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Brown‐Johnson C, Cox J, Shankar M, Baratta J, De Leon G, Garcia R, Hollis T, Verano M, Henderson K, Upchurch M, Safaeinili N, Shaw JG, Fortuna RJ, Beverly C, Walsh M, Somerville CS, Haverfield M, Israni ST, Verghese A, Zulman DM. The Presence 5 for Racial Justice Framework for anti-racist communication with Black patients. Health Serv Res 2022; 57 Suppl 2:263-278. [PMID: 35765147 PMCID: PMC9660409 DOI: 10.1111/1475-6773.14015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To identify communication practices that clinicians can use to address racism faced by Black patients, build trusting relationships, and empower Black individuals in clinical care. DATA SOURCES Qualitative data (N = 112 participants, August 2020-March 2021) collected in partnership with clinics primarily serving Black patients in Leeds, AL; Memphis, TN; Oakland, CA; and Rochester, NY. STUDY DESIGN This multi-phased project was informed by human-centered design thinking and community-based participatory research principles. We mapped emergent communication and trust-building strategies to domains from the Presence 5 framework for fostering meaningful connection in clinical care. DATA COLLECTION METHODS Interviews and focus group discussions explored anti-racist communication and patient-clinician trust (n = 36 Black patients; n = 40 nonmedical professionals; and n = 24 clinicians of various races and ethnicities). The Presence 5 Virtual National Community Advisory Board guided analysis interpretation. PRINCIPAL FINDINGS The emergent Presence 5 for Racial Justice (P5RJ) practices include: (1) Prepare with intention by reflecting on identity, bias, and power dynamics; and creating structures to address bias and structural determinants of health; (2) Listen intently and completely without interruption and listen deeply for the potential impact of anti-Black racism on patient health and interactions with health care; (3) Agree on what matters most by having explicit conversations about patient goals, treatment comfort and consent, and referral planning; (4) Connect with the patient's story, acknowledging socioeconomic factors influencing patient health and focusing on positive efforts; (5) Explore emotional cues by noticing and naming patient emotions, and considering how experiences with racism might influence emotions. CONCLUSION P5RJ provides a framework with actionable communication practices to address pervasive racism experienced by Black patients. Effective implementation necessitates clinician self-reflection, personal commitment, and institutional support that offers time and resources to elicit a patient's story and to address patient needs.
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Affiliation(s)
- Cati Brown‐Johnson
- Evaluation Sciences Unit, Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Joy Cox
- Meta Platforms, Inc.One Hacker WayMenlo ParkCaliforniaUSA
| | - Megha Shankar
- Division of General Internal Medicine, Department of MedicineUC San DiegoSan DiegoCaliforniaUSA
| | | | - Gisselle De Leon
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Raquel Garcia
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Taylor Hollis
- UAB Marnix E. Heersink School of MedicineBirminghamAlabamaUSA
| | - Mae Verano
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | | | | | - Nadia Safaeinili
- Health Policy and ManagementUC Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - Jonathan Glazer Shaw
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | | | - Clyde Beverly
- Presence 5 for Racial Justice Community Advisory BoardStanford University School of MedicinePalo AltoCaliforniaUSA
| | | | | | - Marie Haverfield
- Communication StudiesCollege of Social Studies, San Jose State UniversitySan JoseCaliforniaUSA
| | | | - Abraham Verghese
- Presence CenterStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Donna M. Zulman
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
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Kidd J, Came H, McCreanor T. Using vignettes about racism from health practice in Aotearoa to generate anti-racism interventions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4020-e4027. [PMID: 35302269 PMCID: PMC10078765 DOI: 10.1111/hsc.13795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/02/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Racism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses - reworked into vignettes - to examine the dynamics of racism to generate possible micro, meso and macro anti-racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non-Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti-racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono-cultural practice, (ii) everyday micro-aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence-based micro, meso and macro-level anti-racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti-racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti-racist interventions. Being able to identify racism is essential to being able to effectively counter racism.
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Affiliation(s)
- J. Kidd
- Faculty of Health and Environment SciencesAuckland University of TechnologyAucklandNew Zealand
| | - H. Came
- Faculty of Health and Environment SciencesAuckland University of TechnologyAucklandNew Zealand
| | - T. McCreanor
- Te Rōpū WhārikiMassey UniversityAucklandNew Zealand
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Cobb S, Najand B, Gravidez T, Navarro B, Herreraramos A, Bazargan M. Number of Chronic Medical Conditions and Quality of Life of Ethnic Minority Older Adults. Geriatrics (Basel) 2022; 7:geriatrics7050106. [PMID: 36286209 PMCID: PMC9602015 DOI: 10.3390/geriatrics7050106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The Blacks’ mental health paradox is defined as disproportionately better mental health among Black individuals compared to White individuals, despite their higher exposure to a wide range of adversities. However, the existing literature on this phenomenon is mainly limited to studies that have compared Black and White individuals. There has been little research on this phenomenon among ethnic groups other than Whites. Objectives: This study tested the Blacks’ mental health paradox with consideration of Latinx individuals as the control group. Methods: This cross-sectional study collected demographic data, socioeconomic status, chronic medical conditions, and mental and physical quality of life of 724 older Black and Latinx adults residing in low socioeconomic areas of south Los Angeles. Linear regressions were used for data analysis with mental and physical health-related quality of life (HRQoL) as dependent variables and the number of chronic medical conditions as the independent variable. Results: Overall, a higher number of chronic medical conditions was associated with lower mental and physical quality of life. A statistically significant interaction was found between race/ethnicity and the effect of the number of chronic medical conditions on mental HRQoL, which was indicative of Blacks’ mental health paradox. Conclusion: Older Black adults with a higher number of chronic medical conditions report better mental health compared to their Latinx peers with the same number of chronic medical conditions. Thus, Blacks’ mental health paradox can be seen when Black and Latinx populations are compared. Replication of such a paradox provides additional support for the relative mental health advantage of Black people compared to other ethnic groups.
