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Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels. Nativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites. •Non-Latino Whites most likely to have 12-month disorders, even with SES controls.•Link between race/ethnicity and mood disorder varied by nativity among Whites.•Race/ethnicity interacted with education, but not income, to predict prevalence.•Racial/ethnic minority groups had more persistent mood disorders than Whites.•Observed links to persistent mood and substance disorders varied by education level.

Purpose of Review The present review synthesizes recent literature on social determinants and mental health outcomes and provides recommendations for how to advance the field. We summarize current studies related to changes in the conceptualization of social determinants, how social determinants impact mental health, what we have learned from social determinant interventions, and new methods to collect, use, and analyze social determinant data. Recent Findings Recent research has increasingly focused on interactions between multiple social determinants, interventions to address upstream causes of mental health challenges, and use of simulation models to represent complex systems. However, methodological challenges and inconsistent findings prevent a definitive understanding of which social determinants should be addressed to improve mental health, and within what populations these interventions may be most effective. Summary Recent advances in strategies to collect, evaluate, and analyze social determinants suggest the potential to better appraise their impact and to implement relevant interventions.

Purpose There has been no comprehensive examination of how race/ethnicity and nativity intersect in explaining differences in lifetime prevalence of mental disorders among Asian, Black, Latino, and White adults. This study aims to estimate racial/ethnic differences in lifetime risk of mental disorders and examine how group differences vary by nativity. Methods Survival models were used to estimate racial/ethnic and nativity differences in lifetime risk of DSM-IV anxiety, mood, and substance use disorders in a nationally representative sample of over 20,000 respondents to four US surveys. Results Asians had the lowest lifetime prevalence of mental disorders (23.5%), followed by Blacks (37.0%), Latinos (38.8%), and Whites (45.6%). Asians and Blacks had lower lifetime risk than Whites for all disorders even after adjusting for nativity; Latinos and Whites had similar risk after adjusting for nativity. Risk of disorder onset was lowest for foreign-born respondents in years before migration. There were significant race/ethnicity and nativity interactions for mood and substance use disorders. Odds of mood disorder onset were higher for Whites with at least one US-born parent. Odds of substance use disorder onset among Asians were higher for US-born respondents; for Latinos, they were higher for those with at least one US-born parent. Conclusions Parental foreign-born nativity is associated with a low risk of mental disorders, but not uniformly across racial/ethnic groups or disorders. Exposure to the US context may be associated with greater mental disorder risk for Latinos and Whites particularly. Investigations of cultural processes, including among Whites, are needed to understand group differences.

About the Authors: Alexander C. Tsai * E-mail: actsai@partners.org Affiliations Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America, Harvard Medical School, Boston, Massachusetts, United States of America, Mbarara University of Science and Technology, Mbarara, Uganda ORCID logo http://orcid.org/0000-0001-6397-7917 Margarita Alegría Affiliations Harvard Medical School, Boston, Massachusetts, United States of America, Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ORCID logo http://orcid.org/0000-0003-2241-707X Steffanie A. Strathdee Affiliation: Division of Infectious Diseases and Global Public Health, University of California at San Diego School of Medicine, San Diego, California, United States of America ORCID logo http://orcid.org/0000-0002-7724-691X Citation: Tsai AC, Alegría M, Strathdee SA (2019) Addressing the context and consequences of substance use, misuse, and dependence: A global imperative. [...]although opioid prescribing patterns undoubtedly played a significant role in how opioid use disorders came to be so highly prevalent [27–29] and asymmetrically distributed in the US [30–32], a public health response that focuses solely on prescribing behavior is likely to be ineffective in reducing the number of fatal and nonfatal opioid overdoses. [...]called treatment cascade models have been used to identify gaps in the access and treatment continuum for a wide range of health conditions, including HIV treatment [43], prevention of mother-to-child transmission of HIV [44], depression [45], and, most recently, opioid use disorders [46]. [...]for people with opioid use disorders who either cannot or do not choose to achieve sustained remission, alternative approaches might be considered to reduce the harms associated with ongoing use.

