Mental Health Among Black College Students- A Review
By Christiana T. Joseph
Abstract
This review aims to summarize recent literature exploring how the following factors influence
mental health among Black college students in the United States: racial identity, religious
commitment, racialized issues within academic environments, socioeconomic status, mental health
literacy and stigma. Mental health is clearly a vital factor that influences how students perform in
college, particularly students of color.
Introduction
Addressing the Gap in the Literature Concerning Minority Perspectives on Mental Health
Currently, few studies include the perspectives on mental health of the intended patients in a way that actually brings to light the perspectives minority college students have surrounding mental health, mental disorders, and help-seeking attitudes and behaviors. In particular, seldom have these research studies included or taken account of Black and African American students’ thoughts in their texts. This neglect considerably limits their ability to truly understand the discourse regarding these undergraduate students’perceptions of mental health.
Campus counseling services have rightly focused on providing students with opportunities to explore their mental health needs, address mental concerns, and support campus community members as students push to excel through their academic lives. Without such services, students would not have the institutional support that helps them to face and understand mental difficulties in their lives. The inability to manage such difficulties could result in student isolation and withdrawal from active campus life, feelings of loneliness, inclinations for self-harm, and withdrawal from the campus community entirely. While campus counseling services are crucial to maintaining strong campus communities, they will inevitably fail if they do not take into account their students’ thoughts about mental health. Their failure will be even more likely if campus counseling services exclude minority students’ perspectives.
The narratives specific groups construct around mental health often stem from attitudes that are based on different racial, ethnic, religious, and spiritual associations. These perspectives influence how undergraduate college and university students think about the idea of seeking mental health care in the various forms available today. Neglecting these narratives will preclude the possibility for institutions to make tangible improvements in the services they offer. In addition, neglecting the relationship between students and their institutions will only serve to silence student opinion and prevent the institutions from creating the safe environments they eagerly advertise because they will not have an understanding of what their students’ needs are and how to accommodate them. As a result, mental health discussions will clearly be at a disadvantage if the narratives about mental health are not acknowledged: these discussions won’t have all of the information necessary in order to make significant headway towards improving students’ lives and mental health experiences.
In order to pursue higher education, students must have access to stellar mental health care and mental health accommodations on their campuses. Students both require and expect colleges and universities to meet their mental health needs; one key way for institutions to demonstrate their commitment to the needs of their students is to actively listen to student narratives about mental health and its influence on their academic pursuits. When colleges and universities better understand how students develop their views on mental health and mental health care, then they can enact appropriate changes tailored to the community at hand. By enabling colleges and universities to understand their students’ perspectives, institutions can then make sound decisions regarding on- and off-campus mental health opportunities.
Because institutions must address their students’ specific mental health care needs, it is even more imperative that they take minority students’ narratives into account in order to identify the strengths and inadequacies within their systems. Black and African American students’ mental healthcare needs are more complex than is conventionally assumed by how mental health issues are traditionally addressed in the United States (medication, professional counseling, group therapy, etc). In order to address these needs, Black and African American undergraduate students’ views on mental health and mental disorders must be further explored.
Students’ narratives about mental health are based on their diverse backgrounds. Including their varied perspectives on mental health and mental disorders could offer students of color the rare opportunity to have their thoughts materialized in spaces where their opinions tend to go ignored.
Statistically, student use of mental health care facilities significantly varies across institutions of higher education across the U.S. Some scholars, academics, researchers and faculty might consider the argument that students who find their institution’s mental health care options unsatisfactory should work to find alternate mental health care options themselves. However, we need to recognize that students must have access to institutional avenues that will actually listen to their perspectives on mental health and utilize these perspectives in productive manners. Recognizing students’ perspectives will benefit colleges and universities well beyond public opinion. When institutions take into account their students’ opinions on mental health care and mental health care facility use, they can better understand how students perceive their mental needs and how these needs should be addressed. This attention to students’ opinions can strengthen the relationship between students and campus administration. When campus administrators have a greater understanding of how students use mental health care facilities and their perceptions of mental health care, then institutions of higher education will be able to create the safe and encouraging academic environments they eagerly advertise to prospective students.
