Biomedical subjects

L R Snowden

Publications and source records attributed to L R Snowden.

At least 19 recordsLinked to original sources

PubMed2001

A confirmatory factor analysis of the BASIS-32 in racial and ethnic samples.

The present study performed confirmatory factor analysis across major racial and ethnic groups of the BASIS-32, a measure of functional status of persons receiving mental health treatment and suitable for routine assessment mental health care. The purpose was to perform a preliminary investigation of cross-cultural equivalence in a county-level mental health program in a major metropolitan area. The results indicated a factor structure similar to that reported in the literature, and they suggested acceptable levels of agreement in structure between racial and ethnic minority groups and whites. The study revealed little reason to believe that the BASIS-32 varied in underlying structure across racial and ethnic boundaries, although further research is indicated.

Adult↗

PubMed2001

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.

Adaptation, Psychological↗

PubMed2001

How capitated mental health care affects utilization by youth in the juvenile justice and child welfare systems.

Examine the impact of Colorado's Medicaid mental health carve-out program on children in child welfare and juvenile justice systems. Medicaid claims and encounter data for two experimental managed care sites and one comparison fee-for-service site are used to estimate a two-part model of inpatient, outpatient, and residential treatment center utilization, controlling for patient characteristics. The study finds that juvenile justice and child welfare populations were more strongly affected by managed care than the general youth population, regarding reduced utilization of inpatient and outpatient services. Increases in Residential Treatment Centers use were greater for juvenile justice than either the child welfare sample or the total sample. Youth in child welfare increase utilization of outpatient services. Most utilization effects are stronger for not-for-profit than for-profit managed care organizations. The experience of Colorado implies that a mental health carve-out affects patterns of care for youth and differentially so for youth in juvenile justice and child welfare systems. Controlling for population characteristics, the effects are stronger for not-for-profit than for-profit managed care organizations.

Adolescent↗

PubMed2001

Barriers to effective mental health services for African Americans.

Many African Americans--especially the most marginal--suffer from mental health problems and would benefit from timely access to appropriate forms of care. However, few seek treatment from outpatient providers in the specialty mental health sector and those who do are at risk of dropping out. African Americans visit providers in the general medical sector, although they use another hypothesized alternative to specialty care, voluntary support networks, less than other groups. These help-seeking tendencies may reflect characteristic coping styles and stigma, as well as a lack of resources and opportunities for treatment. More should be learned about differences in need according to location, social standing, and cultural orientation so as to identify treatments and programs that are especially beneficial to African Americans.

Adaptation, Psychological↗

PubMed2000

Medicaid and African American outpatient mental health treatment.

The present study tested the hypothesis that Medicaid-financed African Americans would be more likely to receive outpatient mental health treatment than African Americans whose treatment was financed by private insurance. The hypothesis was confirmed: when compared with privately insured persons eligible for care under either fee-for-service or managed care, the Black-White gap in outpatient service use was significantly smaller under Medicaid. There was no racial difference in outpatient treatment rates among the uninsured. The often-noted difference between Blacks and Whites in the likelihood of receiving outpatient mental health treatment is confined largely to the privately insured.

Black or African American↗

PubMed1999

Ethnic characteristics of mental disorders in five U.S. communities.

The study examined the ethnic ratio of 16 DSM-III mental disorders among White, Black, Hispanic, and Asian Americans. A total of 18,126 residents from 5 sites and 2,939 residents from the Epidemiological Catchment Area's Los Angeles site were studied separately. Logistic regression analysis was performed. Results showed that Blacks were significantly less likely than Whites to have major depressive episode, major depression, dysthymia, obsessive-compulsive disorder, drug and alcohol abuse or dependence, antisocial personality, and anorexia nervosa, but they were significantly more likely than Whites to have phobia and somatization. Lifetime prevalence rates of schizophrenia, obsessive-compulsive disorder, panic, and drug abuse or dependence were significantly lower among Hispanics than among Whites. Asians also had significantly lower rates than Whites of schizophreniform, manic episode, bipolar disorder, panic, somatization, drug and alcohol abuse or dependence, and antisocial personality. Compared with the overall findings, ethnic differences at the Los Angeles site were lessened between Blacks and Whites, enhanced between Hispanics and Whites, and basically unchanged between Asians and Whites.

Adult↗

PubMed1998

Acculturation, alcohol consumption and AIDS-related risky sexual behavior among African American women.

