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Page A, Lewis G, Kidger J, Heron J, Chittleborough C, Evans J, Gunnell D. Parental socio-economic position during childhood as a determinant of self-harm in adolescence. Soc Psychiatry Psychiatr Epidemiol 2014; 49:193-203. [PMID: 23744444 DOI: 10.1007/s00127-013-0722-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/21/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Socio-economic position (SEP) during childhood and parental social mobility have been associated with subsequent health outcomes in adolescence and adulthood. This study investigates whether parental SEP during childhood is associated with subsequent self-harm in adolescence. METHODS This study uses data from a prospective birth-cohort study (the Avon Longitudinal Study of Parents and Children) which followed 14,610 births in 1991-1992 to age 16-18 years (n = 4,810). The association of parental SEP recorded pre-birth and throughout childhood with self-harm was investigated using logistic regression models, with analyses conducted separately for those reporting self-harm (a) with and (b) without suicidal intent. The impact of missing data was investigated using multiple imputation methods. RESULTS Lower parental SEP was associated with increased risk of offspring self-harm with suicidal intent, with less consistent associations evident for self-harm without suicidal intent. Associations were somewhat stronger in relation to measures of SEP in later childhood. Depressive symptoms appeared to partially mediate the associations. Adolescents of parents reporting consistently low income levels during childhood were approximately 1.5 times more likely to engage in SH than those never to report low income. CONCLUSIONS Lower SEP during childhood is associated with the subsequent risk of self-harm with suicidal intent in adolescence. This association is stronger in those experiencing consistently lower SEP.
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Affiliation(s)
- Andrew Page
- Discipline of Epidemiology and Biostatistics, School of Population Health, University of Queensland, Herston Road, Herston, QLD, 4006, Australia,
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Muennig P. What China's experiment in community building can tell us about tackling health disparities: community building and mental health in mid-life and older life: evidence from China. Soc Sci Med 2014; 107:217-20. [PMID: 24636421 DOI: 10.1016/j.socscimed.2014.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/18/2014] [Indexed: 11/24/2022]
Abstract
Disparities in physical and mental health between advantaged and disadvantaged communities are among the largest threats to population health worldwide. These disparities appear to be growing, probably in part because we do not understand how to address their underlying causes. Many believe the underlying causes are thought to arise directly or indirectly from the psychosocial problems underlying poverty, such as hunger, poor housing, drug use, or crime. One logical solution is therefore to provide more community services targeted at addressing these problems within the most disadvantaged communities. However, to date, data on the efficacy of this approach is lacking. China serves as a possible laboratory for studying the efficacy of community-based programs. This is because the extensive community-based programs present prior to economic reforms in 1978 were removed, and then later re-instated in a quasi-experimental manner. In this issue, Yuying Shen uses multi-level models to explore the impact of this experiment on community mental health in a multi-level associational study. She finds that the quantity (but not their length of time in the community) of such services is positively associated with mental health. This study opens the door to more rigorous analyses that might motivate formal social experiments at the community level worldwide. If successful, such experiments might not only transform what we currently know not just about improving health in disadvantaged communities, but also prove transformative for health policy as a discipline.
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Affiliation(s)
- Peter Muennig
- Mailman School of Public Health, Columbia University, MSPH Box 14, 600 West 168th Street, 6th Floor, New York, NY 10032, USA.
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Groß C, Neumann M, Kalkbrenner M, Mick I, Lachnit A, Reichert J, Klotsche J, Zimmermann US. A retrospective analysis of psychosocial risk factors modulating adolescent alcohol binge drinking. Eur Addict Res 2014; 20:285-92. [PMID: 25277424 DOI: 10.1159/000362410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/22/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Adolescent alcohol binge-induced hospital admissions (BIHAs) are an increasing problem in Europe. We investigated whether psychosocial factors (e.g., drinking situations, drinking occasions and neighborhood unemployment) are associated with particularly risky patterns of alcohol or substance use. METHOD We performed a systematic retrospective chart review of all the respective cases in 2003-2008 (n = 586; age range: 12-17 years) from both pediatric hospitals in the city of Dresden, Germany. RESULTS The vast majority of adolescent BIHAs were associated with drinking together with peers at weekend parties. Compared to this 'typical' drinking pattern, adolescents drinking 'atypically' (i.e., drinking either alone, to cope or despite the fact that the next day was a school/work day) more often had already used alcohol and illegal substances before and were more often diagnosed with substance use disorders and other mental disorders prior to BIHA. The unemployment rate in the patients' neighborhood was positively related to the incidence proportion of adolescent BIHAs in the respective subdistricts (r(s) = 0.61). CONCLUSION Adolescent atypical drinking may indicate an increased risk for the development of alcohol and substance use disorders. This information is quickly accessible and can alert clinicians to initiate psychosocial aftercare; their infrastructure should address the strong relation between BIHA probability and neighborhood unemployment rates.