Literature Review
A. Race as a General Topic of Debate
Understanding minority groups’ background is absolutely essential for appropriately responding to their mental health needs, which first requires greater attention to a much more general problem: how people are classified into certain ethnic categories demands further exploration. Ethnic categories, particularly those of mixed African ancestry, are of such a diverse nature that limiting the discussion to broad terms like Black, African, or Black African, may be considered offensive and lacking in accuracy (Agyemang et al. 2005). Those who consider American ethnic groups to be discrete categories that explain how particular people function are not fully engaged with the reality of ethnicity as a complex, multidimensional idea (Phinney 1996). Some scholars advocate that “African” should be considered an appropriate label or prefix and appear on documents defining ethnic labels and for “Black” to be phased out except when used in political contexts (Agyemang et al. 2005). Other scholars view ethnic categories and labels as problematic concepts in general as they neither necessarily nor consistently indicate group membership and are far too simplistic in meaning (Phinney 1996). Even though ethnicity is increasingly being understood as a dynamic multidimensional construct, ethnicity as a categorical variable continues to be used (Phinney 1996). Understanding students’ racial and ethnic associations can help paint a better idea of the cultural sensitivity one needs in order to interact with diverse student bodies.
B. Racial Identity and Religious Commitment and its Impact on Mental Health and Counseling
There are many cultural factors that may influence how people of various backgrounds perceive mental health, but with regard to the community at hand, race, religion, and spirituality can and do play a critical role with regard to mental health. Some scholars explore the cultural factors that influence mental health and well-being among African Americans; they consider the associations between racial and ethnic identity, religious commitment as they define it, overall satisfaction with life, and meaning (Ajibade et al. 2015). Ajibade et al. (2015) conducted their study in part because most of the previous research regarding positive psychology focused on White participants (Ajibade et al. 2015). They argue that religious commitment partly explains how strong identifications with racial or ethnic identity may lead to increases in psychological well-being (Ajibade et al. 2015). When considering clinical or psychological care
for African American clients or communities, the study’s practical implications are as follows: they found that strongly identifying with racial or ethnic identity and religious commitment positively correlates with satisfaction with life and meaning among African Americans; that the client’s racial or ethnic identity may influence the client’s views towards his or her cultural
background and may be helping or hurting progress towards counseling goals; religious commitment and racial or ethnic identity may influence the client’s functioning; and lastly that, overall, the therapeutic process may be aided by including religion in therapy (Ajibade et al. 2015).
C. Racialized Issues and Studies of Their Impact on the Mental Health of Minorities
Because this research project is intended to focus on the voice of minority student needs, it will also focus on how various racialized issues help craft an understanding of mental health within the minds of these students. These issues can take a variety of forms, such as whether or not a student embraces or even identifies with their presumed racial identity (Barr and Neville 2014). In addition, it will include how they deal with issues of racial conflict like being placed outside the norm (Durkee and Williams 2015), racial discrimination (Hudson et al. 2015), mental health disparities, micro-aggressions, and the dangers of institutional betrayal (Gómez 2015). An understanding of racism (Williams and Williams-Morris 2000) can provide valuable information on race-related experiences affecting African American students in a myriad of ways (Greer et al. 2015). This knowledge will allow racialized perspectives to be placed in the appropriate context, while simultaneously providing a frame for the kinds of issues that influence students’
perceptions of mental health and mental disorders. Some scholars do keep racial identity in mind as it relates to mental health among Black college students when examining racial socialization. Others have explored the ecological model of racial socialization (EMRS) among 207 Black college students attending a predominantly White Midwestern university (Barr and Neville 2014). They found that the majority of discussions regarding the realities of racism with parents and peers were associated with the participants’ rejection of the idea that institutional racism no longer exists (Barr and Neville 2014). They also found that participants’ personal narratives regarding discrimination may explain the negative relationship between the Peer Alertness to Racism socialization messages and mental health (Barr and Neville 2014). An example of Alertness to Racism, which refers to protective language that speaks to the racial disparities facing many Black Americans, can be found in the following quote, “You have to work twice as hard as Whites in
order to get ahead in the world” (Barr and Neville 2014). The authors find that their study shows Black young adults who internalize color-blind racial ideas are negatively influenced by the Mainstream Socialization messages their parents offer (Barr and Neville 2014). Messages created to minimize race as a strategy to conform to mainstream America comprise Mainstream Socialization (Barr and Neville 2014). The authors conclude that Black young adults who understand the reality of structural inequalities are better able to successfully incorporate messages their parents offer regarding mainstream culture (Barr and Neville 2014).
