I have a 1pg reaction paper due in 2.5 hours

Hello, I need this one page double spaced. I have included a sample and then the article in which the paper has to be written on. I need this paper to be done relatively quick, and I NEED A TURN IT IN REPORT!!! THANK YOU

Multiculturally Sensitive Mental Health Scale (MSMHS):
Development, Factor Analysis, Reliability, and Validity

Ruth Chu-Lien Chao and Kathy E. Green
University of Denver

Effectively and efficiently diagnosing African Americans’ mental health has been a chronically unre-
solved challenge. To meet this challenge we developed a tool to better understand African Americans’
mental health: the Multiculturally Sensitive Mental Health Scale (MSMHS). Three studies reporting the
development and initial validation of the MSMHS were conducted with African American student
samples. First, an exploratory factor analysis of an initial item pool yielded 5 factors assessing subscales
of perceived racism, depression, well-being, anxiety, and suicidal thoughts. Second, a confirmatory factor
analysis supported the MSMHS’s 5-dimensional factor structure. Third, test–retest reliability, internal
consistency, and validity coefficients supported the viability, use, and potential for continued develop-
ment of this new instrument. Implications for theory and research on multicultural mental health scales
are discussed.

Keywords: racism, African Americans, psychological distress, anxiety, well-being

The Multiculturally Sensitive Mental Health Scale (MSMHS)
was developed to respond to the need for assessing African Amer-
icans’ mental health, including perceptions of racism. The absence
of an adequate assessment of perceived racism has contributed to
a misdiagnosis of African American clients (Clark, Anderson,
Clark, & Williams, 1999; Landrine & Klonoff, 1996). Thus, we
had three reasons for developing this scale. One, the MSMHS
responds to a decades-old belief that if people want to understand
African Americans’ psychology, they must understand African
Americans’ experience of racism. Specifically, racism is a unique
stressor for African Americans (Clark et al., 1999; Harrell, 2000);
according to Landrine and Klonoff (1996), 98% of African Amer-
icans report experiencing racism in their life. Given that almost
every African American experiences racism, it seems prudent to
include perceptions of racism in an instrument measuring African
Americans’ mental health.

Two, some theorists have urged development of a conceptual
model that organizes, explains, and leads to understanding the
psychological behavior of African Americans on the basis of an
African American worldview (Caldwell, Jackson, Tucker, & Bow-

man, 1999. For example, Caldwell et al. (1999) explained that
constructs and instruments developed primarily for Whites have
often been inappropriate for African Americans because African
American heritage and experiences of slavery and racial oppres-
sion have resulted in a framework different from that of other
groups. Thus, most current mental health measures that are extrap-
olated from Caucasian Whites’ perceptions of mental distress may
fail to include assessment of mental health stressors related to
perceived racism (Constantine & Sue, 2006; Ridley, 2005; Sue &
Sue, 2008). African Americans and White Americans may func-
tion psychologically under distinct cosmologies (Broman, Mavad-
dat, & Hsu, 2000). These cosmological systems show different
ontological systems that reflect their distinct approaches to con-
ceptualizing psychological distress. Three, some scholars have
found that perceived racism explained additional variance in Af-
rican Americans’ psychological distress beyond general stress
(Smedley, Myers, & Harrell, 1993). This empirical evidence sug-
gests that perceived racism plays a distinct role for African Amer-
icans.

Psychological Dimensions of Perceived Racism

Despite the ubiquity of the word racism in everyday language,
no consensus on its definition has emerged from the scientific
literature. For example, Ponterotto, Utsey, and Pedersen (2006)
said that racism is the abstract component of physical racial
slavery. Although the physical bondage of slavery has ended in the
United States, racism maintains African Americans in a state of
psychological oppression. Some scholars have described racism as
a relationship between members of oppressed and nonoppressed
groups (Constantine & Sue, 2006); others, such as Clark et al.
(1999), have indicated racism as a stressor for African Americans,
defining it as “beliefs, attitudes, institutional arrangements, and
acts that tend to denigrate individuals or groups because of phe-
notypic characteristics or ethnic group affiliation” (p. 805). Indeed,

This article was published Online First April 25, 2011.
Ruth Chu-Lien Chao, Counseling Psychology Program and Quantitative

Research Methods Program, Morgridge College of Education, University
of Denver; Kathy E. Green, Quantitative Research Methods Program,
Morgridge College of Education, University of Denver.

This study was supported by two research grants, the Promoting Psy-
chological Research and Training on Health Disparities Issues at Ethnic
Minority Serving Institutions (ProDIGS) of the American Psychological
Association/Science Directorate and the Division 17 Counseling Psychol-
ogy Fund of the American Psychological Foundation, awarded to Ruth
Chu-Lien Chao.

Correspondence concerning this article should be addressed to Ruth
Chu-Lien Chao, Counseling Psychology Program, University of Denver,
1999 East Evans Avenue, Denver, CO 80208. E-mail: cchao3@du.edu

Psychological Assessment © 2011 American Psychological Association
2011, Vol. 23, No. 4, 876 – 887 1040-3590/11/$12.00 DOI: 10.1037/a0023710

876

T
hi

s
do

cu
m

en
t i

s
co

py
ri

gh
te

d
by

th
e

A
m

er
ic

an
P

sy
ch

ol
og

ic
al

A
ss

oc
ia

tio
n

or
o

ne
o

f i
ts

a
lli

ed
p

ub
lis

he
rs

.
T

hi
s

ar
tic

le
is

in
te

nd
ed

s
ol

el
y

fo
r t

he
p

er
so

na
l u

se
o

f t
he

in
di

vi
du

al
u

se
r a

nd
is

n
ot

to
b

e
di

ss
em

in
at

ed
b

ro
ad

ly
.

it would be almost impossible for a people to endure more than
300 years of enslavement and not be psychologically affected and
for the relation between racism and psychology to not be culturally
transmitted to succeeding generations after the overt slave era
ended. Because African Americans experienced slavery over a
long period of time, mental and psychological behaviors of African
Americans may still be consciously or unconsciously related to
slavery, because their emancipation was proclaimed only about
150 years ago. Legalized segregation, the core of racist ideology or
racism, ceased in American only around 55 years ago. With the
continuance of individual and institutional racism, African Amer-
icans still experience various aspects of oppression.

Anderson (2003) pointed out that, according to Black psychol-
ogy, even if African American behavioral effects from slavery are
minimized or discounted, the thesis that African Americans are
still afflicted with psychological oppression associated with racism
is generally supported by African American psychologists (Wil-
liams, Neighbors, & Jackson, 2003). Moreover, the perceived
racism or racial oppression is related not only to social dysfunction
but also to the mental health of African Americans (Williams &
Williams-Morris, 2000).

Perceived racism occurs widely and has been measured in
different spheres, from one-item measures to full scales (Essed,
1990; Williams & Williams-Morris, 2000), and a high proportion
of racially discriminatory experiences have been reported by Af-
rican Americans (Landrine & Klonoff, 1996). A majority, 38 of 47
empirical research studies of African Americans, reported signif-
icant relationships between perceived racism and psychological
problems (Williams et al., 2003). Because racism could be expe-
rienced by African Americans on almost a daily basis, Landrine
and Klonoff (1996) suggested that an assessment of the degree of
racism or an appraisal of African Americans’ experience of racism
may be more important than measuring the types of racism. Spe-
cifically, two African Americans may encounter the same racist
situation, and yet whereas one may find it very stressful or be
severely hurt, the other may just dismiss it.

The omnipresence of perceived racism over generations and on
campus has been found to be significantly negatively related to the
quality of life for African American college students. Scholars
have also proposed that perceived racism taxes individual and
collective resources and threatens well-being. Depression, anxiety,
tension, and anger about racism (Fernando, 1984), as well as lower
life satisfaction and suicidal thoughts (Broman, 1997; Jackson et
al., 1996), are common problems in psychotherapy (Klonoff, Lan-
drine, & Ullman, 1999). Despite abundant studies on the relation-
ship between perceived racism and mental health (see e.g., Kes-
sler, Mickelson, & Williams, 1999) and the unique role of racism
in African Americans’ lives, it is surprising that no scale today
includes an appraisal of the experience of racism as a correlate of
mental distress among African Americans. Thus, our MSMHS is
necessary on three counts.

