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Ettman CK, Hatton CR, Castrucci BC, Galea S. Mental Health and Mental Health Care Utilization Across Political Affiliation in U.S. Adults. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00339. [PMID: 39236212 DOI: 10.1097/phh.0000000000002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
In the past decade, depression has become more visible in the public conversation; depression has also become bound in national divides. We sought to assess (1) whether positive screen for depression is associated with political party affiliation and (2) whether use of mental health care varies by political affiliation. Positive screen for depression did not differ significantly for Republicans versus Democrats in Spring 2023. However, Republicans were less likely to have received treatment for their mental health in the past 12 months. Depression is a bipartisan issue, and improving access to mental health care could be a priority that unites political groups during the upcoming election season.
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Affiliation(s)
- Catherine K Ettman
- Author Affiliations: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Drs Ettman and Hatton); Office of the President, de Beaumont Foundation, Bethesda, Maryland (Dr Castrucci); and Office of the Dean, Boston University School of Public Health, Boston, Massachusetts (Dr Galea)
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Lombardi B, de Saxe Zerden L, Jensen T, Galloway E, Gaiser M. Behavioral Health Workforce Distribution in Socially Disadvantaged Communities. J Behav Health Serv Res 2024:10.1007/s11414-024-09897-0. [PMID: 39060877 DOI: 10.1007/s11414-024-09897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
This study sought to understand the geographic distribution of three behavioral health clinician (BHC) types in disadvantaged communities in the U.S. across a standardized index of area disadvantage. CMS National Plan and Provider Enumeration System's data were used to identify BHC practice addresses. Addresses were geocoded and mapped to census block groups across Area Disadvantage Index (ADI) scores. Differences in the proportion of BHCs per 100k people in a block group by ADI, clinician type, and rurality were compared. Zero-inflated negative binomial models assessed associations between ADI score with any amount, and expected count, of BHC type in a block group. The sample included 836,780 BHCs (51.5% counselors, 34.5% social workers, 14.0% psychologists). Results indicated there were fewer BHCs in areas of high disadvantage with 351 BHCs in the lowest need versus 267 BHCs in highest need areas, per 100k people. BHC type was differently associated with the rate of clinicians per 100k by ADI and block groups that were both rural and high ADI had the least BHCs located. Findings suggest the maldistribution of BHCs by ADI underscores how some BHCs may be better positioned to meet the needs of vulnerable communities. Increasing access to behavioral health care requires a workforce equitably positioned in high-need areas. Reforms to payment and practice regulations may support BHCs to deliver services in socially disadvantaged neighborhoods.
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Affiliation(s)
- Brianna Lombardi
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599-3550, USA.
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, 725 Martin Luther King Blvd, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, UNC Behavioral Health Workforce Research Center, 725 Martin Luther King Blvd, Chapel Hill, NC, 27599, USA.
| | - Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599-3550, USA
- Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, UNC Behavioral Health Workforce Research Center, 725 Martin Luther King Blvd, Chapel Hill, NC, 27599, USA
| | - Todd Jensen
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599-3550, USA
- Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, UNC Behavioral Health Workforce Research Center, 725 Martin Luther King Blvd, Chapel Hill, NC, 27599, USA
| | - Evan Galloway
- Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, UNC Behavioral Health Workforce Research Center, 725 Martin Luther King Blvd, Chapel Hill, NC, 27599, USA
| | - Maria Gaiser
- Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, UNC Behavioral Health Workforce Research Center, 725 Martin Luther King Blvd, Chapel Hill, NC, 27599, USA
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Wang S, Wang Y, Tong L, Zhuang J, Xu D, Wu Y. Association between pregnancy loss and depressive symptoms in women: a population-based study. BMC Psychiatry 2024; 24:526. [PMID: 39044239 PMCID: PMC11267727 DOI: 10.1186/s12888-024-05948-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Depression is a common mental disorder with a much higher prevalence in women than in men. Although there has been a gradual increase in research on the association between reproductive health and depression, there is still some inconsistency in the evidence of the relationship between pregnancy loss and depression. This study aimed to investigate the relationship between pregnancy loss and depressive symptoms. METHODS We analyzed data from the 2007-2020 National Health and Nutrition Examination Survey (NHANES), which included female participants aged 20 to 80 years. Pregnancy loss was determined based on participants' self-reported number of pregnancies and pregnancy outcomes. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9, score ≥ 10). Multivariate logistic regression, smoothed curve fitting, and generalized additive modeling were used to examine the association between pregnancy loss and depression. We also performed sensitivity analyses and subgroup analyses to verify the robustness and specificity of the findings. RESULTS A total of 12,873 female participants were included in our study, of which 1,595 (12.39%) were categorized as depressed. Multivariate logistic regression results indicated that experiencing a pregnancy loss increased the risk of prevalence of depression in women (for 1 loss: OR = 1.31, 95% CI 1.15,1.50; for 2 or more losses: OR = 1.58, 95% CI 1.38, 1.81). When sensitivity analyses were performed, an association between pregnancy loss and depression was found in both multivariate linear regressions with PHQ-9 scores as a continuous variable and multivariate logistic regressions with a threshold of 5 PHQ-9 scores. The association between pregnancy loss and depression remained stable across subgroups. CONCLUSION Pregnancy loss correlated with elevated PHQ-9 scores and a heightened risk of depression in adult women across the United States. Focusing on the incidence of adverse pregnancy events in the female population may help prevent or early recognize the onset of depression.
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Affiliation(s)
- Shan Wang
- Obstetrics, Gynecology and Reproduction Research, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, Jiangsu, 214000, P.R. China
| | - Yuan Wang
- Obstetrics, Gynecology and Reproduction Research, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, Jiangsu, 214000, P.R. China
| | - Ling Tong
- Obstetrics, Gynecology and Reproduction Research, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, Jiangsu, 214000, P.R. China
| | - Jiaru Zhuang
- Obstetrics, Gynecology and Reproduction Research, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, Jiangsu, 214000, P.R. China
| | - Dewu Xu
- Department of Medical Education, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, Jiangsu, 214000, P.R. China.
| | - Yibo Wu
- Obstetrics, Gynecology and Reproduction Research, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, Jiangsu, 214000, P.R. China.
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Vestal E, Newman S, Phillips S. Barriers and facilitators to accessing pediatric specialty care for rural-dwelling children with complex chronic conditions: An integrative review. J Pediatr Nurs 2024; 77:e385-e393. [PMID: 38777676 DOI: 10.1016/j.pedn.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
PROBLEM Pediatric specialty services are often geographically concentrated in urban areas, leaving up to 1 in 5 rural-dwelling children in the United States without access to advanced care. The purpose of this review was to identify and review extant literature related to barriers and facilitators to accessing specialty care for rural-dwelling children with complex chronic conditions. ELIGIBILITY CRITERIA The Whittemore and Knafl (2005) integrative review method guided the review which included a critical appraisal and analysis of relevant articles published between 2012 and 2023. SAMPLE Twenty-three studies were identified for inclusion in the integrative review. RESULTS Using the domains of the Levesque et al. (2013) conceptual framework, findings were categorized according to the access to care continuum. Barriers included broadband access, transportation, and inadequate care coordination. Facilitators included telehealth, social support, and outreach clinics. CONCLUSIONS To improve access to pediatric specialty care for rural-dwelling children, nurses, physicians, and policymakers will need to consider how the social determinants of health impact the healthcare access continuum from diagnosis to continuing healthcare. IMPLICATIONS The findings of this integrative review will aid researchers in developing interventions to improve access to pediatric specialty care for rural-dwelling children.
