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The purpose of this study was to perform an in depth examination of the major factors that increase the reluctance among African Americans to seek mental health treatment.

This dissertation tested a methodological explanation for a double paradox in psychiatric epidemiology: a lower prevalence of major depression in Blacks than Whites in the US, coupled with equal and higher levels of psychological distress in Blacks. The first paradox is a lower prevalence of major depression in Blacks than Whites. The second paradox is the discordant results from comparing Blacks and Whites on depression and distress. These are paradoxes from the vantage points of, respectively, dominant theory and conceptual and empirical understandings of the relationship between disorder and distress. The idea that Blacks in the US express depression and distress more somatically than Whites has been in the literature for decades. If true, it could explain the double paradox. A formal diagnosis of major depression requires endorsing a screening symptom, either sad mood or anhedonia, which are both psychological rather than somatic symptoms. To the extent Blacks express depression more somatically than Whites, depression could be disproportionately undercounted in Blacks due to a lower likelihood of Blacks endorsing a screening symptom, adjusting for underlying levels of depression. Measures of distress share symptom content with the diagnostic criteria for depression but typically do not require endorsing screening symptoms. Thus, if Blacks do somatize depression and distress more somatically than Whites, the depression algorithm may produce a greater undercount of depression in Blacks than Whites, whereas a similar undercount would not occur with distress measures. Accordingly, both paradoxes could be explained. This dissertation has three main parts. In part one, the double paradox is documented in a systematic literature review. Using data from two nationally representative household samples, parts two and three test whether Blacks express depression and distress, respectively, more somatically than Whites, whether this accounts for a lower likelihood of Blacks endorsing a screening symptom, and if (part two only) this explains the Black White depression paradox. The systematic review provides robust evidence of the double paradox. Parts two and three reveal slightly higher levels, respectively, of depression and distress somatization in Blacks than Whites. However, the underlying structure of these small differences provides no evidence of a broad somatization hypothesis in Blacks. Moreover, no evidence is found that the somatization difference inhibits Blacks' endorsement of screening symptoms. One unexpected finding points to subsequent steps to take towards resolving the double paradox.

Mental health disparity is an emerging national concern with evidence suggesting individuals from non-dominant populations are less likely to seek and persist in mental health services compared to their dominant culture peers. In particular, African Americans may underutilize professional counseling services due to factors such as stigma, healthy cultural mistrust, and cultural values. To date, researchers have paid limited attention to ways to break through barriers to mental health equity. The purpose of this phenomenological study was to explore African Americans’ experiences and decision-making seeking professional counseling services. I addressed the following questions: How do African Americans make meaning of their decision to seek counselor services? What considerations are involved in decision- making with African Americans who decide to seek professional counseling services? Participants included 10 African American women who had attended counseling with a licensed professional counselor (LPC) or LPC Intern in the past three years. I identified six emergent themes through adapted classic phenomenological analysis: feelings prior to attending counseling, coping mechanisms utilized prior to counseling, barriers to treatment, motivation to attend counseling, characteristics of counselor, and post counseling experiences. Participants reported increased personal growth, insight, and desire to recommend counseling to others. Findings inform communities about what counseling is (and is not) as well as different types of support that can be obtained from a professional counselor. Limitations and future research directions are discussed.

This dissertation was a sub-study of a National Institutes of Health (NIH)-funded randomized clinical trial (R21 NR016112) that examined the effects of resistance training (RT; i.e., weight lifting) on depression in Black/African American (AA) men. The focus of this study was to examine resilience in that population. Resilience is one’s ability to adapt, withstand, and grow in the face of adversity and stress, and it is thought to be inversely associated with stress-related mental illness. Previous research has linked resilience with other intrapersonal factors such as physical self-concept (PSC), and mastery experiences, yet no study has examined the role exercise might play in these relationships. Purpose: To conduct the first study to examine the effects of RT on resilience and PSC, and to explore how mastery experiences might affect these variables. Methods: Twenty-nine participants in the parent study were randomized into either a 12-week RT group or time-matched control. Both groups were required to attend two on-site sessions per week (i.e., 24 total sessions), and all completed questionnaires at three time points (baseline, week 6, week 13). Changes in resilience, PSC, and mastery were analyzed using a series of linear mixed models. Results: There was a significant effect of Time (t = 2.3, p = .02) for resilience, such that the mean score significantly increased by 2.9 points from baseline to the Week 13 in the aggregated sample. There was no significant effect of Group; however, the resistance training group significantly increased their resilience from baseline to Week 13 (p < .01). There was a significant effect of Group (t = 2.5, p = .02) and Time (t= 2.4, p < .01) on PSC from baseline to Week 13. In addition, the results revealed that for every 1-unit increase in PSC from baseline to Week 13, there was a 0.1-point increase in resilience for the aggregated sample. Mastery was not related to any outcome. Conclusion: Results suggest that RT has the potential to influence both resilience and PSC. Furthermore, changes in PSC appeared to be associated with changes in resilience. Future research will be needed to better understand these associations.