First, a culturally sensitive scale is lacking. Psychological liter-
ature increasingly attends to the role of racism in mental health
(Clark et al., 1999; Williams & Williams-Morris, 2000), and yet
scales that assess racism and quantify its relationship to aspects of
mental health are lacking. For example, some intake checklists
(e.g., the Presenting Problems Checklist; Draper, Jennings, &
Baron, 2003) recognize the importance of racism to African Amer-
icans and other ethnic minority populations and include perceived

racism as one item in their intake checklist. However, these intake
checklists with a single racism item are limited in assessing a
relationship between perceived racism and other psychological
factors. An absence of adequate scales contributes to a misdiag-
nosis of African Americans (Constantine & Sue, 2006; Ridley,
2005). For example, without including racism/discrimination
items, intake checklists may have limitations in understanding the
nature of African Americans’ mental health problems and then
have difficulties in conceptualizing their psychological distress
(Draper et al., 2003; Klonoff et al., 1999). By examining the
association between perceived racism and psychological distress,
the MSMHS can be useful for preventive mental health interven-
tion.

Second, current mental health scales were developed with pri-
marily White samples and may as such be inappropriate for Afri-
can Americans. Many instruments in minority mental health re-
search are criticized as taking White middle-class values as the
norm (Ponterotto, 1988). For example, the Brief Symptom Inven-
tory (Derogatis, 1993) was developed on a Eurocentric conceptual
base and then used with non-Whites (e.g., African Americans) and
non-middle-class participants (Lonner & Ibrahim, 1989) without
revision. Most current scales also lack an appraisal of racism-
related stress because they were developed from a majority per-
spective. Some culturally specific measures (e.g., the Vietnamese
American Depression Scale; Kinzie et al., 1982) are highly spe-
cific to a cultural group or difficult to access (Sodowsky, Kuo-
Jackson, & Loya, 1997). Current race-related stress scales—for
example, the Minority-Status Stress (Smedley et al., 1993) or the
Cultural Mistrust Inventory (Terrell & Terrell, 1981)— do not
assess mental health issues or psychological distress (e.g., depres-
sion, anxiety, and school/work adjustment). Ignoring racism-
related stress amounts to applying the standards of the majority
culture to conceptualize African Americans’ mental health issues
(Smith, 1985; Sue & Sue, 2008).

Third, current mental health instruments have items reflecting
only generic stressful events (e.g., “I feel stressed at work/school”)
and lack race-specific stress. Racist events differ from the generic
life events (e.g., getting fired) and hassles (e.g., losing one’s keys)
typically assessed by measures of stressful events. Furthermore, a
racism-inclusive scale fulfills the mandates of guidelines in psy-
chotherapy. Racism-related stress is recognized as a crucial issue
in the “Guidelines for Providers of Psychological Services to
Ethnic, Linguistic, and Culturally Diverse Students” (American
Psychological Association, 1993) and again in the “Guidelines of
Multicultural Education, Training, Research, Practice, and Orga-
nizational Change for Psychologists” (American Psychological
Association, 2003). In short, development of the MSMHS not only
responds to the urgent demands of current research but also fulfills
the American Psychological Association’s ethical considerations
by including the issue of perceived racism in assessing mental
health issues among African Americans.

Theoretical Model for the MSMHS

Perceived Racism as a Stressor

Current social stress models assume that exposure to stress leads
to psychological distress; stress is a term used to describe an event
generated from antecedent, mediating, and response components

877MULTICULTURALLY SENSITIVE MENTAL HEALTH SCALE

T
hi
s
do
cu
m
en
t i
s
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
tio
n
or
o
ne
o
f i
ts
a
lli
ed
p
ub
lis
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
s
ol
el
y
fo
r t
he
p
er
so
na
l u
se
o
f t
he
in
di
vi
du
al
u
se
r a
nd
is
n
ot
to
b
e
di
ss
em
in
at
ed
b
ro
ad
ly
.

(Lazarus & Folkman, 1984). Antecedent factors are called stres-
sors, events that elicit response to stress. The present study con-
ceptualizes perceived racism as analogous to but different from
generic life events and daily hassles, for racist events are culture-
specific stressors for African Americans. As generic stressors are
related to psychological distress such as depression and anxiety, so
are racist events (Williams et al., 2003). Although life stress occurs
for Whites and non-Whites alike, for African Americans life stress
includes unique interactions with perceived racism. The literature
suggests that perceived racism is associated with lower self-esteem
(Broman, 1997; Jackson et al., 1996), lower well-being (Williams,
Yu, Jackson, & Anderson, 1997), increased distress and anxiety
(Kessler et al., 1999), and higher levels of depression and suicidal
thoughts (Karlsen & Nazroo, 2002) for African Americans than for
their White counterparts. Klonoff et al. (1999) examined how
racism relates to psychiatric symptoms. Hierarchical regression
showed that perceived racism contributed significantly to overall
psychiatric problems beyond variance explained by somatization,
obsession– compulsion, interpersonal difficulty, depression, anxi-
ety, and suicidal thoughts. Suicidal thoughts among Blacks can
also be due to their deleterious sociocultural context, one salient
factor of which is racism, and racism increases their feelings of
alienation (Chance, Kaslow, Summerville, & Wood, 1998).

Differentiating African Americans who perceived racism from
those who did not, Broman et al. (2000) found perceived racism
was significantly related to psychological distress and that per-
ceived racism came from varied sources: job applications, work
settings, shopping, and involvement in the legal system. Further,
according to Clark et al. (1999) and Williams et al. (2003),
research on stress also converges with a sociological understand-
ing of racism, underscoring the need to measure stress from the
cultural frame of African Americans, not from a general human
perspective.

Overview

The present study reports the development of a scale that in-
cludes a perceived racism subscale. The study also reports the

results of three studies detailing the MSMHS’s psychometric prop-
erties. The purpose of Study 1 was to generate an item pool to
assess perceived racism, depression, well-being, anxiety, and sui-
cidal thoughts. Items originated from the literature review and
from focus group discussion of racism and its association with
mental health. We asked African American students to complete
the items and then conducted an exploratory factor analysis (EFA)
of responses, computed subscale correlations, and assessed initial
internal consistency. The purpose of Study 2 was to investigate the
structural stability of the Study 1 factor solution and to provide
additional validity evidence. Study 3 assessed test–retest and in-
ternal consistency reliability of the instrument and provided evi-
dence of convergent validity. Table 1 displays the steps taken in
developing the MSMHS.

Study 1

Development of Item Pool

The MSMHS items were generated on the basis of research on
African American experiences (see Clark et al., 1999; Williams &
Williams-Morris, 2000), from the psychological literature on per-
ceived racism and African Americans’ mental health (Essed, 1990;
Harrell, 2000), and from focus group discussions. Items were
oriented to constructs of anxiety, depression, well-being, perceived
racism, and suicidal thoughts.

The development of the initial items included on the MSMHS
was based on informal interviews with 30 African American
college students about their personal life experiences, psycholog-
ical problems, and well-being and also on a review of the litera-
ture. Efforts were made to ensure that the items could be easily
understood (i.e., an eighth-grade reading level). The researchers
reviewed all potential items for redundancy, and those found to be
repetitious were eliminated from the scale. Then six African Amer-
ican licensed psychologists (three men and three women) who had
at least 4 years of counseling with African Americans reviewed the
items. These psychologists either eliminated certain items or sug-

Table 1
Measure Development and Validation Steps

Development phase Scale development steps

Planning Determine the purpose of the measure
Identify the subjects as African Americans
Conduct a review of the literature
Conduct focus groups
Select the rating scale as an item format

Construction Generate an item pool that has redundant and overinclusive items
Conduct expert reviews of all items for content validation
Reduce the item pool as dictated by an expert panel

Quantitative evaluation Administer the items to the development sample
Derive subscales by means of exploratory factor analysis
Assess the concordance of the subscales with the original purpose of the measure
Evaluate the subscale items by means of item analysis and adapt them if necessary
Assess the internal consistency reliability of the subscales
Administer the reduced item pool to a new sample to confirm the structure
Repeat the item analysis and assess the internal consistency reliability of the subscales
Assess the stability reliability

Validation Assess the convergent validity via use of multiple external measures

878 CHAO AND GREEN

gested changes to items to further describe African Americans’
experiences of racism and their impact on mental health. On the
basis of these procedures, a total of 54 items were generated.

