Individual and Family Contributions to Depressive Symptoms in African American Children with Sickle Cell Disease

Depressive disorders in children with chronic illnesses have received little attention despite some evidence suggesting that these children experience increased psychological difficulties as a result of their medical condition. Most of the research on depressive disorders among children has been conducted primarily with Caucasian youth, limiting generalizability to ethnically diverse populations. Further, even less research exists on depressive disorders among African American children with Sickle Cell Disease (SCD) and for African American youth from lower socioeconomic status who are at greater risk for depressive disorders. This paper is an extensive review of the major studies conducted on depression and psychosocial aspects of SCD in African American children. The Transactional Stress and Coping model is provided as a conceptual framework. Following the review, clinical and research implications are provided, as well as an illustration of a psychoeducational family intervention with an African American child who has SCD and internalizing behaviors.     

Association between biological markers of sickle cell disease and cognitive functioning amongst Cameroonian children

Background: Some of the major complications of sickle cell disease (SCD) occur in the brain and apart from overt stroke, patients also present with cognitive impairments. We sought to evaluate the prevalence of cognitive deficits as well as their biological predicting factors in young SCD patients in Cameroon.

Methods: The cognitive performances of Cameroonian SCD young patients were evaluated using a neuropsychological test battery assessing four domains of cognitive functioning (executive functions, attention, memory, and sensory-motor skills) previously adapted and normalized on healthy subjects in Yaoundé.

Findings: Up to 37.5% of the 96 SCD patients aged 6 to 24 years (M?=?13.5, SD?=?4.9) had mild-to-severe cognitive deficits. The cognitive deficits tend to increase with age. There was a significant effect of SCD on executive functions and attention, whereas SCD patients performed as well as controls on memory and sensory-motor skills tests. Structural equation models showed a significant association between (a) severe anemia and lower executive functioning, (b) low fetal hemoglobin levels and lower executive functioning and attention, (c) history of cerebrovascular accidents and lower performances in executive functioning, sensory-motor skills, and memory, (d) pathological electroencephalogram and lower attention, and (e) abnormal Transcranial Doppler and lower memory.

Conclusion: SCD patients in Cameroon presented a very high prevalence of cognitive deficits, with a specific impairment of executive functions and attention. Routine neuropsychological evaluation for early detection of cognitive deficits in SCD patients could represent a cost-effective tool to implement in resource-limited contexts such as in sub-Saharan Africa.     

Somebodiness and Its Meaning to African American Men

The psychological functioning of African American men is often described in negative terms. One way to correct these distorted depictions is to identify culturally grounded concepts that can make a fair‐minded assessment of their psychological functioning. The literature has suggested that “somebodiness” is a culturally relevant, but understudied, concept. In this investigation, an interpretive phenomenological analysis approach was used to explore somebodiness and its meaning to African American men.     

Predictors of Psychosocial and Cognitive Adaptation in Children with Sickle Cell Syndromes

Examined the role of socioecological factors (family functioning and socioeconomic variables) in predicting behavioral and cognitive adaptation in children with sickle cell syndromes (SCD). Participants included 74 African American children and adolescents with SCD and their primary caretakers. Outcomes included internalizing and externalizing behavior symptoms, as rated by caretakers, as well as intellectual abilities and academic achievement, as assessed by individually administered standardized instruments. Family functioning consisted of both caretaker adjustment and family environment (i.e., family adaptability and cohesion). Hierarchical multiple regression analyses revealed that caretaker psychological adjustment predicted externalizing behaviors, while family environment (i.e., adaptability and cohesion) predicted neither behavioral nor cognitive functioning. Socioeconomic variables alone predicted intellectual abilities and academic achievement and also contributed to the prediction of child behavioral adaptation. Results are discussed in terms of relevant sociocultural issues and implications for family-level prevention and intervention.     

Sexual Health Counselor Preferences of African American and European American Women: A Brief Report

African American women (n = 42) and European American women (n = 46) were queried regarding their comfort level discussing various sexual health topics with hypothetical counselors who were varied by race (African American vs. European American) or counseling value (culturally sensitive vs. knowledgeable). Contrary to hypotheses, European American participants were more comfortable with the knowledgeable African American counselor and the culturally sensitive European American counselor, while African American women showed no preference. Implications are discussed for improving sexual health counseling services for African American and European American women with consideration of client sexual attitude and race of counselor in order to reduce disparities in sexual health.     