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Affiliation(s)
- Elisabeth Vestal
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States.
| | - Susan Newman
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States
| | - Shannon Phillips
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States
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Cai S, Qin Q, Veazie P, Temkin-Greener H. Telemedicine and Disparities in Mental Health Service Use Among Community-Dwelling Older Adults With Alzheimer Disease and Related Dementias. J Am Med Dir Assoc 2024; 25:105027. [PMID: 38768645 DOI: 10.1016/j.jamda.2024.105027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To examine disparities in mental health (MH) service utilization, via in-person and telemedicine (ie, tele-MH), by individuals' race, ethnicity, and community socioeconomic status, among community-dwelling older adults with Alzheimer disease and related dementias (ADRD) before and after the expansion of the Centers for Medicare and Medicaid Services' (CMS's) telemedicine policy. DESIGN Observational study. SETTING AND PARTICIPANTS A total of 3,003,571 community-dwelling Medicare beneficiaries with ADRD between 2019 and 2021 were included in the study. METHODS Multiple national data were linked. The unit of analysis was individual-quarter. Three outcomes were defined: any MH visits (in-person or tele-MH), in-person MH visits, and tele-MH visits per quarter. Key independent variables included individual race and ethnicity, the socioeconomic status of the community, and an indicator for the implementation of the telemedicine policy. Regression analyses with individual random effects were used. RESULTS In general, Black and Hispanic older adults with ADRD and those in socioeconomically deprived communities were less likely to have MH visits than white adults and those from less-deprived communities. In-person and tele-MH visits varied throughout the pandemic and across subpopulations. For instance, at the beginning of the pandemic, white, Black, and Hispanic older adults experienced 5.05, 3.03, and 2.87 percentage point reductions in in-person MH visits, and 3.53, 1.26, and 0.32 percentage point increases in tele-MH visits (with P < .01 for racial/ethnic differences), respectively. During the pandemic, the increasing trend in in-person MH visits and the decreasing trend in tele-MH visits varied across different subgroups. Overall, racial and ethnic differences in any MH visits were reduced, but the gap in any MH visits between deprived and less-deprived communities doubled during the pandemic (P < .01). CONCLUSIONS AND IMPLICATIONS Telemedicine may have provided an opportunity to improve access to MH services among underserved populations. However, although some disparities in MH care were reduced, others widened, underscoring the importance of equitable health care access strategies to address the unique needs of different populations.
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Affiliation(s)
- Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Zabelski S, Hollander M, Alexander A. Addressing Inequities in Access to Mental Healthcare: A Policy Analysis of Community Mental Health Systems Serving Minoritized Populations in North Carolina. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:543-553. [PMID: 38285082 PMCID: PMC11196298 DOI: 10.1007/s10488-024-01344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
Racial and ethnic minoritized uninsured populations in the United States face the greatest barriers to accessing mental healthcare. Historically, systems of care in the U.S. were set up using inadequate evidence at the federal, state, and local levels, driving inequities in access to quality care for minoritized populations. These inequities are most evident in community-based mental health services, which are partially or fully funded by federal programs and predominantly serve historically minoritized groups. In this descriptive policy analysis, we outline the history of federal legislative policies that have dictated community mental health systems and how these policies were implemented in North Carolina, which has a high percentage of uninsured communities of color. Several gaps between laws passed in the last 60 years and research on improving inequities in access to mental health services are discussed. Recommendations to expand/fix these policies include funding accurate data collection and implementation methods such as electronic health record (EHR) systems to ensure policies are informed by extensive data, implementation of evidence-informed and culturally sensitive interventions, and prioritizing preventative services that move past traditional models of mental healthcare.
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Affiliation(s)
- Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina, Charlotte, USA.
| | - Mara Hollander
- Department of Public Health Sciences, University of North Carolina, Charlotte, USA
| | - Apryl Alexander
- Department of Public Health Sciences, University of North Carolina, Charlotte, USA
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Zima BT, Edgcomb JB, Fortuna LR. Identifying Precise Targets to Improve Child Mental Health Care Equity: Leveraging Advances in Clinical Research Informatics and Lived Experience. Child Adolesc Psychiatr Clin N Am 2024; 33:471-483. [PMID: 38823818 PMCID: PMC11268960 DOI: 10.1016/j.chc.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
To reduce child mental health disparities, it is imperative to improve the precision of targets and to expand our vision of social determinants of health as modifiable. Advancements in clinical research informatics and please state accurate measurement of child mental health service use and quality. Participatory action research promotes representation of underserved groups in informatics research and practice and may improve the effectiveness of interventions by informing research across all stages, including the identification of key variables, risk and protective factors, and data interpretation.
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Affiliation(s)
- Bonnie T Zima
- UCLA Mental Health Informatics and Data Science (MINDS) Hub, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 37-384B, Los Angeles, CA 90024, USA.
| | - Juliet B Edgcomb
- UCLA Mental Health Informatics and Data Science (MINDS) Hub, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 37-372A, Los Angeles, CA 90024, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Neuroscience, University of California Riverside, School of Medicine, 900 University Avenue, Riverside, CA 92521, USA
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Benevides TW, Jaremski JE, Williams ED, Song W, Pham HH, Shea L. Racial and Ethnic Disparities in Community Mental Health Use Among Autistic Adolescents and Young Adults. J Adolesc Health 2024; 74:1208-1216. [PMID: 38493400 DOI: 10.1016/j.jadohealth.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The purpose of this cohort study was to evaluate differences in rate of co-occurring mental health (MH) conditions among transition-age autistic youth (TAYA) who are Black, indigenous, and other people of color, and to identify enabling variables associated with any community MH visit in this population. METHODS Medicare-Medicaid Linked Enrollees Analytic Data Source 2012 data were used for this study. TAYA 14-29 years old who received fee-for-service Medicare, Medicaid, or both were included. Predisposing, enabling, and need variables associated with both presence of MH conditions and any community MH visit were examined with general linear modeling. RESULTS N = 122,250 TAYA were included. Black, Asian/Pacific Islander, and Hispanic TAYA were significantly less likely than White TAYA to have a diagnosis of substance-use, depressive, anxiety, attention-deficit hyperactivity disorder, or post-traumatic stress disorders. These groups were also significantly less likely to have had a community MH visit in the past year after controlling for predisposing, enabling, and need variables. Enabling variables associated with greater use of at least one community MH visit included dual enrollment in both Medicare and Medicaid and 12+ months of enrollment in 1115 or 1915(C) Medicaid waivers. DISCUSSION Service delivery factors are an important area of future research, particularly dual enrollment and coverage disparities for Black, indigenous, and other people of color TAYA. Examining coverage of managed care enrollees, including differences by state, may offer additional insights on how these factors impact care.
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Affiliation(s)
- Teal W Benevides
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia.
| | - Jennifer E Jaremski
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
| | - Ed-Dee Williams
- School of Social Work, Boston College, Chestnut Hill, Massachusetts
| | - Wei Song
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | | | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
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Frank HE, Albanese A, Sun S, Saadeh F, Johnson BT, Elwy AR, Loucks EB. Mindfulness-Based Stress Reduction Health Insurance Coverage: If, How, and When? An Integrated Knowledge Translation (iKT) Delphi Key Informant Analysis. Mindfulness (N Y) 2024; 15:1220-1233. [PMID: 38817538 PMCID: PMC11133142 DOI: 10.1007/s12671-024-02366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/01/2024]
Abstract
Objectives Hundreds of trials have evaluated Mindfulness-Based Stress Reduction (MBSR), but in the United States, it is generally not covered by health insurance. Consequently, the aims were to identify the following: (1) key questions to make decisions about if, how, and when MBSR should be covered by health insurance; (2a) barriers and (2b) facilitators to understand and resolve for MBSR to be covered by health insurance; and (3) highest priority evidence needed to inform health insurance coverage decisions. Methods Key informants (n = 26) included health insurers, healthcare administrators, policymakers, clinicians, MBSR instructors, and MBSR students. An initial pool of items related to the study aims was generated through qualitative interviews. Through the Delphi process, participants rated, discussed, and re-rated each item's relevance. Items were required to reach a consensus of ≥ 80% agreement to be retained for final inclusion. Results Of the original 149 items, 42 (28.2%) met the ≥ 80% agreement criterion and were retained for final inclusion. The most highly rated items informing whether MBSR should be covered by health insurance included research demonstrating that MBSR works and that it is not harmful. The most highly rated barriers to coverage were that MBSR is not a medical treatment and patient barriers to attendance. Highly rated facilitators included the potential of MBSR to address common mental health and psychosomatic problems. Finally, understanding what conditions are effectively treated with MBSR and the impact of MBSR on stress were rated as the highest priority evidence needed to inform health insurance coverage decisions. Conclusions Findings highlight priorities for future research and policy efforts to advance health insurance coverage of MBSR in the United States. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-024-02366-x.