To aid in assessing the content validity of the MSMHS, the
primary researcher facilitated a focus group comprising eight Af-
rican American college students (four women, four men; ages
19 –23 years) for approximately 2 hr. The MSMHS was not only
evaluated for content validity but examined for its efficiency of
administration and any potential harmful effects that might result
from its completion. The group members completed the test and
then discussed its structure, item clarity, item domain appropriate-
ness, and comprehensiveness. As a result of the focus group’s
efforts, concerns were raised that led to several changes being
made. First, the anchors of the original 5-point response scale (1 �
no reaction; 2 � a little bit of reaction; 3 � some reaction; 4 �
strong reaction; and 5 � extreme reaction) were changed because
group members found it difficult to differentiate between some of
the response choices (e.g., strong reaction and extreme reaction).
The new anchor labels ranged from 1 (almost never happened to
me) to 5 (almost always happened to me). Second, some of the
descriptions or items were ambiguous and needed clarification.
Third, the group pointed out that several significant events fitting
the criteria for inclusion were missed (e.g., “My teachers gave me
poor grades because of my race” and “I think I have got most of
what I want”). Fourth, these participants also expressed the neces-
sity of adding well-being or resilience items to represent African
American psychology. Indeed, according to Veit and Ware (1983),
measures of mental health need to include items assessing a range
of psychological distress including well-being. Items were written
to reflect depression, anxiety, suicidal thoughts, and well-being as
well as perceptions of racism to provide a complete mental health
scale.

In addition to the focus group, five scholars with extensive
research background in race/ethnicity, African Americans’ mental
health, and cultural issues examined the MSMHS items for clarity
and domain appropriateness. Items rated as not being appropriate
were either rewritten or eliminated.

After redundant items were eliminated, 40 items remained from
the initial pool of 54 items plus the four generated by the focus
group. In a final content review, three female and three male
counseling psychology doctoral students (all African Americans)
reviewed the items. They judged items on the basis of whether they
reflected perceived racism, suicidal thoughts, depression, anxiety,
and well-being and offered suggestions for improvement. This
process resulted in minor modifications to items.

Method

Participants. Participants were 397 African American stu-
dents (264 men, 133 women) recruited at a large southern univer-
sity. They ranged in age from 18 to 48 (M � 20.30, SD � 4.02)
and included 94 freshmen (23.68%), 84 sophomores (21.16%), 88
juniors (22.17%), 79 seniors (19.90%), and 52 graduate students
(13.10%).

Measures. The measures in Study 1 included a demographic
questionnaire, the MSMHS–Initial, the Index of Race-Related
Stress (IRRS; Utsey & Ponterotto, 1996), the Outcome Question-
naire (OQ; Lambert, Lunnen, Umphress, Hansen, & Burlingame,
1994), and the Satisfaction With Life Scale (SWLS; Diener, Em-

mons, Larsen, & Griffin, 1985). The IRRS, OQ, and SWLS were
used to assess the concurrent validity of the MSMHS–Initial.

Demographic questionnaire. Participants were asked to pro-
vide demographic information on age, gender, year in school, and
ethnicity.

MSMHS–Initial. The 44 items in the MSMHS–Initial were
randomly ordered. Participants were asked to indicate their re-
sponses by using the following 5-point response scale: 1 (almost
never happened to me) to 5 (almost always happened to me).
Sample items are “People treat me differently because of my racial
background,” “I feel happy,” and “I feel tired or fatigued” (the first
author may be contacted for the complete list of 44 items).

IRRS (Utsey & Ponterotto, 1996). The IRRS is a 46-item,
four-component measure utilizing a 5-point response scale ranging
from 0 (unaffected by the event) to 4 (extremely upset by the event).
A Global Racism score can also be obtained by summing scores
from all items. A sample item is “White people have expected you
to denounce or reject the views or remarks of controversial Black
leaders.” The IRRS measures racism-related events that respon-
dents or their family members have experienced over their lifetime
and the perceived stress caused by these events. Utsey and Pon-
terotto (1996) established structural validity from an aggregate-
item confirmatory factor analysis (CFA) to determine the best fit to
a four-component oblique model. Significant, positive correlations
were found to exist among all subscales of the IRRS with valida-
tion measures (The Racism and Life Experiences Scales; Harrell,
1997). Utsey and Ponterotto (1996) reported the following ade-
quate internal consistency reliabilities for the IRRS subscales:
Cultural Racism � � .87, Institutional Racism � � .85, Individual
Racism � � .84, and Collective Racism � � .79. Our study found
these results: Cultural Racism � � .89, Institutional Racism � �
.83, Individual Racism � � .85, and Collective Racism � � .80.

OQ (Lambert et al., 1994). The OQ is a self-report instrument
used for repeated measurement of people’s changes through the
course of mental health treatment. OQ instructions direct respon-
dents to answer according to how they felt over the past week. The
instrument consists of 45 items, with responses on a 5-point scale
ranging from 0 (never) to 4 (almost always). The OQ was con-
structed to have increasing scores correspond with increasing
levels of distress on 36 items and increasing scores correspond
with decreasing levels of distress on nine items. In the process of
scoring, the scores obtained on these nine items are reversed to
allow OQ item, subscale, and total scores to be uniformly inter-
preted, where higher scores correspond with increasing levels of
distress. The OQ is a psychometrically sound instrument with
adequate 3-week test–retest reliability (.84) and high internal con-
sistency reliability coefficients (.93; Lambert et al., 1994). The OQ
also has strong concurrent validity coefficients with a variety of
self-report scales (e.g., the Beck Depression Inventory, the State–
Trait Anxiety Inventory; Umphress et al., 1997). The data from the
present study yielded a total scale coefficient alpha of .85.

SWLS (Diener et al., 1985). The SWLS is a five-item self-
report measure of subjective well-being rated on a scale ranging
from 1 (strongly disagree) to 7 (strongly agree), with a higher
score reflecting greater life satisfaction. Sample items are “In most
days my life is close to my ideal” and “I am satisfied with my life.”
The SWLS has good internal consistency reliability estimates (� �
.87; test–retest over an 8-week interval, r � .82), has demonstrated
convergent validity with other well-being measures, and correlates

879MULTICULTURALLY SENSITIVE MENTAL HEALTH SCALE

predictably with personality measures (Diener et al., 1985). The
present study yielded a coefficient alpha of .86.

Procedure. Approval was obtained from the university’s
human participants review committee. Students were informed that
their participation was voluntary and their responses would be
anonymous. The first author oversaw completion of the question-
naires by students in African studies courses and psychology
courses, with students earning course credit for their participation.
Before taking the test, participants were given an introduction that
described the purpose of the study, their rights as research partic-
ipants, and how to complete the questionnaires (all three studies
reported here generally followed this procedure).

In Study 1, 410 students completed the demographic question-
naire, the MSMHS–Initial, the IRRS, the OQ, and the SWLS. As
a check on inattentiveness, distractions, or lack of interest, several
survey items (e.g., “Please do not respond to this item,” “Please
circle 1 to this item”) were used to evaluate random responding.
Using a conservative approach to data screening (e.g., elimination
of any case that contained a single indicator of potentially mali-
cious or random responding), we eliminated 13 cases from the data
set. Thus, 397 cases were used for Study 1.

Results

Prior to conducting principal axis factor analysis, we checked to
see whether necessary assumptions were met. The Kaiser-Meyer-
Olkin measure of sampling adequacy for the initial EFA was .92,
indicating that a factor analysis is useful (Bartlett, 1950). Bartlett’s
test of sphericity, converted to a chi-square statistic and tested for
significance, was significant at the .001 level, indicating that (a)
the correlation matrix did not come from a population where the
correlation matrix is an identity matrix and (b) the sample size was
large enough to allow evaluation of the factor structure (Tabach-
nick & Fidell, 2001). The correlation matrix was considered ap-
propriate for factor analysis.

Six factors had eigenvalues higher than 1.00, but a parallel
analysis found five factors to have eigenvalues exceeding chance
values. Parallel analysis is considered a more effective method for
determining the number of factors to retain (Patil, McPherson, &
Friesner, 2010; Thompson & Daniel, 1996). The first five factors
had eigenvalues ranging from 1.57 to 10.92. Additionally, a scree
test indicated that a five-factor solution might be interpretable. The
researchers forced a one-, four-, five-, and six-factor solution using
both orthogonal and oblique rotation. The most interpretable of the
analyses was the five-factor oblique-rotation solution. The five
components together accounted for 56.24% of the variance. The
criteria for retaining items were (a) items with loadings of .40 or
higher were selected and (b) items meeting the .40 criteria on more
than one factor were eliminated due to cross-loading. Ten items
were eliminated on the basis of these two selection criteria. Table
2 lists the 34 retained MSMHS–Initial items, factor loadings from
the principal axis factor analysis, means, standard deviations,
eigenvalues, and percentage variance accounted for by factors.
We labeled the resultant factors Perceived Racism (Factor 1, 10
items measuring racism experiences), Depression (Factor 2,
nine items measuring depressive mood), Well-Being (Factor 3,
seven items measuring subjective satisfaction with life quality),
Anxiety (Factor 4, five items measuring anxiety symptoms), and
Suicidal Thoughts (Factor 5, three items measuring symptoms that

could be related to African Americans’ experiences of racism;
Chance et al., 1998). Subscale means and standard deviations are
provided in Table 3. All the subscale scores were normally dis-
tributed (see Table 3 for skewness and kurtosis).

