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Running head: PSYCHOLOGICAL TESTS DISPARITIES AMONG MINORITIES

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PSYCHOLOGICAL TESTS DISPARITIES AMONG MINORITIES

LITERATURE REVIEW

Introduction

Mental health problems have a significant impact on society. People suffering from mental disorders face stigma and discrimination. It makes their problems worse and more challenging to seek mental health care. People possess unique personalities with individual differences. Psychometric tests are powerful measures of human characteristics. Individuals show varied interests, stamina, and temperaments (Smith & Smith, 2005). With their different personalities and temperaments, the expression of their mental illness may also vary.

Mental health professionals assess mental disorders through various methodologies, including behavioral observation, questionnaires, and standardized psychological tests. These psychological tools play a critical role in assessing and measuring psychological problems such as depression, anxiety, or stress. Some tests are objective, and others are subjective. Psychologists use tests according to the requirements. Problems arise when these tests are standardized for one population and are used to assess a different population's presenting problems. Disparities among racial and ethnic groups is a serious challenge. Disparities, as defined earlier, are the difference between groups in terms of accessing mental health facilities based on preference or groups.

According to (Sashidharan, 2003) “people from Black and Minority Ethnic (BME) communities are susceptible to have relatively poor health outcomes, difficulty in accessing healthcare facilities as compared to the majority of the population, which is a significant concern. This is a global issue in the United States, marked ethnic disparities and variations are widely reported among the BME community. Although the National Institute on Minority Health and Health Disparities acknowledges the need for culturally sensitive tools, the services currently being provided are inadequate.

There has been a significant focus on different aspects of mental health services. Many studies report different test results when applied to subgroups. It is acknowledged that monitoring and examining minority health issues have been inadequate, and there is more research is required in this area (Sashidharan, 2003).

Psychological assessment of mental disorders and tests disparities among African Americans

Based on the literature review that follows, it is evident that there are disparities among minorities, especially African Americans. The psychological assessment of mental disorders for African Americans require more research and evidence-based evaluations.

The Effects of Discrimination on Mental Health

Most clinical decisions are based on psychological assessments; therefore, it is crucial to highlight the disparities in psychological assessment and treatment because of cultural biases. In this study, psychological testing disparities among African Americans will be focused on and how these disparities cause anxiety symptoms in African American's. African Americans were specifically selected for the study because, according to U.S. Census 2019, they make up to 13.4% of the total American population, and their history can be traced back to over two hundred years. African Americans' historical background was primarily based on slavery, the impact of which is still faced by many African Americans today.

(Canedo, Miller, Schlundt, Fadden, & Sanderson, 2018) studied Blacks, Hispanics, and Asians and discrimination faced by them to receive quality care for diabetes in the United States. They collected cross-sectional data from adults diagnosed with Type 2 diabetes examining by race/ethnicity. They observed the difference in adherence to the yearly care recommendations (foot exam, eye exam, HbA1c twice yearly, flu vaccination, and blood cholesterol level). They evaluated three social constructs (poverty, health insurance, and education) alongside in their study. The results showed that compared to Whites, a smaller number of Hispanics, Black, and Asians went through yearly tests. Lack of insurance and education explained to them appeared as major social constructs to keep them from getting quality care.

Racial discrimination and its effects on physical health

Another study (Hoggard & Hill, 2018) investigated how racial discrimination affects sleep quality. They included dual components of Perseverance Cognition (P.C.) as a candidate functional mechanism in the connection between subjective sleep quality and racial discrimination. Sixty-eight African American college students participated in the study. The participants were asked to fill the Penn State Worry Questionnaire (PSWQ), Pittsburgh Sleep Quality Index (PSQI), Perceived Ethnic Discrimination Questionnaire (PEDQ), and Ruminative Responses Scale (RRS). The result highlighted a positive association between racial discrimination and rumination, which was related to poor sleep quality. The results suggested that poor sleep is one of the many causes of depression, heart diseases, and several other illnesses.

Mental Health Service and equal accessibility

(Alegria, Vallas, & Pumariega, 2010) also discussed racial and ethnic disparities in pediatric mental health. They pointed out the enormous gap in unmet need for care for ethnic minority youth. "There is minimal literature on treatment preferences among minorities and their families, and it underscores the importance of developing a line of inquiry." An accurate assessment of psychopathologies is critical to diagnose and treat the problems. It is essential to understand the disparities in testing protocols among minorities. However, it is a complex challenge to find and mitigate these biases. (Gray-Little, 2009) examines various conceptual problems connected to assessing minority groups. The author also reviewed ethnic and racial preference about frequently asked adult-assessment tools.