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Affiliation(s)
- Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Ariana Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Shufang Sun
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI USA
- Mindfulness Center, Brown University, Providence, RI USA
| | - Frances Saadeh
- Mindfulness Center, Brown University, Providence, RI USA
- School of Professional Studies, Brown University, Providence, RI USA
| | - Blair T. Johnson
- Department of Psychological Sciences, University of Connecticut, Storrs, CT USA
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA USA
| | - Eric B. Loucks
- Mindfulness Center, Brown University, Providence, RI USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02910 USA
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Danielson ML, Claussen AH, Bitsko RH, Katz SM, Newsome K, Blumberg SJ, Kogan MD, Ghandour R. ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:343-360. [PMID: 38778436 PMCID: PMC11334226 DOI: 10.1080/15374416.2024.2335625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To provide updated national prevalence estimates of diagnosed attention-deficit/hyperactivity disorder (ADHD), ADHD severity, co-occurring disorders, and receipt of ADHD medication and behavioral treatment among U.S. children and adolescents by demographic and clinical subgroups using data from the 2022 National Survey of Children's Health (NSCH). METHOD This study used 2022 NSCH data to estimate the prevalence of ever diagnosed and current ADHD among U.S. children aged 3-17 years. Among children with current ADHD, ADHD severity, presence of current co-occurring disorders, and receipt of medication and behavioral treatment were estimated. Weighted estimates were calculated overall and for demographic and clinical subgroups (n = 45,169). RESULTS Approximately 1 in 9 U.S. children have ever received an ADHD diagnosis (11.4%, 7.1 million children) and 10.5% (6.5 million) had current ADHD. Among children with current ADHD, 58.1% had moderate or severe ADHD, 77.9% had at least one co-occurring disorder, approximately half of children with current ADHD (53.6%) received ADHD medication, and 44.4% had received behavioral treatment for ADHD in the past year; nearly one third (30.1%) did not receive any ADHD-specific treatment. CONCLUSIONS Pediatric ADHD remains an ongoing and expanding public health concern, as approximately 1 million more children had ever received an ADHD diagnosis in 2022 than in 2016. Estimates from the 2022 NSCH provide information on pediatric ADHD during the last full year of the COVID-19 pandemic and can be used by policymakers, government agencies, health care systems, public health practitioners, and other partners to plan for needs of children with ADHD.
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Affiliation(s)
- Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Angelika H Claussen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Samuel M Katz
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
- Oak Ridge Institute for Science and Education
| | - Kimberly Newsome
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention
| | - Michael D Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration
| | - Reem Ghandour
- Maternal and Child Health Bureau, Health Resources and Services Administration
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Koumpias AM, Fleming O, Lin LA. Association of licensure and relationship requirement waivers with out-of-state tele-mental health care, 2019-2021. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae026. [PMID: 38756180 PMCID: PMC11034529 DOI: 10.1093/haschl/qxae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 05/18/2024]
Abstract
During the COVID-19 public health emergency, states waived in-state licensure and pre-existing patient-physician relationship requirements to increase access to care. We exploit this state telehealth policy variation to estimate the association of in-state licensure requirement waivers and pre-existing patient-physician relationship requirement waivers with out-of-state tele-mental health care utilization of patients diagnosed with COVID-19. Using claims from January 2019 until December 2021 of 2 037 977 commercially insured individuals in 3 metropolitan statistical areas (MSAs) straddling Midwestern state borders, we found increased out-of-state telehealth utilization as a share of out-of-state mental health care by 0.1411 and 0.0575 visits per month or 1679.76% and 467.48% after licensure and relationship waivers, respectively. Within-MSA analyses illustrate an urban-rural digital divide in out-of-state utilization as a share of total or telehealth mental health care. Our findings indicate waivers primarily enhance access to care of established patients by enabling the transition of in-person out-of-state health care online. Interstate medical licensure compact participation may provide broader access to out-of-state tele-mental health care than emergency waivers.
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Affiliation(s)
- Antonios M Koumpias
- Department of Social Sciences, University of Michigan-Dearborn, Dearborn, MI 48128, United States
| | - Owen Fleming
- Department of Economics, Wayne State University, Detroit, MI 48202, United States
| | - Lewei Allison Lin
- Addiction Center, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, United States
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, United States
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Zhang L, Hou XY, Liu Y. Measuring Mental Health Service Accessibility for Indigenous Populations: a Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01899-6. [PMID: 38270837 DOI: 10.1007/s40615-023-01899-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations' mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations.
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Affiliation(s)
- Lihong Zhang
- School of the Environment, The University of Queensland, Brisbane, Queensland, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Yan Liu
- School of the Environment, The University of Queensland, Brisbane, Queensland, Australia.
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Harris BR. Helplines for Mental Health Support: Perspectives of New York State College Students and Implications for Promotion and Implementation of 988. Community Ment Health J 2024; 60:191-199. [PMID: 37351714 DOI: 10.1007/s10597-023-01157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Mental health and suicide are serious concerns in the U.S. Though many adults report struggling with their mental health, a significant proportion do not receive care for various reasons including stigma, limited availability, long wait times, inability to pay, and a lack of culturally appropriate options. Helplines can be used to fill gaps in care and, though currently underutilized, are a significant focus of the federal government in the implementation of 988. To better understand the factors that facilitate and impede the utilization of helplines, we conducted 14 focus groups with 95 college students attending a public university and two private colleges in upstate New York between April 2019 and October 2020. Participants included undergraduates, graduate students, LGBTQIA + students, student-athletes, and international students. Participants shared several reasons for using helplines including convenience, comfort, immediate support, and privacy and anonymity. On the other hand, participants expressed hesitation as they expected ingenuine interactions with operators and a lack of continuity, they feared police involvement, and they felt that helplines are not for them, as they are marketed for those in a mental health or suicide crisis and their issues are not that severe. LGBTQIA + participants provided additional reasons as to why they use and do not use LGBTQIA+-specific helplines. Together, our findings suggest the need for improved education, marketing, and training around helplines and may be used to inform the implementation and promotion of 988 in its early stages.
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Affiliation(s)
- Brett R Harris
- Public Health Research Department, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, 20814, Bethesda, MD, USA.
- Department of Health Policy, Management and Behavior, University at Albany School of Public Health, One University Place, 12144, Rensselaer, NY, USA.
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Chang AR, Slopen N. Racial and Ethnic Disparities for Unmet Needs by Mental Health Condition: 2016 to 2021. Pediatrics 2024; 153:e2023062286. [PMID: 38050421 DOI: 10.1542/peds.2023-062286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES Racial and ethnic minority children receive less care and inferior care in the United States, but less is known about how these disparities vary by mental health conditions. We examined unmet mental health needs by condition types to identify potentially hidden racial and ethnic inequities. METHODS We used data from the nationally representative National Survey of Children's Health, from 2016 to 2021 (n = 172 107). Logistic regression analyses were applied to mental health conditions in aggregate and individually and adjusted for individual and household characteristics. RESULTS Relative to non-Hispanic white children with any mental health condition, non-Hispanic Black children had greater odds of unmet needs (adjusted odds ratio [aOR] = 1.56, 95% confidence interval [CI]: 1.18-2.05). Models disaggregated by specific mental health conditions revealed heterogeneous patterns. Specifically, relative to non-Hispanic white children, non-Hispanic Black children displayed elevated odds of unmet needs for behavioral problems (aOR = 1.41, 95% CI: 1.00-2.02), whereas Asian and Hispanic children displayed elevated odds for anxiety (aOR = 2.60, 95% CI: 1.20-4.29 and aOR = 1.41, 95% CI: 1.05-1.90, respectively). CONCLUSIONS Racial and ethnic minority children are disproportionately affected by unmet treatment needs. These disparities vary by individual mental health conditions and persist after controlling for socioeconomic characteristics. Results reveal clinically underserved racial and ethnic groups across different mental health conditions.
