Cultural Mistrust and the Clinical Diagnosis of Paranoid Schizophrenia in African American Patients

This study examined agreement between clinical diagnoses and research diagnoses of schizophrenia for a sample of African American patients recently admitted to a psychiatric hospital. It also examined the association of cultural mistrust with disagreement between clinical diagnoses and research diagnoses of the paranoid subtype of schizophrenia. Complete data was available for 118 (77%) of the 154 cases from the original sample. Agreement among the different sources of diagnoses was poor in 5 out of 6 comparisons. The lack of agreement can be attributed, in part, to the fact there were significantly more cases of schizophrenia using clinical diagnoses than those using SCID or best estimate methods. Contrary to the hypothesis, however, level of cultural mistrust did not predict the excess in clinical diagnoses of paranoid schizophrenia. Cultural mistrust was positively associated with the odds of a diagnosis of paranoid schizophrenia by the best estimate method. The implications of the results for the diagnosis and treatment of African American patients are discussed.     

GENDER AS A MODERATOR OF THE RELATION BETWEEN RACE-RELATED STRESS AND MENTAL HEALTH SYMPTOMS FOR AFRICAN AMERICANS

The present study tested gender as a moderator of the relationship between race-related stress and mental health symptoms among African American adults. Because African American women are exposed to stressors associated with race and gender, we hypothesized that African American women would have higher levels of race-related stress and more severe mental health outcomes related to experiences of race-related stress compared to African American men. Multivariate analyses revealed that African American men had higher stress appraisals for institutional racism than did women. No significant gender differences were found for cultural and individual racism. Moderated regression analyses revealed that increases in stress appraisals for individual racism were associated with increases in anxiety and obsessive-compulsive symptoms for African American women. Race-related stress had no significant effects on mental health symptoms for African American men. The findings suggest that gender is an important factor in determining the impact of race-related stress on mental health.     

Suicidality in African American men: the roles of southern residence, religiosity, and social support

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.     

Race-related stress,quality of life indicators,and life satisfaction among elderly African Americans

This article examined the relationships among race-related stress, quality of life indicators, and life satisfaction among elderly African Americans. A sample of 127 elderly African Americans, consisting of 87 women and 26 men (and 14 missing values), were administered the Index of Race-Related Stress, the Satisfaction With Life Scale, and the 36-item Short-Form Health Survey. Results indicated that elderly African American men and women differed significantly with regard to institutional and collective racism-related stress. In addition, the authors found that institutional racism-related stress was a significant predictor of psychological health in this sample of elderly African Americans.     

Heart rate variability as a physiological moderator of the relationship between race-related stress and psychological distress in African Americans

This study examined the moderator effects of heart rate variability, a physiological marker of stress vulnerability, on the relationship between race-related stress and psychological distress in African Americans (N = 215). Participants were administered the Index of Race-Related Stress-Brief and the Brief Symptom Inventory-18. Resting heart rate was recorded using the Polar 810s heart rate monitor. Findings indicated that heart rate variability moderated the relationship between institutional race-related stress and psychological distress for men, but not women. These findings suggest that higher levels of resting heart rate variability may buffer African Americans from the deleterious effects of race-related stress.     

The Relation of Self-Hatred and Suicidality in People With Schizophrenia-Spectrum Symptoms

It is well known that depressive symptoms represent a risk for suicidality in general. It is less clear, however, that general depressive symptoms comprise a definite suicide risk factor for people with schizophrenia. Based on this, as well as on the early writings of E. Bleuler (1911/1987), it was hypothesized that there may be a particular aspect of depressive symptoms that combines with schizophrenia to encourage suicidality. Specifically, schizophrenia may impart to self-concept a quality of self-hatred that encourages suicidality in schizophrenic people. If so, then an index of self-hatred should be more correlated with suicidality among people with schizophrenia-spectrum symptoms than among people with fewer such symptoms. Two studies evaluated this possibility. In Study 1 on 243 suicidal outpatients affiliated with the military, self-hate and suicidality were more correlated among people with schizotypal symptoms than among other patients. In Study 2 on 113 VA psychiatric inpatients, self-hate and suicidality were more correlated among people with a diagnosis of schizophrenia than among patients with a diagnosis of major depression. Study limitations were noted, and it was suggested that self-hatred be a focus of suicide risk assessment in schizophrenic people.     