(Jallo et al., 2015) investigates in their study prevalence and predictors of depressive symptoms among African American women population. They were between 14-17 weeks pregnant, a time period that is generally considered critical in overall well-being. The results indicated a significant interaction between the State-Trait Anxiety Inventory (STAI) and the Perceived Stress Scale (PSS) other than predicting depressive symptoms and anxiety. The study further suggests and recommends the early detection and intervention of anxiety and depression in the group. In another similar study conducted by (Walton & Payne, 2016), African Americans were underdiagnosed with major depressive disorder compared to Whites. There are very few researches that explore the gender-based differences in depressive symptoms expression among African Americans. In this study, the researchers analyzed symptom expression differences through social constructs of health structure. They highlight the need to investigate the diagnostic issues of mental illness more accurately.

Factors affecting anxiety outcomes in African Americans

Certain risk factors influence anxiety outcomes and contribute to differences. (Hopkins & Shook, 2017) highlighted some factors as the salience of physical illnesses, stigma towards mental illnesses, discrimination, ethnic identity, and religiosity. The authors also reviewed the literature related to each of these factors. Ethnic identity and stigma for mental maladies were found as the most potent elements underlying disparities in anxiety. These two factors were consistently differed by racial/ethnic groups and were linked with anxiety in African Americans. Stigma towards psychological illnesses may negatively affect African Americans to report anxiety symptoms. Ethnic identity may work as a buffer against the adverse outcomes of anxiety decreasing frequency in African Americans. It overall reduced the prevalence rate, but there was an increase in the severity of treated cases. The other factors, including discrimination, religiosity, and salience of physical illnesses, need more research to obtain clarify.

Racial micro hostilities

Though researches and studies established a clear link between racial micro hostilities and factors of psychological disorders, it was (Williams, 2018) who examined the link between the self-examined experience of micro hostilities and mental health consequences such as stress and trauma symptoms among the African American and European American college students. This particular study showed that African Americans are more prone to ethnic discrimination than European American students, and experience of discrimination is linked with negative affectivity among African Americans. Furthermore, the study established a strong link between ethnic exploitation and symptoms of psychopathology.

Beck Anxiety Inventory (BAI) and its results for the African American community

Beck Anxiety Inventory (BAI) is an adequate inventory to assess anxiety symptoms. It is a brief, criterion-referenced tool. According to (Chapman, Williams, Mast, & Woodruff-Borden, 2008), anxiety literature is incredibly limited and inadequate, and there is minimal research that has investigated the factor structure of anxiety assessment tests within the population of African Americans. They examined the two-factor structure of the BAI in a non-clinical sample of American African. There were one hundred twenty-one European American and one hundred African American adults who completed the BAI. The results indicated the BAI's previous factor analysis does not deliver the best fit for both the populations.

(Chapman, 2014) This book offers a context based on which the impact of cultural, ethnic, and race factors on adult psychopathology is analyzed. In this study, the salient features of the culture, such as morals, philosophies, and behaviors, are integrated while treating psychopathology. Moreover, the study proposes some multiethnic factors that should be integrated into the process while assessing the minorities. The objective of this study is to allow mental health professionals to recognize the impact of cultural factors.

Furthermore, (Chapman L. K., 2015) the study highlighted that the concept of social fear among African Americans is change than the non-Hispanic Whites, and it inspected the clinical usefulness of these degrees to predict the anxiety diagnoses, specifically social fright. For study 65, African American adults completed three surveys and one questionnaire, and it was established that 23 out of 65 African American were detected with social anxiety. The outcomes suggested that factors of social anxiety are highly prognostic of social fear diagnosis. Furthermore, it was established that screening for social phobia among African Americans, the social fear factors, and their measurements could be utilized.

Discussion

Indeed, there is a need for an integrated understanding of racism's functional operation at all levels. It provides a more comprehensive and broader identification of how racisms shape social constructs, a powerful and primary framework for understanding race/ethnic disparities generally. (Sashidharan, 2003) suggests that the neglect of such a thorough assessment for mental disorders has “led to the failure of the development and implementation of policy in this area, as evidenced by the outcomes of the Inside Outside report." The literature above mentioned provides a detailed insight to develop standardized tools, and this study is trying to develop the Beck Anxiety Inventory more valid regarding the African American community.