Internal consistency and subscale intercorrelations. The
coefficient alphas for the MSMHS subscales were .92 for Per-
ceived Racism, .88 for Depression, .84 for Well-Being, .82 for
Anxiety, and .82 for Suicidal Thoughts (see Table 2). Subscale
intercorrelations for the instrument were moderate to high and
statistically significant at p � .05 (see Table 4). Perceived Racism
correlated .54 with Depression, –.63 with Well-Being, .51 with
Anxiety, and .58 with Suicidal Thoughts. The significant correla-
tions of the Perceived Racism subscale with other subscales indi-
cate that more experiences of racism are associated with a lower
level of psychological well-being and higher levels of depression,
anxiety, and suicidal thoughts. Gender had no significant correla-
tion with the MSMHS subscales.

Relationships between MSMHS factors and other measured
subscales. Positive correlations were found between the
MSMHS–Perceived Racism subscale score and the IRRS total
score (r � .70), IRRS–Cultural Racism (r � .67), IRRS–
Institutional Racism (r � .71), IRRS–Individual Racism (r � .62),
and IRRS–Collective Racism (r � .58). The OQ was statistically
significantly correlated with MSMHS–Depression, MSMHS–
Well-Being, MSMHS–Anxiety, and MSMHS–Suicidal Thoughts,
with low to moderate correlations (�r� � .39 to .64). The five
factors of the MSMHS also correlated statistically significantly
with the SWLS (�r� � .45 to .61; see Table 4).

Study 2

Study 2 further examined the MSMHS’s reliability and validity,
as well as the stability of its factor structure using CFA. Competing
models of the MSMHS factor structure were tested to investigate
its structural validity. Study 2 hypothesized that the data obtained
would fit the factor model established in Study 1 and that the
pattern of reliability coefficients and subscale correlations for the
MSMHS would be similar to those found in Study 1. Additional
measures were administered to extend validity information.

Method

Participants and procedure. The participants were a differ-
ent group of 434 African American students (228 men, 206
women) at a large southern public university. They ranged in age
from 17 to 43 (M � 19.94 years, SD � 4.39) and included 151
freshmen (34.79%), 73 sophomores (16.82%), 136 juniors
(31.34%), 65 seniors (14.98%), and 9 graduate students (2.07%).
All participants were enrolled in psychology courses and received
course credit for their participation.

Measures. The questionnaire in Study 2 consisted of the
same demographic questionnaire used in Study 1 plus the 34-item
MSMHS, the Brief Symptom Inventory (BSI; Derogatis, 1993),
the Schedule of Racist Events (SRE; Landrine & Klonoff, 1996),
and the Happiness Measure (HM; Fordyce, 1977).

BSI (Derogatis, 1993). The BSI is a 58-item self-report mea-
sure of the frequency of experiencing a list of physical and psycho-
logical symptoms in the past 7 days. The measure consists of sub-
scales to assess symptoms in five dimensions: Somatization, Anxiety,

880 CHAO AND GREEN

Obsessive–Compulsiveness, Interpersonal Sensitivity, and Depres-
sion. Participants respond on a 4-point scale ranging from 1 (not at
all) to 4 (extremely). Derogatis (1993) reported reliability coefficients
ranging from .84 to .87 for each of the subscales, 1-week test–retest
reliability coefficients ranging from .75 to .84, and support for
criterion-related validity and construct validity. Data from the present
study yielded a coefficient alpha of .92 for the total scale and alphas
of .89, .84, .86, .88, and .79, respectively, for the Somatization,
Anxiety, Obsessive–Compulsiveness, Interpersonal Sensitivity, and
Depression subscales.

SRE (Landrine & Klonoff, 1996). This is an 18-item instru-
ment developed to assess African Americans’ frequencies of experi-
ences of racist events in the past year (SRE–Recent Racist Events),

over their lifetime (SRE–Lifetime Racist Events), and the overall
degree of racism-related stress (SRE–Appraised Racist Events). Each
item is presented three times. For the two frequency scales, a 6-point
scale ranging from 1 (if this has never happened to you) to 6 (if this
has happened almost all of the time [more than 70% of the time]) is
used, and for the stress scale, a 6-point scale ranging from 1 (not at
all) to 6 (extremely) is used. A sample item is “How different would
your life be now if you had not been treated in a racist and unfair
way?” Landrine and Klonoff (1996) reported reliability coefficients
ranging from .94 to .95 for the three subscales and split-half reliability
coefficients ranging from .91 to .93. Evidence of the SRE’s validity
was observed in the correlations between the three SRE subscales and
all BSI subscales. The present sample yielded coefficient alphas of .90

Table 2
Items, Factor Loadings, Means, Standard Deviations, Communalities, Cronbach’s Alpha, and Eigenvalues for the Multiculturally
Sensitive Mental Health Scale

Item

Factor loadings

1 2 3 4 5 M SD h2

1. People treat me differently because of my racial background .64 .21 2.67 0.93 .37
2. I feel discriminated against because I am Black .62 2.51 0.99 .49
3. I feel that our society doesn’t treat everyone equally in

regard to their racial backgrounds .60 .01 �.12 .11 2.74 0.92 .39
4. My teachers gave me poor grades because of my race .54 .13 �.02 .06 2.73 1.05 .32
6. Being Black, I have to tolerate racist policies or systems in

institutions .59 .10 �.13 .11 2.83 0.95 .39
7. I would have fewer difficulties in school or work if I were a

Caucasian White .61 .18 �.08 .12 2.65 1.01 .43
8. Being Black, I was followed by salespersons while shopping .57 .21 �.12 .16 2.79 0.99 .41
9. I feel that people look at me through their stereotypes .64 .11 �.14 .09 2.70 1.04 .35

10. Being Black, despite my capabilities, I am not appreciated by
my boss or co-workers .69 .19 �.17 .13 2.52 1.02 .31

11. People have biased racial impressions about Blacks, e.g.,
Blacks are lazy .62 .18 .20 .15 2.53 0.97 .38

12. I feel depressed .65 3.16 0.97 .45
13. I feel tired or fatigued .62 3.15 1.06 .46
14. I worry about things .59 �.24 2.98 0.90 .64
15. I think I am less interested in things now than before .60 �.20 2.87 0.93 .62
16. I feel blue or downhearted .66 2.89 0.88 .38
17. I feel stressed or pressured .55 3.04 1.08 .29
18. Quite often nothing turns out as I wanted .52 �.22 2.50 0.91 .35
19. I feel like crying .60 �.22 2.60 1.02 .46
20. I tend to feel lonely .61 2.65 0.85 .36
32. I feel happy �.57 2.35 0.92 .40
34. I am satisfied with my life .20 �.22 �.68 2.39 0.93 .52
35. I feel calm, peaceful, or relaxed �.66 2.70 1.01 .50
36. I do not have much to be proud of .69 2.54 0.98 .53
39. I feel refreshed when I wake up �.61 2.38 1.02 .42
41. I tend to feel not supported by family or friends �.21 .57 2.79 1.03 .41
42. I feel I am loved or wanted by family or friends �.52 2.70 0.97 .33
21. I tend to be nervous �.21 .67 2.61 0.91 .50
22. I feel anxious for no reasons �.21 .53 2.51 1.19 .35
23. It’s not easy to calm down .22 .51 2.34 1.03 .35
25. I feel jittery or jumpy .61 2.53 1.10 .43
26. I feel impatient �.24 .26 .57 2.44 1.02 .46
27. Sometimes I have thoughts of ending my life �.21 .80 2.40 0.98 .63
29. Things would be better off if I die �.24 .86 2.36 0.89 .62
30. I sometimes think of taking my own life .86 2.12 0.82 .64

Eigenvalue 10.92 4.74 2.80 2.23 1.59
Percentage of variance 27.31 11.59 6.74 6.08 5.00
Cronbach’s alpha for subscale .92 .88 .84 .82 .82

Note. Factor loadings ��.40� are in bold. Loadings ��.20� are omitted. Factor 1 � Perceived Racism/Discrimination; Factor 2 � Depression; Factor 3 �
Well-Being; Factor 4 � Anxiety; Factor 5 � Suicidal Thoughts; h2 � item communalities at extraction.