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Affiliation(s)
- Sharon Cobb
- Mervyn M. Dymally School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Correspondence:
| | - Babak Najand
- Marginalization-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA 90059, USA
| | - Tara Gravidez
- Mervyn M. Dymally School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Berlin Navarro
- Mervyn M. Dymally School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Alondra Herreraramos
- Mervyn M. Dymally School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Mohsen Bazargan
- Marginalization-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA 90059, USA
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Bucy T, Moeller K, Skarphol T, Shippee N, Bowblis JR, Winkelman T, Shippee T. Serious Mental Illness in Nursing Homes: Stakeholder Perspectives on the Federal Preadmission Screening Program. J Aging Soc Policy 2022; 34:769-787. [PMID: 35786383 PMCID: PMC9709959 DOI: 10.1080/08959420.2022.2083882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/01/2022] [Indexed: 10/17/2022]
Abstract
The federal Preadmission Screening and Resident Review (PASRR) program was enacted in the 1980s amid concerns surrounding the quality of nursing home (NH) care. This program is meant to serve as a tool to assist with level of care determinations for NH applicants with serious mental illness (SMI) and was intended to limit the growth in the number of NH residents with SMI. Despite this policy effort, the prevalence of SMI in NHs has continued to increase, and little is known about the mechanisms driving the heterogeneous and suboptimal administration of the PASRR program, absent routine evaluative efforts. We conducted 20 semi-structured interviews with state and national stakeholders to identify factors affecting PASRR program administration and NH care for residents with SMI. Stakeholders expressed concern regarding fragmentation, specifically lack of clarity in the value of assessments beyond a regulatory requirement. Additionally, they cited variable program administration as contributing to fragmented communication patterns and inconsistent training across jurisdictions. Given the number of people with SMI currently residing in NHs, policy and practice should take a person-centered approach to assess how PASRR can be better used to support resident needs.
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Affiliation(s)
- Taylor Bucy
- Graduate Research Assistant, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kelly Moeller
- Project Support Coordinator, Center for Healthy Aging and Innovation, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Tricia Skarphol
- Research Project Manager, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nathan Shippee
- Associate Professor, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - John R. Bowblis
- Professor, Farmer School of Business, Miami University, Oxford, OH, USA
| | - Tyler Winkelman
- Assistant Professor of Medicine & Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA
- Co-Director, Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Tetyana Shippee
- Associate Professor, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Williams KDA, Wijaya C, Stamatis CA, Abbott G, Lattie EG. Insights Into Needs and Preferences for Mental Health Support on Social Media and Through Mobile Apps Among Black Male University Students: Exploratory Qualitative Study. JMIR Form Res 2022; 6:e38716. [PMID: 36044261 PMCID: PMC9475414 DOI: 10.2196/38716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Black college-aged men are less likely than their peers to use formal, therapeutic in-person services for mental health concerns. As the use of mobile technologies and social media platforms is steadily increasing, it is important to conduct work that examines the future utility of digital tools and technologies to improve access to and uptake of mental health services for Black men and Black men in college. OBJECTIVE The aim of this study was to identify and understand college-attending Black men's needs and preferences for using digital health technologies and social media for stress and mental health symptom management. METHODS Interviews were conducted with Black male students (N=11) from 2 racially diverse universities in the Midwestern United States. Participants were asked questions related to their current mental health needs and interest in using social media platforms and mobile-based apps for their mental health concerns. A thematic analysis was conducted. RESULTS Four themes emerged from the data: current stress relief strategies, technology-based support needs and preferences (subthemes: mobile-based support and social media-based support), resource information dissemination considerations (subthemes: information-learning expectations and preferences and information-sharing preferences and behaviors), and technology-based mental health support design considerations (subtheme: relatability and representation). Participants were interested in using social media and digital technologies for their mental health concerns and needs, for example, phone notifications and visual-based mental health advertisements that promote awareness. Relatability in the context of representation was emphasized as a key factor for participants interested in using digital mental health tools. Examples of methods for increasing relatability included having tools disseminated by minority-serving organizations and including components explicitly portraying Black men engaging in mental health support strategies. The men also discussed wanting to receive recommendations for stress relief that have been proven successful, particularly for Black men. CONCLUSIONS The findings from this study provide insights into design and dissemination considerations for future work geared toward developing mental health messaging and digital interventions for young Black men.
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Affiliation(s)
- Kofoworola D A Williams
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Clarisa Wijaya
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Caitlin A Stamatis
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gabriel Abbott
- Weinberg College of Arts & Sciences, Northwestern University, Chicago, IL, United States
| | - Emily G Lattie
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Bossick AS, Bossick NR, Callegari LS, Carey CM, Johnson H, Katon JG. Experiences of racism and postpartum depression symptoms, care-seeking, and diagnosis. Arch Womens Ment Health 2022; 25:717-727. [PMID: 35504987 DOI: 10.1007/s00737-022-01232-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/20/2022] [Indexed: 11/02/2022]
Abstract
Postpartum depression (PPD) is common and disproportionately affects people of color. Experiences of emotional upset due to racism (EUR) may be an important predictor of PPD outcomes. Therefore, we aimed to determine if EUR during the 12 months before delivery was associated with PPD symptomology, asking for help for depression, and depression diagnosis among postpartum people of color (PPOC). We conducted a cross-sectional secondary data analysis among PPOC from 11 states and New York City using PRAMS data, 1/1/2015-12/31/2017. We assessed symptomology using an unvalidated PHQ-2. Logistic regression was performed without and with stratification by ethnicity (non-Hispanic PPOC vs Hispanic PPOC) to estimate whether EUR during 12 months before delivery was associated with (1) PPD symptoms, (2) asking for help for depression, and (3) depression diagnosis. Models adjusted for age, educational attainment, timely prenatal care, payment method, stress during pregnancy, and pre-pregnancy depression. Seventy-four thousand nine hundred nine (11.8%) PPOC reported EUR in the 12 months before delivery. After adjustment, EUR was associated with a 10.3 percentage point (%pt; 95% CI: 6.8, 13.8), 13.6%pt (95% CI: 8.8, 18.5), and 4.1%pt (95% CI: 1.4, 8.0) higher probability of positive PPD screening among all PPOC, non-Hispanic PPOC, and Hispanic PPOC, respectively. EUR was not associated with asking for help for depression but was associated with a higher prevalence of depression diagnosis among all PPOC (4.6%pt; 95% CI: 1.0, 8.4) and non-Hispanic PPOC (6.0%pt; 95% CI: 0.8, 11.2).Experiences of EUR are associated with an increased prevalence of PPD symptoms. Additional prospective research spanning the pre-pregnancy through postpartum periods is needed to examine the dynamic relationship between racism, symptomology, help-seeking, and diagnosis of depression.