The measurement of self-esteem among Korean Americans: a cross-ethnic study

Studies have indicated that Asians' self-esteem is generally lower than other ethnic groups'. The authors hypothesized that an item response bias would result in lower self-esteem scores for Asians. Specifically, it was hypothesized that positively worded items would be rated lower by Korean Americans but that there would be no difference on negatively worded items across ethnic groups. The hypothesis was tested using 214 individuals diagnosed with schizophrenia who were Korean American, Caucasian, African American, or Latino. Results supported the hypothesis. Korean Americans had significantly lower self-esteem scores than the other 3 groups on all positively worded items but were no different from the other groups on negatively worded items. Additional analyses showed modest support for the cross-cultural construct equivalence of this measure of self-esteem.     

Severity of homelessness and adverse birth outcomes.

Predictors and the prevalence of adverse birth outcomes among 237 homeless women interviewed at 78 shelters and meal programs in Los Angeles in 1997 were assessed. It was hypothesized that they would report worse outcomes than national norms, that African Americans would report the worst outcomes because of their greater risk in the general population, and that homelessness severity would independently predict poorer outcomes beyond its association with other adverse conditions. Other predictors included reproductive history, behavioral and health-related variables, psychological trauma and distress, ethnicity, and income. African Americans and Hispanics reported worse outcomes than are found nationally, and African Americans reported the worst outcomes. In a predictive structural equation model, severity of homelessness significantly predicted low birth weight and preterm births beyond its relationship with prenatal care and other risk factors.     

The validation of a religiosity measure for individuals with schizophrenia

Measures of religiosity validated for psychotic patients do not exist. This study sought to examine the psychometric properties of a modified version of the Religious Life Inventory (RLI) in this population. It was anticipated that religiosity would be affected by psychotic symptoms. The religiosity of patients with schizophrenia was assessed while symptoms were more evident and again after treatment, to evaluate changes in religiosity. Four factors were found which characterized the religiosity of people with schizophrenia. These factors were found to have good construct validity. Patient's responses indicated a reduced need for religion when re-assessed once symptom scores were reduced.     

The relationship between cognitive inhibition and psychotic symptoms

Cognitive models of schizophrenia have highlighted deficits of inhibitory attentional processes as central to the disorder. This has been investigated using "negative priming" (S. P. Tipper, 1985), with schizophrenia patients showing a reduction of negative priming in a number of studies. This study attempted to replicate these findings, but studied psychotic symptoms rather than the broad diagnostic category of schizophrenia. Psychotic individuals exhibiting positive symptoms were compared with asymptomatic psychiatric patients and with a normal control group. As predicted, the symptomatic group failed to show the usual negative priming effect, which was present in the asymptomatic and normal groups. A modest but significant correlation was found between negative priming and delusions. Neither diagnosis, nor affective or negative symptoms, nor chronicity, nor medication, was related to negative priming. These data replicate previous findings that positive symptoms are related to a reduction in cognitive inhibition, although considerable variability was observed among the psychotic patients.     

Perceived cultural attitudes toward homosexuality and their effects on Iranian and American sexual minorities

This study examined the relationship between three mental health constructs and perceived cultural attitudes toward homosexuality among lesbian, gay, and bisexual individuals. Specifically, differences in perceived cultural attitudes and depression, self-esteem, and perceived stress between 49 Iranians and 47 Americans were compared. It was hypothesized that (a) perceived cultural attitudes toward homosexuality would be more negative among Iranians than Americans; (b) perceived cultural attitudes would be related to depression, self-esteem, and perceived stress; and (c) that Iranian participants' scores on the depression, self-esteem, and perceived stress measures would reflect poorer mental health than that of their American counterparts. Results indicated more negative perceptions of cultural attitudes toward homosexuality among Iranians. Contrary to prediction, however, no difference was found in levels of depression, self-esteem, and perceived stress among American and Iranian participants. Findings are discussed in terms of cultural and familial differences with regard to sexual orientation disclosure.     