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Affiliation(s)
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Center on the Developing Child, Harvard University, Boston, Massachusetts
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Elyoseph Z, Hadar Shoval D, Levkovich I. Beyond Personhood: Ethical Paradigms in the Generative Artificial Intelligence Era. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:57-59. [PMID: 38236857 DOI: 10.1080/15265161.2023.2278546] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Zohar Elyoseph
- The Max Stern Yezreel Valley College
- Imperial College, London
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Negaro SND, Hantman RM, Probst JC, Crouch EL, Odahowski CL, Andrews CM, Hung P. Geographic variations in driving time to US mental health care, digital access to technology, and household crowdedness. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad070. [PMID: 38756363 PMCID: PMC10986236 DOI: 10.1093/haschl/qxad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/02/2023] [Accepted: 11/30/2023] [Indexed: 05/18/2024]
Abstract
Rural residents face significant barriers in accessing mental health care, particularly as the demand for such services grows. Telemedicine has been proposed as an answer to rural gaps, but this service requires both access to appropriate technology and private space in the home to be useful. Our study documented longer travel time to mental health facilities in rural areas and greater barriers to digital devices for telemedicine access in those same areas. However, urban areas demonstrated greater household crowdedness than rural noncore areas when looking at private space within the home. Across ZIP Code Tabulation Areas located more than an estimated 30 minutes from the nearest outpatient care, 675 950 (13.1%) rural households vs 329 950 (6.4%) urban households had no broadband internet. The current Affordable Connectivity Program should target mental health-underserved communities, especially in rural America, where the scarcity of digital access compounds travel burdens to mental health care.
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Affiliation(s)
- Sophia N D Negaro
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
| | - Rachel M Hantman
- Department of Psychology, University of South Carolina, Columbia, SC 29208, United States
| | - Janice C Probst
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina,Columbia, SC 29210, United States
| | - Elizabeth L Crouch
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina,Columbia, SC 29210, United States
| | - Cassie L Odahowski
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina,Columbia, SC 29210, United States
| | - Christina M Andrews
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
| | - Peiyin Hung
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina,Columbia, SC 29210, United States
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17
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Xi W, Banerjee S, Zima BT, Alexopoulos GS, Olfson M, Xiao Y, Pathak J. Effects of Geography on Risk for Future Suicidal Ideation and Attempts Among Children and Youth. JAACAP OPEN 2023; 1:206-217. [PMID: 37946932 PMCID: PMC10635419 DOI: 10.1016/j.jaacop.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Objective Geography may influence the relationships of predictors for suicidal ideation (SI) and suicide attempts (SA) in children and youth. Method This is a nationwide retrospective cohort study of 124,424 individuals less than 25 years of age using commercial claims data (2011-2015) from the Health Care Cost Institute. Outcomes were time to SI or SA within 3 months after the indexed mental health or substance use disorder (MH/SUD) outpatient visit. Predictors included sociodemographic and clinical characteristics up to 3 years before the index event. Results At each follow-up time period, rates of SI and SA varied by the US geographic division (p < .001), and the Mountain Division consistently had the highest rates for both SI and SA (5.44%-10.26% for SI; 0.70%-2.82% for SA). Having MH emergency department (ED) visits in the past year increased the risk of SI by 28% to 65% for individuals residing in the New England, Mid-Atlantic, East North Central, West North Central, and East South Central Divisions. The main effects of geographic divisions were significant for SA (p<0.001). Risk of SA was lower in New England, Mid-Atlantic, South Atlantic, and Pacific (hazard ratios = 0.57, 0.51, 0.67, and 0.79, respectively) and higher in the Mountain Division (hazard ratio = 1.46). Conclusion To understand the underlying mechanisms driving the high prevalence of SI and SA in the Mountain Division and the elevated risk of SI after having MH ED visits, future research examining regional differences in risks for SI and SA should include indicators of access to MH ED care and other social determinants of health.
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Affiliation(s)
- Wenna Xi
- Weill Cornell Medicine, New York
| | | | - Bonnie T Zima
- Center for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | | | - Mark Olfson
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
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Akubuiro S, Clay W, Nelson S, Cowan AE. Addressing Structural Racism in Child and Adolescent Psychiatry in Psychotherapy. INNOVATIONS IN CLINICAL NEUROSCIENCE 2023; 20:29-34. [PMID: 38193101 PMCID: PMC10773604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
The increase in mental health issues among children and adolescents has been declared a health crisis in the United States, and recent increases in key measures (e.g., self-harm and suicidal behaviors) have been found to disproportionately impact youth from minority backgrounds. Access to mental health treatment for youth is limited, but for minority youth, access to culturally sensitive care is even more limited. This article discusses the ways in which misdiagnosis and underdiagnosis of mental health conditions can occur in minority youth and provides key points for clinicians to consider while working with minority youth to improve mental health outcomes.
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Affiliation(s)
- Sydnee Akubuiro
- Dr. Akubuiro is with Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine in Atlanta, Georgia
| | - Wendy Clay
- Drs. Clay, Nelson, and Cowan are with Department of Psychiatry, Wright State University in Dayton, Ohio
| | - Suzie Nelson
- Drs. Clay, Nelson, and Cowan are with Department of Psychiatry, Wright State University in Dayton, Ohio
- Dr. Nelson is additionally with Dayton Children's Hospital in Dayton, Ohio
| | - Allison E Cowan
- Drs. Clay, Nelson, and Cowan are with Department of Psychiatry, Wright State University in Dayton, Ohio
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Clarke AT, Grassetti SN, Brumley L, Ross KY, Erdly C, Richter S, Brown ER, Pole M. Integrating trauma-informed services in out-of-school time programs to mitigate the impact of community gun violence on youth mental health. J Prev Interv Community 2023; 51:332-351. [PMID: 38349066 DOI: 10.1080/10852352.2024.2313382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Community gun violence disproportionately impacts youth in low-income urban neighborhoods. Integrating trauma-informed mental health care in community-based out-of-school time (OST) programs is an innovative method of service delivery for these youth. This article provides justification for integrating evidence-based, trauma-informed services in OST programs within communities characterized by high rates of violent crime to minimize the impact of violence exposure on youth mental health. We describe the initial feasibility of a model program, the Violence Intervention and Prevention (VIP) Initiative, implemented in a small city in southeastern Pennsylvania. Within the first six months of the VIP Initiative, 95 community residents (90% under age 18; 51% Hispanic) received intervention services, primarily through single-session and short-term weekly group intervention in OST programs, and 80% of OST youth development staff participated in at least one trauma-informed professional development training. Recommendations to enhance and expand the delivery of trauma-informed services in the novel setting of OST programs are provided.
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Affiliation(s)
- Angela T Clarke
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Stevie N Grassetti
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Lauren Brumley
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Kyle Y Ross
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Courtney Erdly
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Sarah Richter
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Emily R Brown
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Michele Pole
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
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20
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Brown JD, Stewart KA, Miller RL, Dehus E, Rose T, DeWitt K, Chapman R, Wishon A, Breslau J, Dey J, Jacobus-Kantor L. Impacts of the Certified Community Behavioral Health Clinic Demonstration on Emergency Department Visits and Hospitalizations. Psychiatr Serv 2023; 74:911-920. [PMID: 36916061 DOI: 10.1176/appi.ps.20220410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The Certified Community Behavioral Health Clinic (CCBHC) demonstration is designed to increase access to comprehensive ambulatory care and crisis services, which may reduce emergency department (ED) visits and hospitalizations. This study examined whether the demonstration had an impact on ED visits and hospitalizations in Missouri, Oklahoma, and Pennsylvania. METHODS This difference-in-differences analysis used Medicaid claims data from 2015 to 2019 to examine service use during a 12-month baseline period and the first 24 months of the demonstration for beneficiaries who received care from CCBHCs and beneficiaries who received care from other behavioral health clinics in the same state, representing care as usual. Propensity score methods were used to develop treatment and comparison groups with similar characteristics. RESULTS In Pennsylvania and Oklahoma, beneficiaries who received care from CCBHCs had a statistically significant reduction in the average number of behavioral health ED visits, relative to the comparison group (13% and 11% reductions, respectively); no impact on ED visits in Missouri was observed. The demonstration was associated with a statistically significant reduction in all-cause hospitalizations in Oklahoma, when the analysis used a 2-year rather than a 1-year baseline period, and also in Pennsylvania, when hospitalizations were truncated at the 98th percentile to exclude beneficiaries with outlier hospitalization rates. CONCLUSIONS The CCBHC demonstration reduced behavioral health ED visits in two states, and the study also revealed some evidence of reductions in hospitalizations.