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Affiliation(s)
- Cornelius Groß
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Kohrt BA. Child Maltreatment and Global Health: Biocultural Perspectives. HANDBOOK OF CHILD MALTREATMENT 2014. [DOI: 10.1007/978-94-007-7208-3_30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Petresco S, Anselmi L, Santos IS, Barros AJD, Fleitlich-Bilyk B, Barros FC, Matijasevich A. Prevalence and comorbidity of psychiatric disorders among 6-year-old children: 2004 Pelotas Birth Cohort. Soc Psychiatry Psychiatr Epidemiol 2014; 49:975-83. [PMID: 24488152 PMCID: PMC4028510 DOI: 10.1007/s00127-014-0826-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/17/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Most studies published on the prevalence of psychiatric disorders in children were conducted in high-income countries despite the fact that nearly 90 % of the world's population aged under 18 live in low- and middle-income countries. The study aimed to assess the prevalence of psychiatric disorders among children of 6 years of age, to examine the distribution of psychiatric disorders by gender and socioeconomic status and to evaluate the occurrence of psychiatric comorbidities. METHODS The 2004 Pelotas Birth Cohort originally comprised 4,231 live births from Pelotas, southern Brazil. A total of 3,585 (84.7 % of 4,231 births) children aged 6 years were assessed using the Development and Well-Being Assessment (DAWBA). RESULTS Nearly 13 % of the children presented a psychiatric diagnosis according to DSM-IV, being more prevalent among males than females (14.7 and 11.7 %, respectively, p = 0.009). Anxiety disorders were the most prevalent of all disorders (8.8 %) and specific phobias (5.4 %) and separation anxiety disorder (3.2 %) were the most common subtypes. Attention deficit hyperactivity disorder (2.6 %), oppositional defiant disorder/conduct disorder (2.6 %), and depression (1.3 %) were also diagnosed. More than one psychiatric disorder was presented by 17 % of children. Socioeconomically disadvantaged children had a higher prevalence of psychiatric disorders. CONCLUSION Our findings underline the early onset of psychiatric disorders among children and the frequent occurrence of psychiatric comorbidity. Early prevention is needed in the field of mental health in Brazil and should start during infancy.
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Affiliation(s)
- Sandra Petresco
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil,
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Copeland WE, Angold A, Shanahan L, Costello EJ. Longitudinal patterns of anxiety from childhood to adulthood: the Great Smoky Mountains Study. J Am Acad Child Adolesc Psychiatry 2014; 53:21-33. [PMID: 24342383 PMCID: PMC3939681 DOI: 10.1016/j.jaac.2013.09.017] [Citation(s) in RCA: 338] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 07/08/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aims of this study were 2-fold: to provide a brief introduction to the prospective longitudinal Great Smoky Mountains Study and review recent findings; and to use this sample to conduct an epidemiologic analysis of common childhood anxiety disorders. METHOD The population-based Great Smoky Mountains Study assessed 1,420 participants from 11 counties in the southeastern United States up to 11 times between ages 9 and 26 years with the structured Child and Adolescent Psychiatric Assessment and its upward extension, the Young Adult Psychiatric Assessment. RESULTS The U-shaped age prevalence curve for any anxiety disorder was the product of high levels of childhood separation anxiety and adult panic, agoraphobia, and generalized anxiety. More than 1 in 5 subjects met criteria for an anxiety disorder by early adulthood. In terms of cumulative comorbidity, there was evidence of overlap between anxiety disorders, but the level of overlap was generally consistent with what is seen among other common childhood disorders. All childhood anxiety disorders were associated with adverse functioning in at least 1 young adult functional domain, with the poorest outcomes for childhood generalized anxiety and DSM-III-R overanxious disorder. CONCLUSION Clinically significant anxiety is a common mental health problem to have had by adulthood. There was little evidence to support the consolidation of anxiety disorders, and some evidence to justify reintroduction of DSM-III-R overanxious disorder. The transition to young adulthood appears to be a key period for understanding the development of common adult anxiety disorders such as panic and agoraphobia.