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Affiliation(s)
- Andrew S Bossick
- Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D, VA Puget Sound Healthcare System, Seattle, WA, USA. .,Department of Health Services, University of Washington, Magnuson Health Sciences Center, 1959 NE Pacific StRoom H-680, Box 357660, Seattle, WA, 98195, USA.
| | | | - Lisa S Callegari
- Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D, VA Puget Sound Healthcare System, Seattle, WA, USA.,Department of Health Services, University of Washington, Magnuson Health Sciences Center, 1959 NE Pacific StRoom H-680, Box 357660, Seattle, WA, 98195, USA.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Cathea M Carey
- Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Hannah Johnson
- Department of Health Services, University of Washington, Magnuson Health Sciences Center, 1959 NE Pacific StRoom H-680, Box 357660, Seattle, WA, 98195, USA
| | - Jodie G Katon
- Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D, VA Puget Sound Healthcare System, Seattle, WA, USA.,Department of Health Services, University of Washington, Magnuson Health Sciences Center, 1959 NE Pacific StRoom H-680, Box 357660, Seattle, WA, 98195, USA
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Diagnosis and Management of Perinatal Depression. Nurs Womens Health 2022; 26:318-330. [PMID: 35714763 DOI: 10.1016/j.nwh.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022]
Abstract
Perinatal depression is a mood disorder that may occur during pregnancy or within a year after childbirth. It can be disabling for the birthing parent and cause attachment and developmental problems for the infant. A host of risk factors, including genetics, reproductive history, and life experiences, are associated with perinatal depression. With validated screening tools, health care providers can assess individuals, initiate treatment, and/or refer as appropriate. Successful treatment, which may include modalities such as cognitive behavioral therapy and/or pharmacologic therapies, helps individuals maintain a sense of control, develop self-confidence, take control of their thinking, and learn coping skills. Integrative therapies and lifestyle changes have some success but may not be adequate for many individuals. Patients may benefit from providers learning and initiating cognitive behavioral therapy techniques while awaiting therapy.
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Bogan E, Adams‐Bass VN, Francis LA, Gaylord‐Harden NK, Seaton EK, Scott JC, Williams JL. “Wearing a Mask Won't Protect Us from Our History”: The Impact of COVID‐19 on Black Children and Families. SOCIAL POLICY REPORT 2022. [PMCID: PMC9350213 DOI: 10.1002/sop2.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Erin Bogan
- The Collaborative for Academic Social, and Emotional Learning
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Rodgers CRR, Flores MW, Bassey O, Augenblick JM, Cook BL. Racial/Ethnic Disparity Trends in Children's Mental Health Care Access and Expenditures From 2010-2017: Disparities Remain Despite Sweeping Policy Reform. J Am Acad Child Adolesc Psychiatry 2022; 61:915-925. [PMID: 34627995 PMCID: PMC8986880 DOI: 10.1016/j.jaac.2021.09.420] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/08/2021] [Accepted: 09/30/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine trends in mental health care use for Black and Latinx children and adolescents. METHOD Data from the Medical Expenditure Panel Survey for 2010-2017 were analyzed to assess trends among youth ages 5-17 in use and expenditures for any mental health care, outpatient mental health care, and psychotropic medication prescription fills. Unadjusted trends for all youth and the subpopulation of youth reporting need for mental health care and disparities adjusting for need were examined. RESULTS Between 2010 and 2017, Black youth rates of any past year mental health care use decreased (from 9% to 8%), while White (from 13% to 15%) and Latinx (from 6% to 8%) youth rates increased. Among the subpopulation with need and in regression analysis adjusting for need, we identified significant Black-White and Latinx-White disparities in any mental health care use and any outpatient mental health care use in 2010-2011 and 2016-2017, with significant worsening of Black-White disparities over time. White youth were more than twice as likely as Latinx youth to use psychotropic medications, and Latinx-White and Black-White disparities in psychotropic medication prescription fills persisted over time. Black-White disparities existed in overall mental health expenditures (2016-2017) and outpatient mental health expenditures (2010-2011 and 2016-2017). CONCLUSION Affordable, ubiquitous access to mental health care for Black and Latinx youth remains an elusive target. Significant disparities exist in receiving mental health care despite reforms and policies designed to increase mental health care access in the general population. Additional outreach and treatment strategies tailored to the cultural, linguistic, and structural needs of youth of color are required.
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Affiliation(s)
| | - Michael William Flores
- Harvard Medical School, Boston, Massachusetts; Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, Massachusetts
| | | | | | - Benjamin Lê Cook
- Albert Einstein College of Medicine, Bronx, New York; Harvard Medical School, Boston, Massachusetts; Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, Massachusetts
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Adepoju OE, Kim LH, Starks SM. Hospital Length of Stay in Patients with and without Serious and Persistent Mental Illness: Evidence of Racial and Ethnic Differences. Healthcare (Basel) 2022; 10:healthcare10061128. [PMID: 35742179 PMCID: PMC9223052 DOI: 10.3390/healthcare10061128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Prior studies have documented racial and ethnic differences in mental healthcare utilization, and extensively in outpatient treatment and prescription medication usage for mental health disorders. However, limited studies have investigated racial and ethnic differences in length of inpatient stay (LOS) in patients with and without Serious and Persistent Mental Illness. Understanding racial and ethnic differences in LOS is necessary given that longer stays in hospital are associated with adverse health outcomes, which in turn contribute to health inequities. Objective: To examine racial and ethnic differences in length of stay among patients with and without serious and persistent mental illness (SPMI) and how these differences vary in two age cohorts: patients aged 18 to 64 and patients aged 65+. Methods: This study employed a retrospective cohort design to address the research objective, using the 2018 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. After merging the 2018 National Inpatient Sample’s Core and Hospital files, Generalized Linear Model (GLM), adjusting for covariates, was applied to examine associations between race and ethnicity, and length of stay for patients with and without SPMI. Results: Overall, patients from racialized groups were likely to stay longer than White patients regardless of severe mental health status. Of all races and ethnicities examined, Asian patients had the most extended stays in both age cohorts: 8.69 days for patients with SPMI and 5.73 days for patients without SPMI in patients aged 18 to 64 years and 8.89 days for patients with SPMI and 6.05 days for patients without SPMI in the 65+ cohort. For individuals aged 18 to 64, differences in length of stay were significantly pronounced in Asian patients (1.6 days), Black patients (0.27 days), and Native American patients/patients from other races (0.76 days) if they had SPMI. For individuals aged 65 and older, Asian patients (1.09 days) and Native American patients/patients from other races (0.45 days) had longer inpatient stays if they had SPMI. Conclusion: Racial and ethnic differences in inpatient length of stay were most pronounced in Asian patients with and without SPMI. Further studies are needed to understand the mechanism(s) for these differences.