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Affiliation(s)
- Jonathan D Brown
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Kate A Stewart
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Rachel L Miller
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Eric Dehus
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Tyler Rose
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Kathryn DeWitt
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Richard Chapman
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Allison Wishon
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Joshua Breslau
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Judith Dey
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Laura Jacobus-Kantor
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
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Oluwoye O, Lissau A, Stokes S, Selloni AT, James N, Amiri S, McDonell MG, Anglin DM. Study protocol for a multi-level cross-sectional study on the equitable reach and implementation of coordinated specialty care for early psychosis. Implement Sci Commun 2023; 4:90. [PMID: 37553719 PMCID: PMC10410783 DOI: 10.1186/s43058-023-00476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Approximately 115,000 young adults will experience their first episode of psychosis (FEP) each year in the USA. Coordinated specialty care (CSC) for early psychosis is an evidence-based early intervention model that has demonstrated effectiveness by improving quality of life and reducing psychiatric symptoms for many individuals. Over the last decade, there has significant increase in the implementation of CSC programs throughout the USA. However, prior research has revealed difficulties among individuals and their family members accessing CSC. Research has also shown that CSC programs often report the limited reach of their program to underserved populations and communities (e.g., ethnoracial minorities, rural and low socioeconomic neighborhoods). Dissemination and implementation research focused on the equitable reach and implementation of CSC is needed to address disparities at the individual level. METHODS The proposed study will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the USA that will include program-level data (e.g., geocoded location, capacity, setting, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (e.g., residential segregation, ethnic density, area deprivation, rural-urban continua, public transit time). This database will be used to characterize variations in CSC programs by geographical location and examine the overall reach CSC programs to specific communities. The quantitative data will be combined with qualitative data from state administrators, providers, and service users that will inform the development of dissemination tools, such as an interactive dashboard, that can aid decision making. DISCUSSION Findings from this study will highlight the impact of outer contextual determinants on implementation and reach of mental health services, and will serve to inform the future implementation of CSC programs with a primary focus on equity.
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Affiliation(s)
- Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA.
| | - Ari Lissau
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Sheldon Stokes
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Alexandria T Selloni
- Department of Psychology, City College of New York, City University of New York, New York, USA
| | - Najé James
- Department of Psychology, City College of New York, City University of New York, New York, USA
| | - Solmaz Amiri
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Deidre M Anglin
- Department of Psychology, City College of New York, City University of New York, New York, USA
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Willging A, Castro E, Galet C, Xu J. Exploring Outcomes Related to Residential Determinants in Acute Mesenteric Ischemia Patients. J Surg Res 2023; 289:69-74. [PMID: 37086598 DOI: 10.1016/j.jss.2023.03.036] [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: 12/05/2022] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION To access the relationship between residential status and outcomes in surgical acute mesenteric ischemia (AMI) patients. METHODS Retrospective chart review of 153 AMI patients admitted to our institution between 2007 and 2021. Residential median income and Rural-Urban Commuting Area (RUCA) code were used as residential proxies. RESULTS Being of the female sex (odds ratio [OR] = 3.116 [1.276-7.609] P = 0.013) and having a vascular intervention performed (OR = 2.927 [1.087-7.883] P = 0.034) were both associated with a threefold increase in the risk of mortality. Increased age (OR = 1.037 [1.002-1.073] P = 0.039), elevated blood urea nitrogen (OR = 1.032 [1.012-1.051] P = 0.001), and living in higher residential income area (OR = 1.049 [1.009-1.091] P = 0.017) had a small, but statistically significant, increased risk of mortality. Patients in higher median income areas were less likely to undergo colonic resection (OR = 0.953 [0.911-0.997] P = 0.038) and tended to have a lower likelihood of receiving an ostomy (OR = 0.963 [0.927-1] P = 0.051). Being from urban or rural areas was not associated with mortality (OR = 1.565 [0.647-3.790] P = 0.321, although rural patients were more likely to undergo colon resection (OR = 2.183 [0.938-5.079] P = 0.070). Furthermore, rural patients were much more likely to be readmitted than urban dwellers (OR = 4.700 [1.022-21.618] P = 0.047). CONCLUSIONS AMI patients living in rural or small-town areas were more likely to be readmitted and tended to undergo colonic resection. Patients residing in higher income areas had a slightly higher risk of mortality but tended to be less likely to require ostomy or colonic resection. These findings suggest a potential need for postoperative care initiatives focused on AMI patients living in rural and lower income areas.
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Affiliation(s)
- Abbygale Willging
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Elvis Castro
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Colette Galet
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Jun Xu
- Department of Surgery, University of Iowa, Iowa City, Iowa.
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Haro-Ramos AY, Rodriguez HP, Aguilera A. Effectiveness and implementation of a text messaging intervention to reduce depression and anxiety symptoms among Latinx and Non-Latinx white users during the COVID-19 pandemic. Behav Res Ther 2023; 165:104318. [PMID: 37146444 PMCID: PMC10105646 DOI: 10.1016/j.brat.2023.104318] [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: 06/22/2022] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
Text messaging interventions are increasingly used to help people manage depression and anxiety. However, little is known about the effectiveness and implementation of these interventions among U.S. Latinxs, who often face barriers to using mental health tools. The StayWell at Home (StayWell) intervention, a 60-day text messaging program based on cognitive behavioral therapy (CBT), was developed to help adults cope with depressive and anxiety symptoms during the COVID-19 pandemic. StayWell users (n = 398) received daily mood inquiries and automated skills-based text messages delivering CBT-informed coping strategies from an investigator-generated message bank. We conduct a Hybrid Type 1 mixed-methods study to compare the effectiveness and implementation of StayWell for Latinx and Non-Latinx White (NLW) adults using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using the PHQ-8 depression and GAD-7 anxiety scales, assessed before starting and after completing StayWell. Guided by RE-AIM, we conducted a thematic text analysis of responses to an open-ended question about user experiences to help contextualize quantitative findings. Approximately 65.8% (n = 262) of StayWell users completed pre-and-post surveys. On average, depressive (-1.48, p = 0.001) and anxiety (-1.38, p = 0.001) symptoms decreased from pre-to-post StayWell. Compared to NLW users (n = 192), Latinx users (n = 70) reported an additional -1.45 point (p < 0.05) decline in depressive symptoms, adjusting for demographics. Although Latinxs reported StayWell as relatively less useable (76.8 vs. 83.9, p = 0.001) than NLWs, they were more interested in continuing the program (7.5 vs. 6.2 out of 10, p = 0.001) and recommending it to a family member/friend (7.8 vs. 7.0 out of 10, p = 0.01). Based on the thematic analysis, both Latinx and NLW users enjoyed responding to mood inquiries and sought bi-directional, personalized text messages and texts with links to more information to resources. Only NLW users stated that StayWell provided no new information than they already knew from therapy or other sources. In contrast, Latinx users suggested that engagement with a behavioral provider through text or support groups would be beneficial, highlighting this group's unmet need for behavioral health care. mHealth interventions like StayWell are well-positioned to address population-level disparities by serving those with the greatest unmet needs if they are culturally adapted and actively disseminated to marginalized groups. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04473599.
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Affiliation(s)
- Alein Y Haro-Ramos
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Hector P Rodriguez
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Adrian Aguilera
- Digital Health Equity and Access Lab, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
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Brown JD, Bell N. Factors Associated with the Receipt of Follow-Up Care Among Medicare Beneficiaries Discharged from Inpatient Psychiatric Facilities. J Behav Health Serv Res 2023; 50:221-227. [PMID: 35902514 DOI: 10.1007/s11414-022-09810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/29/2022]
Abstract
This study examined the extent to which facility characteristics, discharge practices, and the availability of outpatient mental health care are associated with receiving follow-up care within 7 days of discharge from an inpatient psychiatric facility among Medicare beneficiaries. The study merged 2018 National Mental Health Services Survey data with 2018 Inpatient Psychiatric Facility Quality Reporting program data representing 1147 inpatient psychiatric facilities. Results from logistic regression analyses indicated that inpatient facilities operated by private for-profit organizations and public agencies had lower odds of achieving high performance on a measure that assessed if Medicare beneficiaries received follow-up care within 7 days of discharge relative to private nonprofit facilities; follow-up rates were inversely associated with the proportion of involuntarily committed patients at the facility. Follow-up rates were not associated with other facility characteristics, discharge practices, the availability of outpatient care at the location of the inpatient facility, or the density of outpatient mental health providers in the community. Improving follow-up care for Medicare beneficiaries could target for-profit and public hospitals and those that serve a high proportion of individuals involuntarily committed to inpatient care.