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The Protective Role of Optimism and Self-esteem on Depressive Symptom Pathways Among Canadian Aboriginal Youth. J Youth Adolesc 2013; 44:142-54. [DOI: 10.1007/s10964-013-0016-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/02/2013] [Indexed: 10/26/2022]
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Williams DR, Mohammed SA. Racism and Health II: A Needed Research Agenda for Effective Interventions. THE AMERICAN BEHAVIORAL SCIENTIST 2013; 57:10.1177/0002764213487341. [PMID: 24347667 PMCID: PMC3863360 DOI: 10.1177/0002764213487341] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This article reviews the empirical evidence that suggests that there is a solid foundation for more systematic research attention to the ways in which interventions that seek to reduce the multiple dimensions of racism can improve health and reduce disparities in health. First, research reveals that policies and procedures that seek to reduce institutional racism by improving neighborhood and educational quality and enhancing access to additional income, employment opportunities and other desirable resources can improve health. Second, research is reviewed that shows that there is the potential to improve health through interventions that can reduce cultural racism at the societal and individual level. Finally, research is presented that suggests that the adverse consequences of racism on health can be reduced through policies that maximize the health-enhancing capacities of medical care, address the social factors that initiate and sustain risk behaviors and empower individuals and communities to take control of their lives and health. Directions for future research are outlined.
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Affiliation(s)
- David R Williams
- Department of Society, Human Development and Health, Harvard School of Public Health ; Department of African and African American Studies and of Sociology, Harvard University ; Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Selina A Mohammed
- Nursing and Health Studies Program, University of Washington Bothell, Bothell, WA
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McGorry P. Prevention, innovation and implementation science in mental health: the next wave of reform. Br J Psychiatry 2013; 54:s3-4. [PMID: 23288498 DOI: 10.1192/bjp.bp.112.119222] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although the corrosive effect of mental ill health on human health and happiness has long been recognised, it is only relatively recently that mental illness has been acknowledged as one of the major threats to economic productivity worldwide. This is because the major mental disorders most commonly have their onset during adolescence and early adulthood, and therefore have a disproportionate impact on the most productive decades of life. With the costs associated with mental ill health estimated to double over the next two decades, a greater emphasis on prevention and early intervention has become even more imperative. Although prevention largely remains aspirational for many reasons, early intervention is well within our current reach and offers the potential to significantly reduce the impact of mental ill health on our health, happiness and prosperity in the immediate future.
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Wilde ET, Rosen Z, Couch K, Muennig PA. Impact of welfare reform on mortality: an evaluation of the Connecticut jobs first program, a randomized controlled trial. Am J Public Health 2013; 104:534-8. [PMID: 23678929 DOI: 10.2105/ajph.2012.301072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether Jobs First, a multicenter randomized trial of a welfare reform program conducted in Connecticut, demonstrated increases in employment, income, and health insurance relative to traditional welfare (Aid to Families with Dependent Children). We also investigated if higher earnings and employment improved mortality of the participants. METHODS We revisited the Jobs First randomized trial, successfully linking 4612 participant identifiers to 15 years of prospective mortality follow-up data through 2010, producing 240 deaths. The analysis was powered to detect a 20% change in mortality hazards. RESULTS Significant employment and income benefits were realized among Jobs First recipients relative to traditional welfare recipients, particularly for the most disadvantaged groups. However, although none of these reached statistical significance, all participants in Jobs First (overall, across centers, and all subgroups) experienced higher mortality hazards than traditional welfare recipients. CONCLUSIONS Increases in income and employment produced by Jobs First relative to traditional welfare improved socioeconomic status but did not improve survival.
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Affiliation(s)
- Elizabeth T Wilde
- Elizabeth T. Wilde, Zohn Rosen, and Peter A. Muennig, are with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Kenneth Couch is with the Department of Economics, University of Connecticut, Storrs
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Muennig P, Kuebler M, Kim J, Todorovic D, Rosen Z. Gender differences in material, psychological, and social domains of the income gradient in mortality: implications for policy. PLoS One 2013; 8:e59191. [PMID: 23527129 PMCID: PMC3604107 DOI: 10.1371/journal.pone.0059191] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/12/2013] [Indexed: 01/20/2023] Open
Abstract
We set out to examine the material, psychological, and sociological pathways mediating the income gradient in health and mortality. We used the 2008 General Social Survey-National Death Index dataset (N = 26,870), which contains three decades of social survey data in the US linked to thirty years of mortality follow-up. We grouped a large number of variables into 3 domains: material, psychological, and sociological using factor analysis. We then employed discrete-time hazard models to examine the extent to which these three domains mediated the income-mortality association among men and women. Overall, the gradient was weaker for females than for males. While psychological and material factors explained mortality hazards among females, hazards among males were explained only by social capital. Poor health significantly predicted both income and mortality, particularly among females, suggesting a strong role for reverse causation. We also find that many traditional associations between income and mortality are absent in this dataset, such as perceived social status.
