=2.52, 95% confidence interval [CI]=1.91-3.33) and Caribbean blacks (OR=2.74, CI=1.98-3.82) had higher odds than whites of having a psychiatric hospitalization in their lifetime. U.S.-born Caribbean blacks had much higher odds of hospitalization (OR=5.47, CI=3.60-8.32) than whites, whereas the likelihood of hospitalization of foreign-born Caribbean blacks did not differ from that of whites (OR=.96, CI=.51-1.82). Disparities between blacks and whites in the prevalence of psychiatric inpatient treatment appear to be persistent, but global comparisons mask important heterogeneity within the black population.

2.56 Understanding Pediatric Mental Health in Primary Care: Needs in a Rural State

OBJECTIVE: This study estimated the rates of sexual victimization among prison inmates with and without a mental disorder. METHODS: The study sampled inmates aged 18 or older in 13 prisons within a single mid-Atlantic state prison system (12 facilities for men and one for women). A total of 7,528 inmates completed the survey instrument, which was administered by audio-computer-assisted technology. Of the 6,964 male respondents, 58.5% were African American, 16.2% were non-Hispanic white, 19.8% were Hispanic, and 5.5% were of another race or ethnicity. Of the 564 female respondents, 48.4% were African American, 30.9% were non-Hispanic white, 14.4% were Hispanic, and 7.3% were of another race or ethnicity. Mental disorder was based on self-reported previous mental health treatment for particular mental disorders. Sexual victimization was measured by using questions adapted from the National Violence Against Women and Men surveys. RESULTS: Approximately one in 12 male inmates with a mental disorder reported at least one incident of sexual victimization by another inmate over a six-month period, compared with one in 33 male inmates without a mental disorder. Among those with a mental disorder, sexual victimization was three times as high among female inmates (23.4%) as among male inmates (8.3%). African-American and Hispanic inmates with a mental disorder, independent of gender, reported higher rates of sexual victimization than their non-Hispanic white counterparts. CONCLUSIONS: Prisons are hazardous places. Steps must be taken to protect inmates from predators inside prison, to screen them for posttraumatic stress disorder, to provide trauma-related treatment, and to keep them safe.