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Beauchamp AM, Lehmann CU, Medford RJ, Hughes AE. The Association of a Geographically Wide Social Media Network on Depression: County-Level Ecological Analysis. J Med Internet Res 2023; 25:e43623. [PMID: 36972109 PMCID: PMC10131939 DOI: 10.2196/43623] [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: 10/18/2022] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Social connectedness decreases human mortality, improves cancer survival, cardiovascular health, and body mass, results in better-controlled glucose levels, and strengthens mental health. However, few public health studies have leveraged large social media data sets to classify user network structure and geographic reach rather than the sole use of social media platforms. OBJECTIVE The objective of this study was to determine the association between population-level digital social connectedness and reach and depression in the population across geographies of the United States. METHODS Our study used an ecological assessment of aggregated, cross-sectional population measures of social connectedness, and self-reported depression across all counties in the United States. This study included all 3142 counties in the contiguous United States. We used measures obtained between 2018 and 2020 for adult residents in the study area. The study's main exposure of interest is the Social Connectedness Index (SCI), a pair-wise composite index describing the "strength of connectedness between 2 geographic areas as represented by Facebook friendship ties." This measure describes the density and geographical reach of average county residents' social network using Facebook friendships and can differentiate between local and long-distance Facebook connections. The study's outcome of interest is self-reported depressive disorder as published by the Centers for Disease Control and Prevention. RESULTS On average, 21% (21/100) of all adult residents in the United States reported a depressive disorder. Depression frequency was the lowest for counties in the Northeast (18.6%) and was highest for southern counties (22.4%). Social networks in northeastern counties involved moderately local connections (SCI 5-10 the 20th percentile for n=70, 36% of counties), whereas social networks in Midwest, southern, and western counties contained mostly local connections (SCI 1-2 the 20th percentile for n=598, 56.7%, n=401, 28.2%, and n=159, 38.4%, respectively). As the quantity and distance that social connections span (ie, SCI) increased, the prevalence of depressive disorders decreased by 0.3% (SE 0.1%) per rank. CONCLUSIONS Social connectedness and depression showed, after adjusting for confounding factors such as income, education, cohabitation, natural resources, employment categories, accessibility, and urbanicity, that a greater social connectedness score is associated with a decreased prevalence of depression.
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Affiliation(s)
- Alaina M Beauchamp
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Dallas, TX, United States
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Christoph U Lehmann
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Richard J Medford
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Amy E Hughes
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Liberman J, Pesa J, Rui P, Joshi K, Harding L. Social determinants and distance from certified treatment centers are associated with initiation of esketamine nasal spray among patients with challenging-to-treat major depressive disorder. Medicine (Baltimore) 2023; 102:e32895. [PMID: 36800597 PMCID: PMC9935983 DOI: 10.1097/md.0000000000032895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Indicated for treatment-resistant depression or major depression with suicidal ideation, esketamine (ESK) is self-administered under supervision at certified treatment centers. Our study was to determine if social determinants of health and distance were associated with ESK utilization. We conducted a retrospective cohort study among 308 US adults initiating ESK between October 11, 2019 and December 31, 2020 and 1540 propensity-score matched controls with treatment-resistant depression or major depression with suicidal ideation. Adjusting for demographics, prior health care utilization and comorbidities, social determinant variables and distance were regressed separately on each outcome: ESK initiation, failure to complete induction (8 treatments in 45 days), and discontinuation within 6 months. ESK initiation was associated with higher population density (odds ratio [OR]: 2.12), American Indian, Alaska Native, Native Hawaiian, Other Pacific Islander (OR: 3.19), and mental health (OR: 1.55) and primary care providers (OR: 1.55) per capita. Lower likelihood of ESK initiation was associated with living > 7.2 miles from a treatment center (OR: 0.75), living in rural areas (OR: 0.64), and percent non-Hispanic African American (OR: 0.58) and Hispanic (OR: 0.40). Health care providers should tailor patient engagement strategies to mitigate potential barriers to initiating and continuing appropriate treatment. Failing to complete induction was associated with substance use disorder and longer distance to treatment center was associated with discontinuation (hazard ratio: 1.48), as was percent Asian population (hazard ratio: 1.37). Prior psychiatric care and residence in counties with high rates of primary care providers per capita, unemployment, and high school graduation were associated with both higher likelihood of completing induction and lower likelihood of discontinuation.
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Affiliation(s)
- Joshua Liberman
- Health Analytics, LLC, Columbia, MD
- * Correspondence: Joshua Liberman, Health Analytics, LLC, Columbia, MD (e-mail: )
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Rochford B, Pendse S, Kumar N, De Choudhury M. Leveraging Symptom Search Data to Understand Disparities in US Mental Health Care: Demographic Analysis of Search Engine Trace Data. JMIR Ment Health 2023; 10:e43253. [PMID: 36716082 PMCID: PMC9926343 DOI: 10.2196/43253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals. OBJECTIVE We aimed to understand the differences in how people in shortage and nonshortage areas search for information about mental health on the web. METHODS We analyzed search engine log data related to health from 2017-2021 and examined the differences in mental health search behavior between shortage and nonshortage areas. We analyzed several axes of difference, including shortage versus nonshortage comparisons, urban versus rural comparisons, and temporal comparisons. RESULTS We found specific differences in search behavior between shortage and nonshortage areas. In shortage areas, broader and more general mental health symptom categories, namely anxiety (mean 2.03%, SD 0.44%), depression (mean 1.15%, SD 0.27%), fatigue (mean 1.21%, SD 0.28%), and headache (mean 1.03%, SD 0.23%), were searched significantly more often (Q<.0003). In contrast, specific symptom categories and mental health disorders such as binge eating (mean 0.02%, SD 0.02%), psychosis (mean 0.37%, SD 0.06%), and attention-deficit/hyperactivity disorder (mean 0.77%, SD 0.10%) were searched significantly more often (Q<.0009) in nonshortage areas. Although suicide rates are consistently known to be higher in shortage and rural areas, we see that the rates of suicide-related searching are lower in shortage areas (mean 0.05%, SD 0.04%) than in nonshortage areas (mean 0.10%, SD 0.03%; Q<.0003), more so when a shortage area is rural (mean 0.024%, SD 0.029%; Q<2 × 10-12). CONCLUSIONS This study demonstrates differences in how people from geographically marginalized groups search on the web for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals use when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role that structural factors play in expressions of distress and they should attempt to design search engine algorithms and interfaces to close gaps in care.
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Affiliation(s)
- Ben Rochford
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Sachin Pendse
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Neha Kumar
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Munmun De Choudhury
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
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Dir AL, Pederson CA, Ouyang F, Monahan PO, Schwartz K, Wiehe SE, Aalsma MC. Examining Patterns of Psychotherapy Service Utilization Among Medicaid-Enrolled Adolescents. Psychiatr Serv 2023; 74:374-380. [PMID: 36597697 DOI: 10.1176/appi.ps.202100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents. METHODS Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit. RESULTS A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001). CONCLUSIONS These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.
