Mental Health Utilization Among Diverse Parenting Young Couples

Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social–personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor–Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow‐up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse’s influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.     

Outpatient Psychotropic Medication Use in the US: A Comparison Based on Foster Care Status

Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and correlates of psychotropic medication receipt for youth who live with families and in foster care are compared. The medication rate is similar for both groups, with slightly more than one-third of youth treated with medication. Additionally, when medication is prescribed, it is the sole intervention provided for close to one half of each group, and the distribution of other services received (such as clinical case management and collateral services) is similar, regardless of living situation. However, the predictors of medication use differ for the two groups. Among foster care youth, only presenting problems of depressed mood, being withdrawn, and suicidality significantly increase the odds of medication; among youth with families, sociodemographic characteristics (male gender), and a range of clinical factors (disruptive behavior disorder, presenting problems of hyperactivity and sleep disturbance, prior mental health service receipt, and inpatient or residential care referral sources) increase the likelihood of medication. The conclusion that distinct sets of factors predict medication for the two groups was reinforced by results of multivariate analyses; foster care status moderates the association between medication receipt and only one of the correlates examined (gender). Implications, limitations, and areas for future research are presented.     

Poverty and Mental Health: Underclaiming of Welfare Benefits

The study undertaken by a local MIND welfare benefits service found that 51% of people attending a local mental health resource centre were not receiving the welfare benefits to which they were entitled. Being in receipt of correct benefit entitlement was found to be unaffected by: whether a person had a long history of using mental health services; whether they had a care manager; or whether they had previously been given benefits advice. Women were less likely to be receiving their correct benefit entitlement than men. It is argued that the only way to guarantee that people receive their full benefit entitlement is to ensure that highly trained and experienced welfare benefits advisers are readily accessible to all people who use mental health services.     

Relationship Between Religiosity and Conduct Problems Among African American and Caucasian Adolescents

This study investigated the relationship between religiosity and conduct problems in a racially diverse sample of high school aged adolescents (ages 13–19) who attended public schools in a large metropolitan area. The results of the study found racial and gender differences in religiosity: African American adolescents were more likely to attend church, describe themselves as very religious and use Collaborative and Deferring religious coping styles; they were less likely to use Self-Directing religious coping styles when compared to Caucasian adolescents. Females were more likely to be involved in church activities, use a Collaborative religious coping style and tended to be less likely to use a Self-Directing religious coping style when compared to males. The results of multiple regression analyses, after controlling for race, gender, and self-reported religiousness found that Self-Directing and Deferring religious coping styles were risk factors for conduct problems; there was no relationship between Collaborative religious coping and conduct problems. The findings from the study provide additional support for the importance of considering religiosity, race and gender when examining mental health outcomes in adolescents and have implications for the development of mental health interventions for adolescents.     

Attributions for Memory Performance in Adulthood: Age Differences and Mediation Effects

We examined age differences in attributions to internal (controllable and uncontrollable), external (uncontrollable), and unstable factors for performance on a free recall memory task in 149 young, middle-aged, and older adults. Attributions varied by age and by level of memory performance. Middle-aged and older adults rated internal, uncontrollable factors (ability and genes) as more influential for high performance than for low performance, and they were less likely than young adults to attribute low performance to these factors. Within age groups, only the older adults rated memory ability as more influential than strategy use, even though they were as likely as the other age groups to use a categorization strategy. Attributions to both internal controllable (strategy use) and uncontrollable (ability) factors as well as to health were associated with better memory performance. These attributions partially mediated the relationship between age and memory performance. Thus, attributions may provide some insight into sources of age differences in memory performance.     

Factors contributing to the utilization of mental health services in a rural setting

The purpose of this study was to examine if age, attitudes toward help-seeking, education, and sex were related to previous or intended future mental health utilization in a rural population. Data were collected via a mail survey from 438 adults. Regression analyses suggested that positive attitudes toward help-seeking, being female, and being younger were significantly related to both previous and intended future mental health service utilization. In addition, prior mental health use was significantly related to whether one would seek out mental health services in the future, Implications for mental health practitioners in rural settings are addressed, and limitations of the study discussed.     

Homeless Youths and Young Adults in Los Angeles: Prevalence of Mental Health Problems and the Relationship Between Mental Health and Substance Abuse Disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults is increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems, as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorder included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Life Satisfaction and Cannabis Use: A Study on Young Adults

Cannabis is the illicit substance most used by young adults and adolescents in rich nations. Cannabis use may have negative consequences on mental and physical health and has been associated with low wellbeing indexes (i.e., life satisfaction). The present study aims to investigate the relationship of life satisfaction with cannabis use in young adults compared with personality and sociodemographic variables. Previous studies have found relationships between the Big Five traits and cannabis use as well as a gender gap. Males have been shown to have a higher consumption of cannabis than females. We conducted a survey by means of a self-report questionnaire on a sample of 600 young adults (average age 22.20 years) and performed a regression analysis to test the relationships of sociodemographic variables, personality, and life satisfaction with cannabis use. The results confirmed the gender gap and showed an association between cannabis use and conscientiousness, agreeableness, openness and life satisfaction. Life satisfaction was negatively related to cannabis use, which suggests that this behaviour may be motivated by coping with unsatisfactory life conditions.     

