Coping Resources of African-American and White Patients Hospitalized for Bipolar Disorder

A total of 122 patients—42 African-American and 80 white patients—completed the CRI. Participants were predominantly female (77 patients, or 63 percent), were admitted to the hospital voluntarily (72 patients, or 59 percent), were in the lower socioeconomic classes (100 patients, or 82 percent), and were without a partner (103 patients, or 84 percent). The mean±SD age was 35.4±9.5 years.

There were no statistically significant differences between the two groups for any of the demographic variables examined: gender, age, living arrangements when discharged, religious affiliation, employment before admission, social position, financial support, or marital status. There were also no significant differences between the two groups for any of the psychiatric variables examined: admission legal status, psychotic symptoms on admission, number of psychiatric hospitalizations, axis II diagnosis, or documented medication noncompliance before admission. Differences for three variables were significant when initial comparisons were made, but were not when adjustments were made for multiple tests: education (p=.018, adjusted p=.288), past or current involvement with the criminal justice system (p=.004; adjusted p=.064), and a secondary diagnosis of a substance use disorder (p=.016; adjusted p=.256). Cronbach's alphas for the CRI ranged from .76 to .92.

Total CRI scores of the African-American participants were significantly higher than those of the white participants (see Table 1). The African-American group also scored significantly higher than the white group on three of the five scales—cognitive, emotional, and spiritual-philosophical. No statistically significant differences were found between the two groups on the social and physical scales.

The lack of statistically significant differences between the African-American and white patients on any of the background or psychiatric characteristics examined suggests that characteristics related to race account for the several significant differences between the two groups in their coping resources scores. These findings provide some support for those of Guarnaccia and Parra (5), although we sampled a different population. Those authors reported differential patterns based on ethnic group differences in their study of family members' experiences of caring for a mentally ill relative.

The African-American patients scored significantly higher than the whites on the total coping resource score and the three scales that indicate resources considered to be more internal than external, that is, factors embodied within the individual rather than accessed from others (9). This finding suggests that cultural orientations influencing personal life philosophies may explain the differences between the African Americans and the whites on perceptions of their coping resources.

Perhaps because of having overcome many obstacles in life in the past, the African Americans perceived themselves more as having an internal strength, a positive outlook, and more resources with which to cope than did the white participants. The strong spiritual foundation that is part of the upbringing of many African Americans (10) may instill powerful internal resources that persist into adulthood. Working with a sample of family members of patients with mental illness, Axelrod and colleagues (4) found that attitudes about self and a family's belief in its ability to care for a patient influenced the way family members thought about coping with the crisis of chronic mental illness.

We considered the question of whether the African Americans' significantly higher scores might have resulted from more frequent use of denial as a coping mechanism. We were unable to evaluate this possibility, but if denial was used more frequently by the African Americans, it was not pervasive enough to influence responses on all five scales. Differences in use of denial thus do not appear to account for the higher scores of the African-American patients.

Coping resources were perceived to be significantly higher by African-American than by white inpatients with bipolar disorder. The findings provide a foundation on which to base interventions that identify, support, and strengthen existing coping resources and to plan future studies with larger sample sizes.

This study was funded by grant 1-R15-NR-03766-01A1 from the National Institute of Nursing Research of the National Institutes of Health; by grant T15-SP-07775 from the Center for Substance Abuse Prevention, U.S. Department of Health and Human Services faculty development program for 1995-1998; and by the Center for Nursing Research of the School of Nursing at the University of Texas-Houston Health Science Center.

Dr. Pollack is affiliated with the School of Nursing of the University of Texas-Houston (UT-H) Health Science Center, 1100 Holcombe Boulevard, Office 5.540, Houston, Texas 77030. Ms. Harvin is with the Prairie View A&M University College of Nursing in Houston; at the time of the study she was at the UT-H Harris County Psychiatric Center in Houston. Ms. Cramer is with the department of statistics at Rice University.