Discrimination and Identity: An Investigation of How Cultural Correlates Relate to the Expression, Evaluation, and Treatment of Social Anxiety Disorder.

Abstract

The purpose of this dissertation is to investigate how cultural and racial factors impact the evaluation, expression and treatment of social anxiety disorder (SocAD) in racial minority populations. This investigation involved three distinct, but related projects. The first project used the National Survey of American Life (NSAL), the most comprehensive study of black Americans in the U.S., to investigate how discrimination impacts SocAD at an epidemiological level. Previous work highlighted a strong association between discrimination and mental health symptoms, but few studies have examined the effects of particular types of discrimination on specific anxiety disorders among different black subgroups. In this study, logistic regression analyses indicated that everyday but not major experiences of discrimination are associated with SocAD for African Americans, Caribbean blacks and non-Hispanic whites.

The second project investigated cultural correlates of SocAD in a socio-economically deprived, largely minority, job-seeking population. This research built on an existing project in a vocational service setting led by Dr. Joseph Himle, which involved developing and disseminating a cognitive behavioral (CBT) group therapy intervention designed to enhance the employment success of people whose job attainment efforts have been undermined by the presence of SocAD. This study investigated how racial identity and experiences of discrimination relate to SocAD in this population. Our findings indicated that higher levels of racial discrimination and lower levels of private regard were associated with increased SocAD symptoms.

The third project in this dissertation evaluated whether the SocAD assessment procedures used at the vocational services center are functioning adequately in this low income, largely minority population. Overall, the Mini-SPIN demonstrated sound psychometric properties in this sample, showing that it can be used as a screener in this population. Given the Mini-SPIN’s brevity combined with ease of scoring and interpretation, it may be able to identify individuals in a variety of settings that may benefit from treatment. Taken together, this dissertation aims to understand SocAD in a culturally and racially sensitive context at both local and national levels to help demonstrate how cultural competence can inform the expression, assessment, and treatment of SocAD.