Current Psychiatry Reviews - Volume 12, Issue 2, 2016

Although considerable strides have been made in understanding, diagnosing, and treating obsessive-compulsive disorder (OCD), not all groups have benefited from these advances. OCD in ethnic and racial minority groups has been – and continues to be – a neglected area of study. The last 15 years of research has shed new light on OCD in African Americans, with some fascinating findings and new questions to answer. This review describes barriers to treatment, such as low income, reduced access to care, racism, and mental health stigma. Also addressed are cultural differences in symptomology, test and measurement issues, and family factors in the development and maintenance of the disorder. Implications of findings to date are discussed, as well as unstudied areas of concern, such as treatment efficacy and African American youth with OCD.

Hoarding Disorder (HD) is characterized by difficulty discarding and parting with possessions, resulting in the accumulation of belongings that congest and clutter active living areas and compromises their use. While HD is thought to be a universal phenomenon, the phenomenological, epidemiological, and clinical research studies published to date have mainly been conducted in Western, industrialized countries, precluding conclusions about the prevalence and phenomenological differences that may exist across cultures in the expression of HD. A systematic review of treatment studies in HD revealed that all have been carried out in the US and have included a large majority (about 90%) of White/Caucasian individuals, making it difficult to ascertain whether existing treatments are equally effective for minority groups. There is a need to consider HD from a transcultural perspective in order to understand the expression of this disorder across different cultures and ethnic groups. We highlight areas of priority for future studies to ensure that the conception of hoarding and its study is inclusive, sensitive, and informative.

In light of the recent incorporation of the DSM-5, this updated comprehensive review of racial/ethnic differences in Posttraumatic Stress Disorder (PTSD) makes a significant and timely contribution for clinicians and researchers. Racial/ethnic differences in the prevalence and symptom expression of PTSD are the focus of the current review. In particular, this review examines differences in PTSD expression and prevalence among three major racial/ethnic groups in the United States: African American, Hispanic/Latino, and Asian/Asian Americans. Further, cultural factors believed to influence the epidemiology and phenomenology of PTSD, such as differential rates of trauma exposure, acculturation, racism, and stigma, are discussed within the context of PTSD expression and symptom disclosure. The current review examines empirical literature published since 2000 on academic databases including PsychInfo, PubMed, PsychARTICLES, Psychiatry Online, Psychology and Behavioral Sciences, with aggregate data prioritized when possible. After a general summary of the major findings of the breadth of topics described above, implications for improving treatment utilization, retention and outcomes across diverse racial/ethnic groups based on research findings are discussed. Finally, directions for future empirical examination into this important area are offered.

Evidence demonstrates that adolescent substance use is prevalent and extends to adolescents of immigrant minority groups. Given the large presence and growth of Hispanic-Latino and Asian populations in the United States, examining the role of culturally specific experiences in substance use risk among Hispanic-Latino and Asian adolescents is critical. In particular, evidence indicates that acculturation may pose particular challenges for Hispanic-Latino and Asian adolescents, thereby increasing risk for substance use. This review aims to synthesize existing evidence for the role of acculturation in substance use and the proposed mechanisms underlying this relation among Hispanic-Latino and Asian adolescents. Based on this review, the implications of this evidence on future research and the development and implementation of substance use interventions for Hispanic-Latino and Asian adolescents are discussed.

Latino/a individuals comprise the largest and fastest growing United States ethnic minority group of youth. Latino/a adolescents are a high priority, vulnerable population at risk for death and serious injury. More specifically, Latino/a adolescents are at high risk for being diagnosed with depression and thus experiencing depressive symptoms, including suicide ideations, attempts, and completions. The current article summarizes the scant research regarding the expression of depressive symptoms and depression care in Latino/a adolescents. In the current article we describe select literature focused on Latino/a adolescents and the following areas of mental health research: (a) prevalence rates of depression; (b) the intersection of gender and depressive symptoms; (c) the intersection of age and depressive symptoms; and (d) depression care (i.e., assessment and treatment) for Latino/a adolescents.