While it is important to consider how students who identify as Black or African American embrace their racial or ethnic identity, it is also important to appreciate how accusations of acting outside the norms assumed for those particular racial identities can influence students’ psyches. The impact accusations of acting White have on Black students revolves around how such accusations negatively impact Black college students’ mental health, in part because they are associated with lower racial identification (Durkee and Williams 2015). They refer to a study where the participants, Black high school students in Washington, DC, intentionally underachieved in order to not be accused of acting White by their peers, indicating the possibility that the acting White insult may negatively influence Black students’ conscious academic performance (Durkee and Williams 2015). The authors described how previous research with Black adolescents showed that accusations of acting white included speaking Standard American English and dressing in a preppy manner (Durkee and Williams 2015). In this study, the authors found that the frequency at which participants were accused of acting White was associated both with lower racial or ethnic identity as well as with severe mental health fallouts (Durkee and Williams 2015). Even though this study focuses on high schoolstudents, it is important to include here and consider how students’ understandings of themselves may manifest well before they begin higher education and continue to have an impact as they progress in their academic careers.
Shifting away from academic performance, other scholars focus on more psychological aspects suggesting that racial discrimination and depression are directly associated (Hudson et al. 2015). African Americans with varying socioeconomic status (SES) levels report different exposures to racial discrimination, with those with higher SES levels reporting greater exposure. Although the authors found no evidence supporting the idea that the effects of John Henryism, a measure of high-effort coping, influenced the relationship between discrimination and depression, higher levels of John Henryism were related to increased chances of depression (Hudson et al. 2015).
Aside from academic performance and psychological response, issues related to mental health disparity, microagression, and institutional betrayal because of access to (or lack thereof) adequate services may influence how students perceive mental health. Gómez combines mental health disparity and microaggression literatures to introduce a changeable systemic cause for mental health disparities (2015). She criticizes the reality that federal focus on reducing mental health disparities for Black Americans exists while mental health disparities still occur, and often lead to reduced accessibility to mental health care (Gómez 2015). She refers to Smith and Freyd’s (2013) definition of institutional betrayal as that which occurs within organizations that don’t take the proper steps to prevent or deal with problematic events, and in so doing, betray their members (Gómez 2015). She defines mental health disparities as “inequity in treatment opportunities due to unequal access to and benefit from efficacious and culturally appropriate mental health care” and claims that the present moment is an important time to work to eradicate mental health disparities because it is clear that Black Americans have been systemically oppressed: Black Americans are overly represented in in-patient and psychiatric hospitals, and
by and large receive inadequate care (Gómez 2015, 136). She suggests dealing with microagressions among mental health professionals of various cultural backgrounds as an avenue for change at individual and systemic levels (Gómez 2015).
These authors identify and criticize the focus of scholarship on how race-related experiences influence academic achievement and college adjustment among African American students at predominantly White colleges and universities (PWCUs) as being that of intergroup racism (Greer et al. 2015). These authors seek to address the literary gap concerning academic and mental health outcomes for students dealing with race-related difficulties created through social interactions with peers of the same race (Greer et al. 2015). Using existing literature, they claim that the racial climate on campus settings proves significant in students’ adjustment to
college and academic achievements, with students experiencing more supportive and less racially conflicting environments at Historically Black College and Universities (HBCUs) than students of the same race at PWCUs (Greer et al. 2015). The authors also seek to address the literary gap regarding the types of coping strategies students use to manage stress relating to intragroup race-related issues (Greer et al. 2015). By also testing the effects of other, less explored, types of intragroup race-related issues, they use their research study to improve on previous research efforts to explore skin tone bias as a type of intragroup racial difficulty (Greer et al. 2015). These researchers found that race-related conflict among same-race peers does exist as a source of stress for African American students at PWCUs and that the varying extent to which coping strategies are used influences the effects of intragroup racial difficulty in addressing racial conflicts (Greer et al. 2015).
From a more general perspective, certain scholars choose to provide an overview of research conducted within the United States exploring how racism can influence mental health (Williams and Williams-Morris 2000). These studies detail changes in racial attitudes over time and explore the scientific evidence that indicates that racism can negatively influence mental health status in three specific aspects (Williams and Williams-Morris 2000). The first, acknowledges that racism in societal institutions can decrease socioeconomic mobility and lead to unequal access to resources as well as poor living conditions that can negatively influence mental health (Williams and Williams-Morris 2000). Second, that discrimination can cause physiological and psychological reactions that may eventually lead to negative mental health status changes (Williams and Williams-Morris 2000). Third, for people living in societies that are conscious about race, embracing negative cultural stereotypes can lead to negative self-evaluations that have unfortunate effects on psychological well-being (Williams and Williams-Morris 2000).