Neuropsychological Functioning in Preschool-age Children with Sickle Cell Disease: The Role of Illness-related and Psychosocial Factors

Cognitive and academic deficits have been identified in school-aged children with sickle cell disease (SCD). However, there have been very few identified studies that examine neuropsychological functioning in preschool-age children with SCD. It is important to understand effects of SCD from a developmental perspective and to consider the contribution of environmental factors in this at-risk population. Neuropsychological functioning of preschool-age children with SCD and no history of overt stroke (n = 26) was examined across several domains (language, immediate memory/brief attention, visuospatial/visuoconstructional, motor/visuomotor). The mean Full Scale IQ for the sample was 89.0. Performance on the Immediate Memory/ Brief Attention domain was significantly higher than the other domains, although the pattern of performance was relatively consistent, with mean standard scores ranging from 88.0 to 95.0. Disease severity was not significantly related to cognitive functioning in this group of young children with SCD. Socioeconomic status (SES) was significantly correlated with most domain scores and, based on regression analyses, accounted for 18% to 47% of the variance in functioning. Psychosocial factors, such as number of children living in the home and parental stress levels, were negatively associated with Motor/Visuomotor skills, and weekly hours in school/day care was positively associated with language-related skills. Results suggest that, at this young age, psychosocial risk factors appear to be appropriate targets for intervention, with the goal of improving long-term outcome in children with SCD. Further investigations should include comparison to a matched control group.     

Neuropsychological functioning in preschool-age children with sickle cell disease: the role of illness-related and psychosocial factors.

Cognitive and academic deficits have been identified in school-aged children with sickle cell disease (SCD). However, there have been very few identified studies that examine neuropsychological functioning in preschool-age children with SCD. It is important to understand effects of SCD from a developmental perspective and to consider the contribution of environmental factors in this at-risk population. Neuropsychological functioning of preschool-age children with SCD and no history of overt stroke (n = 26) was examined across several domains (language, immediate memory/brief attention, visuospatial/visuoconstructional, motor/visuomotor). The mean Full Scale IQ for the sample was 89.0. Performance on the Immediate Memory/ Brief Attention domain was significantly higher than the other domains, although the pattern of performance was relatively consistent, with mean standard scores ranging from 88.0 to 95.0. Disease severity was not significantly related to cognitive functioning in this group of young children with SCD. Socioeconomic status (SES) was significantly correlated with most domain scores and, based on regression analyses, accounted for 18% to 47% of the variance in functioning. Psychosocial factors, such as number of children living in the home and parental stress levels, were negatively associated with Motor/Visuomotor skills, and weekly hours in school/day care was positively associated with language-related skills. Results suggest that, at this young age, psychosocial risk factors appear to be appropriate targets for intervention, with the goal of improving long-term outcome in children with SCD. Further investigations should include comparison to a matched control group.     

Racism experiences and psychological functioning in African American college freshmen: is racial socialization a buffer?

Previous research has documented the negative effects of racism on the psychological health of African Americans. However, consideration of racial socialization as a potential buffer against racism experiences has received limited attention. The present study investigated whether two types of parental racial socialization messages reduced the impact of racism on psychological functioning in a sample of 247 African American college freshmen (M=18.30). Results indicated that students who reported more racism experiences also had poorer levels of psychological functioning as indicated by higher levels of psychological stress and psychological distress. Parental messages emphasizing the use of African American cultural resources to cope with racism reduced the impact of racism on psychological stress only. Cultural pride messages predicted less psychological distress while messages emphasizing the use of cultural resources predicted greater psychological distress. However, neither message type moderated the relationship between racism experiences and psychological distress. These results suggest that racial socialization messages have complex relations to psychological functioning in African American college students.     

Patterns of service utilization among pregnant and parenting African American adolescents

This study explored factors associated with differential patterns of social and health service use among pregnant and parenting African American adolescents. One hundred seventy-seven young women between the ages of 14 and 22 took part in the study. Cluster analysis suggested three groups of users: frequent users, moderate users, and inconsistent users. These groups were distinct in terms of their frequency of service usage, perceptions of barriers to usage, and psychological and social functioning. Moderate users appeared to be healthier than either the frequent or inconsistent users, as indicated by their relatively higher levels of psychological functioning. In contrast, inconsistent users were distinguished by their high rates of sexual victimization, their low use of medical services, and their perceptions of many programmatic and personal barriers to usage. Suggestions for research and interventions that encompass the diverse needs of young African American women are made.     

