Minority Mental Health

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From Helping Give Away Psychological Science at the University of Maryland, College Park. Team: Wilson Lazo-Salmeron, Madelyn Harris, Jolie Chaleff, Hannahlise Wang and Hide Okuno

Identity is the way an individual sees themselves independently from and in relation to others. Identity may include personal and social ascriptions, for example an individual's favorite music, birth order, and self-description (personal identity ascriptions), and gender, sex, and race (social identity groups).^[1] Identity is developed and differentiated over the lifespan, with adolescence and early adulthood being particularly crucial periods. However, identity development may be difficult for individuals of marginalized identities because of the social pressures they face (i.e. minority stress).^[2]

Development of sexual identity involves the synthesis of an individual’s sex, gender identity, sex role (adherence to social values regarding sex), sexual orientation, and intention/valuative framework.^[3] The six stages of Cass' (1979) homosexual identity development and synthesis are " identity confusion (early connections between one’s experiences of same-sex attraction and the topic of homosexuality), identity comparison (beginning to accept that one may not be heterosexual with respect to one’s attractions), identity tolerance (admitting not the possibility but the probability that one has a homosexual orientation), identity acceptance (characterized by increased contacts with others who have identified with their experiences of same-sex attraction), identity pride (moving from acceptance to preference for one’s same-sex attractions and identity) and identity synthesis (relinquishing any 'us versus them' mentality toward heterosexually identified persons)."^[3] Characteristics forming the foundation of LGB identity theory are self-definition, self-acceptance, and disclosure of identity to others. The positive impact of openness to experience on mental health was fully mediated by positive LBG identity development.^[2]

Cross’ model of Black racial identity development (1971, 1978, 1991) includes 5 stages: pre encounter, encounter, immersion/emersion, internalization, and internalization-commitment. During pre encounter, the individual fails to emphasize their racial group membership, perhaps contributing to the belief that the US is a meritocracy. In the encounter phase, a new experience causes the individual to acknowledge race and racism in their own life. During the immersion/emersion stage, the individual “surrounds oneself with visible symbols of one's racial identity and an active avoidance of symbols of Whiteness.” ^[4] Internalization is characterized by security in one’s own racial identity which allows the individual to build relationships with others of dominant and oppressed racial groups. The fifth stage, internalization-commitment, is differentiated from the internalization stage by the individual’s ability to translate their racial identity into a commitment.^[4]

Conflicts of allegiances (CIA) describe perceived incompatibility between an individual’s racial/ethnic and sexual orientation identities. “CIA was positively correlated with experiences of racism within LGB communities and perceived heterosexism in one’s mother (but not one’s father), and negatively correlated with outness to family (but not outness to others in one’s everyday life). An interaction was found between racial/ethnic and LGB group identity with respect to behavioral engagement: CIA levels were highest among participants with high racial/ethnic behavioral engagement and low sexual orientation behavioral engagement.”^[5]

Racial identity invalidation occurs when an individual is placed in a racial category which is incongruent with their identity. The qualitative study collected data from 49 Black/white biracial individuals, and focused on two types of racial identity invalidation: negotiation (“you’re not really a Black person”) and imposition (“you should identify as Black”). In response to racial invalidation, 37% of participants responded by either addressing the invalidation and voicing disagreement or by accepting the invalidation. Other responses included active disagreement with the invalidator (22% of participants), deflecting (i.e. not responding; 16% of participants), internal disagreement with invalidator (29%), reflecting of others’ construction of race (43%), and reflecting on race as a construct (18%). The majority of participants (69%) reported feelings in response to the invalidation, the most common of which were upset or hurt (33%), confused (20%), and isolated (20%). Factors which mitigated the invalidation included strong sense of self and relationships with others who affirm the individual’s racial identity.^[6]

Sources of resistance in classrooms include the treatment of race as a taboo topic, the belief that United States is a meritocracy, and a lack of acknowledgment of one’s own participation in racist systems.^[4]

Enculturation that an individual goes through also may have an affect of how a person view mental health concerns. One barrier to mental health support access could be the perceived attitudes towards mental health concerns due to the person’s enculturation.  For example, in Asian Americans, the stereotype associated with being the "model minority" and the stigma associated with shame or loss of face maybe a barrier to access mental health support services (Leong & Lau, 2001), and the stigma towards mental health maybe be predicted by how the individuals associated with acculturation (Atkinson & Gim, 1989; Luu et al., 2009). In one study (Goel et al., 2022), the authors found that in disordered-eating treatment-seeking women of South Asian background not only faced stigma based on cultural attitude towards mental health, but also social stigma revolving social ostracization as a barrier of seeking treatment.

