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Research Round-up

Black Patients’ Mental Illness Goes Undetected

African-American patients in mental distress usually seek treatment in primary care medical settings as opposed to specialty care. This was the conclusion of a recent study conducted by Howard University researchers published in the Journal of the National Medical Association.

Black patients often may not discuss their mental problems, researchers say, and in many cases the mental disorders are unrecognized by the provider.

According to Dr. Tanya Alim, 50 percent of patients in primary care practices at the Howard University Hospital were found to have been exposed to severe, often life-threatening trauma. More than half of these individuals developed post-traumatic stress disorder, the severe anxiety disorder seen in combat veterans. More than one-third developed severe depression.

In a report to the International Journal of Bipolar Disorder, Dr. Elaine Graves found that 10 percent of the African-American population had bipolar disorder or were manic depressive, meaning they needed psychiatric treatment. Almost none of the patients received treatment for the disorders, often because the disorders were not recognized. These findings are consistent with other reports of mental disorders in general medical settings.

These studies underscore the importance of screening for mental disorders in primary care clinics and developing funding and referral systems that allow access to specialty mental health services.

The research at Howard was supported by a grant from the National Institute of Mental Health with Dr. William B. Lawson as principal investigator.

Black Neighborhoods in New York Twice as Likely to Report Poor Health

In a study examining the relationship between racial/ethnic neighborhood concentration and self-reported health, researchers at Columbia University’s Mailman School of Public Health found that individuals living in neighborhoods with a high concentration of Blacks were twice as likely to report poor health when compared to their counterparts living in neighborhoods with a lower concentration of Blacks. 

The study, “Racial/ethnic neighborhood concentration and self-reported health in New York City,” will be published in the autumn 2006 edition of Ethnicity and Disease, and is based on data from more than 2,800 people who self-identified as White, Black, Hispanic or Asian. 

“We used proportion of Black residents living in a zip code as a measure of residential segregation. Residential segregation is the damaging form of racial discrimination in this country and one that affects everyone regardless of their race or ethnicity,” says Dr. Luisa N. Borrell, an assistant professor of epidemiology at the Mailman School of Public Health and co-author of the study.

People living in neighborhoods heavily concentrated with Blacks were more likely to report their health as poor (27 percent) when compared to counterparts living in low (17 percent) and medium Black concentrated neighborhoods (22 percent). Living in a neighborhood with a high concentration of Blacks, regardless of individuals’ race or ethnicity, education, income or access to health insurance resulted in a two-fold increased chance that residents would report poor health, the report says. This finding persisted even after additional adjustments for the socioeconomic circumstances of the neighborhoods and the individual’s perception of their own neighborhoods.

“Segregated neighborhoods tend to suffer from concentrated poverty, economic disinvestment and a lack of health resources. It is important to continue to determine the neighborhood elements that may facilitate or impede health,” says Kellee White, a doctoral student in the department of epidemiology at the Mailman School and study co-author.

Minority Medical Students Experience Lower Quality of Life Than Peers

A new study published in Mayo Clinic Proceedings has found that minorities, who account for only 8 percent of the physician work force, experience less personal satisfaction during medical school than non-minority students.

More than 1,000 students from three Minnesota medical schools were surveyed and minority students were found to have a lower sense of personal accomplishment and quality of life than their non-minority peers. They were more likely than non-minority students to have experienced a personal illness in the past year and to have children, both stressors that could impact their quality of life and sense of accomplishment.

The study’s authors say improving well-being among minority medical students is key to promoting diversification in the physician work force. Further study is warranted to assess how to aid minority students during their education to prevent attrition, says Dr. Liselotte Dyrbye, the study’s lead author.

“Further research exploring medical school experience of minority students is needed to help understand the barriers to development of a racially and ethnically diverse physician workforce,” says Dyrbye. “Understanding these barriers will hopefully result in support programs and other interventions that will improve both the quality of life of physicians in training and maximize their learning.”

Stress among medical students was the subject of a second article that concluded a pass-fail grading method produces less stress among medical school students than the traditional A-F grading method, without affecting scores on standardized exams.

As a component of the study, the grading system for Mayo Medical School students was changed to pass-fail in 2006. Study authors note that these students experienced less stress and had greater group cohesion than students who received the equivalent of A-F grades in 2005.

“The quality of future health care is dependent upon the creation of psychologically healthy physicians who work cooperatively in multidisciplinary teams,” says Dr. Daniel Rohe, lead author of the second study. “Pass-fail grading enhances learning the critical social skills required to function effectively in multidisciplinary health teams.”

— Diverse staff reports

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