There is a lack of empirical research that test theories regarding Black male mental health treatment disparities. The present study evaluates a theory that explains Black men’s beliefs, perceptions of specific structural racism, and cultural barriers to mental health (CBMH) treatment. Structural equation modeling (N = 240) was used to estimate and compare primary and competing structural models. Maximum likelihood estimation with Satorra-Bentler (SB) standard errors were used. A model showing tripartite police fear (TPF) was positively correlated to Black men’s perceptions of CBMH treatment demonstrated the best fit with the data. After adding one theoretically relevant correlated error, the model was no longer significantly different than the optimal saturated model. Policy and cognitive-behavioral practice implications of the study are discussed.
AddisonH. A.RichmondT. S.LewisL. M.JacobyS. (2022). Mental health outcomes in formerly incarcerated Black men: A systematic mixed studies review. Journal of Advanced Nursing, 78(7), 1851–1869. https://doi.org/10.1111/jan.15235
2.
Adkins-JacksonP. B.ChantaratT.BaileyZ. D.PonceN. A. (2022). Measuring structural racism: A guide for epidemiologists and other health researchers. American Journal of Epidemiology, 191(4), 539–547. https://doi.org/10.1093/aje/kwab239
3.
AlangS. M. (2019). Mental health care among blacks in America: Confronting racism and constructing solutions. Health Services Research, 54(2), 346–355. https://doi.org/10.1111/1475-6773.13115
4.
AlexanderJ. C. (2016). Culture trauma, morality and solidarity: The social construct of ‘Holocaust’ and other mass murders. Thesis Eleven, 132(1), 3–16. https://doi.org/10.1177/0725513615625239
5.
AlexanderM. (2010). The new Jim Crow: Mass incarceration in the age of colorblindness. The New Press.
6.
BeckJ. S (2021). Cognitive behavior therapy: Basics and beyond (3rd ed.). Guilford Press.
7.
BlumbergS. J.ClarkeT. C.BlackwellD. L. (2016). Racial and ethnic disparities in men’s use of mental health treatments. NCHS Data Brief. Number 206. National Center for Health Statistics. https://pubmed.ncbi.nlm.nih.gov/26079520/
8.
BorJ.VenkataramaniA. S.WilliamsD. R.TsaiA. C. (2018). Police killings and their spillover effects on the mental health of black Americans: A population-based, quasi-experimental study. Lancet, 392(10144), 302–310. https://doi.org/10.1016/S0140-6736(18)31130-9
ByrneB. M. (2016). Structural equation modeling with AMOS: Basic concepts, applications, and programming (3rd ed.). Taylor & Francis.
12.
CarsonE. A.KluckowR. (2024, October 15). Prisoners in 2022 – Statistical tables (NCJ 307163). U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. https://bjs.ojp.gov/document/p22st.pdf
CookT.CampbellD. (1979). Quasi-experimentation: Design & analysis issues for field settings.Houghton Mifflin.
15.
DasA.SinghP.KulkarniA. K.BrucknerT. A. (2021). Emergency department visits for depression following police killings of unarmed African Americans. Social Science & Medicine, 269, 113561. https://doi.org/10.1016/j.socscimed.2020.113561
16.
DavidD.CristeaI.HofmannS. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9(Article 4), 1–3. https://doi.org/10.3389/fpsyt.2018.00004
17.
EpsteinR. (1984). The principle of parsimony and some applications in psychology. The Journal of Mind and Behavior, 5(2), 119–130. https://www.jstor.org/stable/43853318
18.
EzawaI. D.StrunkD. R. (2022a). Working with Black vs. White patients: An experimental test of therapist decision-making in cognitive behavioral therapy for depression. Cognitive Behaviour Therapy, 51(3), 229–242. https://doi.org/10.1080/16506073.2021.1970799
19.
EzawaI. D.StrunkD. R. (2022b). Differences in the delivery of cognitive behavioral therapy for depression when therapists work with Black and White patients. Cognitive Therapy and Research, 46(1), 104–113. https://doi.org/10.1007/s10608-021-10254-0
20.
GilbertK. L.RayR.SiddiqiA.ShettyS.BakerE. A.ElderK.GriffithD. M. (2016). Visible and invisible trends in Black men’s health: Pitfalls and promises for addressing racial, ethnic, and gender inequities in health. Annual Review of Public Health, 37, 295–311. https://doi.org/10.1146/annurev-publhealth-032315-021556
21.
GregoryV. L.Jr. (2019). Cognitive-behavioral therapy for anxious symptoms in persons of African descent: A meta-analysis. Journal of Social Service Research, 45(1), 87–101. https://doi.org/10.1080/01488376.2018.1479344
22.