Cultural also intersect with religion, and strong religious beliefs may also affect attitudes towards mental health concerns. For Islam-practicing individuals, an individual with mental illness may be considered a punishment by God or may attribute the mental health concerns to spirits (Ciftci et al., 2012). However, as the examples of Asian American, the intersectionality between religion and culture maybe more nuanced. In a study examining cross-national comparisons of help-seeking attitudes in the Middle East (Al-Krenawi et al., 2009), the authors found that mental health stigma and help-seeking attitudes differs by nations. However, as the authors note, these differences in attitude has to also account for other identities, such as gender, education, as well as the countries' history.

Previous literature is consistent that children with developmental disabilities (e.g., mental retardation, autism, Down syndrome, cerebral palsy, etc.) and adverse mental health conditions (e.g., depression, anxiety, etc.) have greater difficulties accessing health services compared to children with physical disorders. The following study is also consistent with these results, where children with developmental disabilities, mental health conditions, or both have challenges accessing health services compared to children with physical disorders. More specifically, families who have children with developmental disabilities often lack helpful information and have limited access to referrals to necessary resources. Families with children who have mental health conditions have challenges in finding evidence-based care and health insurance coverage. Finally, Hispanic children with special health care needs were less likely to access treatment compared to White children, possibly due to language barriers. However, future research needs to explore this relationship further. Although the current study does not mention the stigmas of mental health treatment, the results may suggest a negative connotation when seeking services for mental conditions, in which future research may investigate in greater detail. ^[7]  

Individuals with disabilities often have poorer mental health outcomes than non-disabled peers. Moreover, people with disabilities encounter unique financial hardship and fewer supportive figures, which correlates with poorer mental health outcomes. The article below explores the current situation of exclusion amongst individuals with disabilities. Within the study, disabilities included physical, sensory, and intellectual conditions. Researchers used secondary data analysis to conclude individuals (Ages 15-29) the relationship between low social support and high economic struggles with lower mental health outcomes amongst individuals with disabilities. Social support explored how the individual engages in the surrounding environment and how supported they feel by others. Meanwhile, financial hardship examined differentiating events that occur as a result of a shortage of money. Overall, the results imply a need for services for this community and combating stigmas and systemic barriers that prevent individuals with disabilities from maintaining positive health outcomes. ^[8]

The article explores the connection between stigma of physical disabilities and mental health outcomes in heterosexual relationships. More specifically, observing relationships in which at least one partner has a physical disability, and how the experience of stigmas impact wellbeing. The study finds that stigma impacts the mental health of women in a relationship where at least one individual has a disability. In greater detail, vicarious stigma (define later) indicates psychological distress amongst women in couple relationships.^[9]

College students with multiple disabilities, such as ADHD, learning disabilities, and psychiatric disabilities are at risk of increased psychological distress and cognitive deficits without proper care. College students require additional assistance and assessment to ensure their mental, emotional, and physical health remains intact throughout their college education.^[10]

The article employed a literature search consisting of 18 articles, with 13 being from the United States. Within the U.S, Asian Americans with limited English proficiency reported less incentive to seek therapeutic services, where as Asian Americans with greater English proficiency indicated greater access to mental health services. Furthermore, there was a negative correlation between English proficiency in Latinos and the usage of mental health services. These findings were generally consistent in Australia, Canada, and the Netherlands. Ultimately, there is an association between limited language proficiency and limited use of psychiatric care. However, further studies are needed to confirm the relationship, while healthcare settings may need to expand the accessibility of treatment. ^[11] 