D. Taking Into Account Campus Environment
The academic environment in which students are situated must be taken into account in order to better understand how students of various racial and ethnic groups understand mental health in relation to universities with distinct demographics. Some scholars first examined the role of majority/minority status in the college community by exploring differences in mental health functioning across White and racial and ethnic minority students, and gender (Smith et al. 2014). In order to study the majority/ minority status in the college community in mind, they focused on two types of institutions of higher education: a predominantly White college (PWC, where the racial and ethnic minority students are in the minority) and a majority-minority college (MMC, where the racial and ethnic minority students make up the majority) (Smith et al. 2014). To explore their second research goal, they set out to analyze racial and ethnic minority status on mental health functioning (Smith et al. 2014). Overall, they concluded that minority or majority status and mental health outcomes among racial and ethnic minority students were not related (Smith et al. 2014). Their findings suggest that Black, Hispanic, and White students at the MMC reported greater psychological distress than White students at the PWC, with racial and ethnic minorities anticipating poorer mental health outcomes (including being higher in loneliness, depression, and previous suicidality) and female gender foretelling depression, current suicidal ideation, and previous suicide attempt regardless of the majority/minority status on their campus (Smith et al. 2014).
Another way to explore how the institution’s environment might play a role in a students’ understanding of mental health would be to take into account the plans and goals those in leadership positions created and shaped at those institutions of higher education. One type of academic institution to consider is Historically Black College and Universities (HBCU). HBCU campus presidents’ views on the mission of four-year HBCUs can help readers better understand the significance and role of these institutions of higher education (Ricard and Brown 2008). Fifteen presidents share how they understand their campus mission and put it to use, understand
and deal with the issues they face, as well as the issues that aid or hurt how these missions are set in motion (Ricard and Brown 2008). The authors claim that this research project is the first study to examine the presidents’ roles at Black colleges, describing how HBCUs haven’t gotten their fair share of attention in the past, often leading to them not being appropriately understood (Ricard and Brown 2008). In the end, while learning more about the perspectives and hopes of the academic environment administrators have at their institutions of higher education, the perspectives of students working, living, and participating in the campus community (or not) are
also significant.
E. Alternative Support Methods
In order to understand how undergraduate Black college students understand mental health, we need to know more about the various avenues students will take that relate to mental health intervention, including institutional and more informal student-led alternative services. Informal support networks like the African American Student Network (AFAM) may serve as alternatives to formal mental health counseling and operate as culturally sensitive therapeutic intervention (Grier-Reed 2013). The major debate regarding this issue centers on the idea that even in an informal networking setting, therapeutic factors may be created by the group process
associated with counseling or therapy (Grier-Reed 2013). Her work may have implications for assisting institutions of higher education and their counseling centers as they work to better support and engage the psychological health and well-being of Black students at predominantly White institutions (Grier-Reed 2013).
F. The Influence Of Socioeconomic Status on Interpretations of Mental Health Treatment and Its Correlation with Mental Health Issues
True of both the university context as well as generally, students’ socioeconomic status may play a role not only in how they perceive mental health (Nealy 2007), but also how they respond to mental disorders (Salami and Walker 2014). Cultural biases and low socioeconomic status may be considered the biggest challenge facing minorities with mental health issues, but not the only ones (Nealy 2007). Black Americans who are uninsured and living in poverty are at a disadvantage in accessing mental health care. Studies seem to indicate that many Blacks who continue to be skeptical of psychological treatment tend to opt more for spiritual approaches to
mental health instead (Nealy 2007). Taking these issues into account, Historically Black Colleges and Universities (HBCU) should work together across systems and departments to increase awareness and eradicate the stigma associated with mental heath care (Nealy 2007); increase their knowledge of how students perceive their mental health care and the kinds of narratives they construct around those perceptions.
Despite the focus on socioeconomic status in the studies above, how it plays a role among issues specifically related to mental health still needs further consideration. Scholars such as Salami and Walker explore the main effect of socioeconomic status (SES) and the mediating effect of hopelessness as it relates to acute symptoms of depression and anxiety among 133 African American college students (Salami and Walker 2014). They describe hopelessness as an aspect of cognitive vulnerability (Salami and Walker 2014). Their findings, which in their opinion were unexpected, show that individuals with higher SES typically had increased symptoms of depression, anxiety and hopelessness (Salami and Walker 2014). Though this may seem counterintuitive, if this kind of study were integrated with the impact of accusations of acting (or being) White, which can accord with higher economic status, there may in fact be very clear explanations for this relationship.
G. Mental Health Stigma and Literacy
Another aspect of mental health research that scholars pursue relates to stigmas associated with mental health. Mental health stigma can play a significant role for people suffering from mental illnesses and those treating patients with these disorders (Adewuya and
Makanjuola 2005; Altindag et. al 2006; Ay et. al 2006; Christison et. al 2002; Ando et. al 2011; Corrigan 2007). The greater mental health and mental disorder literacy students have could indicate how likely they would be to seek help and advise others to do the same if necessary (Stansbury et al. 2011), likely reducing the deleterious effects of stigmatization. In particular, the issue of stigma is a significant obstacle for mental health service use among African Americans (Masuda et al. 2012). When searching to identify if mental health stigma and self-concealment were distinctly associated with perceptions toward seeking professional mental health services
among African American college students, they found that the two ideas were in fact statistically associated with help-seeking attitudes (Masuda et al. 2012).