881MULTICULTURALLY SENSITIVE MENTAL HEALTH SCALE

for the SRE–Recent Racist Events subscale, .88 for the SRE–Lifetime
Racist Events subscale, and .87 for the SRE–Appraised Racist Events
subscale.

HM (Fordyce, 1977). The HM measures happiness by com-
bining frequency and intensity of positive affect. It has been used
extensively and is one of the validated measures of happiness,
showing good test–retest reliability for the overall score (.86 over
a 2-week interval and .67 over a 4-month interval; ps � .001). A
sample item is “In general, how happy or unhappy do you usually
feel?” The HM has significant validity coefficients with measures
of personality characteristics of happiness (Compton, Smith, Cor-
nish, & Qualls, 1996). The HM also has significant validity coef-
ficients with measures of positive mood or affect.

Results

CFA. To examine the stability of the five-factor solution
derived from EFA, we conducted a CFA on the 34 items of the
MSMHS using LISREL 8.72 (Jöreskog & Sörbom, 2005). Com-
parisons were made between an identified five-component oblique
model (hypothesized model) found in the EFA in Study 1, two
simpler models—a global component model (Competing Model
A) and a four-component model (Competing Model B)—and a
six-factor model (Competing Model C).

Several indices assessing the degree to which the model fit the
data were computed for all four competing models. First, a chi-
square statistic was computed for each model. As suggested by
Byrne (2001), we computed several alternative indices of fit,
including the �2/df ratio, goodness-of-fit index (GFI), adjusted

goodness-of-fit index (AGFI), root-mean-square residual (RMSR),
comparative fit index (CFI), parsimony comparative fit index, and
root-mean-square error of approximation (RMSEA). Goodness-of-
fit indicators for the competing hypothetical models for the 34-
item MSMHS are shown in Table 5.

The hypothesized model (five-component oblique model) con-
sisted of five latent variables, representing the five subscales, with 10
(Perceived Racism), 9 (Depression), 7 (Well-Being), 5 (Anxiety), and
3 (Suicidal Thoughts) items. Table 5 indicates that this model repre-
sented an acceptable fit to the data, with all the fit indices being
“good” (CFI � .97; normed fit index [NFI] � .94; nonnormed fit
index [NNFI] � .96; incremental fix index [IFI] � .97; RMSEA �
.041; 90% CI [0.034, 0.048]; Byrne, 2001; Quintana & Maxwell,
1999; Schumacker & Lomax, 1996). Of the models tested, the hy-
pothesized model had the lowest �2 value (925.23), the highest GFI
(.92) and AGFI (.90), the lowest �2/df value (1.75), the lowest RMSR
(.06), and the highest relative noncentrality index (.94).

We compared the hypothesized model with three competing
models to determine whether another structure had acceptable, if
not the best, fit. Specifically, competing Model A showed poor fit
(i.e., .82–.83 for CFI, NNFI, and IFI). The indices of GFI and
RMSEA for competing Models B and C were lower than indices
of our hypothesized model (see Table 5). Thus, the hypothesized
five-component oblique model was selected as the best of the
models tested.

Internal consistency and correlations of MSMHS subscales.
The internal consistency reliability estimates of the MSMHS sub-
scales were determined to be adequate. For the Perceived Racism

Table 3
Means, Standard Deviations, Internal Consistency Estimates, Skewness, and Kurtosis for
MSMHS Subscale Scores for Studies 1–3

Study and variable
Perceived
Racism Depression Well-Being Anxiety

Suicide
Thoughts

Study 1 (N � 394)
M 2.67 2.87 2.55 2.49 2.43
SD 0.99 0.97 0.98 1.05 0.96
� .89 .89 .85 .80 .81
Skewness 1.21 1.32 1.56 1.64 1.53
Kurtosis 1.48 1.54 2.13 1.88 1.76

Study 2 (N � 434)
M 2.60 2.85 2.48 2.51 2.45
SD 0.92 0.94 0.92 0.90 0.93
� .88 .86 .85 .88 .82
Skewness 1.04 1.14 1.11 1.50 1.55
Kurtosis 1.53 1.62 1.78 1.34 1.41

Study 3a (N � 40)
M 2.61 2.82 2.57 2.43 2.49
SD 0.89 0.93 0.94 0.99 0.95
� .87 .84 .82 .87 .84
Skewness 1.17 1.71 1.81 1.82 1.71
Kurtosis 1.32 2.16 2.08 1.54 1.76

Study 3b (N � 38)
M 2.59 2.89 2.47 2.55 2.41
SD 0.93 0.92 0.96 0.98 0.92
� .88 .85 .84 .83 .83
Skewness 1.52 1.11 1.41 1.45 1.63
Kurtosis 1.76 1.42 1.94 1.08 1.45

Note. Study 1: N � 394; Study 2: N � 434; Study 3 (a): N � 40. Study 3b: N � 38. In Study 3b, participants
were retested 2 weeks after initial testing in Study 3a. MSMHS � Multiculturally Sensitive Mental Health Scale.

882 CHAO AND GREEN

subscale, Cronbach’s alpha was .88; for Depression, alpha was .88;
for Well-Being, alpha was .85; for Anxiety, alpha was .84; and for
Suicidal Thoughts, alpha was .82. The MSMHS subscale correla-
tions approximated those found in Study 1 (see Table 5). These
correlation coefficients indicate that the MSMHS subscales mea-
sure related yet distinct aspects of racism and mental health prob-
lems.

Convergent validity. Pearson product–moment correlation
coefficients were computed between MSMHS subscales and the
BSI, SRE, and HM (see Table 5). All correlations between
MSMHS subscales and these measures were statistically signifi-
cant (�r� � .34 –.72). The means for the MSMHS subscales indicate
that the participants generally have some level of experience with

racism that in turn is significantly related to their psychological
distress (depression, anxiety, and well-being).

Study 3

Study 3 provided additional reliability data, specifically test–
retest reliability estimates, for the MSMHS.

Method

Thirty-nine African American undergraduates (21 men, 18
women) ages 18 – 44 (M � 20.95, SD � 6.27) completed the
34-item MSMHS for Study 3.

Table 4
Correlations Between MSMHS Subscales, Demographic Variables, and Selected Predictor Variables

Variable

Study 1 (N � 394) Study 2 (N � 434)

1 2 3 4 5 1 2 3 4 5

MSMHS subscale
1. Perceived Racism — —
2. Depression .54�� — .46�� —
3. Well-Being �.63�� .49�� — �.62�� .44�� —
4. Anxiety .51�� .44�� .50�� — .50�� .46�� .43�� —
5. Suicidal Thoughts .58�� .52�� .60�� .45�� — .61�� .48�� .55�� .49�� —

Gender .07 .02 .03 .04 .03 .08 �.01 �.01 �.00 .02
OQ

Subjective Distress .61�� .64�� .52�� .57�� .63��

Interpersonal Relations .55�� .42�� .49�� .45�� .58��

Social Role .57�� .39�� .42�� .46�� .55��

IRRS
Cultural Racism .67�� .46�� .56�� .52�� .70��

Institutional Racism .71�� .41�� .54�� .42�� .68��

Individual Racism .62�� .37�� .42�� .32�� .60��

Collective Racism .58�� .36�� .44�� .39�� .55��

SWLS �.50�� .61�� .45�� .54�� .48��

BSI
Depression .65�� .69�� .63�� .60�� .52��

Anxiety .61�� .68�� .60�� .72�� .68��

Global Distress .63�� .71�� .62�� .68�� .56��

SRE
Past year .67�� .37�� .45�� .39�� .43��

Entire life .61�� .34�� .44�� .41�� .48��

Appraisal .66�� .42�� .41�� .50�� .42��

HM �.43�� .51�� .54�� .48�� .50��

Note. MSMHS � Multiculturally Sensitive Mental Health Scale; OQ � Outcome Questionnaire; IRRS � Index of Race-Related Stress; SWLS �
Satisfaction With Life Survey; BSI � Brief Symptom Inventory; SRE � Schedule of Racist Events; HM � Happiness Measure.
�� p � .01.