The early literature on eating disorders focused primarily on young, White women in the United States and Europe. However, there is alarming recent evidence showing that there are increasing rates of eating disorders both in the United States among non-European American ethnic groups and across the globe in previously non- Westernized countries. Some researchers attribute these increased prevalence rates to the growing role of Westernization across the world. It has also been suggested that eating disorders, specifically bulimia nervosa, may be culture-bound syndromes. Indeed, one of the primary theories behind the development of eating disorders is the socio-cultural model of eating disorders, which posits that eating disorders develop from a mixture of social and cultural risk factors. The current review focuses on the cultural and ethnic differences and similarities of eating disorders and disordered eating behaviors among (a) diverse ethnic groups in the United States (African American, Hispanic American, and Asian American) and (b) women in several Asian countries (Japan, China, India, and Pakistan). Specifically, we focus on cultural differences in excessive dieting, restriction, fears of fatness, body dissatisfaction, purging, and bingeing, which are core behavioral expressions of disordered eating that are common across the eating disorders. We pay special attention to socio-cultural factors and values present in each of these ethnic and cultural groups, which may influence the expression of these behaviors. Finally, we end by discussing the clinical implications that stem from the differences and similarities in these behaviors across groups and cultures.

With the new revision of the DSM-5, research and theory related to the diagnosis of gender dysphoria (GD) have increased. Through debates and discussions of controversy with the GD diagnosis, knowledge of gender identity and psychopathology related to minority stress have also become more prevalent. One of the primary limitations noted in the majority of research on transgender issues and GD is the lack of inclusion of ethnic and racial minorities within samples; it is not uncommon for studies to report samples that are 80% or more White. The few studies that have focused on racial/ethnic differences for individuals diagnosed with GD indicate that having multiple minority statuses, specifically identifying as a racial or ethnic minority, increases the likelihood of anxiety and mood disorders and substance. Research on lesbian, gay, bisexual, and transgender (LGBT) individuals indicates that multiple minority statuses lead to additive stressors that can increase mental health concerns due to experiencing proximal (internal stigma) and distal (actual discrimination) stressors. We discuss the reasons why psychopathology has been linked to minority individuals diagnosed with GD and provide recommendations for best practices to cultural competence for researchers and practitioners.

There has been an increase in literature that addresses risks associated with suicide vulnerability and death for American Indian/Alaska Native, Asian American, Black American, and Hispanic American adults. However, much more definitive work is needed. In comparison to previous decades, research in the area of ethnic minority suicide may have lost some momentum for certain racial/ethnic groups. As the U.S. population becomes increasingly diverse, the need for advanced research efforts regarding the full spectrum of suicide behavior grows increasingly urgent. Objective: To provide a summary of putative risk factors and plausible protective factors highlighting both unique and common factors for American Indian/Alaska Native, Asian American, Black American, and Hispanic American adults. The dearth of literature is also addressed by the proposition of emergent needs in the study of ethnic minority suicide. Further, we will examine the ways in which the last decade of research has expanded suicide science as well as areas that have been understudied. Conclusions: A review of empirical studies and conceptual reports published in the last decade revealed common trends associated with suicide across ethnic groups, including sociodemographic variables, psychiatric risks, cultural factors, and factors related to interpersonal relations. Ethnic minority groups also shared notable protective factors, such as religious and spiritual beliefs, and familial ties. Suggested directions for future research include the examination of individual subgroups within ethnic communities as well as the exploration of understudied correlates that show promising evidence as influential to suicidal behavior. Additionally, factors that lead to suicide attempts for American Indian/Alaska Native, Asian American, Black American, and Hispanic American adults remain relatively unexamined.

Despite decades of research on the treatment of mental illness, providing services to the public remains a significant concern. According to recent data from the Centers for Disease Control and Prevention, a large number of individuals suffer from psychiatric conditions, yet few receive the necessary treatment. Among ethnic minority populations, there is a larger gap in the lack of service use. Help-seeking for professional help has been linked to a variety of variables including education level, stigma towards services, ethnic background, and cultural variables. Research on improving mental health outcomes in primary care settings has been prioritized over the years. However, ethnic minorities are often underrepresented in outpatient mental health care settings. The purpose of this paper is to overview factors that contribute to and hinder ethnic minorities’ use of outpatient psychiatric treatment. The paper will review the current literature on help-seeking among African Americans, Asian Americans, American Indians, and Latino Americans; and explore implications for improving care.

Hallucinogen Persistent Perception Disorder (HPPD) is considered an “uncommon” disorder described in association with use of hallucinogens such as LSD, mescaline and psilocybin. Despite multiple mentions of persistence of visual disturbances reported by users on online forums, clinicians may not be aware of this complication. There have been few descriptions of HPPD in association with use of new psychoactive substances (such as 2C-E). Increasing use of these designer stimulants places greater numbers at risk for psychiatric morbidities including HPPD. Here we report the first documented case of HPPD due to high dose 2C-E and blunting of symptoms with addition of lamotrigine.