Theoretical Perspective

Among researchers, bias and polarization is a common problem. According to (Pérez-Stable, 2020), race and ethnicity are "social constructs" that connect with self-identity and surrounds culture, history, traditions, and values equally. These social constructs pose a serious impact and real. The appearance, skin color, language, social class all have their influence on developing this construct. In the United States, racial and ethnic minorities face disparities and uneven treatment. National Institute on Minority Health and Health Disparities has funded many types of research and studies to investigate the problems and their solutions. There are certain social conditions responsible for health disparities that affect African Americans. They usually live in areas where access to health services is limited. They are more exposed and vulnerable to develop physical and mental illnesses. There are limited educational opportunities for them, and due to employment discrimination, they get low-paid jobs with no health insurance. They are more susceptible to suffering from psychological distress, including anxiety and depression. Hence, it is essential to address the issue and assess the mental illness according to the population.

Summary

The current literature collects evidence about problems that arise in racial and ethnic bias and the impact on evaluation and assessment procedures of psychological disorders. Several studies support more room to conduct additional studies to reduce disparities and bias among minorities, especially African Americans, as they make 13% of the total population of the U.S. Multiple factors contribute that affect the reporting and then overall data collection. The researches support developing and generating awareness and policies to minimize the stigma attached to mental health problems.

References Alegria, M., Vallas, M., & Pumariega, A. J. (2010). Racial and Ethnic Disparities in Pediatric Mental Health. Child and Adolescent Psychiatric Clinics of North America, 759-774. Canedo, J. R., Miller, S. T., Schlundt, D., Fadden, M. K., & Sanderson, M. (2018). Racial/Ethnic Disparities in Diabetes Quality of Care: The Role of Healthcare Access and Socioeconomic Status. J Racial Ethn Health Disparities, 7-14. Chapman, K. L., Williams, S. R., Mast, B. T., & Woodruff-Borden, J. (2008). A Confirmatory Factor Analysis of the Beck Anxiety Inventory in African American and European American Young Adults. J Anxiety Disord, 387-392. Chapman, L. K. (2014). Impact of race, ethnicity, and culture on the expression and assessment of psychopathology. In Adult psychopathology and diagnosis. Adult psychopathology and diagnosis. Chapman, L. K. (2015). The Efficacy of Self-Report Measures in Predicting Social Phobia in African American Adult. Journal of the National Medical Association. Gray-Little, B. (2009). The Assessment of Psychopathology in Racial and Ethnic Minorities. In J. N. Butcher, Oxford book of Personality Assessment. Oxford: Oxford University Press. Hoggard, L. S., & Hill, L. K. (2018). Original Articles Examining How Racial Discrimination Impacts Sleep Quality in African Americans: Is Perseveration the Answer? Behavioral Sleep Medicine, 471-481. Hopkins, P. D., & Shook, N. J. (2017). A review of sociocultural factors that may underlie differences in African American and European American anxiety. Journal of Anxiety Disorders, 104-113. Jallo, N., Elswick Jr., R. K., Kinser, P., Masho, S., Price, S. K., & Svikis, D. S. (2015). Prevalence and Predictors of Depressive Symptoms in Pregnant African American Women. Issues in Mental Health Nursing, 860-869. Pérez-Stable, E. J. (2020, June 12). Racism and the Health of Every American. Retrieved from named: https://www.nimhd.nih.gov/resources/health-info.html Sashidharan, S. P. (2003). Inside outside: improving mental health services for black and minority ethnic communities in England. Mental Health Review Journal, 22-25. Smith, M., & Smith, P. (2005). Testing People At Work: Competencies In Psychometric Testing. Oxford: Uk: Wiley-Blackwell. Walton, Q. L., & Payne, J. S. (2016). Missing the mark: Cultural expressions of depressive symptoms among African-American women and men. Social work in Mental Health, 637-657. Williams, M. T. (2018). Anxiety, stress, and trauma symptoms in African Americans: Negative affectivity does not explain the relationship between microaggressions and psychopathology. Journal of racial and ethnic health disparities.