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Affiliation(s)
- Allyson L Dir
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Casey A Pederson
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Fangqian Ouyang
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Patrick O Monahan
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Katherine Schwartz
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Sarah E Wiehe
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
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El Battioui F, El Malki F, Barrijal S. Quality of life assessment of breast cancer survivors in Northern Morocco: Rural-urban disparity. Breast Dis 2023; 42:291-298. [PMID: 37742628 DOI: 10.3233/bd-230012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
This article is a cross-sectional study of 216 women undergoing adjuvant hormone therapy for breast cancer in two oncology centers in northern Morocco. Quality of life (QoL) was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaire and its endocrine subscale (ES). The relationship between rural-urban status in our sample and QoL was assessed by linear regression analysis using sociodemographic and clinical variables as covariates. Our results show that physical and functional well-being are significantly (p < 0.001) higher in rural areas (24 and 29, respectively) than in urban areas (16 and 19, respectively), while social and emotional well-being are significantly (p < 0.001) higher in urban areas (22 and 21, respectively) than in rural areas (15 and 16, respectively). However, there was no significant difference (p = 0.097) between rural and urban breast cancer survivors regarding endocrine symptom burden. Regarding the effect of sociodemographic and clinical factors on overall HRQOL of breast cancer survivors, hormone type was shown to have a significant effect on overall HRQOL (FACT-ES) of rural and urban breast cancer survivors (𝛽 = +0.849 and 𝛽 = +0.678, respectively). A similar effect was observed for ES (𝛽 = +0.896 and 𝛽 = +0.180, respectively).In contrast, other factors (age, marital status, economic status, menopausal status, type of surgery) did not have a significant effect on HRQOL (FACT-ES) or ES.The study highlighted the need for increased psychosocial supportive care efforts for rural breast cancer survivors to improve their QoL.
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Affiliation(s)
- Fadoua El Battioui
- Laboratory of Biotechnology, Genomic and Bioinformatics, Faculty of Science and Techniques, Tangier, Abdelmalek Essaâdi University, Tetouan, Morocco
| | | | - Said Barrijal
- Laboratory of Biotechnology, Genomic and Bioinformatics, Faculty of Science and Techniques, Tangier, Abdelmalek Essaâdi University, Tetouan, Morocco
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Hoffmann JA, Attridge MM, Carroll MS, Simon NJE, Beck AF, Alpern ER. Association of Youth Suicides and County-Level Mental Health Professional Shortage Areas in the US. JAMA Pediatr 2023; 177:71-80. [PMID: 36409484 PMCID: PMC9679958 DOI: 10.1001/jamapediatrics.2022.4419] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
Abstract
Importance Suicide is the second leading cause of death among US adolescents. Workforce shortages of mental health professionals in the US are widespread, but the association between mental health workforce shortages and youth suicides is not well understood. Objective To assess the association between youth suicide rates and mental health professional workforce shortages at the county level, adjusting for county demographic and socioeconomic characteristics. Design, Setting, and Participants This retrospective cross-sectional study included all US counties and used data of all US youlth suicides from January 2015, through December 31, 2016. Data were analyzed from July 1, 2021, through December 20, 2021. Exposures County health-professional shortage area designation for mental health, assigned by the US Health Resources and Services Administration based on mental health professionals relative to the population, level of need for mental health services, and service availability in contiguous areas. Designated shortage areas receive a score from 0 to 25, with higher scores indicating greater workforce shortages. Main Outcomes and Measures Suicides by youth aged 5 to 19 years from 2015 to 2016 were identified from the US Centers for Disease Control and Prevention's Compressed Mortality File. A multivariable negative binomial regression model was used to analyze the association between youth suicide rates and mental health workforce shortage designation, adjusting for the presence of a children's mental health hospital and county-level markers of health insurance coverage, education, unemployment, income, poverty, urbanicity, racial and ethnic composition, and year. Similar models were performed for the subgroups of (1) firearm suicides and (2) counties assigned a numeric shortage score. Results During the study period, there were 5034 youth suicides (72.8% male and 68.2% non-Hispanic White) with an annual suicide rate of 3.99 per 100 000 youths. Of 3133 US counties, 2117 (67.6%) were designated as mental health workforce shortage areas. After adjusting for county characteristics, mental health workforce shortage designation was associated with an increased youth suicide rate (adjusted incidence rate ratio [aIRR], 1.16; 95% CI, 1.07-1.26) and an increased youth firearm suicide rate (aIRR, 1.27; 95% CI, 1.13-1.42). For counties with an assigned numeric workforce shortage score, the adjusted youth suicide rate increased 4% for every 1-point increase in the score (aIRR, 1.04; 95% CI, 1.02-1.06). Conclusions and Relevance In this cross-sectional study, US county mental health professional workforce shortages were associated with increased youth suicide rates. These findings may inform suicide prevention efforts.
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Affiliation(s)
- Jennifer A. Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan M. Attridge
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael S. Carroll
- Smith Child Health Outcomes Research and Evaluation Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norma-Jean E. Simon
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew F. Beck
- Divisions of General and Community Pediatrics and Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Kim K, Tsai AC, Sumner JA, Jung SJ. Posttraumatic stress disorder, cardiovascular disease outcomes and the modifying role of socioeconomic status. J Affect Disord 2022; 319:555-561. [PMID: 36174781 DOI: 10.1016/j.jad.2022.09.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Substantial evidence indicates that post-traumatic stress disorder (PTSD) is associated with an increased incidence of cardiovascular disease (CVD), and differential PTSD-CVD association by socioeconomic status had been suggested. However, there are inadequate evidence on differential association. This study investigated sociodemographic heterogeneity in the association between PTSD and CVD. METHODS A total of 53,749 patients diagnosed with PTSD in 2004-2018 were recruited from Korean National Health Insurance Database. Date of first diagnosis of PTSD was set as an index date. We recruited 3 controls per each patient, matched by age and sex (N = 161,247). Monthly insurance premiums were used as a surrogate variable for socioeconomic status. Cox proportional hazard model was used to estimate the hazard of incident coronary artery disease, incident stroke, and cardiovascular mortality. We stratified participants by age, sex, and insurance premium to test heterogeneities in the association. RESULTS PTSD was associated with increased risk for coronary artery disease, hemorrhagic stroke, and cardiovascular mortality. Elevation in risk of cardiovascular disease was more prominent in younger individuals. PTSD increased the risk of coronary artery disease and ischemic stroke more in individuals with lower SES, especially in men. LIMITATIONS Insurance premium might not fully represent socioeconomic status of individual. Misclassification or misdiagnosis of PTSD by might have introduced biases. CONCLUSIONS PTSD was associated with increased incidence of CVD, particularly in male patients with low SES. For PTSD patients with lower SES, preventive measures against cardiovascular disease would be able to decrease the disease burden of cardiovascular comorbidity in PTSD.
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Affiliation(s)
- Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA.
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NEWTON HELEN, HUMENSKY JENNIFER, GOLDMAN HOWARD, BUSCH SUSANH. What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings? Milbank Q 2022; 100:1166-1191. [PMID: 36575952 PMCID: PMC9836237 DOI: 10.1111/1468-0009.12592] [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: 01/24/2022] [Revised: 05/10/2022] [Accepted: 07/18/2022] [Indexed: 12/29/2022] Open
Abstract
Policy Points Community mental health facilities often do not offer the full range of evidence-based clinical and support services for individuals with serious mental illness. Facilities were no more likely to offer six of seven services studied in 2019 compared with 2010 in both Medicaid expansion and nonexpansion states. For-profit facilities generally experienced the largest declines in service availability, while public facilities experienced the smallest declines with small increases in availability of select services. New payment models that incentivize the offer of specialty support services may be needed to encourage adoption of clinical and support services by specialty mental health organizations. CONTEXT Community mental health facilities often do not offer the full range of evidence-based clinical and support services for individuals with serious mental illness. This creates equity issues, particularly when low-income and minority communities have access to fewer facilities. Medicaid expansion might encourage facilities to offer these services. However, this decision may also be affected by facility ownership type or mediated by service cost structure, particularly in the absence of innovative payment mechanisms. In this study, we determine whether and how Medicaid expansion and facility ownership are associated with changes in specialty mental health service availability in organized settings over time. METHODS We estimated two-way fixed effects models using six cross-sections of the National Mental Health Services Survey and compared changes in facility-reported offering of seven services from 2010 to 2019 (54,885 facility years): psychotropic medication, case management, family psychoeducation, psychiatric emergency walk-in services, supported employment, assertive community treatment, illness management, and recovery services. We tested whether Medicaid expansion and facility ownership (private for-profit, private not-for-profit, public) were associated with differential changes in service availability from 2010 to 2019. FINDINGS Overall, facilities were no more likely to offer nearly all services in 2019 than 2010. We found smaller declines for psychotropic medication and psychiatric emergency walk-in services among facilities in Medicaid expansion states compared to declines in non-Medicaid expansion states (6.3 (95% CI 95% CI = 1.8-10.7) and 5.5 (95% CI = 0.2-10.8) percentage points respectively). For-profit facilities experienced the largest declines in availability from 2010 to 2019, while public facilities experienced the smallest declines and some increases in availability of select services. CONCLUSIONS Specialty mental health services are still not widely offered in community outpatient settings despite significant investments in Medicaid, although Medicaid expansion was associated with slower declines in availability. New payment models that incentivize outpatient facilities to offer clinical and support services may be needed.