The prevalence of mental disorders among Black, Latino, and Asian adults is lower than among Whites. Factors that explain these differences are largely unknown. We examined whether racial/ethnic differences in exposure to traumatic events (TEs) or vulnerability to trauma-related psychopathology explained the lower rates of psychopathology among racial/ethnic minorities. We estimated the prevalence of TE exposure and associations with onset of DSM-IV depression, anxiety and substance disorders and with lifetime post-traumatic stress disorder (PTSD) in the Collaborative Psychiatric Epidemiology Surveys, a national sample (N = 13 775) with substantial proportions of Black (35.9%), Latino (18.9%), and Asian Americans (14.9%). TE exposure varied across racial/ethnic groups. Asians were most likely to experience organized violence - particularly being a refugee - but had the lowest exposure to all other TEs. Blacks had the greatest exposure to participation in organized violence, sexual violence, and other TEs, Latinos had the highest exposure to physical violence, and Whites were most likely to experience accidents/injuries. Racial/ethnic minorities had lower odds ratios of depression, anxiety, and substance disorder onset relative to Whites. Neither variation in TE exposure nor vulnerability to psychopathology following TEs across racial/ethnic groups explained these differences. Vulnerability to PTSD did vary across groups, however, such that Asians were less likely and Blacks more likely to develop PTSD following TEs than Whites. Lower prevalence of mental disorders among racial/ethnic minorities does not appear to reflect reduced vulnerability to TEs, with the exception of PTSD among Asians. This highlights the importance of investigating other potential mechanisms underlying racial/ethnic differences in psychopathology.

Beliefs concerning the causes of mental illness may help to explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their white counterparts. This study applies the cultural influences on mental health framework to identify the relationship between race/ethnicity and differences in 1) beliefs on the cause of mental illness, 2) preferences for type of treatment, and 3) provider characteristics. Analyses were conducted using baseline data collected from participants who completed the cultural attitudes toward healthcare and mental illness questionnaire, developed for the Primary Care Research in Substance Abuse and Mental Health for the Elderly study, a multisite randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1,257 non-Latino whites, 536 African Americans, 112 Asian Americans, and 303 Latinos. African Americans, Asian Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared with non-Latino whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services.

Objectives: We assess whether posttraumatic stress disorder (PTSD) varies in prevalence, diagnostic criteria endorsement, and type and frequency of potentially traumatic events (PTEs) among a nationally representative US sample of 5071 non-Latino whites, 3264 Latinos, 2178 Asians, 4249 African Americans, and 1476 Afro-Caribbeans. Methods: PTSD and other psychiatric disorders were evaluated using the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) in a national household sample that oversampled ethnic/racial minorities (n = 16,238) but was weighted to produce results representative of the general population. Results: Asians have lower prevalence rates of probable lifetime PTSD, whereas African Americans have higher rates as compared with non-Latino whites, even after adjusting for type and number of exposures to traumatic events, and for sociodemographic, clinical, and social support factors. Afro-Caribbeans and Latinos seem to demonstrate similar risk to non-Latino whites, adjusting for these same covariates. Higher rates of probable PTSD exhibited by African Americans and lower rates for Asians, as compared with non-Latino whites, do not appear related to differential symptom endorsement, differences in risk or protective factors, or differences in types and frequencies of PTEs across groups. Conclusions: There appears to be marked differences in conditional risk of probable PTSD across ethnic/racial groups. Questions remain about what explains risk of probable PTSD. Several factors that might account for these differences are discussed, as well as the clinical implications of our findings. Uncertainty of the PTSD diagnostic assessment for Latinos and Asians requires further evaluation.