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Affiliation(s)
- Omolola E. Adepoju
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, TX 77204, USA;
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, TX 77204, USA;
- Correspondence:
| | - Lyoung H. Kim
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, TX 77204, USA;
| | - Steven M. Starks
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, TX 77204, USA;
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Jones AL, Rafferty J, Cochran SD, Abelson J, Mays VM. Persistence, Impairment, Disability and Unmet Treatment of Lifetime and 12-Month Anxiety Disorders in Black Men and Women, 50 Years of Age and Older. J Aging Health 2022; 34:378-389. [PMID: 35435023 PMCID: PMC9133161 DOI: 10.1177/08982643221086065] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To examine anxiety disorders in aging Black adults. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime/12-month prevalence of anxiety disorders in Black men and women, age 50+ (N = 1561). Disorder-specific persistence and severity, functional impairment, and mental health service utilization were investigated using multivariate regressions. Results: Black men and women who met criteria for anxiety disorders (lifetime prevalence=12.4%/18.3% in men/women) also demonstrated persistent disorders (percent meeting criteria = 40.3%-61.2%). Those with a 12-month anxiety disorder (6.2%/10.5% of men/women) typically reported severe task interference (38.3%-85.7%). Those with any 12-month anxiety disorder, compared to those without, experienced greater impairment in days out of role, work, family burden, cognition and, in women, mobility (p's < .05). Only 47.0%/65.2% of Black men/women with any lifetime anxiety disorder used mental health services. Discussion: Despite low prevalence, older Blacks with anxiety disorders experience substantial mental health burden in middle age and later.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), 422567Veteran Affairs Salt Lake City Health Care System, UT, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, USA
| | - Jane Rafferty
- Program for Research on Black Americans, 51331Institute of Social Research, Ann Arbor, MI, USA
- School of Social Work, 143265University of Michigan, Ann Arbor, USA
| | - Susan D Cochran
- Departments of Epidemiology and Statistics, Fielding School of Public Health, 25808University of California, Los Angeles, USA
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions (BRITE), Los Angeles, CA, USA
| | - Jamie Abelson
- Program for Research on Black Americans, 51331Institute of Social Research, Ann Arbor, MI, USA
- School of Social Work, 143265University of Michigan, Ann Arbor, USA
| | - Vickie M Mays
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions (BRITE), Los Angeles, CA, USA
- Departments of Psychology and Health Policy and Management, Fielding School of Public Health, 8783University of California, Los Angeles, USA
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Jones AL, Rafferty J, Cochran SD, Abelson J, Hanna MR, Mays VM. Prevalence, Severity and Burden of Post-Traumatic Stress Disorder in Black Men and Women Across the Adult Life span. J Aging Health 2022; 34:401-412. [PMID: 35510479 PMCID: PMC9175561 DOI: 10.1177/08982643221086071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To examine post-traumatic stress disorder (PTSD) among Black adults in younger, middle, and older ages. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime and 12-month prevalence of PTSD in Black men and women ages 18-34, 35-49, and 50+. We determined PTSD persistence and severity by age group, then associations of PTSD with socio-economic status, chronic stress, and racial discrimination in middle age. Results: The lifetime prevalence of PTSD was higher in Black women/men ages 18-34 (prevalence=14.0%/6.3%) and 35-49 (12.8%/4.6%) versus 50 and older (8.7%/5.1%). Those ages 35-49 were more likely than younger/older Black adults to have severe interference in work, relationships, and activities domains. In middle age, PTSD was associated with unemployment, lower education, poverty, and stress in Black men, and unemployment, divorce, poverty, stress, and discrimination in Black women. Discussion: Black women experience a disproportionate burden of PTSD in middle age.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center, 20122Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jane Rafferty
- Program for Research on Black Americans, 51331Institute of Social Research, Ann Arbor, MI, USA
- School of Social Work, 143265University of Michigan, Ann Arbor, MI, USA
| | - Susan D Cochran
- Departments of Epidemiology and Statistics, Fielding School of Public Health, 25808University of California, Los Angeles, CA, USA
- UCLA BRITE Center for Science, Research & Policy, Los Angeles, CA, USA
| | - Jamie Abelson
- Program for Research on Black Americans, 51331Institute of Social Research, Ann Arbor, MI, USA
- School of Social Work, 143265University of Michigan, Ann Arbor, MI, USA
| | - Matthew R Hanna
- Department of Psychology, 5926The New School for Social Research, New York, NY, USA
| | - Vickie M Mays
- UCLA BRITE Center for Science, Research & Policy, Los Angeles, CA, USA
- Departments of Psychology and Health Policy and Management, Fielding School of Public Health, 8783University of California, Los Angeles, CA, USA
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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Knighton JS, Dogan J, Crowell C, Stevens-Watkins D. Superwoman Schema: a context for understanding psychological distress among middle-class African American women who perceive racial microaggressions. ETHNICITY & HEALTH 2022; 27:946-962. [PMID: 32931323 PMCID: PMC7956919 DOI: 10.1080/13557858.2020.1818695] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/30/2020] [Indexed: 05/29/2023]
Abstract
Objective: Current racial mental health disparities among African American women have been attributed to chronic experiences of race-related stressors. Increased exposure to racism in predominately White spaces may increase reliance on culturally normative coping mechanisms. The objective of this study was to investigate the relationship between psychological distress, perceived racial microaggressions, and an obligation to show strength/suppress emotions among educated, middle-class African American women.Design: A sample of 243 African American women aged 19-72 years (M = 39.49 years) participated in an online study. Participants completed self-report measures of psychological distress (PHQ-8 and GAD-7), racial microaggressions (IMABI), and modified items from the Stereotypical Roles for Black Women (SRBWS) to assess an obligation to show strength/suppress emotions. Factor analyses were conducted to assess the reliability of the obligation to show strength/suppress emotions subscale in our sample. Descriptive statistics, multiple linear regression, and mediation analyses were also conducted to examine variable associations.Results: Statistical analyses revealed educated, middle-class African American women who endorse an obligation to show strength/suppress emotions with perceived racial microaggressions experienced increased psychological distress.Conclusion: Obligation to show strength/suppress emotion may increase risk for psychological distress among African American women who perceive racial microaggressions. Future research and clinical implications are discussed.
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Affiliation(s)
- Joi-Sheree’ Knighton
- Michigan Department of Health and Human Services (MDHHS), Center for Forensic Psychiatry
| | - Jardin Dogan
- Department of Educational, School, and Counseling Psychology, University of Kentucky, 36 Dickey Hall, Lexington, Kentucky 40506
| | - Candice Crowell
- Department of Educational, School, and Counseling Psychology, University of Kentucky, 36 Dickey Hall, Lexington, Kentucky 40506
| | - Danelle Stevens-Watkins
- Department of Educational, School, and Counseling Psychology, University of Kentucky, 36 Dickey Hall, Lexington, Kentucky 40506
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The unfulfilled promise of equitable first episode care for Black-Americans: A way forward. Schizophr Res 2022; 241:171-173. [PMID: 35124436 PMCID: PMC9158457 DOI: 10.1016/j.schres.2022.01.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 11/21/2022]
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Yelton B, Friedman DB, Noblet S, Lohman MC, Arent MA, Macauda MM, Sakhuja M, Leith KH. Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031498. [PMID: 35162519 PMCID: PMC8834771 DOI: 10.3390/ijerph19031498] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.