Mental Health and Incarcerated Youth. II: Service Utilization

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program (n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities (n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarcenation may benefit from intensive mental health services to prevent out-of-home placement and later incarceration.     

Forgiveness and Health: Age Differences in a U.S. Probability Sample

Forgiveness is a variable closely related to religiousness and spirituality that has been hypothesized to be protective of mental and physical health. However, we do not clearly understand which aspects of forgiveness are most clearly associated with health outcomes, and the conditions under which these relationships occur. This study used national probability data to systematically examine age differences in the association between forgiveness, religiousness/ spirituality, and respondent reports of mental and physical health. Results showed age differences in the levels of forgiveness of others and feeling forgiven by God. In both cases, middle and old age adults showed higher levels of these forms of forgiveness than young adults. Furthermore, the relationship between forgiveness of others and respondent reports of mental and physical health varies by age. Forgiveness of others was more strongly related to self-reported mental and physical health for middle and old age adults than for young adults.     

Race,gender, and the response to stress: Autoworkers' vulnerability to long-term unemployment

A three-wave panel study of auto plant closings focused on the mental health effects of unemployment on blue-collar workers. This paper explores how the impact of long-term unemployment varies across race and gender. We also examine whether other demographic factors can themselves modify the impactsof race and gender. Dependent variables include two measures of distress and two drinking measures. Results showed that the effect of long-term unemployment on distress and drinking was more severe among less educated workers, and responses of blacks were especially sensitive to level of education. In addition, men showed a greater association of long-term unemployment with depression (and to some extent anxiety) than did women. Marriage affected the responses of men but not of women, and of whites but not of blacks. Explanatory variables—the worker's experiences of financial hardship, other negative life events, and lack of a confidant—largely accounted for male-female differences. We conclude by discussing theoretical implications of these effects and address the limitations of the traditional term “vulnerability” in describing them. A prior version of this paper was presented at the North Central Sociological Association meeting in Dearborn, Michigan, April 25, 1991. Funds for the research were provided by the Michigan Health Care Research and Education Foundation and by the International Union-UAW. We are especially grateful to the men and women of the UAW, whose experiences and views form this investigation. We thank Kiseon Chung, Scott McKearney, David Rauma, and the anonymous reviewers for their comments on earlier drafts.     

Ageism in Mental Health and Health Care: A Critical Review

Discussions of aging and mental health widely assume that ageism among mental health providers is an important factor limiting access to mental health services for older adults. Given the widespread citation of ageism as a problem, we critically review the history of the ageism construct, and evidence for its existence in both mental health and medical professionals. There is surprisingly little empirical evidence for age bias among mental health providers. Considerable evidence does suggest differential medical treatment for older adults in such diverse areas as physician–patient interaction, use of screening procedures, and treatment of varied medical problems, although it is unclear whether age bias accounts for these differences. We suggest that innovations in delivery of psychological services, such as collaborative medical/psychological care in primary care settings, may ultimately prove more useful in improving access to mental health services than efforts to combat ageism.     

Referral by clergy who counsel older adults

The purpose of this cross sectional study of clergy (N?=?493) was to examine the likelihood of referral to formal mental health providers by those clergy who counsel older adults. Responding clergy completed a brief questionnaire that included information on the amount of counselling they do with older adults, the Attitudes towards Older Adults and Mental Illness (AOAMI) scale, their relationships with mental health professionals, their knowledge of resources for referring people for additional help, and basic demographic data, such as race, age, years in the clergy, and education level. In logistic regression analysis, respondents with more education, those who felt less prepared to provide counselling, and those with more positive attitudes based on the AOAMI indicated that they were more likely to refer, and no differences were found based on their denominational affiliation race, relationships with mental health professionals, or knowledge of resources for referring people for additional help. We believe that public-private partnerships should be formed to help clergy recognise when referrals are appropriate, and to help improve relationships between clergy and mental health professionals.     

Mental health provision,religion, politics,and guns: college students express their concerns

The purpose of this study was to gather the opinions of college students regarding their concerns about guns and mental illness and how they differed by gender, race, religion, and political party. Four hundred and nineteen college students participated in an online survey. Eighty-one per cent believe increasing mental health services will prevent gun violence. A logistic regression analysis revealed that all agreed regardless of race, religion, gender, and political party that insurance companies should be required to offer benefits for mental health care that are similar to health care. Males were three times as likely to agree there should be laws prohibiting persons with a mental illness to carry a hand gun (3.8502 AOR). Overall, college students believe mental health care should be funded. It is less clear what the role of government should be in funding mental health services.     