Despite the election of a Black President and media assertions at the time heralding a “post racial” America in which racial divides no longer exist, health disparities, poverty rates, incarceration rates, discrimination and educational inequality still are a daily reality for African Americans. African Americans still have the burden of having to cope with racism making the explorations of coping strategies for African Americans dealing with racism vitally important. The present study explored religious orientation, spirituality, race-related stress, mental health outcomes and activism for African Americans. In particular, race -related stress was predicted to be significantly predictive of activism, such that the more one has experienced race related stressors the more likely they would be activated to engage in social justice related activities (H1). The study predicted that higher levels of quest religious orientation and intrinsic spirituality would be related to higher levels of African American activism (H2a). It was also predicted that higher levels of religious fundamentalism would be related to lower levels of activism (H2b). Regarding the relationship of spirituality and activism to mental health, it was predicted that quest religious orientation and intrinsic spirituality and activism would be related to greater mental health outcomes (H3a), while a fundamentalist spiritual orientation and race-related stress would be related of poorer mental health (H3b). It was also predicted that African American activism would be related to greater mental health outcomes (H4a) and that racism-related stress would be negatively related to mental health (H4b) The results indicated that for this sample, none of the spirituality variables (Quest Orientation, Fundamentalism Orientation, and Intrinsic Spirituality), nor the experience of racism (race-related stress), nor African American Activism, was related to mental health. However, the variables examined were significantly related to African American Activism. Quest Religious Orientation, Intrinsic spirituality, and race-related stress were all positively related to engagement in action for racial justice. Fundamentalist religious orientation was negatively related to action for social justice.

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In light of health disparities involving African Americans having disproportionately high rates of obesity, type II diabetes, cancer risk, heart disease and hypertension, the study was conducted with an all-Black adult sample (n= 470). Some 53.0% were female and the sample had a mean age of 32 years. The study evaluated the Knowledge of Physical Activity and Dietary Intake Guidelines Survey (KOPA-DIGS-40) as a new True-False knowledge test—with all True items. The study found moderately high levels of knowledge using the KOPA-DIGS-40. Findings using paired t-tests found evidence that ratings for (1) knowledge of guidelines and (2) self-efficacy for adherence to guidelines were significantly higher after taking the test. The study found noteworthy predictors of a higher KOPA-DIGS-40 score to be older age, higher education, and higher Body Mass Index. The study focused on three time periods (1-before the COVID-19 pandemic, 2-during the pandemic, 3-currently) and ratings on four health dimensions (1-physical health, 2-mental/emotional health, 3-physical activity level, 4-eating a healthy diet). Findings showed declines on the four dimensions during the pandemic, yet by Spring 2023 there were significant improvements—with a return by Spring 2023 to pre-pandemic levels. Findings suggested evidence of resilience after experiencing the stress of a global pandemic. Thus, a resilience theory and framework may be vital in guiding a future era of health disparities research with African Americans. Further, the study found an increase in social support during the pandemic, which continued into their current lives. Future research should continue to utilize the innovation of the genre of research reflected in this study’s use of the new Knowledge of Physical Activity and Dietary Intake Guidelines Survey (KOPA-DIGS-40)—as a True-False test with all True items; this follows from evidence the KOPA-DIGS-40 served as a brief online e-health intervention associated with increases in (1) knowledge of the guidelines and (2) self-efficacy for adherence to physical activity and dietary intake guidelines. Given the high rates of obesity, type II diabetes, cancer risk, heart disease and hypertension for African Americans, the findings make an important contribution to the literature—while suggesting future directions in research and interventions.

Changing trends within the mental health system treatment practices demand exploration of the cultural context of assessment and treatment of Black/African Americans. Culturally competent assessments include a realistic integration of historical context. Clinicians counseling Black/African Americans must be prepared to assess and address PTSD, racial trauma, micro-aggressions, and other known (or unknown) issues that may affect Black/African Americans. In addition, clinicians must be prepared for the depth and permanence of race-based stress and trauma, as well as the idea that said stress and trauma can result from unaddressed environmental, familial, and/or individual factors. The purpose of this study is to explore cultural competence in the practices of clinicians working with Black/African Americans clients as it relates to assessment, treatment and engagement. Through the exploration of current multicultural counseling and assessment trends, the study explores the origins of stress and trauma in American descendents of African slaves, and proposes an evaluation of clinicians' mental health assessment for PTSD with said clients based on those implications. Exploring to what extent a culturally-proficient clinician engages Black/African Americans clients from initial through on-going assessment and treatment process in conjunction with the professional literature on treatment practices, research suggests that Black/African American clients do suffer from intergenerational trauma and are often mis- or under-diagnosed for mental health issues. With proper assessment of Black/African Americans, the reduction of misdiagnosed or under diagnosed cases of Posttraumatic stress disorder (PTSD), as well as other mental health conditions will occur. / Graduation date: 2012