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Affiliation(s)
- Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Meghan Kuebler
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Jaeseung Kim
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Dusan Todorovic
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Zohn Rosen
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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112
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Spillane NS, Smith GT, Kahler CW. Perceived access to reinforcers as a function of alcohol consumption among one First Nation group. Alcohol Clin Exp Res 2012; 37 Suppl 1:E314-21. [PMID: 22823415 DOI: 10.1111/j.1530-0277.2012.01864.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 04/11/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spillane and Smith (2007, Psychol Bull 133:395-418) postulated that high levels of problem drinking in some First Nation (FN) communities resulted in part from the perception that there is low access to alternative reinforcers (e.g., jobs, friendships, family relationships, and financial security), that many alternative reinforcers are less contingent on sobriety, and that others are available regardless of drinking status for reserve-dwelling FN members. METHODS This study examined perceptions of access to alternative reinforcers and the extent to which access varied as a function of drinking in 211 FN members living on 1 reserve in Canada, 138 middle socioeconomic status Caucasians (MCCs), and 98 low socioeconomic status Caucasians (LCCs). RESULTS The FN group expected less access to employment, quality family and friend relationships, and financial security compared with the MCC group. After controlling for perceived access in general, gender, and age, the FN group reported that drinking would not cause a decrease in access to employment, family relationships, friendships, and finances as compared to the MCC group. The FN group did not differ from the LCC group in the degree to which they expected drinking to cost access to family relationships or finances, but the LCC group expected drinking to have less of an impact on access to jobs and friendships as compared to the FN group. CONCLUSIONS The results provide initial support for the Spillane and Smith theory of problem drinking among this 1 FN group. The results suggest that increasing access to these reinforcers may reduce problematic drinking in this FN group.
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Affiliation(s)
- Nichea S Spillane
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA.
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113
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Abstract
Abstract
The legalization of American Indian casino gaming in the late 1980s allows examination of the relationship between income and health in a quasi-experimental way. Revenue from gaming accrues to individual tribes and has been used both to supplement tribe members’ income and to finance tribal infrastructure. We assembled annual data from 1988–2003 on tribal gaming, health care access (from the Area Resource File), and individual health and socioeconomic characteristics data (from the Behavioral Risk Factors Surveillance System). We use this information within a structural, difference-in-differences framework to study the effect of casino gaming on tribal members’ income, health status, access to health care, and health-related behaviors. Our difference-in-differences framework relies on before-after comparisons among American Indians whose tribe has at some time operated a casino and with-without comparisons between American Indians whose tribe has and those whose tribe has not initiated gaming. Our results provide identified estimates of the positive effect of gaming on American Indian income and on several indicators of American Indian health, health-related behaviors, and access to health care.
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114
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Jaffee SR, Strait LB, Odgers CL. From correlates to causes: can quasi-experimental studies and statistical innovations bring us closer to identifying the causes of antisocial behavior? Psychol Bull 2012; 138:272-95. [PMID: 22023141 PMCID: PMC3268012 DOI: 10.1037/a0026020] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Longitudinal, epidemiological studies have identified robust risk factors for youth antisocial behavior, including harsh and coercive discipline, maltreatment, smoking during pregnancy, divorce, teen parenthood, peer deviance, parental psychopathology, and social disadvantage. Nevertheless, because this literature is largely based on observational studies, it remains unclear whether these risk factors have truly causal effects. Identifying causal risk factors for antisocial behavior would be informative for intervention efforts and for studies that test whether individuals are differentially susceptible to risk exposures. In this article, we identify the challenges to causal inference posed by observational studies and describe quasi-experimental methods and statistical innovations that may move researchers beyond discussions of risk factors to allow for stronger causal inference. We then review studies that used these methods, and we evaluate whether robust risk factors identified from observational studies are likely to play a causal role in the emergence and development of youth antisocial behavior. There is evidence of causal effects for most of the risk factors we review. However, these effects are typically smaller than those reported in observational studies, suggesting that familial confounding, social selection, and misidentification might also explain some of the association between risk exposures and antisocial behavior. For some risk factors (e.g., smoking during pregnancy, parent alcohol problems), the evidence is weak that they have environmentally mediated effects on youth antisocial behavior. We discuss the implications of these findings for intervention efforts to reduce antisocial behavior and for basic research on the etiology and course of antisocial behavior.