The present study examined the relationship between acculturation, alcohol consumption and AIDS-related risky sexual behavior in a national probability sample of 533 African American women. Results indicated that women who were the heaviest drinkers were also the least acculturated. However, women most likely to engage in risky sexual behavior, including having multiple partners, being nonmonogamous or in a nonmonogamous relationship, and being nonmonogamous or in a nonmonogamous relationship and not using a condom consistently, were high in acculturation rather than low. Alcohol use proved related to risky sexual behavior when considered in conjunction with respondents' level of acculturation. Women at risk for contracting AIDS were not low acculturated African American women who drank heavily, but high acculturated African American women. Findings from this study extend our understanding of risk and contain implications for research and prevention efforts in the area of alcohol use and AIDS-related sexual behavior among African American women.

Acculturation↗

PubMed1997

Problem type and referral to HMO mental health treatment.

The present study examined the cases of 353 patients seen in the outpatient department of psychiatry at a large west coast HMO. Comparisons were made between self-referred and physician-referred patients in the types of problems presented for treatment. Patients with relationship problems were self-referred more than those with adjustment, anxiety, and mood disorders who were more likely to be physician-referred. HMO patients with a self-referral option appear to enter mental health treatment because of relationship problems at a higher rate than their physician-referred counterparts.

Adult↗

PubMed1996

Ethnic minority populations and mental health outcomes.

This chapter presents a framework for evaluating outcomes from mental health intervention in ethnic minority populations, reviews existing outcomes research, and describes ways to increase the quantity and quality of minority outcomes research.

Culture↗

PubMed1995

Emergency care avoidance: ethnic matching and participation in minority-serving programs.

Using data from a county level mental health service system, relationships were examined between ethnic matching, program involvement and emergency service use. When clients were matched with an ethnically similar clinician who was also proficient in their preferred language, they had fewer emergency service visits than did clients who were unmatched on the basis of ethnicity and language. Equally if not more significant than ethnicity or language matching was the client's program and the proportion of minority clients it served. Clients in programs serving a relatively large proportion of minority clients had fewer emergency service visits than those in programs serving a smaller proportion of minority clients. More research is needed to document the impact of matching along with greater attention to minority oriented programs.

Adolescent↗

PubMed1993

Symptoms of depression among blacks and whites.

OBJECTIVES: We sought to examine relationships between sociodemographic indicators of risk and depression symptoms within the Black and White populations. METHODS: In a national probability sample, differences in sex, age, marital status, religion, social class, employment status, urbanicity, and region were evaluated against a Center for Epidemiological Studies Depression Scale score of 16 or greater. Risk factors were identified within the two populations and compared between them. RESULTS: For both races, females were at greater risk for depression than males, and respondents who were formerly married or separated were at greater risk than those who were currently married. Major differences in patterns of risk were also found between the races. Blacks who were 30 to 39 years of age, belonged to non-Western religious groups, and lived in the West were at greater risk than comparable Whites. Blacks who were widowed, members of the middle and lower-middle class, and unemployed were at less risk. CONCLUSIONS: Similarities and differences in patterns of risk were evident. The nature of the differences suggests important divergence in sociocultural and economic experience.

Adult↗

PubMed1992

Ethnic differences in emergency psychiatric care and hospitalization in a program for the severely mentally ill.

Ethnic differences in rehospitalization were examined in a program of intensive services for severely mentally ill hospital recidivists. The purpose was to determine whether ethnicity-related differences in psychiatric admissions observed in national data would appear among clients at great risk for hospitalization but enrolled in a program of case-managed care to promote community adjustment and tenure. After accounting for differences in prior emergency visits and hospitalizations as well as sociodemographic and clinical differences, blacks were found more likely than whites to visit the psychiatric emergency room and to be hospitalized. The marked needs of the severely mentally ill and the intention to address these needs with services did not obviate the continuing importance of racial differences in explaining reliance on inpatient sources of care.

Alcoholism↗

PubMed1992

Costs and use of public mental health services by ethnicity.

This paper used data obtained from Santa Clara County, California, to study the costs and use of public mental health services among ethnic populations (Asians, Blacks, Hispanics, and Whites). The study had access to 12,436 unduplicated users of services. The study found Whites had the highest per capita costs, while Asians incurred the lowest. However, after controlling for other demographic characteristics, Asians incurred higher costs than Whites. This reversal of Whites and Asians occurred because cost distributions are more skewed for Whites than Asians. Asians had the highest median costs and Hispanics the lowest. The top 5% of users incurred about 50% of the total public mental health costs.