Use of Services Prior to and Following Intensive Family Preservation Services

A goal of short-term intensive family preservation services (IFPS) is to facilitate access to other services. However, service use following IFPS has rarely been studied. I describe the types of aftercare services that IFPS therapists recommended and use of these services in the two months following IFPS termination. Since families were using services that were not on the recommended aftercare plans, use of these services is also described. Primary caregivers of families who received family preservation through either child welfare or mental health were interviewed at two months after family preservation for the purpose of ascertaining service use. Different types of services were recommended and used based on whether families received IFPS through child welfare or mental health. However, there were also differences in the presenting problems and demographics between families in child welfare and mental health. Future research should include an independent assessment of need in order to determine the relationship between need and the types of services recommended and used. Even though families used services prior to IFPS, the findings indicated that IFPS facilitated use of new services. More research is needed on the process of how therapists decide what services to recommend and what they do to help families access services. It is also important to examine whether use of less restrictive services helps prevent out-of-home placements and the relationship between informal support and use of formal services.     

American Indian Youth: Who Southwestern Urban and Reservation Youth Turn to for Help with Mental Health or Addictions

We illustrate the addictions and mental health service use of American Indian adolescents. Interviews concerning mental health need and service configurations with 401 Southwestern American Indian (AI) youth used questions from the Diagnostic Interview Schedule (DIS) and the Service Assessment for Children and Adolescents (SACA). Seventy-nine percent had mental health or addiction problems, with half meeting criteria for at least one diagnosis. One in 4 youth met criteria for drug dependence'abuse or conduct disorder, 1 in 5 for depression, and 1 in 8 for alcohol dependence'abuse. Most youth were helped by a combination of providers. Youth meeting more diagnostic criteria were increasingly likely to use service configurations with adults, nonspecialist professionals, and specialists, respectively. Regardless of disorder, youth were least likely to use configurations with traditional healers or specialists and there was little difference in rates of use between the two. The lack of services from specialist providers was potentially offset by use of an extensive range of informal adults, nonspecialist professionals, and peers. Since informal helpers, peers, and nonspecialist providers, but not specialists, are providing the bulk of services they must be given support and skills so they can function effectively.     

Suicidal behavior among urban,African American young adults

The objectives of the present study were four-fold. First, to determine the lifetime, last year, and 6-month prevalence and demographic correlates of suicidal behavior in a defined population of urban, African American young adults. Second, to determine the degree of mental health service utilization among attempters. Third, to study the comorbidity between mental disorders and suicidal behavior, along with the variation in the numbers and types of psychiatric disorders associated with attempts versus ideation only. Fourth, to examine gender differences in the psychiatric diagnoses associated with attempts and ideation. Data relevant to each of these objectives were gathered through structured interviews of 1,157 economically disadvantaged, African American young adults. Lifetime, last year, and 6-month prevalence rates for attempts were 5.3%, 1.2%, and 0.4%, respectively, whereas the lifetime and 6-month prevalence of ideation were 14% and 1.9%, respectively. Approximately two thirds of those who reported lifetime ideation, and a similar proportion of those who reported lifetime attempts, had a history of at least one lifetime psychiatric disorder. There were no gender differences in terms of the degree of risk for suicidal behavior (ideation or attempts) associated with any of the comorbid psychiatric diagnoses assessed. Despite the severity of most attempts, few attempters received mental health services in their lifetime or at the time of their most recent attempt.     

Psychological Well-Being of Sexual Minority Young Adults in Iceland: Assessing Differences by Sexual Attraction and Gender

The literature on sexual minority adolescents and young adults has highlighted a poor mental status among those groups compared to their heterosexual peers. Sexual minorities are also more likely to experience stress factors such as bullying and physical violence. However, sexual minority young adults have not been studied much in Iceland, a Nordic country renowned for a high degree of sexual equality. Given what the literature has shown to date, a noteworthy question is whether patterns of mental well-being of sexual minority adolescents and young adults in Iceland are comparable to other countries. The aim of the present study was to provide an assessment of mental well-being in sexual minority young adults in Iceland. We used population data to examine a selection of mental well-being indicators in 16–20 year-olds, both-sex-attracted and same-sex-attracted participants, and compared them to other-sex-attracted peers. Findings indicated that sexual minority young adults exhibited significantly greater levels of depressed mood, anger, and perceived stress than other-sex-attracted young adults. However, when stratified by gender and sexual attraction pattern, the analyses revealed that both-sex-attracted young women scored significantly higher on all indicators than any other group. We conclude that studies in this area should strive to distinguish between same-sex and both-sex attraction as well as to stratify analyses by gender. The well-being of both-sex-attracted young women is a compelling topic for future research.