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Affiliation(s)
- Brooks Yelton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
- Correspondence:
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Prevention Research Center, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Matthew C. Lohman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Michelle A. Arent
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Mark M. Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Center for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Mayank Sakhuja
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Katherine H. Leith
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
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Samander LJ, Harman J. Disparities in Offered Anxiety Treatments Among Minorities. J Prim Care Community Health 2022; 13:21501319211065807. [PMID: 34996307 PMCID: PMC8744160 DOI: 10.1177/21501319211065807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose The primary purpose of this article was to determine if race and ethnicity
played a role in if primary care physicians offered anxiety treatment in
office visits by adult patients who were diagnosed with an anxiety
disorder(s). Methods This study pooled data from the 2011 to 2018 National Ambulatory Medical Care
Survey (NAMCS) that included adult patients with an anxiety disorder and the
type of treatment offered to them. Logistic regressions were performed to
examine the odds of offered anxiety treatment in office visits by
non-Hispanic Black, Hispanic, and other race/ethnicity patients compared to
office visits by non-Hispanic White patients. Results Physicians offered anxiety treatment in more than half of office visits where
the patient was diagnosed with an anxiety disorder. Providers offered
counseling or talk therapy in less than 13% of all office visits. Office
visits by non-Hispanic Black patients had half the odds of being offered
counseling/talk therapy (P = .068) compared to those by
non-Hispanic White patients. Conclusions These findings suggest that statistically significant differences in the
offering of any anxiety treatments in office visits to minorities compared
to non-Hispanic White patients do not exist; however, there are still
differences in the rates of counseling/talk therapy offered in office visits
by minorities versus non-minorities. Future studies may want to examine
reasons for lower rates of counseling/talk therapy offered to minority and
majority patients and the specific pharmacological or therapeutic treatments
offered to different races.
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Affiliation(s)
- Laura J Samander
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Jeffrey Harman
- Florida State University College of Medicine, Tallahassee, FL, USA
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Shippen N, Horn SR, Triece P, Chronis-Tuscano A, Meinzer MC. Understanding ADHD in Black Adolescents in Urban Schools: A Qualitative Examination of Factors that Influence ADHD Presentation, Coping Strategies, and Access to Care. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:213-229. [PMID: 35602172 PMCID: PMC9122271 DOI: 10.1080/23794925.2021.2013140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The high school years are a challenging developmental period for adolescents with attention-deficit/hyperactivity disorder (ADHD), their families, and those who work with them in the school system. Moreover, racially minoritized families and schools in low-resource, urban settings often experience additional adverse experiences that can make access to evidence-based mental health care particularly difficult. This qualitative investigation into the experiences of Black high school students with ADHD, their caregivers, teachers, and school mental health providers (SMHPs) aimed to understand this community's experiences with ADHD across development and to explore the barriers/facilitators to adequate services. Through focus group interviews with stakeholders (i.e., 6 adolescents with a diagnosis of ADHD, 5 caregivers of adolescents with ADHD, 6 teachers, 5 school mental health providers), themes emerged related to (1) developmental changes observed in ADHD presentation in high school students and (2) contextual factors (including barriers/facilitators to optimal school and home functioning). These themes led to the development of an ecological model that show various contextual factors influencing the experiences of Black adolescents with ADHD in under-resourced urban public high schools (e.g., adolescents' coping strategies, caregiver involvement, teacher burden or lack of ADHD-knowledge, socioeconomic status, access to care). This qualitative study represents the first step of a treatment development project assessing the implementation of a depression prevention intervention for Black adolescents with ADHD in urban public-school settings. Clinical implications (e.g., coordination of care between home and schools, increasing attention to social determinants of health, ensuring culturally competent discussion of ADHD and its treatment) are discussed.
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Affiliation(s)
| | | | | | | | - Michael C. Meinzer
- University of Illinois at Chicago, Chicago, IL,University of Maryland, College Park, MD
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Shim RS, Tierney M, Rosenzweig MH, Goldman HH. Improving Behavioral Health Services in the Time of COVID-19 and Racial Inequities. NAM Perspect 2021; 2021:202110c. [PMID: 34901776 DOI: 10.31478/202110c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Subramanian I, Hinkle JT, Chaudhuri KR, Mari Z, Fernandez H, Pontone GM. Mind the gap: Inequalities in mental health care and lack of social support in Parkinson disease. Parkinsonism Relat Disord 2021; 93:97-102. [PMID: 34887173 PMCID: PMC9664995 DOI: 10.1016/j.parkreldis.2021.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Inequalities in mental healthcare and lack of social support during the COVID-19 pandemic have lowered quality of life and increased overall burden of disease in people with Parkinson's (PWP). Although the pandemic has brought attention to these inequalities, they are long standing and will persist unless addressed. Lack of awareness of mental health issues is a major barrier and even when recognized disparities based on race, gender, and socioeconomic factors limit access to already scarce resources. Stigma regarding mental illness is highly prevalent and is a major barrier even when adequate care exists. Limited access to mental healthcare during the pandemic and in general increases the burden on caregivers and families. Historically, initiatives to improve mental healthcare for PWP focused on interventions designed for specialty and academic centers generally located in large metropolitan areas, which has created unintended geographic disparities in access. In order to address these issues this point of view suggests a community-based wellness model to extend the reach of mental healthcare resources for PWP.
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Affiliation(s)
- Indu Subramanian
- Dept of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Southwest Parkinson's Disease Research, Education and Clinical Centers, Veterans Administration, Los Angeles, CA, USA.
| | - Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, King's College London, London, UK; Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Zoltan Mari
- Parkinson's and Movement Disorders Program, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Hubert Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gregory M Pontone
- Dept. of Neurology & Dept. of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Misra S, Jackson VW, Chong J, Choe K, Tay C, Wong J, Yang LH. Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:486-512. [PMID: 33811676 DOI: 10.1002/ajcp.12516] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Stigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self-stigma than White American groups. In within-group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family's sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self-stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.