Provider shortages and lack of culturally responsive care limit mental health services in reaching multicultural populations worldwide. We examined the effectiveness of a psychoeducational intervention aimed at building community capacity to address depression and anxiety among racial, ethnic, and linguistic minoritised adults. Strong Minds–Strong Communities (SM–SC) was a 6-month, multicentre, longitudinal, randomised trial done in 37 community-based organisations and clinics in two US sites (Massachusetts and North Carolina). Adults aged 18 years and older speaking English, Spanish, Mandarin, or Cantonese, with moderate to severe depression or anxiety symptoms assessed using the Computerized Adaptive Test for Mental Health (CAT-MH), were eligible for inclusion. Participants were randomly assigned (1:1) to a psychoeducational intervention provided by community health workers or a usual care condition, which constituted receiving a US National Institutes of Health booklet about anxiety and depression. Both conditions included referrals for social determinants of health needs. Randomisation was stratified by site using computer-generated blocks of size 2. Investigators and participants were not masked to treatment allocation, but outcome assessors were. Primary outcomes were changes from baseline at months 6 and 12 in self-reported depression and anxiety symptoms using the Hopkins Symptom Checklist-25 (HSCL-25), level of functioning using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2·0), and perceived quality of care using the Global Evaluation of Care domain of the Perceptions of Care Outpatient Survey (PoC-OP) in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT04092777, and has been completed. From Sept 4, 2019, to March 3, 2023, 5265 potential participants were approached for study inclusion. 2681 were excluded and 2584 were assessed for eligibility. A further 1417 were excluded, and 1167 were deemed eligible for study inclusion. 1044 participants were randomly assigned, 524 to the SM–SC intervention and 520 to the usual care group. The mean age of participants was 42·6 years (SD 13·3) and 875 (83·8%) were female, 165 (15·8%) were male, and four (0·4%) were other. Between baseline and 6 months, intervention participants reported greater improvements in depression and anxiety symptoms (standardised effect size, 0·39 [95% CI 0·27–0·52]), functioning (standardised effect size, 0·28 [0·16–0·39]), and perceived quality of care (standardised effect size, 0·47 [0·31–0·62]). These greater improvements in depression and anxiety symptoms, functioning, and perceived quality of care attenuated but remained significant 6 months post-intervention (standardised effect sizes of 0·28 [95% CI 0·16–0·40] for depression and anxiety, 0·21 [0·08–0·33]) for functioning, and 0·33 [0·16 –0·50] for perceived quality of care). The intervention shows that a culturally adapted intervention can improve depression and anxiety symptoms in Black, Latino, and Asian populations and provides an alternative to mental health care shortages by building community capacity. National Institute of Mental Health. For the Spanish and Mandarin translations of the abstract see Supplementary Materials section.

Objectives. We examined rates of mental health–related service use (i.e., any, general medical, and specialty mental health services) as well as subjective satisfaction with and perceived helpfulness of care in a national sample of Asian Americans, with a particular focus on immigration-related factors. Methods. Data were derived from the National Latino and Asian American Study (2002–2003). Results. About 8.6% of the total sample (n=2095) sought any mental health–related services; 34.1% of individuals who had a probable diagnosis sought any services. Rates of mental health–related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation. US-born Asian Americans demonstrated higher rates of service use than did their immigrant counterparts. Third-generation or later individuals who had a probable diagnosis had high (62.6%) rates of service use in the previous 12 months. Conclusions. Asian Americans demonstrated lower rates of any type of mental health–related service use than did the general population, although there are important exceptions to this pattern according to nativity status and generation status. Our results underscore the importance of immigration-related factors in understanding service use among Asian Americans.

PurposeStudies document the substantial underutilization of mental health services by US Latinos in young adulthood. Rates of service use are higher in childhood, raising questions about whether mental health service use during childhood may facilitate access to services later in life. This article examines the extent to which utilization of mental health services in childhood is predictive of utilization in young adulthood among US Latinos.MethodsData come from the Boricua Youth Study, a longitudinal study of Puerto Rican youth at two sites (South Bronx, New York, and the standard metropolitan area of San Juan, Puerto Rico). Data were collected in three waves during childhood (ages 5–13; surveyed 1 year apart), with an approximately 11-year follow-up in young adulthood (ages 16–29). In childhood, parents reported on youth mental health service use (Waves 1–3). In Wave 4, as youth transitioned to young adults (N = 2004), they reported on their past year mental health service use.ResultsWhereas 30.2% of parents reported their child received mental health services, only 3.5% of young adults reported mental health service use in the past year. After controlling for young adult disorders and their severity, childhood disorders were associated with increased likelihood of mental health service use in young adulthood. Childhood mental health service use was also associated with young adult service use; however, this association attenuated when controlling for childhood disorders.ConclusionFindings suggest the importance of specifically considering childhood disorders in understanding mechanisms for improving access to mental health services among Latino young adults.