GregoryV. L.Jr.ClaryK. L. (2022). Addressing anti-Black racism: The roles of social work. Smith College Studies in Social Work, 92(1), 1–27. https://doi.org/10.1080/00377317.2021.2008287
23.
GregoryV. L.Jr.Tucker EdmondsJ. L. (2023). The racial pandemic experienced by Black American men: Cognitive-behavioral and structural implications. American Journal of Orthopsychiatry, 93(1), 1–16. https://doi.org/10.1037/ort0000651
24.
GregoryV. L.Tucker EdmondsJ. L. (2024a). Cultural Trauma Scale (CuTS): Parsimonious principal component analysis, independent Black American male sample. Journal of Aggression, Maltreatment & Trauma, 33(3), 369–386. https://doi.org/10.1080/10926771.2023.2256741
25.
GregoryV. L.Jr. (in press). Cognitive-behavioral therapy with Black Americans: A principle and structurally informed perspective. Springer.
26.
GregoryV. L.Tucker EdmondsJ. L. (2024b). Cultural Trauma Scale: Psychometric evaluation of Black men’s beliefs, emotions, and coping. Psychological Trauma: Theory, Research, Practice, and Policy, 16(8), 1329–1337. https://doi.org/10.1037/tra0001607
27.
HankersonS. H.MoiseN.WilsonD.WallerB. Y.ArnoldK. T.DuarteC.Lugo-CandelasC.WeissmanM. M.WainbergM.YehudaR.ShimR. (2022). The intergenerational impact of structural racism and cumulative trauma on depression. The American Journal of Psychiatry, 179(6), 434–440. https://doi.org/10.1176/appi.ajp.21101000
28.
HoopsickR. A.HomishG. G.LeonardK. E. (2021). Differences in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex, 1999–2018. Public Health Reports, 136(2), 192–200. https://doi.org/10.1177/0033354920968806
29.
HuL.BentlerP. M. (1999). Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
30.
HuangF. Y.ChungH.KroenkeK.DelucchiK. L.SpitzerR. L. (2006). Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Journal of General Internal Medicine, 21(6), 547–552. https://doi.org/10.1111/j.1525-1497.2006.00409.x
31.
KimJ. W.MorganE.NyhanB. (2020). Treatment versus punishment: Understanding racial inequalities in drug policy. Journal of Health Politics, Policy and Law, 45(2), 177–209. https://doi.org/10.1215/03616878-8004850
32.
KlineR. B. (2023). Principles and practice of structural equation modeling (5th ed.). Guilford Press.
33.
KohnL. P.OdenT.MuñozR. F.RobinsonA.LeavittD. (2002). Brief report: Adapted cognitive behavioral group therapy for depressed low-income African American women. Community Mental Health Journal, 38(6), 497–504. https://doi.org/10.1023/A:1020884202677
34.
KroenkeK.SpitzerR. L.WilliamsJ. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
LiC.FriedmanB.ConwellY.FiscellaK. (2007). Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. Journal of the American Geriatrics Society, 55(4), 596–602. https://doi.org/10.1111/j.1532-5415.2007.01103.x
37.
LittleR. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.1080/01621459.1988.10478722
38.
LittleR. J. A.RubinD. B. (2020). Statistical analysis with missing data (3rd ed.). John Wiley & Sons.
39.
LiuG. S.NguyenB. L.LyonsB. H.SheatsK. J.WilsonR. F.BetzC. J.FowlerK. A. (2023). Surveillance for violent deaths—National violent death reporting system, 48 States, the District of Columbia, and Puerto Rico, 2020. Morbidity and Mortality Weekly Report: Surveillance Summaries, 72(5), 1–38. https://doi.org/10.15585/mmwr.ss7205a1
40.
MartinC. E.Parlier-AhmadA. B.BeckL.ScialliA.TerplanM. (2017). Need for and receipt of substance use disorder treatment among adults, by gender, in the United States. Public Health Reports, 137(5), 955–963. https://doi.org/10.1177/00333549211041554
41.
MohebbiF.ForatiA. M.TorresL.deRoon-CassiniT. A.HarrisJ.TomasC. W.MantschJ. R.GhoseR. (2024). Exploring the association between structural racism and mental health: Geospatial and machine learning analysis. JMIR Public Health and Surveillance, 10, e52691. https://doi.org/10.2196/52691
ParkersonH. A.ThibodeauM. A.BrandtC. P.ZvolenskyM. J.AsmundsonG. J. G. (2015). Cultural-based biases of the GAD-7. Journal of Anxiety Disorders, 31, 38–42. https://doi.org/10.1016/j.janxdis.2015.01.005
45.