Racial identity and the MMPI in African American male college students

The relation of the Minnesota Multiphasic Personality Inventory (MMPI) to the Racial Identity Attitude Scale--Black, Short Form (RIAS-B) was examined among 50 African American male college students in a reanalysis of unpublished MMPI data described in R. H. Dana (1993). This permitted study of relationships between MMPI scores and specific psychological variables hypothesized to produce cultural differences among African Americans. Results indicated RIAS-B scale scores functioned as predictors of MMPI scale scores. Similar research with the MMPI-2 incorporating larger samples that more adequately represent African American heterogeneity is needed. Methodological implications of these findings for MMPI-2 research with ethnic and racial groups are discussed, emphasizing the importance of research to depathologize African American racial and cultural identity.     

Race and Cognitive-Ability Test Performance: The Mediating Effects of Test Preparation, Test-Taking Strategy Use and Self-Eff icacy

Test-taking strategy use, cognitive-ability test preparation, and test-taking self-efficacy were examined as possible mediators of the relationship between race and cognitiveability test performance. We hypothesized that African Americans would report using fewer test-taking strategies and less test preparation when compared to White Americans. In addition, we proposed that Afiican Americans would report lower levels of test-taking self-efficacy when faced with a cognitive-ability test. It was expected that these 3 variables would mediate the relationship between race and cognitive-ability test performance. Using a sample of 170 college students, results indicated that African Americans reported using more ineffective test-taking strategies, reported participating in more cognitiveability test preparation, and reported higher levels of test-taking self-efficacy when compared to White Americans. A portion of the difference in performance on a cognitiveability test between African Americans and White Americans could be attributed to the use of ineffective strategies and test preparation.     

A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia

A sociocultural stress, appraisal, and coping model was developed to understand relatives' burden of care and negative affective attitudes toward patients with schizophrenia. Ninety-two African American and 79 White patients and a significant other (80% mothers) completed 2 10-min family problem-solving discussions. In addition, the Kreisman Rejection Scale and a global self-report rating of family burden were administered to relatives, and a self-report rating of substance use was administered to patients. Results indicated that subjective burden of care and patients' odd and unusual thinking during the family discussion each independently predicted relatives' attitudes toward patients, suggesting that negative attitudes are based in part on both patients' symptoms and perceived burden of care. African American relatives' perceived burden was also predicted by patients' substance abuse. Finally, White family members were significantly more likely than African Americans to feel burdened by and have rejecting attitudes toward their schizophrenic relative suggesting that cultural factors play an important role in determining both perceived burden and relatives' attitudes toward patients.     

Psychotic symptoms in posttraumatic stress disorder

Recent data suggest that the presence of psychotic symptoms in patients suffering from posttraumatic stress disorder (PTSD) may represent an underrecognized and unique subtype of PTSD. Among combat veterans with PTSD, 30% to 40% report auditory or visual hallucinations and/or delusions. The presence of psychotic symptoms in PTSD is associated with a more severe level of psychopathology, similar to that of chronic schizophrenia. In this review, the differential diagnosis of psychotic symptoms in PTSD is discussed, including possible comorbid schizophrenia, psychotic depression, substance-induced psychosis, and personality disorder. A recent biologic study supporting the existence of a unique subtype of PTSD with psychotic features is also addressed, as are the similarities between PTSD with psychotic features and psychotic depression disorder. Finally, data on the treatment implications of psychotic symptoms in PTSD are presented. The intriguing recent findings on psychotic symptoms in PTSD need further investigation in noncombat-related PTSD populations before findings can be generalized to all individuals with PTSD.     

Social embeddedness and psychological well-being among African Americans and whites

Using data from the National Medical Expenditure Survey, a household survey of more than 18,000 respondents, this study examined racial and gender differences in social embeddedness, an indicator of community well-being and social support. The study hypothesized that higher levels of social embeddedness would be found among African Americans than among Whites and that the association between social embeddedness and psychological well-being would be stronger among African Americans than among Whites. African American men reported themselves more socially embedded overall than White men and, in one instance, their social involvement was especially important in predicting psychological well-being. African American women were more likely than White women to report attending meetings of churches and community groups, but otherwise were less socially involved than White women. There was no evidence of a difference between African American and White women in strength of the connection between social embeddedness and psychological well-being. African American social involvement is more selective than previously believed and generalizations must be qualified on the basis of gender.     