Other scholars slightly shift their focus in order to address the issue of reducing stigma related to mental health, and the role that stigma can play for people suffering from mental illnesses and those treating patients with these disorders (Adewuya and Makanjuola 2005; Altindag et. al 2006; Ay et. al 2006; Christison et. al 2002; Ando et. al 2011; Corrigan 2007). Studies have shown that there is a strong likelihood that increasing general knowledge related to mental health diseases allows for greater understanding of those diseases and reduces stigma (Adewuya and Makanjuola 2005; Altindag et. al 2006). In Adewuya and Makanjuola’s (2005) study on Nigerian University students, they acknowledged that there is a need for increasing public awareness of mental illness and reducing the stigma associated with it. They found that it may be that the lack of the scientific understanding of what mental illness is may encourage
people to have negative and inaccurate ideas about mental health. Altindag et. al’s study (2006), performed with medical students at different times during their education, analyzed whether or not an anti-stigma program may change attitudes towards people who have schizophrenia. The results seemed promising, but as to date aren’t definitive, suggesting that more work needs to be done in this area.
People with and without diagnosed mental illnesses need to interact more in order for non-diagnosed persons to better understand a particular mental illness. Ay et al.’s (2006) study provided evidence that increasing medical students’ interaction with people diagnosed with mental health disorders betters the attitudes that medical students had towards them. This study noted the importance of maintaining a social environment that “aims to reduce the distance between the patient and the medical staff through introducing a holistic approach in medical schools” (Ay et al 2006). Other researchers note that students who have increased exposure to psychiatry clerkship tend to show greater regard for patients with major depression than students who are not exposed to clerkship (Christison et. al 2002). Similarly, students who participated in an addiction treatment program tend to show greater regard for patients suffering from alcoholism than students not exposed (Christison et. al 2002). These two studies demonstrated that increased interaction between persons with and without diagnosed mental illnesses has the ability to reduce the stigma non-mentally ill persons have towards mentally ill persons. Ando et. al (2011), however, noted that while such attempts to allow people to better understand mental disorders may prove successful, they need to be used with caution. For example, Corrigan (2007) suggests that the act of categorizing people according to the name of an illness and working with people based specifically on their mental disorder proves to be an issue because it creates a sense that persons with mental health disorders are inherently different. Despite that problem, Corrigan (2007) still agrees with the previous scholars mentioned who believe that increased interaction between people suffering and not suffering from mental
disorders would help reduce the stigmas attached to persons with mental disorders.
Increasing mental health and mental disorder literacy would also be beneficial for those seeking to reduce mental health stigma. Some scholars criticize the lack of research directly addressing African American college students’ mental health literacy on depression (its symptoms and their views on treatment options) and use their study as an opportunity to decrease that gap in knowledge (Stansbury et al. 2011). Some scholars describe depression as a serious public health concern within the United States that affects nearly 18.8 million adults and is commonly found in college students, with African American college students being at a higher risk for depression due to “racism, sleep deprivation, and lack of academic and social support” (Stansbury et al. 2011, 497). This gap in knowledge must be addressed in order to preclude complications developing into other problems like self-medication with drugs and alcohol (Stansbury et al. 2011). The authors draw from other research to explain how using this approach may result in finding that individuals who are mental health literate are likely to look for help themselves or even suggest professional help to family and friends likely suffering from depression (Stansbury et al. 2011). While Stansbury et al. focus on African American students’ literacy of depression and help-seeking (2011), it brings attention to the larger issue at hand: learning what African American students know about mental health which we can infer in part by hearing how they think about mental health.
Conclusions
This literature review provides ample background for the research project I am conducting this fall. This research project will best enable students at a consortium of five undergraduate institutions in the northeast to share their unique perspectives on mental health, mental disorders, and seeking help for mental disorders or disturbances because it will specifically focus on their voices and their experiences through surveys and interviews. By including these perspectives, this project will provide significant information that will encourage institutions to make tangible improvements in the services they offer to their students. When how Black and African
American undergraduate students in the U.S. perceive mental health and mental disorders is better understood, then better methods can be developed that cater to their mental needs, help students feel safe and a part of the campus community, and keep more students in school.
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