Adolescent↗

PubMed1991

Ethnic populations in public mental health: services choice and level of use.

BACKGROUND: Barriers to access and use of mental health care by Asians, Blacks, and Hispanic Americans have been a source of concern for many years. Limitations in our knowledge base persist regarding patterns of use in public sector programs of certain services. Using a sample of almost 27,000 persons, this study examined access and level of use by ethnic minority groups of emergency services, inpatient care, individual outpatient visit, and case management. METHODS: Data from the management information systems of San Francisco and Santa Clara counties were analyzed for fiscal year 1987/1988. Multivariate models were evaluated at two stages, reflecting whether or not a service had been used, and if used, the level of use. RESULTS: Asians and Hispanics used less emergency and inpatient but more outpatient care than did Whites; Blacks used more emergency and less outpatient care. CONCLUSIONS: Ethnicity continues to play a role in understanding the utilization of mental health services. Regarding emergency and inpatient care, Asian and Hispanic patterns of use appear relatively favorable, whereas the patterns of Blacks continue to be problematic.

Black or African American↗

PubMed1990

Community mental health and ethnic minority populations.

National trends in minority utilization of mental health services are reviewed, and recommendations are made for needed research. In relation to their representation in the population, blacks use services more than expected, and Asian American/Pacific Islanders use services less; Hispanics and Native American/Alaska Islander use varies according to type of service. Hospitalization accounts for part of the increase in minority utilization; this trend is problematic. Disruptions in service continue to plaque minority clients, possibly stemming from inadequacies in the organization and financing of care, and from cultural incongruity. Much more must be learned about these problems in utilization, as well as about other key issues.

Community Mental Health Services↗

PubMed1990

Use of inpatient mental health services by members of ethnic minority groups.

National data on psychiatric hospitalization point to marked ethnic-related differences. Blacks and Native Americans are considerably more likely than Whites to be hospitalized; Blacks are more likely than Whites to be admitted as schizophrenic and less likely to be diagnosed as having an affective disorder; Asian Americans/Pacific Islanders are less likely than Whites to be admitted, but remain for a lengthier stay, at least in state and county mental hospitals. These differences are clear-cut, but they ignore a major source of care: psychiatric hospitalization in placements other than psychiatric units and hospitals. Explanations for observed minority-White differences in hospitalization can be evaluated only partially or not at all: Such explanations include ethnic-related differences in socioeconomic standing and in the prevalence of major psychopathology; differential stigma, or capacity to tolerate or support a dysfunctional significant other; access and use of alternative services; and bias in the behavior of gatekeepers, especially practitioners assigning diagnostic labels and making involuntary commitment decisions. More research is needed to help explain these striking differences in utilization.

Diagnosis, Differential↗

PubMed1989

Low-income blacks in community mental health: forming a treatment relationship.

Sociodemographics, psychological symptom distress, and global adjustment were related to perceived quality of the therapeutic relationship at a community mental health center serving a predominantly low-income and black clientele. Data were collected at intake describing 56 clients; additional data were collected after two sessions of treatment, recording therapist perceived quality of the therapeutic relationship. Results indicated that with all else controlled, three factors predicted a favorable therapist evaluation: having ever been married; reporting more symptoms of psychological distress; having been rated as better adjusted. Apart from symptoms of hostility and somatization, the type of symptom distress suffered appeared less important than the number of symptoms and their severity. In this little studied but increasingly prevalent population of clients, it is possible to predict the formation of a promising therapeutic relationship by means of a relatively straightforward model of symptoms and adjustment.

Adult↗

PubMed1987

The peculiar successes of community psychology: service delivery to ethnic minorities and the poor.

The 20-year history of community psychology is considered with respect to activities on behalf of ethnic minority participation in psychotherapy, increasing cultural diversity, and to a considerably lesser extent, enhancing community systems. A discrepancy was found between community psychology in principle and community psychology in practice. For the future, community psychologists are advised to identify and seek to strengthen (a) indigenous resources for solving personal and community problems; and (b) pathways of help seeking followed by community members. Community psychology is encouraged to reclaim and enact more vigorously its own legacy. To do otherwise, it is argued, forfeits development of potentially significant research and practice and risks continued ambivalence and dissatisfaction despite worthwhile contribution--suffering the peculiar successes of community psychology.

Community Mental Health Services↗