Table 5
Goodness-of-Fit Indicators for the Competing and Hypothesized Models for the 34-Item MSMHS for Study 2

Model �2 df �2/df GFI AGFI RMSR CFI PCFI RMSEA 90% CI

Null 3,269.12 570 6.61 .54 .47 .18 .80 .47 .18 [0.16, 0.20]
A: One-factor 2,662.97 533 5.00 .57 .49 .15 .83 .49 .17 [0.16, 0.18]
B: Four-factor 2,040.88 529 3.86 .74 .69 .08 .88 .63 .11 [0.11, 0.12]
C: Six-factor 1,446.52 527 2.74 .72 .69 .09 .89 .85 .09 [0.08, 0.10]
Five-factor oblique 925.23 528 1.75 .92 .90 .06 .97 .92 .04 [0.03, 0.05]

Note. N � 434. All chi-square differences are statistically significant at the p � .01 level. MSMHS � Multiculturally Sensitive Mental Health Scale;
GFI � goodness-of-fit index; AGFI � adjusted goodness-of-fit index; RMSR � root-mean-square residual; CFI � comparative fit index; PCFI �
parsimony comparative fit index; RMSEA � root-mean-square error of approximation.

883MULTICULTURALLY SENSITIVE MENTAL HEALTH SCALE

Participants were recruited from four undergraduate-level engi-
neering, chemistry, psychology, and agriculture courses in a south-
ern public university. The retest was administered 2 weeks after
the first administration. Participants signed a consent form at the
first administration and completed the MSMHS and a demo-
graphic questionnaire during each of two class periods. Partici-
pants were given a debriefing form describing the hypotheses of
the study after the second administration.

Results

Reliability estimates. The 2-week test–retest reliability esti-
mates for the MSMHS subscales were .87 for Perceived Racism,
.88 for Depression, .86 for Well-Being, .85 for Anxiety, and .84 for
Suicidal Thoughts. Table 3 also reports internal consistency esti-
mates with subscale means and standard deviations from all stud-
ies. Internal consistency estimates from Study 3 were comparable
to those from Studies 1 and 2.

Discussion

The present study reported (a) development of a measure of
mental health among African Americans inclusive of experiences
of racism and (b) evidence of initial reliability and validity for this
new instrument. Inclusion of perceived racism in a mental health
measure stems from previous research that found perceived racism
to play a substantial role in mental health for African Americans.
The present study found evidence of validity for the MSMHS
in the following results: (a) significant positive correlations be-
tween the Perceived Racism subscale of the MSMHS and the
IRRS and SRE, indicating that the MSMHS appropriately de-
scribed racist stress among African Americans; (b) the Depression,
Anxiety, and Suicidal Thoughts subscales of the MSMHS corre-
lated with two existing measures of mental health; and (c) corre-
lations between four subscales of the MSMHS (e.g., level of
perceived racism significantly and negatively correlated with level
of well-being) were in the hypothesized direction.

The results of EFA and CFA of the MSMHS revealed that the
relationships between the original MSMHS items were explained
by the five hypothesized subscales. The MSMHS included (a)
African Americans’ daily life stressor racism and (b) items of
mental health representing depression, anxiety, well-being, and
suicidal thoughts. The strength and significance of the subscale
correlations for Studies 1 and 2 were highly consistent, as were
subscale reliability coefficients.

The relationship between perceived racism and mental health
(e.g., well-being, depression) among African Americans is of
interest to many researchers and counselors. For researchers, these
relationships support previous literature on the influence of per-
ceived racism on well-being and psychological distress. For coun-
selors, items addressing perceived racism can be used to describe
an individual African American client’s experience of racism and
give counselors an initial understanding of how racism relates to
an individual African American’s mental health (Utsey & Pon-
terotto, 1996).

For African Americans, perceived racism has been found to be
a more powerful predictor of psychological symptoms than have
generic stressors and social status (Klonoff et al., 1999). Because
most research on stress and symptoms has been conducted with

White Americans, current mental health scales lack items on
perceived racism.

Racism as a scale. Previous researchers measured racism in
a wide variety of ways, ranging from a single statement such as
“ever experienced any unfavorable or unfair event in the past”
(Sanders Thompson, 1996), through self-designed questionnaires
on frequency of racist events, to a full five-factor instrument
(Utsey & Ponterotto, 1996). The present MSMHS has a multi-item
subscale measuring African Americans’ perceived racism that
ranges from personal experience of a racist event to institutional
racism. This inclusion of a multi-item subscale is in contrast to the
previous use of separate measures to assess perceived racism and
psychological distress, despite wide agreement on significant re-
lationships between racism and mental health concerns.

The present study measured African Americans’ mental health
with an instrument focused on their daily experiences. Perceived
racism is a daily stressor. Such stress is shared among African men
and women but not by Caucasian Whites, who may report no
significant racism stress.

The other four subscales of the MSMHS (Depression, Well-
Being, Anxiety, and Suicidal Thoughts) were appropriately related
for this sample of African Americans. The Well-Being subscale of
the MSMHS was significantly related to the SWLS and the HM in
the hypothesized direction. The Well-Being subscale of the
MSMHS was negatively related to the OQ and the BSI, indicating
that a higher level of well-being is related to less psychological
distress.

Frequently used mental health instruments such as the OQ claim
to be useful in assessing cross-cultural populations because scores
from varied racial groups (e.g., Whites, African Americans, Lati-
nos/Latinas) were not found be significantly different (Lambert et
al., 1994). Partially on the basis of this conclusion, researchers
have used the OQ to investigate the mental health of participants
from different racial groups. Unfortunately, previous mental health
instruments did not measure perceived racism and so could not
assess its role in mental health. Thus, the previous instruments
failed to assess how racism relates to mental health.

When we examined African Americans’ scores on the Depres-
sion, Well-Being, Anxiety, and Suicidal Thoughts subscales of the
MSMHS, together with the Perceived Racism subscale, we noted
that for African Americans racist experiences are related to well-
being, depression, and anxiety. Scholars and counselors alike may
need to understand the components of mental health by taking into
account people’s cultural experiences. For example, it is a double-
edged dilemma for counselors to consider the role of racism for
African Americans. On the one hand, many African Americans
may wish to discuss perceived racism, because racist experience
has been part of their daily life. On the other hand, some (though
few) African Americans report no serious racist events, possibly
due to their specific environment (Smedley et al., 1993). For
example, some students in historically black universities reported
little racist experience, possibly because they have fewer daily
interactions with non-African American communities. As a result,
the role racism plays for individual African Americans is individ-
ual. To take this into account, the MSMHS assesses racial stressors
on an individual basis.

Limitations and future studies. The MSMHS conceptual-
izes overall experiences of perceived racism as a stressor for
African Americans but does not specify types of racism or ascer-

884 CHAO AND GREEN

tain number of factors on racism. According to Williams et al.
(2003), acutely perceived racism creates immediate acute stress,
whereas lifetime racism contributes to chronic, long-term stress.
The variation in duration and severity of stress may in turn exert
different impacts on African Americans’ mental health. The
MSMHS is limited to distinguishing perceived racism from other
mental health concerns and does not differentiate acute from
lifetime, chronic stress. Another relevant limitation is that overall
experience of racism does not equate to a multidimensional solu-
tion for racism (Williams & Williams-Morris, 2000). Future re-
search may further examine the number of factors on racism-
related experience and their relations to psychological distress.

The MSMHS was developed specifically for use with African
American populations, so the item content, measure structure, and
validity are unique to the samples employed. Although findings
were positive with respect to the stability and validity of the
instrument, additional research is necessary to further examine the
stability and validity of the MSMHS structure with additional
African American participants and to expand its use with other
racial groups such as Latino/Latina and Asian American groups.
Thus, extending the concept of racially related stress as a compo-
nent of mental health to other groups requires replication of this
process with individuals from other racial backgrounds. Our par-
ticipants were mainly African American college students, and the
homogeneous sample could be a limitation. Our results may be
limited in assessing samples from clinical settings, communities,
or populations other than college students. Thus, future research is
needed to examine whether our results are applicable to other
African American populations. Finally, we did not focus on the
relation between gender and the MSMHS subscales, though gender
may moderate the relations between racism and well-being or
psychological distress (Clark, 2006). Future studies can further
evaluate whether gender moderates racism and other MSMHS
subscales such as Well-Being and Suicidal Thoughts.