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Affiliation(s)
- Supriya Misra
- San Francisco State University, San Francisco, CA, USA
| | | | - Jeanette Chong
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karen Choe
- Teachers College, Columbia University, New York, NY, USA
| | - Charisse Tay
- Teachers College, Columbia University, New York, NY, USA
| | - Jazmine Wong
- New York University Langone Health, New York, NY, USA
| | - Lawrence H Yang
- New York University School of Global Public Health, New York, NY, USA
- Columbia Mailman School of Public Health, New York, NY, USA
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Alang S, Rogers TB, Williamson LD, Green C, Bell AJ. Police brutality and unmet need for mental health care. Health Serv Res 2021; 56:1104-1113. [PMID: 34350595 PMCID: PMC8586484 DOI: 10.1111/1475-6773.13736] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE National movements have raised awareness of the adverse mental health effects of police brutality. This study examines the relationship between perceived police brutality and unmet need for mental health care. DATA SOURCES We used the 2018 Survey of the Health of Urban Residents (N = 4338), a quota sample survey of adults in urban areas in the contiguous United States. STUDY DESIGN Multivariate regressions were used to understand the association between police brutality and unmet need for mental health care. Unmet need was regressed on police brutality (the independent variable), controlling for sociodemographic and health status characteristics of respondents and access to care. We then stratified the sample by experiences of police brutality (no negative encounters with the police, encounters that were perceived as necessary, and encounters that were considered unnecessary) and described how medical mistrust and perceived respect within health care settings were associated with odds of unmet need for each subsample. DATA COLLECTION Data were collected online. PRINCIPAL FINDINGS Negative police encounters perceived as necessary were associated with greater odds of unmet need compared to no negative police encounters (odds ratio [OR] = 1.98, confidence interval [CI] = 1.30-2.65). Odds of unmet need were also higher among persons with negative and unnecessary police encounters (OR = 1.28, CI = 1.05-1.56). Greater respect was associated with lower odds of unmet need among persons who reported negative unnecessary encounters with the police (OR = 0.88, CI = 0.72-0.97). Medical mistrust was associated with greater odds of unmet need among those with negative unnecessary police encounters (OR = 1.52, CI = 1.12-1.93). CONCLUSIONS Persons who are exposed to police brutality are also likely to be those who experience unmet need for mental health care. Ensuring that they feel respected within medical settings and establishing conditions that build trust in medical institutions are important for eliminating unmet need for mental health care.
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Affiliation(s)
- Sirry Alang
- Department of Sociology, Program in Health, Medicine and Society, and Health Justice CollaborativeLehigh UniversityBethlehemPennsylvaniaUSA
| | - Taylor B. Rogers
- Department of Health Policy and Management, Fielding School of Public HealthUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Lillie D. Williamson
- Department of Communication ArtsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Cherrell Green
- Department of Criminology & Criminal JusticeUniversity of MissouriSt. LouisMissouriUSA
| | - April J. Bell
- California Preterm Birth Initiative, Obstetrics, Gynecology & Reproductive SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
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74
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Family Functioning Assessment in a Community Sample of African American Caregivers and Children. CONTEMPORARY FAMILY THERAPY 2021. [DOI: 10.1007/s10591-021-09604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Racial disparities in alcohol-related liver disease mortality in a 75 year follow-up study of Michigan autoworkers. SSM Popul Health 2021; 15:100886. [PMID: 34401463 PMCID: PMC8353471 DOI: 10.1016/j.ssmph.2021.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background Suicide, drug overdose, and alcohol-related liver disease (ALD) mortality have been rising in the United States. While suicide and overdose have received a great deal of attention, far less public health concern has focused on chronic ALD. To address this gap, we examine ALD mortality rates, by race, in a cohort of autoworkers to describe trends over the past 75 years, from the peak in automobile manufacturing employment through its decline. Methods Based on the United Autoworkers-General Motors (UAW-GM) cohort we estimated temporal trends in age-adjusted ALD mortality rates from 1941 through 2015 at three automobile manufacturing plants in Michigan. We compared these rates to county, state, and U.S. rates, directly standardized to the 2000 U.S. census, to assess the roles of race and employment on ALD mortality. Results The overall age-adjusted ALD mortality rate among 41,097 male autoworkers peaked at 46.1 per 100,000 in the 1970s, followed by a gradual decline and a recent rise. Rates were slightly higher for black than white men until early 2000s, when rates increased only for white men. ALD mortality rates in the study cohort tracked national, state, and county rates for white men until the most recent time period, but were lower throughout the study period for black men, especially in the 1970s and 1980s. Conclusions Employment in automobile manufacturing may have offered some protection against death from ALD for black men, and loss of those manufacturing jobs may have impacted white men without a college degree more in recent decades. In a cohort of autoworkers, the alcohol-related liver disease (ALD) mortality rate has declined from its peak in the 1970s. ALD mortality was lower for black male autoworkers than for black men in the general population of the county, state, or US. ALD mortality was higher for black than white male autoworkers until 2000, when rates increased only for white autoworkers. Union jobs in Michigan automobile manufacturing may have offered some protection against risk of ALD for black men. Recent loss of US manufacturing jobs may have impacted white men more than black men without a college degree.
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76
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Affiliation(s)
- Ruth S Shim
- Department of Psychiatry, University of California, Davis
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77
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Alang S, McAlpine D, McClain M, Hardeman R. Police brutality, medical mistrust and unmet need for medical care. Prev Med Rep 2021; 22:101361. [PMID: 33850697 PMCID: PMC8039814 DOI: 10.1016/j.pmedr.2021.101361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 01/05/2023] Open
Abstract
Police brutality is a social determinant of health that can directly impact health status. Social determinants of health can also impact health indirectly by shaping how people access health care. In this study, we describe the relationship between perceived police brutality and an indicator of access to care, unmet need. We also examine medical mistrust as a potential mechanism through which perceived police brutality affects unmet need. Using data from the 2018 Survey of the Health of Urban Residents (N = 4,345), direct effects of perceived police brutality on unmet need and indirect effects through medical mistrust were obtained using the Karlson-Holm-Breen method of effect decomposition. Experiencing police brutality was associated with greater odds of unmet need. Controlling for covariates, 18 percent of the total effect of perceived police brutality on unmet need was explained by medical mistrust. Experiences outside of the health care system matter for access to care. Given the association between police brutality and unmet need for medical care, addressing unmet need among marginalized populations requires public health leaders to engage in conversations about reform of police departments. The coronavirus pandemic makes this even more critical as both COVID-19 and police brutality disproportionately impact Black, Indigenous, Latinx and other communities of color.
