Table 3 shows the results of four regression equations predicting respondent beliefs about the effectiveness of treatment. We did not include family income, education, or the vignette version schizophrenia vs. Equation 2 shows controls for age, gender, the perception that the condition will improve on its own, and the seriousness of the condition.
The number of cases differs slightly for each dependent variable because we excluded respondents with missing data on those variables. Missing values for predictor variables were replaced using conditional mean imputation Allison Figure 1 presents these relationships in diagrammatic form and shows that for African Americans, believing a mental illness will improve on its own was unrelated to the beliefin the effectiveness of mental health professionals. Across all levels of belief in the natural course of mental illness, the sentiment that mental health professionals can help remained high for African American respondents.
For Caucasians, however, as the belief that mental illness will improve on its own decreased, the belief that a mental health professional can help increased. The modifying effects of beliefs about the natural course and seriousness of mental illness on perceived treatment effectiveness.
African Americans, on the other hand, endorse the effectiveness of mental health professionals regardless of perceived illness severity. The purpose of the present study was to shed light on racial differences in mental health help-seeking by examining differences between African Americans and Caucasians in their beliefs about the effectiveness of mental health pro-fessionals, and the severity and natural course of mental illness.
Consistent with Schnittker et al. Even though studies consistently demonstrate that African Americans underutilize voluntary mental health services e. If anything, African American attitudes about treatment are more favorable than those of the Caucasian majority. Consistent with other literature on public attitudes about mental health treatment Diala et al. We also examined whether African Americans differ from Caucasians in their views on the natural course of mental illness.
We found that a higher percentage of African Americans compared to Caucasians believed that mental illness conditions will improve on their own. This describes the situation for Caucasians in the sample and may partly explain why African Americans are less likely to utilize mental health treatment notwithstanding their more positive endorsement of professional care. African Americans may also believe mental illness will remit without professional intervention rendering mental health treatment effective but unnecessary.
Furthermore, we found that for African Americans, the belief in the effectiveness of treatment was not at all related to beliefs about the course of illness or the severity of illness. For Caucasians, the belief in the effectiveness of mental health professionals was inversely related to the belief that the condition would improve on its own and positively related to the belief that the condition was serious. Our analyses revealed an interesting pattern of results. We consistently found strong endorsement of the mental health system among African Americans regardless of other beliefs about the nature of mental illness.
These results do not fully explain the discrepancy for African Americans between beliefs in the effectiveness of mental health treatment and actual help seeking. However, our investigation does add to the explanation. For Caucasians, the belief about the effectiveness of professional mental health care is partially contingent upon beliefs that the said illness is serious and unlikely to improve without treatment. While one might expect this unwavering endorsement of psychologists, psychiatrists and social workers to translate into increased service use, it is possible that African American beliefs in the likelihood of remittance without professional help undermine their more positive attitudes toward the benefits of seeking care: Why invest the time, energy and money involved in seeking professional treatment when the illness may be transitory?
Spirituality and mental health
Research suggests that African Americans are more likely to seek extended family networks and spiritual help when faced with emotional problems Blank et al. It is possible that the belief that mental illness will improve without professional mental health intervention is related to the belief that mental illness intervention can improve via other non-professional means e.
The present study does not have data to test this explicitly, but given the importance of family and religion in African American culture Boyd-Franklin , future large community studies should assess the extent to which endorsement of non-professional means of mental health care may help explain our findings. Researchers as well as practitioners working in African American communities must begin to identify factors that undermine these positive expectations about mental health treatment and result in the pattern of African American service underutilization so often identified by large, representative epidemiological studies.
Some research suggests that positive, pre-treatment attitudes diminish once contact with mental health professionals is made Diala et al. This type of therapeutic interaction may give rise to factors such as feelings of cultural mistrust among African American clients, thus eroding initial positive feelings toward treatment. Cultural mistrust has been shown to lead to increased drop-out and decreased client satisfaction among African Americans in treatment Nickerson et al. More attention should be focused on the dynamics between practitioners and African American clients that might reverse pre-treatment positive attitudes toward therapy.
Spirituality and mental health
The present study has strengths that add to the literature but is not without limitations. First, two inherent limitations of the vignette experiment should be noted. The vignettes describe specific scenarios, necessarily limiting our ability to generalize to all cases of mental illness. In addition, respondents were asked questions about a hypothetical individual and not themselves. It is possible that answers to questions about oneself might differ from answers about the vignette subject. Nevertheless, it is reasonable to suppose that stated feelings about the effectiveness of mental health professionals would have some bearing on whether respondents feel it would be effective for themselves.