We found in various studies of test–retest reliability, when
developing new scales, that sample sizes for test–retest reliability
are below 50 in many scales (e.g., 38 participants in Waelde et al.,
2010; 26 participants in Hill, Terrell, Hladkyj, & Nagoshi, 2009;
38 participants in Murphy, MacKillop, Skidmore, & Pederson,
2009; 31 participants in Utsey & Ponterotto, 1996; 37 participants
in Worthington, Dillon, & Becker-Schutte, 2005). Still, we believe
that our sample size (n � 38) for Study 3 on test–retest reliability
was a limitation.

The MSMHS assesses constructs relevant to mental health.
However, the causal relationships between these constructs are not
necessarily evidenced by their correlation. The question remains
whether perceptions of racism cause differences in mental health
or whether differences in mental health cause differences in per-
ceptions of racism. In either case, inclusion of perceptions of
racism proves clinically useful. Understanding clients’ perceptions
of racism enhances clinicians’ conceptualization of clients’ pre-
senting problems. Future research can also investigate causal re-
lationships between racism and mental health. In other words, do
mental health problems make people vulnerable to racism, or does
the constant experience of racism engender mental health prob-
lems?

In sum, the findings of the present study support the reliability
and validity of the MSMHS as a measure of the multidimensional
aspects of mental health among African Americans and can prove

useful for assessing the impact of racism on well-being and dis-
tress for these clients and for determining specific issues related to
experience with racism.

Because it is a subscale sensitive to African Americans, the
MSMHS may also prove valuable in future research. The research
utility of the MSMHS demands examination of effects of moder-
ating variables such as education and socioeconomic status on
perceived racism and relationships with psychological distress.
Other research directions include understanding the effects of
therapy targeted at racial stressors among African American cli-
ents, the impact of racism on racial identity development (Ridley,
2005), within-group variation in perceptions of racism and its
relationship to life satisfaction, and the impact of racism on per-
sonal interactions and academic outcomes.

References

American Psychological Association. (1993). Guidelines for providers of
psychological services to ethnic, linguistic, and culturally diverse stu-
dents. American Psychologist, 48, 45– 48. doi:10.1037/0003-
066X.48.1.45

American Psychological Association. (2003). Guidelines on multicultural
education, training, research, practice, and organizational change for
psychologists. American Psychologist, 58, 377– 402. doi:10.1037/0003-
066X.58.5.377

Anderson, T. (2003). Black psychology and psychological concepts. In
D. A. Y. Azibo (Ed.), African-centered psychology: Culture-focusing for
multicultural competence (pp. 3–38). Durham, NC: Cambridge Aca-
demic Press.

Bartlett, M. S. (1950). Tests of significance in factor analysis. British
Journal of Psychology, 3, 77-85.

Broman, C. L. (1997). Race-related factors and life satisfaction among
African Americans. Journal of Black Psychology, 23, 36 – 49. doi:
10.1177/00957984970231004

Broman, C. L., Mavaddat, R., & Hsu, S. (2000). The experiences and
consequences of racial discrimination. Journal of Black Psychology, 26,
165–180. doi:10.1177/0095798400026002003

Byrne, B. M. (2001). Structural equation modeling with Amos. Mahwah,
NJ: Erlbaum.

Caldwell, C. L., Jackson, J. S., Tucker, M. B., & Bowman, P. J. (1999).
Culturally-competent research methods. In R. L. Jones (Ed.), Advances
in African American psychology (pp. 101–128). Hampton, VA: Cobb &
Henry.

Chance, S. E., Kaslow, N. J., Summerville, M. B., & Wood, K. (1998).
Suicidal behavior in African American individuals: Current status and
future directions. Cultural Diversity and Mental Health, 4, 19 –37.
doi:10.1037/1099-9809.4.1.19

Clark, R. (2006). Perceived racism and vascular reactivity in Black college
women: Moderating effects of seeking social support. Health Psychol-
ogy, 25, 20 –25. doi:10.1037/0278-6133.25.1.20

Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999). Racism
as a stressor for African Americans: A biopsychosocial model. American
Psychologist, 54, 805– 816. doi:10.1037/0003-066X.54.10.805

Compton, W. C., Smith, M. L., Cornish, K. A., & Qualls, D. L. (1996).
Factor structure of mental health measures. Journal of Personality and
Social Psychology, 71, 406 – 413. doi:10.1037/0022-3514.71.2.406

Constantine, M. G., & Sue, D. W. (Eds.). (2006). Addressing racism:
Facilitating cultural competence in mental health and educational set-
tings. Hoboken, NJ: Wiley.

Derogatis, L. R. (1993). Brief Symptom Inventory: Administration, scoring,
and procedures manual—II. Minneapolis, MN: National Computer Sys-
tems.

Diener, E., Emmons, R., Larsen, R., & Griffin, S. (1985). The Satisfaction

885MULTICULTURALLY SENSITIVE MENTAL HEALTH SCALE

With Life Scale. Journal of Personality Assessment, 49, 71–75. doi:
10.1207/s15327752jpa4901_13

Draper, M. R., Jennings, J., & Baron, A. (2003). Factor analysis and
concurrent validity of a university counseling center presenting problem
checklist. Retrieved May 21, 2004, from University of Texas at Austin,
Counseling and Mental Health Center, website: http://www.utexas.edu/
student/cmhc/research/rescon.html

Essed, P. (1990). Everyday racism: Reports from women of two cultures.
Claremont, CA: Hunter House.

Fernando, S. (1984). Racism as a cause of depression. International Jour-
nal of Social Psychiatry, 30, 41– 49. doi:10.1177/002076408403000107

Fordyce, M. W. (1977). Development of a program to increase personal
happiness. Journal of Counseling Psychology, 24, 511–521. doi:
10.1037/0022-0167.24.6.511

Harrell, S. P. (1997). The Racism and Life Experiences Scales (RaLES).
Unpublished manuscript.

Harrell, S. P. (2000). A multidimensional conceptualization of racism-
related stress: Implications for the well-being of people of color. Amer-
ican Journal of Orthopsychiatry, 70, 42–57. doi:10.1037/h0087722

Hill, E. D., Terrell, H. K., Hladkyj, S., & Nagoshi, C. T. (2009). Validation
of the Narrative Emplotment Scale and its correlations with well-being
and psychological adjustment. British Journal of Psychology, 100, 675–
698. doi:10.1348/000712608X396585

Jackson, J. S., Brown, T. N., Williams, D. R., Torres, M., Sellers, S. L., &
Brown, K. (1996). Racism and the physical and mental health status of
African Americans: A thirteen-year national panel study. Ethnicity and
Disease, 6, 132–147.

Jöreskog, K. G., & Sörbom, D. (2005). LISREL 8.72: User’s reference
guide. Mooresville, IN: Scientific Software.

Karlsen, S., & Nazroo, J. Y. (2002). Relation between racial discrimina-
tion, social class, and health among ethnic minority groups. American
Journal of Public Health, 92, 624 – 631. doi:10.2105/AJPH.92.4.624

Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The preva-
lence, distribution, and mental health correlates of perceived discrimi-
nation in the United States. Journal of Health and Social Behavior, 40,
208 –230. doi:10.2307/2676349

Kinzie, J. D., Manson, S. M., Vinh, D. T., Toland, N. T., Anch, B., & Pho,
T. N. (1982). Development and validation of a Vietnamese American
depression rating scale. American Journal of Psychiatry, 139, 1276 –
1281.

Klonoff, E. A., Landrine, H., & Ullman, J. B. (1999). Racial discrimination
and psychiatric symptoms among Blacks. Cultural Diversity and Ethnic
Minority Psychology, 5, 329 –339. doi:10.1037/1099-9809.5.4.329

Lambert, M. J., Lunnen, K., Umphress, V., Hansen, N., & Burlingame,
G. M. (1994). Administration and scoring manual for the Outcome
Questionnaire (OQ-45.1). Salt Lake City, UT: IHC Center for Behav-
ioral Healthcare Efficacy.

Landrine, H., & Klonoff, E. A. (1996). The Schedule of Racist Events: A
measure of racial discrimination and a study of its negative physical and
mental health consequences. Journal of Black Psychology, 22, 144 –168.
doi:10.1177/00957984960222002

Lazarus, R. S., & Folkman (1984). Stress, appraisal, and coping. New
York, NY: Springer.

Lonner, W. J., & Ibrahim, F. A. (1989). Assessment in cross-cultural
counseling. In P. B. Pedersen, J. G. Draguns, W. J. Lonner, & J. E.
Trimble (Eds.), Counseling across cultures (3rd ed., pp. 299 –334).
Honolulu, HI: University of Hawaii Press.

