FROM THE EDITOR: Introduction of Special Issue on Minority Mental Health

From time to time, journal issues seem to simply assemble themselves. Such is the case with this special issue on minority mental health. A nice set of manuscripts arrived, received the necessary revisions, and—voila!—became the issue that is before you. Although several groundbreaking issues on minority mental health have been published during my years as editor, the topic continues to deserve attention. Distressing disparities in the delivery of mental health services to minorities were documented in a 2001 report of the United States Surgeon General ([U.S. Public Health Service Office of the Surgeon General, 2001]). The report amply documented the disproportionate burden of disability from mental health disorders that is experienced by minorities, such as Native Americans, African Americans, Asian Americans, and Hispanic Americans. In 2003, The President's New Freedom Commission on Mental Health included, as Goal 3, the elimination of disparities in access, quality, and cultural acceptability of psychiatric interventions.

Articles in this special issue reveal many causes for concern about minority mental health. Both high morbidity and low service utilization were evident. For example, elevated depressive symptoms were found among 30% of the Korean American sample studied by Eunjung Kim, despite their middle class socioeconomic status. Perhaps not surprisingly, marginalization was linked to their depressive symptoms. Barriers to seeking mental health services among Korean Americans (e.g., lack of knowledge, perceived stigma) were discovered by Wu, Kviz, and Miller, and underutilization of inpatient services by Asians was revealed in the study conducted by Shin. Shin's analysis showed not only underutilization of inpatient mental health services among Asians with psychiatric diagnoses, but also higher incidence of emergency admissions and longer inpatient hospital stays than non-Asian patients. It appears that Asians are hospitalized only after they are exhibiting more severe symptoms of mental illness that then create alarm among their family members. The needs for earlier detection and more aggressive outpatient treatment are glaringly evident.

Mental health nurses must devote more attention to promoting positive coping strategies among minority populations. An exemplar is the Life Management Enhancement Group Intervention for homeless African American women described in the article by Washington, Moxley, and Taylor. Women in the group sessions learned to increase their confidence and perceived control through the cognitive-behavioral intervention. The study by Barksdale, Farrug, and Harkness also illustrates positive coping strategies (apparently self-initiated). To wit, Barksdale et al. found that many Black Americans coped with the stressor of racial discrimination by speaking out and by prayer.

Two studies in this issue are devoted to the psychometric properties of instruments. Obviously, for research on minorities to proceed, adequate measurement tools must be developed and tested for reliability and validity. Sun Kim, Seong-Ho Kim, and Gulick examined psychometric properties of an instrument that tested smoking cessation self-efficacy with a sample of Korean American men. Hatcher and Hall assessed the appropriateness of using the Rosenberg Self-Esteem Scale in research on African American women. Their paper sheds light on an apparent contradiction between some studies that show African American women score high on depression and other studies that show they have high self-esteem. The contradiction is perhaps explained by the bidimensionality of the construct of self-esteem for African-American women, at least when measured by the Rosenberg Self-Esteem Scale.

I am happy to present this interesting collection of articles to you, while ever-mindful of the huge gaps that remain in the literature on minority mental health. It is regrettable that no papers on Hispanic mental health or Native American mental health were submitted during the time frame for this special issue. It also is regrettable that barriers to receiving mental health treatment, such as stigma, remain so problematic among our minority populations. What part could you play in case-finding, tailoring interventions, educating the public, or conducting research?