The findings suggest that, although African Americans are at least as likely as Caucasians to believe mental health professionals can alleviate mental illness, this belief may not have the same implications for service utilization as it does for the Caucasian majority. We found that for African Americans, this belief was not related to other beliefs about the nature of mental illnesses that would likely increase the probability of service utilization. Furthermore, Caucasians actually seek treatment more frequently than African Americans. In fact, this belief may have nothing to do with whether an African American will actually go to a mental health professional, and so the belief that a professional can help should not necessarily be equated with more positive attitudes about seeking treatment.
If the goal is to improve service utilization for African Americans, the results of this current research suggest the focus of outreach efforts should be on educating communities about the course of mental illness and its potentially chronic nature. Even though African Americans may believe treatment can help, they might think it is not necessary to rectify problems and instead may believe obtaining help from family members or spiritual leaders Blank et al.
Creating more alliances between spiritual and religious sectors of the African American community and mental health sectors may be a place to begin educating the community about when professional mental health treatment is really necessary. Crafting messages that reinforce positive expectations is a start, however, more attention needs to be focused on ways in which clienttherapist interactions can maintain these positive expectations in the face of the mistrust and wariness that treatment may engender.
While our data do not allow us to test the impact of these beliefs on service utilization directly, our findings represent a relevant addition to the discussion.
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Specifically, they suggest that cultural differences in conceptions of mental illness are complex and thus research efforts should spend more time examining beliefs about mental illness. Further research needs to explore how conceptions of mental disease, particularly about the course of illness, may hinder seeking services. Research examining how beliefs about mental illness may delay treatment seeking should be conducted in clinical populations. African Americans may enter services too late because they think the symptoms will get better on their own, and this may lead to poorer psychiatric outcomes.
This area of research needs further exploration.
In sum, campaigns designed to increase awareness about the benefits of mental health treatment are designed with the assumption that people will feel a need to go because it is so useful. These efforts may be misguided for African Americans because there is no real relationship between endorsing mental health treatment and believing mental health treatment is necessary.
Our results suggest a way in which community psychologists and outreach activists could modify mental health awareness strategies and interventions to be more appropriate and relevant for African Americans. National Center for Biotechnology Information , U. Am J Community Psychol. Author manuscript; available in PMC May 5. Anglin , Philip M. Alberti , Bruce G. Link , and Jo C. The publisher's final edited version of this article is available at Am J Community Psychol. See other articles in PMC that cite the published article. African Americans, Beliefs, Mental health, Treatment effectiveness.
Methods Sample and Procedures The goal of the parent study was to assess the impact of genetic attributions for mental illness on stigmatizing attitudes in a multi-ethnic sample of Americans African-Americans, Caucasians, Mexican-Americans, Chinese-Americans and Puerto Ricans. The Vignettes Respondents were randomly assigned to hear one vignette describing a hypothetical person with major depressive disorder, schizophrenia, or one of a number of physical illnesses.
Measures Dependent Variables Three single item measures were used as dependent variables. Covariates We control for sociodemographic variables that were found to be correlates of race that could account for any racial differences in attitudes about mental illness and its treatment. Results Table 1 shows the distribution of African American and Caucasian responses to the item about mental health pro-fessional effectiveness and the two items about whether mental illness conditions are serious and will not improve on their own. Table 1 Percentages of African Americans and Caucasians endorsing dependent variables.
Open in a separate window. Table 2 Bivariate correlations between dependent variables for combined sample and stratified by race. Table 3 Summary of regression analyses for mental help effectiveness. Variables A mental health professional can help the condition Equation 1 Equation 2 Equation 3 Equation 4 b s. Discussion The purpose of the present study was to shed light on racial differences in mental health help-seeking by examining differences between African Americans and Caucasians in their beliefs about the effectiveness of mental health pro-fessionals, and the severity and natural course of mental illness.
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Potential Limitations The present study has strengths that add to the literature but is not without limitations. Conclusions and Implications The findings suggest that, although African Americans are at least as likely as Caucasians to believe mental health professionals can alleviate mental illness, this belief may not have the same implications for service utilization as it does for the Caucasian majority. Contributor Information Deidre M. Sage Publications; Thousand Oaks, California: Racial differences instigmatizing attitudes about people with mental illness: The practice of social research.
Alternative mental health services: The Role of the Black church in the South. American Journal of Public Health. Black families in therapy: Understanding the African American Experience. Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology.