Murphy, J. G., MacKillop, J., Skidmore, J. R., & Pederson, A. A. (2009).
Reliability and validity of a demand curve measure of alcohol reinforce-
ment. Experimental and Clinical Psychopharmacology, 17, 396 – 404.
doi:10.1037/a0017684

Patil, V. H., McPherson, M. Q., & Friesner, D. (2010). The use of

exploratory factor analysis in public health: A note on parallel analysis
as a factor retention criterion. American Journal of Health Promotion,
24, 178 –181.

Ponterotto, J. G. (1988). Racial/ethnic minority research in the Journal of
Counseling Psychology: A content analysis and methodological critique.
Journal of Counseling Psychology, 35, 410 – 418. doi:10.1037/0022-
0167.35.4.410

Ponterotto, J. G., Utsey, S. O., & Pedersen, P. B. (2006). Preventing
prejudice: A guide for counselors, educators, and parents (2nd ed.).
Thousand Oaks, CA: Sage.

Quintana, S. M., & Maxwell, S. E. (1999). Implications of recent devel-
opments in structural equation modeling for counseling psychology.
Counseling Psychologist, 27, 485–527. doi:10.1177/0011000099274002

Ridley, C. R. (2005). Overcoming unintentional racism in counseling and
therapy: A practitioner’s guide to intentional intervention. Thousand
Oaks, CA: Sage.

Sanders Thompson, V. L. (1996). Perceived experiences of racism as
stressful life events. Community Mental Health Journal, 32, 223–233.
doi:10.1007/BF02249424

Schumacker, R. E., & Lomax, R. G. (1996). A beginner’s guide to struc-
tural equation modeling (2nd ed.). Mahwah, NJ: Erlbaum.

Smedley, B. D., Myers, H. F., & Harrell, S. P. (1993). Minority-status
stresses and the college adjustment of ethnic minority freshmen. Journal
of Higher Education, 64, 434 – 452. doi:10.2307/2960051

Smith, E. M. J. (1985). Ethnic minorities: Life stress, social support, and
mental health issues. Counseling Psychologist, 13, 537–579. doi:
10.1177/0011000085134002

Sodowsky, G. R., Kou-Jackson, P. Y., & Loya, G. L. (1997). Outcome of
training in the philosophy of assessment: Multicultural counseling com-
petencies. In D. B. Pope-Davis & H. L. K. Coleman (Eds.), Multicultural
counseling competencies: Assessment, education and training, and su-
pervision (pp. 3– 42). Thousand Oaks, CA: Sage.

Sue, D. W., & Sue, D. (2008). Counseling the culturally different (5th ed.).
New York, NY: Wiley.

Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th
ed.). New York, NY: Harper & Row.

Terrell, F., & Terrell, S. (1981). An inventory to measure cultural mistrust
among Blacks. Western Journal of Black Studies, 5, 180 –184.

Thompson, B., & Daniel, L. G. (1996). Factor analytic evidence for the
construct validity of scores: A historical overview and some guidance.
Educational and Psychological Measurement, 56, 197–208. doi:
10.1177/0013164496056002001

Umphress, V. J., Lambert, M. J., Smart, D. W., Barlow, S. H., Clouse,
G. C., & Hansen, N. B. (1997). Concurrent and construct validity of the
Outcome Questionnaire. Journal of Psychoeducational Assessment, 15,
40 –55. doi:10.1177/073428299701500104

Utsey, S. O., & Ponterotto, J. G. (1996). Development and validation of the
Index of Race-Related Stress (IRRS). Journal of Counseling Psychol-
ogy, 43, 490 –501. doi:10.1037/0022-0167.43.4.490

Veit, C. T., & Ware, J. E. (1983). The structure of psychological distress
and well-being in general populations. Journal of Consulting and Clin-
ical Psychology, 51, 730 –742. doi:10.1037/0022-006X.51.5.730

Waelde, L. C., Pennington, D., Mahan, C., Mahan, R., Kabour, M., &
Marquett, R. (2010). Psychometric properties of the Race-Related
Events Scale. Psychological Trauma: Theory, Research, Practice, and
Policy, 2, 4 –11. doi:10.1037/a0019018

Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/ethnic
discrimination and health: Findings from community studies. American
Journal of Public Health, 93, 200 –208. doi:10.2105/AJPH.93.2.200

Williams, D. R., & Williams-Morris, R. (2000). Racism and mental health:
The African American experience. Ethnicity & Health, 5, 243–268.
doi:10.1080/713667453

886 CHAO AND GREEN

Williams, D. R., Yu, Y., Jackson, J., & Anderson, N. (1997). Racial
differences in physical and mental health: Socioeconomic status, stress,
and discrimination. Journal of Health Psychology, 2, 335–351. doi:
10.1177/135910539700200305

Worthington, R. L., Dillon, F. R., & Becker-Schutte, A. M. (2005).
Development, reliability, and validity of the Lesbian, Gay, and Bisexual
Knowledge and Attitudes Scale for Heterosexuals (LGB-KASH). Jour-

nal of Counseling Psychology, 52, 104 –118. doi:10.1037/0022-
0167.52.1.104

Received October 20, 2009
Revision received December 7, 2010

Accepted March 15, 2011 �

New Editors Appointed, 2013–2018

The Publications and Communications Board of the American Psychological Association an-
nounces the appointment of 5 new editors for 6-year terms beginning in 2012. As of January 1,
2012, manuscripts should be directed as follows:

● Journal of Experimental Psychology: Learning, Memory, and Cognition (http://www.apa.org/
pubs/journals/xlm/), Robert L. Greene, PhD, Department of Psychology, Case Western
Reserve University

● Professional Psychology: Research and Practice (http://www.apa.org/pubs/journals/pro/),
Ronald T. Brown, PhD, ABPP, Wayne State University

● Psychology and Aging (http://www.apa.org/pubs/journals/pag), Ulrich Mayr, PhD, Depart-
ment of Psychology, University of Oregon

● Psychology, Public Policy, and Law (http://www.apa.org/pubs/journals/law/), Michael E.
Lamb, PhD, University of Cambridge, United Kingdom

● School Psychology Quarterly (http://www.apa.org/pubs/journals/spq/), Shane R. Jimerson,
PhD, University of California, Santa Barbara

Electronic manuscript submission: As of January 1, 2012, manuscripts should be submitted
electronically to the new editors via the journal’s Manuscript Submission Portal (see the website
listed above with each journal title).

Current editors Randi C. Martin, PhD, Michael C. Roberts, PhD, Paul Duberstein, PhD, Ronald
Roesch, PhD, and Randy W. Kamphaus, PhD, will receive and consider new manuscripts through
December 31, 2011.

887MULTICULTURALLY SENSITIVE MENTAL HEALTH SCALE

Reaction to “Non-Cognitive ability, College Learning, and Student Retention”

Marilyn D. Lovett

Florida A&M University

I found the idea of measuring non-cognitive ability intriguing. However, I did not get said measurement in this article. The literature review does not seem to support what the researchers say occurred with the SE2 program. While the policy emphasized rewarding effort with grades, such research was not mentioned in the literature review. As a result, I was not sure how effort was measured. The authors mentioned information in the “sociology literature” but I believe examining psychological literature might have made for a more sound argument. I also wondered if students of African descent were in any of the studies mentioned in the literature review.

In the methodology section, the authors stated that the SE2 policy was developed “to improve student performance by increasing study skills and the preparedness of the students” (Gray & Swinton, 2017, p. 67). However, I do not understand how that would have increased preparedness. I also was not clear on the equations used to answer the research questions, but that is probably because I am not familiar with the Cox proportional hazard model.

There were a couple of times throughout the article that mentioned some information being “available upon request.” I appreciated that because it is a nod toward transparency in research. It reminded me about the replication program touted by the Association for Psychological Science in which researchers are invited to upload their data for other researchers to replicate. I noticed that Table 4 had no non-cognitive skills recorded. I wondered why cognitive and non-cognitive skills could not be increased simultaneously when the authors stated that the SE2 policy “helps those students with unmeasured non-cognitive skills, while potentially harming some of the students with higher measured cognitive skills” (Gray & Swinton, 2017, p. 74). This brought me back to wondering why non-cognitive skills were not operationalized in the first place.

Turn in your highest-quality paper
Get a qualified writer to help you with

“ I have a 1pg reaction paper due in 2.5 hours ”

Get high-quality paper

NEW! AI matching with writer

Still stressed with your coursework?

Get quality coursework help from an expert!

Order now