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Affiliation(s)
- Sirry Alang
- Department of Sociology and Program in Health, Medicine and Society, Health Justice Collaborative, Lehigh University Bethlehem Pennsylvania, United States
| | - Donna McAlpine
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Malcolm McClain
- Department of Sociology and Anthropology, Lehigh University Bethlehem, PA, United States
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
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78
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Moon KJ, Montiel GI, Cantero PJ, Nawaz S. Addressing Emotional Wellness During the COVID-19 Pandemic: the Role of Promotores in Delivering Integrated Mental Health Care and Social Services. Prev Chronic Dis 2021; 18:E53. [PMID: 34043502 PMCID: PMC8220949 DOI: 10.5888/pcd18.200656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction The disproportionate impact of the COVID-19 pandemic on Latino communities has resulted in greater reports of depression, anxiety, and stress. We present a community-led intervention in Latino communities that integrated social services in mental health service delivery for an equity-based response. Methods We used tracking sheets to identify 1,436 unique participants (aged 5–86) enrolled in Latino Health Access’s Emotional Wellness program, of whom 346 enrolled in the pre–COVID-19 period (March 2019–February 2020) and 1,090 in the COVID-19 period (March–June 2020). Demographic characteristics and types of services were aggregated to assess monthly trends using Pearson 𝜒2 tests. Regression models were developed to compare factors associated with referrals in the pre–COVID-19 and COVID-19 periods. Results During the pandemic, service volume (P < .001) and participant volume (P < .001) increased significantly compared with the prepandemic period. Participant characteristics were similar during both periods, the only differences being age distribution, expanded geographic range, and increased male participation during the pandemic. Nonreferred services, such as peer support, increased during the pandemic period. Type of referrals significantly changed from primarily mental health services and disease management in the prepandemic period to affordable housing support, food assistance, and supplemental income. Conclusion An effective mental health program in response to the pandemic must incorporate direct mental health services and address social needs that exacerbate mental health risk for Latino communities. This study presents a model of how to integrate both factors by leveraging promotor-led programs.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, Ohio
| | | | | | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, Ohio.,Ohio State University, 381 Cunz Hall, 1841 Neil Ave, Columbus, OH 43210.
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79
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Gajaria A, Guzder J, Rasasingham R. What's race got to do with it? A proposed framework to address racism's impacts on child and adolescent mental health in Canada. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:131-137. [PMID: 33953765 PMCID: PMC8056965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
This commentary responds to current events that have highlighted the ways that systemic racism affects a wide variety of health outcomes. We specifically discuss how systemic racism adversely affects the mental health of children and adolescents in a Canadian context and use a structural framework to demonstrate how race is embedded in various Canadian systems and thus affects child and adolescent mental health in both conscious and unconscious ways throughout the lifespan. Experiences of systemic racism affect the mental health of Canadian young people in multiple complex and intersecting ways including access to care, experience of mental health services, and outcomes of care. We currently lack a national best practice framework for mental health professionals that unifies approaches to research, education, and clinical care for young racialized Canadians; in addition, concerted efforts to collect race-based data are lacking. We suggest that a blueprint for improved services for racialized young people in Canada would include: Development of a funded and sustainable research agenda responsive to community expertise, development and implementation of a Canadian Child and Adolescent task force focused on educational strategies on racism and service provision at both the postgraduate and continuing professional development (CPD) levels, and consideration of clinical parameters that improve access to, and experience of, care for Canadian racialized youth.
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Affiliation(s)
- Amy Gajaria
- Staff Psychiatrist, Centre for Addiction and Mental Health (CAMH), Assistant Professor, Department of Psychiatry, University of Toronto, Clinician Scientist, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Toronto, Ontario
| | - Jaswant Guzder
- Professor, McGill University Department of Psychiatry, Division of Social and Cultural Psychiatry, Division of Child Psychiatry, Institute of Community and Family Psychiatry, Montreal, Quebec
| | - Raj Rasasingham
- Director of Continuing Professional and Practice Development, Department of Psychiatry, University of Toronto, Director of Post-Graduate Education, Psychiatry, Humber River Hospital, University of Toronto, Clinical Head, Outpatient Child and Youth, Humber River Hospital, University of Toronto, Section Head, Global Psychiatry, Canadian Academy of Child and Adolescent Psychiatry., Toronto, Ontario
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80
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Bajracharya R, Qato DM. Patterns of Psychoactive Medication Use in Community-Dwelling Older Adults in the US in 2016: A Descriptive Cross-Sectional Study. J Aging Health 2020; 33:86-100. [PMID: 32960115 DOI: 10.1177/0898264320959293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We aim to quantify any use and long-term use patterns of psychoactive medications and explore differences in use by sociodemographic factors in older adults (60-85 years) using the 2016 Medical Expenditure Panel Survey. Methods: Prevalence estimates of any use and long-term use were calculated. Chi-square and crude odds ratios were calculated to estimate differences in any use and long-term use of psychoactive medication by sociodemographic characteristics of respondents. Results: Thirty percent of older adults in the US reported any use of psychoactive medications. Long-term use was significantly higher in women (28.3% [95% confidence interval: 26.5, 30.2]), white (27.8 [26.1, 29.7]), presently unmarried (27.5 [25.4, 29.7]), and low-income (30.3 [27.7, 32.9]) subgroups than in men (20.5 [18.4, 22.5]), Black (14.7 [12.3, 17.1]), presently married (22.8 [20.7, 24.9]), and high-income (21.1 [19.1, 23.1]) subgroups, respectively. Discussion: Despite continued risks associated with use, long-term use of psychoactive medications is prevalent in the older adult population in the US. Given the increased complexity of pharmacotherapy regimens in this population, enhanced efforts at improving use of psychoactive medications should be intensified.
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Affiliation(s)
- Rashmita Bajracharya
- Division of Gerontology, School of Medicine, 12265University of Maryland Baltimore, Baltimore, MD, USA
| | - Danya M Qato
- Division of Gerontology, School of Medicine, 12265University of Maryland Baltimore, Baltimore, MD, USA.,School of Pharmacy, 12265University of Maryland Baltimore, Baltimore, MD, USA
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81
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Alang S, McAlpine DD, Hardeman R. Police Brutality and Mistrust in Medical Institutions. J Racial Ethn Health Disparities 2020; 7:760-768. [PMID: 31989532 DOI: 10.1007/s40615-020-00706-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/24/2019] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND People bring the social contexts of their lives into the medical encounter. As a social determinant of health, police brutality influences physical and mental health. However, negative experiences with institutions such as law enforcement might decrease trust in other institutions, including medical institutions. Mistrust might limit engagement with the healthcare system and affect population health. This study investigates the relationship between police brutality and medical mistrust and assesses whether it varies by race. BASIC PROCEDURES Data were obtained from a 2018 cross-sectional survey of adults living in urban areas in the USA (N = 4389). Medical mistrust was regressed on police brutality (experiences and appraisal of negative encounters with the police), controlling for socio-demographics, health status, and healthcare access. Means of mistrust were predicted by racial group after including interactions between police brutality and race. MAIN FINDINGS Respondents who had negative encounters with the police, even if they perceived these encounters to be necessary, had higher levels of medical mistrust compared to those with no negative police encounters. Police brutality increased mistrust for all racial groups. PRINCIPAL CONCLUSIONS Conditions outside the medical system such as experiencing police brutality impact relationships with the medical system. Given that clinicians are in a unique position of having access to firsthand information about the struggles and injustices that shape their patients' health, advocating for systemic change on behalf of their patients might build trust.