Statistical power analysis for the behavioral sciences. Identification of patient attitudes and preferences regarding treatment of depression. Journal of General Internal Medicine. Race, gender, and partnership in the patient-physician relationship. Journal of the American Medical Association.
On the definition of response rates. Racial differences in attitudes towards professional mental health care and in the use of services. American Journal of Orthopsychiatry. The Tuskegee Syphilis experiment. The Free Press; New York: Archives of General Psychiatry. The month prevalence and correlates of serious mental illness SMI In: Mental health, United States. Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders.
Teaching social inequalities in health: Scandinavia Journal of Public Health. Anxiety disorders research with African Americans: The importance of spirituality in mental health is now widely accepted. As John Turbott[ 1 ] puts it, rapprochement between religion and psychiatry is essential for psychiatric practice to be effective.
The American College of Graduate Medical Education mandates in its special requirements for residency training in Psychiatry, that all programs must provide training in religious and spiritual factors that can influence mental health. The World Psychiatric Association recently established a section on psychiatry and religion.
I understand that the Indian Psychiatric Society has formed a task force on spirituality and mental health which is urging the Medical council of India to include taking the spiritual history as part of psychiatric evaluation. Even so the importance of religion and spirituality are not sufficiently recognized by the psychiatric community. Religion does not have a place in most of the psychiatry text books. Only very few psychiatrists make use of religion and spirituality in the therapeutic situation. This paper makes an attempt to bring out the importance of spirituality in mental health.
Spirituality is a globally acknowledged concept. It involves belief and obedience to an all powerful force usually called God, who controls the universe and the destiny of man. It involves the ways in which people fulfill what they hold to be the purpose of their lives, a search for the meaning of life and a sense of connectedness to the universe. The universality of spirituality extends across creed and culture.
At the same time, spirituality is very much personal and unique to each person. It is a sacred realm of human experience. Spirituality produces in man qualities such as love, honesty, patience, tolerance, compassion, a sense of detachment, faith, and hope.
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Of late, there are some reports which suggest that some areas of the brain, mainly the nondominant one, are involved in the appreciation and fulfillment of spiritual values and experiences. Religion is institutionized spirituality. Thus, there are several religions having different sets of beliefs, traditions, and doctrines. They have different types of community-based worship programs.
Spirituality is the common factor in all these religions. It is possible that religions can lose their spirituality when they become institutions of oppression instead of agents of goodwill, peace and harmony. They can become divisive instead of unifying. History will tell us that this had happened from time to time. It has been said that more blood has been shed in the cause of religion than any other cause.
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The medieval holy wars of Europe; the religion-based terrorism and conflicts of modern times are examples. We must remember that the institutions of religion are supposed to help us to practice spirituality in our lives. They need periodical revivals to put spirituality in place. Mental health has two dimensions—absence of mental illness and presence of a well-adjusted personality that contributes effectively to the life of the community. Ability to take responsibility for one's own actions, flexibility, high frustration tolerance, acceptance of uncertainty, involvement in activities of social interest, courage to take risks, serenity to accept the things which we cannot change, courage to change the things which we can change, the wisdom to know the difference between the above, acceptance of handicaps, tempered self-control, harmonious relationships to self, others, including Nature and God, are the essential features of mental health.
Spirituality is an important aspect of mental health. Religion is important, directly and indirectly, in the etiology, diagnosis, symptomatology, treatment and prognosis of psychiatric disturbances. Lack of spirituality can interfere with interpersonal relationships, which can contribute to the genesis of psychiatric disturbance. Psychiatric symptoms can have a religious content. For example, the loss of interest in religious activities is a common symptom of depression.
Too much and distorted religious practices are common in schizophrenia. It is well recognized that some religious states and experiences are misdiagnosed as symptoms of psychiatric illness. Visions and possession states are examples. The spiritual background of the patient will help in the diagnosis of psychiatric disturbance. They are important in the treatment of psychiatric disturbance because spiritual matters can be profitably incorporated in psychotherapy. Spirituality is important in the prognosis of psychiatric conditions. In the spiritual perspective, a differentiation must be made between cure and healing.
Cure is the removal of symptoms. Healing is the healing of the whole person. Adversity often produces maturity. Hence in psychotherapy, the patient must be helped to accept the handicap and transform the handicap to a life of usefulness. Recent studies show that religious beliefs and practices are supportive to cope with stresses in life and are beneficial to mental health. Thomas Ashby Wills,[ 6 ] Professor of Epidemiology and population health at Albert Einstein College of Medicine developed a scale that determines how important is religion to people.
