Psychiatric and Psychological Predictors of Self-Reported Health of African Americans With Severe Mental Illness

Objective: Persons with severe mental illness do not receive adequate general medical health care, and African Americans are at greater risk of poor-quality care than their European-American counterparts. Services for patients with mental illness should include an assessment of health status. Self-report is the most efficient means of obtaining health information but may be susceptible to bias. The purpose of the study was to determine the effects of psychiatric symptoms, psychological factors, and demographic variables on the global self-reported health of African-American psychiatric patients. Methods: Study participants were a sample of 151 African-American psychiatric patients who received an orally administered screening interview of self-report scales, including measures of paranoia, lack of trust, need for approval, and self-esteem. Structural equation modeling (SEM) was used to estimate the effects of demographic characteristics (gender, age, and education), psychological factors (distrust, need for approval, cultural mistrust, and self-esteem), and psychiatric symptoms (subjective and objective measures of psychosis) on global self-reported health. Results: The best-fitting SEM model excluded demographic variables and indicated that the latent construct for psychological factors (beta=.63) had a much stronger influence than psychiatric symptoms (beta=.37) on the self-reported health status of these patients. Conclusions: Physicians' assessments of medical complaints by patients with severe mental illness should consider the effects of nonclinical psychological factors on patients' reporting. Psychological factors associated with attitudes in the larger African-American community toward health care providers are also present in the segment with severe mental illness. (Psychiatric Services 61: 669-674, 2010)