Psychological Control Associated with Youth Adjustment and Risky Behavior in African American Single Mother Families

A distinction between parental behavioral control and psychological control has been elucidated in the literature, yet far less is known about the role of psychological control in youth adjustment broadly or risky behavior in particular. We examined the interrelationship of maternal psychological control, youth psychosocial adjustment, and youth risk behaviors among African American single mother-youth (11–16-year old) dyads (n = 194), families in which youth are more vulnerable to adjustment problems and risky behavior than Caucasian youth or youth from intact homes. Higher levels of maternal psychological control were associated with increased youth psychosocial adjustment problems as well as increased youth risk behavior, after statistically controlling for one domain of behavioral control, parental knowledge about a child’s whereabouts and activities. Furthermore, youth externalizing problems mediated the relation between psychological control and risk behavior. The findings suggest that parenting programs targeting risk behavior among African American youth may benefit from including psychological control among the parenting dimensions that are targeted.     

Safe haven in adolescence: Improving parental reflective functioning and youth attachment and mental health with the Connecting and Reflecting Experience

Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored. The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community. This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19. Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%). At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents’ psychosocial functioning. Adolescents completed scales regarding attachment and psychosocial functioning. Results showed a significant decrease in caregivers’ prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents’ reports of attachment security on the Security Scale. These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.     

Cognitive Behavioral Treatment for Insomnia in Veterans with Long-Standing Posttraumatic Stress Disorder: A Pilot Study

This uncontrolled pilot study assessed the effects of cognitive behavioral therapy for insomnia in veterans with long-standing posttraumatic stress disorder. Male veterans with current chronic insomnia and PTSD (n?=?8; M age = 58.6, SD?=?3.0; 87.5% African American, 12.5% European American; 87.5% Vietnam Veterans, 12.5% 1st Gulf War Veterans) reported a trauma related to their military service. Participants appeared for five weekly individual sessions of cognitive behavioral therapy for insomnia and completed one-week assessments of objective sleep (actigraphy) and subjective sleep (sleep diaries), the Insomnia Severity Index, and measures of functioning, posttraumatic stress disorder, and psychological distress both before and after treatment. Paired t tests revealed significant posttreatment improvements for various subjective assessments of sleep patterns but actigraphy-defined sleep was unchanged. Measures of functioning, nightmares, and posttraumatic stress disorder severity were also unchanged at posttreatment. Preliminary results were encouraging in improving subjective perceptions of sleep in individuals with posttraumatic stress disorder, warranting further study with more rigorous methodology.     

An Examination of Race Differences in Patients' Psychological Adjustment to Cancer

Although African Americans are at increased risk of cancer morbidity and mortality, very little is known about their psychological adjustment. African American males may be at especially high psychological risk, considering their disproportionately higher cancer mortality. Subjects were 42 African American and 56 White adults similar in age, cancer stage, marital status, and socioeconomic status. Analyses revealed no significant race or gender effects on global indices of psychological adjustment, depression, or anxiety. However, African Americans were more likely than Whites (a) to use avoidant coping strategies in dealing with the exigencies of their illness, (b) to report more cancer-related disruption in family relations, and (c) to identify fewer individuals in their social support network. No significant race differences were found on a measure of health care satisfaction. These findings highlight the need to provide a more comprehensive examination of individual, family, and socioecological variables and their relationship to psychological adaptation among minorities with cancer.     

An Exploration of Families' Psychosocial Well-Being in a South African Context

The aim of this study was to explore and describe aspects that contribute to the psychosocial well-being of families from diverse cultures in a South African context by analysing data obtained through narratives, drawings and interviews with families. Participant families took part voluntarily in family interviews (N=36), written narratives (N=23) and drawings (N=14). These different methods of data collection provided rich data on family psychosocial well-being in a South African context with culturally diverse families, as well as on those aspects that influence family psychosocial well-being. The findings suggest that communication, mutual support, togetherness as a family and spirituality are the most prominent contributing factors, while financial difficulties and interpersonal conflicts or arguments are the most prominent hindering factors with regard to family psychosocial well-being in this group of participants.     