The association of religiosity,spirituality, and ethnic background with ego-pathology in acute schizophrenia

Studies have highlighted the impact of ego-consciousness, religiosity and spirituality on psychotic symptoms, although so far no study has investigated if and how these factors may be interrelated. In this exploratory cross-sectional study, involving 42 patients with a diagnosis of acute paranoid schizophrenia (DSM-IV), we assessed religiosity (Religious Orientation Test) spirituality (Spiritual Transcendence Scale) and ego-pathology (Ego Pathology Inventory) and analysed any relationship with these and psychopathological symptoms (Positive and Negative Symptom Scale). The subjects were divided into four ethnic groups (Caucasian, Afro-Caribbean, African, and Asian) and a structured, qualitative interview on religious needs and self-concepts was also conducted. Using a multivariate analysis, we found statistically significant negative associations between the scores on ego and common pathology and religiosity and spirituality as covariates. This was seen across all ethnic groups. The findings are discussed in respect of the potential clinical importance of ethnic, religious and spiritual factors for assessment and management of patients with schizophrenia.     

Differences between African American and European American first-year college students in the relationship between self-efficacy, outcome expectations, and academic achievement

First-year African American and European American college students were surveyed to examine ethnic differences in how their social cognitive beliefs (self-efficacy and outcome expectations) influenced their academic achievement. It was hypothesized that outcome expectations may better explain academic achievement for African Americans due to the fact that they may perceive that external factors such as discrimination may influence their academic outcomes. Because European Americans are less likely to anticipate discrimination, they are more likely to believe that their outcomes would be the result of their own behavior. Higher levels of self-efficacy were related to better academic achievement for both ethnic groups. However, African Americans with negative outcome expectations (e.g. my education will not lead to a well paying job) had better achievement than those with more positive outcome expectations. This pattern was not found for European Americans. Potential explanations for the relationship between outcome expectations and academic achievement for African Americans such as racial socialization for preparation for bias are discussed and implications for interventions are addressed.     

Mind wandering in schizophrenia: A thought-sampling study

Mind wandering has consistently been associated with impairments in cognition, emotion and daily performance. However, few experimental studies on mind wandering have been conducted in individuals with schizophrenia. The present study aimed to examine mind wandering in schizophrenia patients with a thought-sampling experiment embedded in a rapid go/no-go task and the relationship between the frequency of mind wandering and psychotic symptoms. Fifty-eight schizophrenia patients and 56 matched healthy controls were recruited and engaged in a task that assessed mind wandering. The results showed that schizophrenia patients (1.4%) reported less frequent mind wandering than healthy controls (5.8%). Moreover, there was no significant correlation between the frequency of mind wandering and psychotic symptoms in schizophrenia patients. Further studies in different stages of schizophrenia and in patients with more severe psychotic symptoms are needed to demonstrate a more comprehensive picture of mind wandering in schizophrenia.     

An investigation of schizotypy in injecting amphetamine users

A fully dimensional view of psychiatric disorder conceptualises schizotypy as both a continuous personality trait and an underlying vulnerability to the development of psychotic illness. Such a model would predict that the structure of schizotypal traits would closely parallel the structure of schizophrenia or psychosis. This was investigated in injecting amphetamine users (N = 322), a clinical population who have high rates of acute psychotic episodes and subclinical schizotypal experiences. Schizotypy was assessed using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), and psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). Using confirmatory factor analysis, O-LIFE subscale scores were mapped onto latent variables with their more clinical counterparts from the BPRS. A four-factor model comprising positive schizotypy, disorganisation, negative schizotypy, and disinhibition provided the best model fit, consistent with prior research into the structure of schizotypy. The model provided a good fit to the data, lending support to the theory that schizotypy and psychotic symptoms map onto common underlying dimensions.