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Affiliation(s)
- Sirry Alang
- Department of Sociology and Anthropology, and Program in Health, Medicine, and Society, Lehigh University, Bethlehem, PA, USA.
| | - Donna D McAlpine
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN, 55455, USA
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82
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McKenzie S, Lev-Tov H, Shi V, Hsiao J. Clinical Pearls for Managing Hidradenitis Suppurativa Patients of Low Socioeconomic Status. Dermatology 2020; 236:439-444. [DOI: 10.1159/000505149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/29/2019] [Indexed: 11/19/2022] Open
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83
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Srivastav A, Strompolis M, Kipp C, Richard CL, Thrasher JF. Moderating the Effects of Adverse Childhood Experiences to Address Inequities in Tobacco-Related Risk Behaviors. Health Promot Pract 2020; 21:139S-147S. [PMID: 31908193 DOI: 10.1177/1524839919882383] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adverse childhood experiences (ACEs) can increase the risk of engagement in unhealthy behaviors including tobacco use. Protective factors, such as safe, stable, and nurturing relationships (SSNRs) can potentially moderate the long-term impact of ACEs by helping children build resilience. However, there is limited research on whether the impact of these factors is stronger among Black children and families, who face disproportionately poorer health outcomes compared to their White counterparts. This study examined the relationships among protective factors in childhood, ACEs (one or more vs. none), and tobacco use (smoking tobacco, e-cigarette use) in adulthood, including whether these relationships differed by race. Data were obtained from the 2016 South Carolina administration of the Behavioral Risk Factor Surveillance System (n = 7,014). Using stratified, multivariate logistic regression, the presence of an SSNR in childhood (whether participants' basic needs were met and whether they felt safe and protected during childhood) was assessed as a potential moderator of the association between ACEs (one or more vs. none) and smoking tobacco or e-cigarettes stratified by race (Black and White). Control variables included sex, age, educational attainment, and income. Statistically significant moderating effects of an SSNR was present for White adults only: The relationship between ACEs and risk behaviors was weakened when an SSNR was present in childhood. Although SSNRs appear to prevent some risk behavior consequences from ACEs among some groups, additional research is needed to understand their potential utility across population subgroups.
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Affiliation(s)
- Aditi Srivastav
- University of South Carolina, Columbia, SC, USA.,Children's Trust of South Carolina, Columbia, SC, USA
| | | | - Colby Kipp
- University of South Carolina, Columbia, SC, USA.,Children's Trust of South Carolina, Columbia, SC, USA
| | - Chelsea L Richard
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
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84
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Psychiatric Disorders and Alcohol Consumption Among Low-Income African Americans:Gender Differences. Brain Sci 2019; 9:brainsci9040086. [PMID: 31003459 PMCID: PMC6523251 DOI: 10.3390/brainsci9040086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Although cooccurrence of nonsubstance use disorders (non-SUDs) and substance use is well-established in the literature, most of what we know in this regard is derived from studies that have recruited predominantly White sample populations. As a result, there is a gap in knowledge on this link among low-income African Americans (AAs). There is also a need to understand how low-income AA men and women differ in these associations. Objective: To study whether there is an association between number of non-SUDs and amount of alcohol consumption by AA adults, and whether this association varies between AA men and women. Methods: This cross-sectional study recruited a nonrandom sample of 150 AA adults with non-SUDs (i.e., major depression, bipolar disorders, obsessive–compulsive disorder, paranoid disorder, panic disorder, posttraumatic stress disorder (PTSD), and schizoaffective disorder). The independent variable was the number of non-SUDs. The dependent variable was the amount of alcohol consumption. Age, socioeconomic status (educational attainment and household income), and self-rated health were covariates. Gender was the moderator. Linear regression models were used to analyze the data. Results: A higher number of non-SUDs was not associated with a higher amount of alcohol use in the pooled sample of AA adults. We, however, found a significant interaction between gender and number of non-SUDs on the amount of alcohol use, suggesting a stronger effect of non-SUDs on alcohol consumption in AA men than in AA women. Gender-stratified linear regression models showed a positive association between number of non-SUDs and amount of alcohol consumption in AA men but not in AA women. Conclusion: Non-SUDs impact alcohol use of AA men but not women. Future research should test whether AA men may have a higher tendency to turn to alcohol to regulate their emotions and cope with psychological pain due to multiple non-SUDs. The results also suggest that integration of services for SUDs and non-SUDs may be more relevant to provision of mental health services for AA men than AA women.
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85
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Alang SM. Mental health care among blacks in America: Confronting racism and constructing solutions. Health Serv Res 2019; 54:346-355. [PMID: 30687928 DOI: 10.1111/1475-6773.13115] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To describe reasons for unmet need for mental health care among blacks, identify factors associated with causes of unmet need, examine racism as a context of unmet need, and construct ways to improve service use. DATA SOURCES Data from the 2011-2015 National Survey on Drug Use and Health were pooled to create an analytic sample of black adults with unmet mental health need (N = 1237). Qualitative data came from focus groups (N = 30) recruited through purposive sampling. STUDY DESIGN Using sequential mixed methods, reasons for unmet need were regressed on sociodemographic, economic, and health characteristics of respondents. Findings were further explored in focus groups. PRINCIPAL FINDINGS Higher education was associated with greater odds of reporting stigma and minimization of symptoms as reasons for unmet need. The fear of discrimination based on race and on mental illness was exacerbated among college-educated blacks. Racism causes mistrust in mental health service systems. Participants expressed the importance of anti-racism education and community-driven practice in reducing unmet need. CONCLUSION Mental health systems should confront racism and engage the historical and contemporary racial contexts within which black people experience mental health problems. Critical self-reflection at the individual level and racial equity analysis at the organizational level are critical.
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Affiliation(s)
- Sirry M Alang
- Program in Health, Medicine, and Society, Department of Sociology and Anthropology, Lehigh University, Bethlehem, Pennsylvania
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