Parental Problem-Solving Abilities and the Association of Sickle Cell Disease Complications with Health-Related Quality of Life for School-Age Children

Children with sickle cell disease (SCD) are at risk for poor health-related quality of life (HRQOL). The current analysis sought to explore parent problem-solving abilities/skills as a moderator between SCD complications and HRQOL to evaluate applicability to pediatric SCD. At baseline, 83 children ages 6–12 years and their primary caregiver completed measures of child HRQOL. Primary caregivers also completed a measure of social problem-solving. A SCD complications score was computed from medical record review. Parent problem-solving abilities significantly moderated the association of SCD complications with child self-report psychosocial HRQOL (p = .006). SCD complications had a direct effect on parent proxy physical and psychosocial child HRQOL. Enhancing parent problem-solving abilities may be one approach to improve HRQOL for children with high SCD complications; however, modification of parent perceptions of HRQOL may require direct intervention to improve knowledge and skills involved in disease management.     

Stress,coping, HIV status,psychosocial resources,and depressive mood in African American gay,bisexual, and heterosexual men

The associations between stress, physical health, psychosocial resources, coping, and depressive mood were examined in a community sample of African American gay, bisexual, and heterosexual men (N=139). Data were collected from physical exams and in-person interviews. In our theoretical framework, depressive mood scores were regressed first on stressors, next on psychosocial resources, and finally on coping strategy variables. Results revealed that psychosocial resources mediate the effects of stressors, including health symptoms, hassles, and life events, on depressive mood. There were no significant differences in depressive mood associated with HIV status or sexual orientation. Results are discussed in terms of community interventions needed to provide social support as a buffer between stress and psychological distress in African American men. The research was completed at the Center for AIDS Prevention Studies, University of California at San Francisco and was supported in part by National Institute of Mental Health Grants MH44045 and MH42459. The authors express their appreciation to the participants in this study.     

Daily Hassles and African American Adolescent Females�� Psychological Functioning: Direct and Interactive Associations with Gender Role Orientation

Given that stressors may accumulate across the life span, the extent to which daily hassles are associated with African American females?? psychological functioning during the adolescent years remains an important question. Understanding the potential impact of daily hassles is important due to indications that African American women report greater daily hassles and have higher incidence rates of stress-related disorders. The current study examines the relationship between daily hassles and psychological functioning (e.g., depression and anxiety symptoms) among 103 U.S. African American adolescent females (M?=?15.50; SD?=?1.70) residing in a moderately-sized Midwestern city. Additionally, this investigation explores gender role orientation as a moderator of this relationship. Results indicated that increased daily hassles were associated with greater depressive and anxiety symptoms. Also, this investigation provides some support for the direct and moderating role of gender role orientation. A greater feminine or androgynous role orientation was associated with fewer depressive and anxiety symptoms. In addition, although not directly associated, this investigation indicated that a masculine role orientation moderated the association between daily hassles and girls?? psychological outcomes. Specifically, among African American adolescent females with a greater masculine role orientation, increased daily hassles were associated with reduced psychological functioning (e.g., greater depressive and anxiety symptoms). Neither feminine nor androgynous role orientation, however, moderated the relationship between daily hassles and psychological functioning (e.g., depressive and anxiety symptoms). Implications of findings are discussed.     

Operating within the mainstream: Coping and adjustment among a sample of homosexual youths

A sample (N = 37) of African American adolescent homosexual males was administered a questionnaire that focused on four areas of social psychological functioning (self‐identity, family relation, school‐work relations, and social adjustment). The findings contradicted several past studies that reported in general that homosexual males experience crippling cognitive dissonance. Even with the existence of homophobia in the society, the adolescents were found to possess an adequate social psychological attitude and survival skills. The sampled adolescents reported being comfortable with their sexual orientation even though the majority of them had not disclosed their homosexuality. The respondents reported how they managed self‐presentation among heterosexual persons. The adolescents appeared well‐adjusted and stable in their social functioning and disagreed with the idea that they needed professional counseling.     

The Influence of Cultural and Racial Identification on the Psychosocial Adjustment of Inner-City African American Children in School

The purpose of this study was to examine the relationship and combined influence of racial identity and Africentric values on African American children's psychosocial adjustment. Participants were 104 (53 males, 51 females) African American fourth-grade students attending an inner-city public school in a northeastern city. Child and teacher ratings were used to assess the relationship between racial identity, Africentric values, and several indices of child psychosocial adjustment, including child behavior control, school interest, and teacher perceptions of child strengths and problems in the classroom. Child self-esteem and the effects of gender and cohort were used as covariates in several analyses in the study. Overall, findings from the study supported the usefulness of combining racial identity and Africentric values into a single model of ethnic identification for African American children. Implications for risk prevention and enhancement of psychosocial functioning among African American children are discussed.