PedersonA. B.McLaughlinC.HawkinsD.JainF. A.AnglinD. M.YeungA.TsaiA. C. (2025). Medical mistrust and willingness to use mental health services among a cohort of Black adults. Psychiatric Services, 76(4), 318–325. https://doi.org/10.1176/appi.ps.20240016
46.
RindskopfD.RoseT. (1988). Some theory and applications of confirmatory second-order factor analysis. Multivariate Behavioral Research, 23(1), 51–67. https://doi.org/10.1207/s15327906mbr2301_3
47.
SahaS.LimC. C. W.CannonD. L.BurtonL.BremnerM.CosgroveP.HuoY.McGrathJ. J. (2021). Co-morbidity between mood and anxiety disorders: A systematic review and meta-analysis. Depression and Anxiety, 38(3), 286–306. https://doi.org/10.1002/da.23113
48.
SheaM.WongY. J.NguyenK. K.GonzalezP. D. (2019). College students’ barriers to seeking mental health counseling: Scale development and psychometric evaluation. Journal of Counseling Psychology, 66(5), 626–639. https://doi.org/10.1037/cou0000356
49.
ShimR. S. (2021). Dismantling structural racism in psychiatry: A path to mental health equity. The American Journal of Psychiatry, 178(7), 592–597. https://doi.org/10.1176/appi.ajp.2021.21060558
50.
ShresthaS.RamosK.FletcherT. L.Kraus-SchumanC.StanleyM. A.RamseyD.AmspokerA. B. (2020). Psychometric properties of worry and anxiety measures in a sample of African American and Caucasian older adults. Aging & Mental Health, 24(2), 315–321. https://doi.org/10.1080/13607863.2018.1544217
51.
Smith LeeJ. R.RobinsonM. A. (2019). “That’s my number one fear in life. It’s the police”: Examining young Black men’s exposures to trauma and loss resulting from police violence and police killings. Journal of Black Psychology, 45(3), 143–184. https://doi.org/10.1177/0095798419865152
52.
SpitzerR. L.KroenkeK.WilliamsJ. B. W.LöweB. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report
55.
TaylorR. E.KuoB. C. H. (2020). A theory-driven exploration of Black Canadians’ psychological help-seeking intentions. Canadian Journal of Counselling and Psychotherapy, 54(3), 464–485. https://cjc-rcc.ucalgary.ca/article/view/62851
56.
ThomeerM. B.MoodyM. D.YahirunJ. (2023). Racial and ethnic disparities in mental health and mental health care during the COVID-19 pandemic. Journal of Racial and Ethnic Health Disparities, 10(2), 961–976. https://doi.org/10.1007/s40615-022-01284-9
57.
TomazV.MoreiraD.Souza CruzO. (2023). Criminal reactions to drug-using offenders: A systematic review of the effect of treatment and/or punishment on reduction of drug use and/or criminal recidivism. Frontiers in Psychiatry, 14, 1–19. https://doi.org/10.3389/fpsyt.2023.935755
58.
TurnerE. A.DouglasC.HaseebA. (2024). Predictors of seeking mental health treatment in Black men: Therapy fears and expectations about counseling. Community Mental Health Journal, 60(2), 385–393. https://doi.org/10.1007/s10597-023-01183-1
59.
VanHookC. (2025). Perceptions, attitudes, and experiences regarding mental health care among young Black men. American Journal of Men’s Health, 19(1), 15579883241310756. https://doi.org/10.1177/15579883241310755
60.
WardE. C.BrownR. L.Sullivan-WadeL.SainvilmaS. (2021). A culturally adapted depression intervention for African American adults: An efficacy trial. WMJ : Official Publication of the State Medical Society of Wisconsin, 120(4), 273–280. https://pmc.ncbi.nlm.nih.gov/articles/PMC9815899/
61.
WardE. C.WiltshireJ. C.DetryM. A.BrownR. L. (2013). African American men and women's attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nursing Research, 62(3), 185–194. https://doi.org/10.1097/NNR.0b013e31827bf533
62.
WilliamsM. T.MalcounE.SawyerB. A.DavisD. M.NouriL. B.BruceS. L. (2014). Cultural adaptations of prolonged exposure therapy for treatment and prevention of posttraumatic stress disorder in African Americans. Behavioral Sciences, 4(2), 102–124. https://doi.org/10.3390/bs4020102
63.
WolfE. J.HarringtonK. M.ClarkS. L.MillerM. W. (2013). Sample size requirements for structural equation models: An Evaluation of power, bias, and solution propriety. Educational and Psychological Measurement, 73(6), 913–934. https://doi.org/10.1177/0013164413495237
