The Effect of Cultural Stereotypes on Mental and Public Health
Lorenzo Lorenzo-Luaces graduated from the University of Puerto Rico–Rio Piedras, where he studied cross-cultural differences in suicidality. He is currently a graduate student in the University of Pennsylvania clinical psychology PhD program. Lorenzo-Luaces is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation, the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
The population of groups referred to as “minority” is growing at a faster rate in this country than Caucasians, with estimates suggesting that by 2060, 57 percent of the U.S. population will be non-White. This demographic shift could create a public health concern if racial/ethnic minorities remain underrepresented in mental health research. At present, these populations are less likely to receive mental health care than Whites. When they do receive care, it is usually of lesser quality.
Stereotypes among racial/ethnic minority communities regarding mental health are complex. Research suggests that they tend to have more negative beliefs about mental illnesses than White communities; for example, they are more likely to believe that mental illnesses occur due to factors outside of the individual’s control (e.g., spiritual or environmental reasons). However, despite generally holding more negative views about mental illnesses, research shows that racial/ethnic minorities tend to have less punitive attitudes about the mentally ill. Moreover, they tend to be more accepting about mental health treatments, although they express a clear preference for psychological services over medications.
Differences in access to care, rather than attitudes, likely explain the racial/ethnic gap in service use. Besides the obvious discrepancies in socioeconomic status (SES) between Caucasians and racial/ethnic minorities, the latter’s preference for psychological services may be one barrier to access. This is because, even among the insured, psychological services are more expensive in the short term and harder to access than psychotropic medications. There also are questions as to whether psychological interventions tested largely on White populations are effective for minorities.
Members of ethnic minorities report that they would prefer a therapist of their own ethnicity, yet ethnic minorities are underrepresented in health professions. The lack of same-ethnicity providers may be a deterrent to initiating treatment, even though the research on matching therapists and clients on ethnicity suggests little, if any, effect on patient outcomes. Even so, ethnic identity can play a role in the delivery of psychotherapy. Meta-analytic reviews suggest that therapy interventions that are adapted to specific ethnic groups are associated with better outcomes than interventions that are not adapted. Research also indicates that the superiority of these interventions is mainly driven by using metaphors/symbols that match clients’ cultural worldview and describing mental illness in a way that is consistent with their culture.
In contrast to the complexity of the reported relationships between race/ethnicity and beliefs about mental health, the literature offers a much clearer picture on stereotypes about the mental health of racial/ethnic minorities. For example, there is a widespread belief that Blacks are more likely to use and abuse drugs than Whites. This could partly be fueled by the fact that televised media is more likely to report drug-related crimes when the perpetrator is from a racial or ethnic minority background. However, this belief is wholly inconsistent with the data, which shows Whites are more likely to consume drugs than Blacks. (By contrast, Blacks are substantially more likely to be incarcerated for drug possession.) These and other negative stereotypes about racial/ethnic minorities are stressors that adversely affect their mental health in a manner that may become a self-fulfilling prophecy.
To recognize the existence of erroneous stereotypes is not to discount the significant differences in mental health across racial/ethnic groups. However, structural variables also explain these differences.
Ultimately, mental health cannot be separated from factors like racism and discrimination that pervade everyday life for racial/ethnic minorities, including commonly reported micro-aggressions. Reducing mental health stereotypes among racial/ethnic minority communities is likely to improve outcomes, but the greater impact may be felt by addressing widely held and inaccurate negative stereotypes about racial/ethnic minorities in general.
Author’s Note: Much of the research on this topic has not made a distinction between race and ethnicity. Some of the articles referenced treat African Americans, Afro-Caribbeans, and Africans living in the United States as a single ethnic group. To avoid confusion, I have used “racial/ethnic minorities” as an all-encompassing term for the Black and Latino populations referenced here.
· Anglin, D., Link, B., & Phelan, J. (2006). Racial differences in stigmatizing attitudes toward people with mental illness. Psychiatric Services, 57(6), 857-862.
· Benish, S. G., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis. Journal of Counseling Psychology, 58(3), 279.
· Dixon, T. L., & Linz, D. (2000). Overrepresentation and underrepresentation of African Americans and Latinos as lawbreakers on television news. Journal of communication, 50(2), 131-154.
· Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, National Association of County Behavioral Health & Developmental Disability Directors, National Institute of Mental Health, The Carter Center Mental Health Program. Attitudes Toward Mental Illness: Results from the Behavioral Risk Factor Surveillance System. Atlanta (GA); Centers for Disease Control and Prevention; 2012.
· Geller, S. E., Koch, A., Pellettieri, B., & Carnes, M. (2011). Inclusion, analysis, and reporting of sex and race/ethnicity in clinical trials: have we made progress? Journal of Women's Health, 20(3), 315-320.
· Griner, D., & Smith, T.B. (2006). Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43(4), 531–548.
· Hall, G.C.N. (2001). Psychotherapy research and ethnic minorities: Empirical, ethical, and conceptual issues. Journal of Counseling and Clinical Psychology, 69, 502–510.
· Lorenzo-Luaces, L., & Phillips, J. A. (2013). Racial and ethnic differences in risk factors associated with suicidal behavior among young adults in the USA. Ethnicity & health, (ahead-of-print), 1-20.
· Shim, R., Compton, M., Rust, G., Druss, B., & Kaslow, N. (2009). Race-ethnicity as a predictor of attitudes toward mental health treatment seeking. Psychiatric Services, 60(10), 1336-1341.
· Smith, T.B., Domenech-Rodriguez, M., & Bernal, G. (2010). Culture. Journal of Clinical Psychology: In Session, 67(2)166-175
· Wu, L. T., Woody, G. E., Yang, C., Pan, J. J., & Blazer, D. G. (2011). Racial/ethnic variations in substance-related disorders among adolescents in the United States. Archives of General Psychiatry, 68(11), 1176-1185.
This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.