Ethnicity Differences in Family Attitudes toward Psychiatric Medications

Background/Purpose: Concerns about social stigma impact mental health treatment-seeking behavior on the part of African-American adults by delaying access to formal treatment, limiting treatment engagement, and lengthening the time spent dealing with untreated symptoms. Little research has been done to examine how stigma may impact early intervention efforts and the experience of treatment for African-American adolescents and their parents. This study explored whether African-American and Caucasian parents and adolescents differ in their attitudes toward psychiatric medications.

Methods: The research was funded by the National Institute of Mental Health and the Columbia University Center for the Study of Social Work Practice/Jewish Bureau of Children's and Family Services. Study procedures were approved by the Institutional Review Board of University Hospitals of Cleveland prior to participant recruitment. Adolescent and parent dyads were recruited from outpatient community mental health settings. Study inclusion criteria required that adolescents were between 12-17 years old, taking a medication for an Axis I mental illness, and living with their primary caregiver/parent. Adolescents and parents completed the 30-item Drug Attitude Inventory (DAI), which measures attitudes toward psychiatric medications. Independent samples t-tests were used to evaluate differences in average DAI scores between African-American and Caucasian adolescents/parents.

Results: 79 Caucasian and 35 African-American adolescents and their primary caregiving parents (n=114) completed the DAI. Independent samples t-tests indicated significant differences in adolescent DAI score by ethnicity [t (111) = 3.07, p < .01]. African-American teens had significantly less positive attitudes toward medication [X=3.35, (SD=.59)] than Caucasian teens [X=3.714, (SD=.58)]. Similar results held for parents [t (112) = 3.30, p < .001]; African-American parents had less positive attitudes toward medication [X=3.70, (SD=.33)] than Caucasian parents [X=3.97, (SD=.43)].

Conclusions/Implications: These findings uncover potential ethnicity differences in attitudes toward medication, which may be rooted in individuals' experience/awareness of stigma in the general culture. Both the adolescent and the parent DAI scores demonstrated a significant relationship with ethnicity - African-American adolescents and their parents demonstrated less positive attitudes toward medication than Caucasian adolescents and parents. These results correspond to findings in the existing literature that African-Americans engage in formal mental health treatment less readily than Caucasians. This may indicate that, like adults, African-American youth experience or fear greater stigma from having a mental health diagnosis or from taking psychiatric medications than their Caucasian counterparts. Similarly, African-American parents may experience greater stigma from having a child with a psychiatric illness than Caucasian parents or may harbor more concern about the consequences of stigma for their children. Results from this study corroborate an emerging literature showing that African-Americans are less likely to use mental health services than whites due to concerns about stigma (Anglin, Link, & Phelan, 2006; Bolden & Wicks, 2005; Thompson, Akbar, & Bazile, 2002). If stigma underlies these ethnicity differences in adolescent/parent attitudes toward psychiatric medication, it suggests that awareness of racial stigma in the context of mental illness occurs as early as adolescence and may affect the ability of African-American youth and families to seek early intervention for psychiatric disorders.