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Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness

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Abstract

Black consumers with serious mental illness (SMI) face significant challenges in obtaining quality mental health care and are at risk for experiencing significant disparities in mental health care outcomes, including recovery from mental illness. Patient-provider interactions may partly contribute to this disparity. The purpose of the current study was to understand the effects of race, psychosis, and therapeutic alliance on mental health recovery orientation among Veterans with SMI. Participants were Veterans who had an SMI being treated at two Veteran Affairs outpatient mental health clinics by a psychiatrist or nurse practitioner. Participants completed the Behavior and Symptom Identification Scale (BASIS-24), Mental Health Recovery Measure, and patient-report Scale to Assess the Therapeutic Relationship (STAR-P) which includes three subscales: positive collaboration, positive clinician input, and non-supportive clinician input. Regression analyses were used to determine interactive effects of race, psychosis severity, and therapeutic alliance variables. The sample was 226 Veterans (50% black, 50% white). Black participants were slightly older (p < .05), had higher baseline psychosis (p < .05), higher mental health recovery (p < .05), and perceived less non-supportive clinician input (p < .01) than white participants. Regression analyses indicated a significant three-way interaction among race, psychosis, and positive collaboration (p < .01). Greater positive collaboration attenuated the negative effect of higher levels of psychosis on mental health recovery orientation for black participants. Conversely, for white participants, positive collaboration had little effect on the negative relationship between psychosis severity and mental health recovery orientation. Increased levels of psychosis may inhibit patients’ perceptions of their ability to recover from SMI. However, for black participants, positive collaboration with mental health providers may moderate the effects of psychotic symptomatology.

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Authors and Affiliations

  1. Department on Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Mana K. Ali

  2. VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA

    Samantha M. Hack, Clayton H. Brown, Deborah Medoff, Elizabeth A. Klingaman, Stephanie G. Park & Julie A. Kreyenbuhl

  3. School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA

    Samantha M. Hack, Deborah Medoff, Lijuan Fang, Elizabeth A. Klingaman, Stephanie G. Park & Julie A. Kreyenbuhl

  4. Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Howard Hall Suite 200, 660 W. Redwood Street, Baltimore, MD, 21201, USA

    Clayton H. Brown

  5. Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA

    Lisa B. Dixon

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  1. Mana K. Ali
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Correspondence to Mana K. Ali.

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Conflicts of Interest

There are no potential conflicts of interest. We do not have a financial relationship with the organization that sponsored this research. The manuscript has been seen and approved by all authors. All authors have full control of all primary data and agree to allow the journal to review the data if requested. The findings in the manuscript have not been published nor are being submitted elsewhere and it does not contain data that are currently submitted or published elsewhere.

Ethical Approval

The protocol for data collection was approved by the Institutional Review Board of University of Maryland School of Medicine. All procedures performed in studies involving human participants were in accordance with the ethical standards of this institution’s research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Funding

This study was funded by a US Department of Veterans Affairs Health Services Research and Development Merit Award (IIR-07-256) to Dr. Julie Kreyenbuhl. It is the result of work supported with resources and the use of facilities at the VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC). This work reflects the authors’ personal views and in no way represents the official view of the Department of Veterans Affairs or the US Government.

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Ali, M.K., Hack, S.M., Brown, C.H. et al. Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness. J. Racial and Ethnic Health Disparities 5, 235–242 (2018). https://doi.org/10.1007/s40615-017-0363-z

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