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Affiliation(s)
- Sara R Jaffee
- MRC Social, Genetic, and Developmental Psychiatry Centre, King's College London, London, UK.
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115
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Gone JP, Trimble JE. American Indian and Alaska Native mental health: diverse perspectives on enduring disparities. Annu Rev Clin Psychol 2011; 8:131-60. [PMID: 22149479 DOI: 10.1146/annurev-clinpsy-032511-143127] [Citation(s) in RCA: 229] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As descendants of the indigenous peoples of the United States, American Indians and Alaska Natives (AI/ANs) have experienced a resurgence in population and prospects since the beginning of the twentieth century. Today, tribally affiliated individuals number over two million, distributed across 565 federally recognized tribal communities and countless metropolitan and nonreservation rural areas. Although relatively little evidence is available, the existing data suggest that AI/AN adults and youth suffer a disproportionate burden of mental health problems compared with other Americans. Specifically, clear disparities have emerged for AI/AN substance abuse, posttraumatic stress, violence, and suicide. The rapid expansion of mental health services to AI/AN communities has, however, frequently preceded careful consideration of a variety of questions about critical components of such care, such as the service delivery structure itself, clinical treatment processes, and preventive and rehabilitative program evaluation. As a consequence, the mental health needs of these communities have easily outpaced and overwhelmed the federally funded agency designed to serve these populations, with the Indian Health Service remaining chronically understaffed and underfunded such that elimination of AI/AN mental health disparities is only a distant dream. Although research published during the past decade has substantially improved knowledge about AI/AN mental health problems, far fewer investigations have explored treatment efficacy and outcomes among these culturally diverse peoples. In addition to routine calls for greater clinical and research resources, however, AI/AN community members themselves are increasingly advocating for culturally alternative approaches and opportunities to address their mental health needs on their own terms.
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Affiliation(s)
- Joseph P Gone
- Department of Psychology, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Bruckner TA, Brown RA, Margerison-Zilko C. Positive income shocks and accidental deaths among Cherokee Indians: a natural experiment. Int J Epidemiol 2011; 40:1083-90. [PMID: 21527447 PMCID: PMC3156370 DOI: 10.1093/ije/dyr073] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several studies in low-income populations report the somewhat counterintuitive finding that positive income gains adversely affect adult health. The literature posits that receipt of a large portion of annual income increases, in the short term, risk-taking behaviour and/or the consumption of health-damaging goods. This work implies the hypothesis that persons with an unexpected gain in income will exhibit an elevated risk of accidental death-the fifth leading cause of death in the USA. We test this hypothesis directly by capitalizing on a natural experiment in which Cherokee Indians in rural North Carolina received discrete lump sum payments from a new casino. METHODS We applied Poisson regression to the monthly count of accidental deaths among Cherokee Indians over 204 months spanning 1990-2006. We controlled for temporal patterns in accidental deaths (e.g. seasonality and trend) as well as changes in population size. RESULTS As hypothesized, the risk of accidental death rises above expected levels during months of the large casino payments (relative risk = 2.62; 95% confidence interval = 1.54-4.47). Exploratory analyses of ethnographic interviews and behavioural surveys support that increased vehicular travel and consumption of health-damaging goods may account for the rise in accident proneness. CONCLUSIONS Although long-term income gains may improve health in this population, our findings indicate that acute responses to large income gains, in the short term, increase risk-taking and accident proneness. We encourage further investigation of natural experiments to identify causal economic antecedents of population health.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health & Department of Planning, Policy, and Design, University of California, Irvine, Irvine, CA, USA.
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Abstract
AbstractChildren in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young children's response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.
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Stringaris A. Abstract thinking: environmental modification, development, and psychopathology. J Am Acad Child Adolesc Psychiatry 2010; 49:1180. [PMID: 21093765 DOI: 10.1016/j.jaac.2010.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 09/13/2010] [Indexed: 10/18/2022]
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