Researching Black Communities: A Methodological Guide

14. Methods for the Study of Mental Health in African American Populations

14 | Methods for the Study of Mental Health in African American Populations Lonnie R. Snowden Everyone concerned with the well-being of African American populations must attend to African American mental health. Mental health forms the basis for a personal sense of happiness and feeling of satisfaction . It facilitates successful performance of personally valued tasks and attainment of important personal goals (U.S. Department of Health and Human Services 1999). But in ways that often are overlooked, mental health also affects the economic and social fate of individual African Americans and African American communities. Mental health facilitates performance of productive activities (U.S. Department of Health and Human Services 1999) and promotes formation of human and social capital (Coleman 1988). The ability of African Americans to optimize individual and community well-being is inextricably linked to African American mental health (Snowden 2003). Former surgeon general David Satcher issued a report entitled Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services 2001). Subsequent reviews echo many of the supplement’s conclusions (Snowden and Yamada 2005). The report consolidated what is known about African American mental health by reviewing the best available scienti‹c evidence. Well-founded conclusions were drawn, several of which are restated below. It is clear from the report that although much has been learned, much more remains to be learned. Conjecture is common. Important empirical observations occur but rarely are followed up in programs of study yielding cumulative knowledge. Questions addressed thus far cover a narrow band from a very wide spectrum. The research base must be enlarged. 254 Wide-Ranging Methods to Match Diverse Questions How can we increase the amount of rigorous research on African American mental health? A starting point is to recognize that questions of interest span a wide range. It is widely recognized that research methods must be geared to research tasks—that the methods chosen for a study should be those best suited to theoretical and policy-related concerns motivating inquiry. Put another way, it is important to ensure that the choice of research methods is dictated by the research question at hand. In studying African American mental health, diverse issues demand that the research program draw investigators and methods from many disciplines. To do otherwise would be to arti‹cially restrict the range of methods and thereby give short shrift to important questions. Effectiveness, Differential Effectiveness, and Cost Effectiveness In Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health (2001), the former surgeon general noted a lack of evidence on outcomes of care for African Americans receiving mental health treatment . The report called for more research evaluating the African American response to novel but standardized treatments as well as to care delivered under the usual conditions of community practice. The former kind of studies address ef‹cacy—the impact of interventions studied under tightly controlled but arti‹cial conditions—and the latter address effectiveness in real-world conditions. A ‹rst step toward enlarging the body of research is to examine its underlying logic, especially as that logic applies to research with African American populations.Whether psychosocial or biomedical (Herbeck et al. 2004), interventions typically are promoted in something like a standard form. Although subject to variation at the discretion of clinicians, crucial elements de‹ne a core. The core is readily seen in treatments delivered following a manual constructed to standardize the intervention’s key features. Investigators rarely examine whether there are differences between African Americans and whites in intervention effectiveness, and few determine whether there are African American versus white treatment interactions . An underlying assumption is universalist. That is, an effective treatment touches on something fundamental and, as a matter of course, will be equally effective for everyone who receives it. Methods for the Study of Mental Health | 255 Arguing from a sociocultural point of view (Snowden and Yamada 2005)—and often in the name of cultural competence (e.g., Cross et al. 1989; Betancourt et al. 2003)—critics sometimes object to standard treatments. They assert that African American traditions and beliefs are such that standard treatments cannot achieve therapeutic objectives when used with African Americans. They claim that to be effective, treatment must take account of a distinctive African American sociocultural perspective, if not be designed entirely from that perspective. The position re›ects a belief that African Americans...