The systematic literature review examines immigrant populations in the U.S seeking therapy. The previous reviews focused on African, Asian, Latinx, and Refugee individuals. Amongst 62 reviews, immigrant populations reported lower access to mental health services, especially undocumented immigrants or those without health insurance. A few structural barriers include language concerns, overpriced services, and a lack of knowledge in locating resources. Furthermore, cultural barriers involved the stigma surrounding mental health and personal beliefs of seeking treatment. Finally, the article proposes additional research to this marginalized community to reduce the mental health disparities. ^[12] 

Mental Health Resources for U.S. Immigrants:

General website that offers information about therapy and where to locate mental health resources for different immigrant populations.

1. ↑ Social Identity Wheel. Adapted for use by the Program on Intergroup Relations and the Spectrum Center, University of Michigan. Resource hosted by LSA Inclusive Teaching Initiative, University of Michigan. http://sites.lsa.umich.edu/inclusive-teaching/
2. ↑ ^{2.0 2.1} Zoeterman, S. E., & Wright, A. J. (2014). The role of openness to experience and sexual identity formation in LGB individuals: Implications for mental health. Journal of Homosexuality, 61(2), 334–353. https://doi.org/10.1080/00918369.2013.839919
3. ↑ ^{3.0 3.1} Yarhouse, M. A., Tan, E. S. N., & Pawlowski, L. M. (2005). Sexual identity development and synthesis among LGB-identified and LGB dis-identified persons. Journal of Psychology and Theology, 33(1), 3–16.
4. ↑ ^{4.0 4.1 4.2} Tatum, B. (1992). Talking about race, learning about racism: The application of racial identity development theory in the classroom. Harvard Educational Review, 62 (1), 1–25. https://doi.org/10.17763/haer.62.1.146k5v980r703023
5. ↑ Sarno, E. L., Mohr, J. J., Jackson, S. D., & Fassinger, R. E. (2015). When identities collide: Conflicts in allegiances among LGB people of color. Cultural Diversity and Ethnic Minority Psychology, 21(4), 550–559. https://doi.org/10.1037/cdp0000026
6. ↑ Franco, M. G., Katz, R., & O’Brien, K. M. (2016). Forbidden identities: A qualitative examination of racial identity invalidation for Black/White Biracial individuals. International Journal of Intercultural Relations, 50, 96–109. https://doi.org/10.1016/j.ijintrel.2015.12.004
7. ↑ Nageswaran, S., Parish, S. L., Rose, R. A., & Grady, M. D. (2010). Do children with developmental disabilities and mental health conditions have greater difficulty using health services than children with physical disorders? Maternal and Child Health Journal, 15(5), 634–641. https://doi.org/10.1007/s10995-010-0597-4
8. ↑ Honey, A., Emerson, E., & Llewellyn, G. (2009). The Mental Health of young people with disabilities: Impact of social conditions. Social Psychiatry and Psychiatric Epidemiology, 46(1), 1–10. https://doi.org/10.1007/s00127-009-0161-y
9. ↑ Brown, R. L., & Ciciurkaite, G. (2021). The “own” and the “wise” revisited: Physical disability, stigma, and mental health among couples. Journal of Health and Social Behavior, 62(2), 170–182. https://doi.org/10.1177/0022146521998343
10. ↑ Wolf, L. E. (2006). College students with ADHD and other hidden disabilities. Annals of the New York Academy of Sciences, 931(1), 385–395. https://doi.org/10.1111/j.1749-6632.2001.tb05792.x
11. ↑ Ohtani, A., Suzuki, T., Takeuchi, H., & Uchida, H. (2015). Language barriers and access to psychiatric care: A systematic review. Psychiatric Services, 66(8), 798–805. https://doi.org/10.1176/appi.ps.201400351
12. ↑ Derr A. S. (2016). Mental health service use among immigrants in the United States: A systematic review. Psychiatric services (Washington, D.C.), 67(3), 265–274. https://doi.org/10.1176/appi.ps.201500004