This was administered to children in New York. It was found that religiosity kept children from smoking, drinking and drug abuse by buffering the impact of life stresses. Brody,[ 7 ] a research professor of child and family development at the University of Georgia, Athens, found that parents who were more involved in church activities were more likely to have harmonious marital relationships and better parenting skills.
That in turn enhanced children's competence, self-regulation, psychosocial adjustment and school performance. They also reported that low level of religiosity was associated with substance abuse in the offsprings.
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Scott Tonigan,[ 10 ] a research professor of psychiatry at the University of New Mexico, followed up patients of alcohol dependence and reported that spirituality predicts behavior such as honesty and responsibility which in turn promoted alcohol abstinence. Wagner and King[ 11 ] conducted a study involving three groups—one group of patients who had psychotic illness, one group of formal care givers, and a third group of informal caregivers. The existential needs were the most important for the patient group, while the other groups considered material needs such as housing and work as more important.
Neeleman and King[ 12 ] surveyed the psychiatric practices of psychiatrists in London. In an Australian survey, a large majority of patients with psychiatric illness wanted their therapists to be aware of their spiritual beliefs and needs and believed that their spiritual practices helped them to cope better. They reported that majority of the parents believed that spiritual concerns were important and that therapists should consider their spiritual beliefs in the management of the problems of the children.
In USA, Curlin et al. Several empirical studies on psychiatrists' religious characteristics have indicated that psychiatrists are significantly less religious than the general population, their patients and other physicians. A study on the factors in the course and outcome of schizophrenia was conducted in the Department of psychiatry, Christian Medical College, Vellore..
It was a collaborative study among three centers—Vellore, Madras and Lucknow. A two-year and five-year follow up showed that those patients who spent more time in religious activities tended to have a better prognosis. The sense of hope and spiritual support that patients get by discussing religious matters help them to cope better. They also suggest that the importance of religion and spirituality is not sufficiently recognized by the psychiatric community.
Mental health workers must take it seriously since psychiatry cannot afford to ignore the importance of spirituality and religion in psychiatry. Sims[ 22 ] gives two case histories which drives home this fact. One is the case of Jim who suffered from Korsakov's psychosis. He was so deteriorated that he mistook his wife for a hat. In the ward, others considered him as desolate individual.
But his behavior in the chapel was normal. In absolute concentration and attention, he would partake Holy Communion. He did not forget anything nor did he show any signs of Korsakov's psychosis. The other patient had chronic schizophrenia. He used to hear a voice commanding him to jump out of the window. His simple devout mother had taught him to resist the voice by praying to God.
His mind was destroyed, but the capacity for spiritual life was present. Unfortunately, on the final occasion, he was too late to pray and he lost his life. She has suggested that it is the responsibility of psychiatrists to remind the medical fraternity the necessity of putting back the soul in medical ethics and the fact that spirituality is of vital importance for the mental health of people. As pointed out earlier, spiritual values and religious practices are important in the lives of our patients.
Many of their problems may centre round existential preoccupations. It is therefore important that we incorporate spirituality and religious practices in our treatment protocol. We must propagate the Bio-psycho-socio-spiritual model in our approach in psychiatry. Harold Koening,[ 26 ] in his paper Religion and Mental health: This is a treatment technique, incorporating spiritual values to Cognitive behavior therapy, which was developed and promoted at the University of Sydney.
Four key areas are emphasized—acceptance, hope, achieving meaning and purpose and forgiveness. The patient is guided through five phases to achieve meaning and purpose. This starts with examining the inevitables of life such as birth and death. After desensitizing the patient to mortality, the patient is moved to the next phase of letting go of fear and turmoil in life. The next phase examines the patient's lifestyle aspects that avoid confronting mortality and perpetuate fear and turmoil. The next phase involves a focus on seeking divine purpose, after examining and accepting one's journey in life.
Finally, meaning is sought by seeking meaning for each day. This is achieved by identifying meaningful and realistic factors within whatever limitations life and illness bring. The main techniques are empathic listening, facilitation of emotional expression and problem solving. The use of meditation, prayers and rituals together with monitoring effects of beliefs and rituals on symptoms form the behavioral components of the treatment. When the patient shows negative cognition, cognitive restructuring is employed. Generally, the treatment takes about 16 sessions, each lasting about 1 hour.
The main indications are depression and adolescent problems. National Center for Biotechnology Information , U. Journal List Indian J Psychiatry v. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Psychiatric history should be catered to the patients' spiritual orientation and religious practices.
When we take psychiatric history, we usually ask for the denomination the patient belongs.