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Cluster Analysis of the Highest Users of Medical, Behavioral Health, and Social Services in San Francisco. J Gen Intern Med 2022; 38:1143-1151. [PMID: 36447066 PMCID: PMC9708142 DOI: 10.1007/s11606-022-07873-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND In the City and County of San Francisco, frequent users of emergent and urgent services across different settings (i.e., medical, mental health (MH), substance use disorder (SUD) services) are referred to as high users of multiple systems (HUMS). While often grouped together, frequent users of the health care system are likely a heterogenous population composed of subgroups with differential management needs. OBJECTIVE To identify subgroups within this HUMS population using a cluster analysis. DESIGN Cross-sectional study of HUMS patients for the 2019-2020 fiscal year using the Coordinated Care Management System (CCMS), San Francisco Department of Public Health's integrated data system. PARTICIPANTS We calculated use scores based on nine types of urgent and emergent medical, MH, and SUD services and identified the top 5% of HUMS patients. Through k-medoids cluster analysis, we identified subgroups of HUMS patients. MAIN MEASURES Subgroup-specific demographic, comorbidity, and service use profiles. KEY RESULTS The top 5% of HUMS patients in the study period included 2657 individuals; 69.7% identified as men and 66.5% identified as non-White. We detected 5 subgroups: subgroup 1 (N = 298, 11.2%) who were relatively younger with prevalent MH and SUD comorbidities, and MH services use; subgroup 2 (N = 478, 18.0%), who were experiencing homelessness, with multiple comorbidities, and frequent use of medical services; subgroup 3 (N = 449, 16.9%), who disproportionately self-identified as Black, with prolonged homelessness, multiple comorbidities, and persistent HUMS status; subgroup 4 (N = 690, 26.0%), who were relatively older, disproportionately self-identified as Black, with prior homelessness, multiple comorbidities, and frequent use of medical services; and subgroup 5 (N=742, 27.9%), who disproportionately self-identified as Latinx, were housed, with medical comorbidities and frequent medical service use. CONCLUSIONS Our study highlights the heterogeneity of HUMS patients. Interventions must be tailored to meet the needs of these diverse patient subgroups.
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Cummings JR, Shellman MH, Stein BD, Asplund J, Lin H, Serban N. Association Between In-Home Treatment and Engagement in Psychosocial Services Among Medicaid-Enrolled Youth. J Am Acad Child Adolesc Psychiatry 2022; 61:1351-1361. [PMID: 35427731 DOI: 10.1016/j.jaac.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Prior studies have identified low rates of engagement in mental health (MH) services in clinic settings among children enrolled in Medicaid. Yet, little is known about whether the delivery of in-home MH treatment (in which the clinician travels to the child's home) improves engagement for this population. This study examines the association between the delivery of in-home psychosocial treatment and engagement in services among Medicaid-enrolled youth. METHOD We used 2010 to 2014 Georgia Medicaid claims data to identify 53,508 children and adolescents (aged 5-17 years) with a MH diagnosis that initiated new psychosocial treatment. We estimated regression models controlling for covariates to examine the relationship of the receipt of any in-home psychosocial treatment in the home setting with 3 outcome measures of engagement: receipt of at least 4 psychosocial visits during the first 12 weeks; total number of psychosocial visits during the first 12 weeks; and total duration of service use. RESULTS Those who received any in-home psychosocial treatment (compared to those who did not) had 4.3 times the odds (odds ratio = 4.3, 95% CI = 4.0, 4.7) of receiving at least 4 visits during the first 12 weeks, had 4.5 (95% CI = 4.3, 4.7) more predicted visits during the first 12 weeks, and had a longer treatment episode duration (mean rate ratio = 1.54, 95% CI = 1.48,1.59). CONCLUSION Although many Medicaid-enrolled youth do not receive a sufficient number of MH services to achieve positive outcomes, our findings suggest that providing in-home psychosocial treatment can improve service engagement and potentially help address this challenge.
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Affiliation(s)
- Janet R Cummings
- Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Melody H Shellman
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
| | | | - John Asplund
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta; Metron, Inc., Reston, Virginia
| | - Hannah Lin
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
| | - Nicoleta Serban
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
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Abstract
The COVID-19 pandemic is having substantial impacts on the health status of individuals with alcohol use disorder (AUD) and alcohol-associated liver disease (ALD). AUD and ALD have both been impacted throughout the pandemic, with increases in alcohol use during the early stages of the pandemic, reduced access to treatment during the mid-pandemic, and challenges in managing the downstream effects in the post-COVID era. This review will focus on how the COVID-19 pandemic has impacted AUD and ALD epidemiology and access to treatment, and will discuss to address this rising AUD and ALD disease burden.
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Mental Health Care Access and Individual Help-Seeking During the Covid-19 Pandemic. Community Ment Health J 2022; 58:1572-1583. [PMID: 35467308 PMCID: PMC9035499 DOI: 10.1007/s10597-022-00973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/03/2022] [Indexed: 01/27/2023]
Abstract
The UJA Covid-19 Jewish Impact Study constitutes a random sample of 4403 adults in Jewish households in the New York area. Collected between February and May 2021, the data include symptoms of depression and anxiety and the use of professional help. Via respondents' zip code tabulation areas (ZCTAs), these data are linked to contextual measures of mental health care access from two data sources: the SAMHSA Locator on specialty community treatment clinics, and the Zip Code Business Patterns database on solo and small group practices. Both treatment facilities and office practices are added to multilevel logistic regression models as density rates (per 10,000 people) and as binary indicators of presence. While we find no meaningful relationship between the general presence of mental health care services and help-seeking behavior, the ZCTA-level density of office practices is significantly associated with service utilization among the socially isolated, foreign-born and Hispanics or non-white respondents.
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Hoffmann JA, Alegría M, Alvarez K, Anosike A, Shah PP, Simon KM, Lee LK. Disparities in Pediatric Mental and Behavioral Health Conditions. Pediatrics 2022; 150:e2022058227. [PMID: 36106466 PMCID: PMC9800023 DOI: 10.1542/peds.2022-058227] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/31/2022] Open
Abstract
Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.
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Affiliation(s)
- Jennifer A. Hoffmann
- . Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Margarita Alegría
- . Disparities Research Unit, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kiara Alvarez
- . Disparities Research Unit, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA
| | - Amara Anosike
- . Office of Government Relations, Boston Children’s Hospital, Boston, MA
| | | | - Kevin M. Simon
- . Adolescent Substance use and Addiction Program, Boston Children’s Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- . Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
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Cos TA, Levkovich N, Tjoa CW, Williams SK, Larach CS. Integrated primary care behavioural health in a regional network of FQHC agencies during COVID-19. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2022-000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives(1) Examine the ability to sustain integrated primary care behavioural health (eg, colocation, communication and coordination) in 40 community health centres, during the COVID-19 pandemic and (2) review adaptations and challenges to provide integrated behavioural health via telehealth.Methods and analysisThis qualitative investigation assessed 55 behavioural health consultants (BHCs), via semistructured interviews, spanning 40 practice sites and 10 organisations, on their adjustment to telehealth delivery, modified practice workflows and challenges of maintaining integration while displaced by the pandemic. Assessment of the level of integrated care was also conducted with available semistructured toolsResultsThe results highlight rapid service adjustment, positive patient and provider satisfaction, increased but lowered ratings of remote BHC integration and collaboration with the primary care teams and reduced behavioural health screening, compared with prepandemic levels. This investigation also highlights the co-occurring importance of racial disparities and injustice in patient care. In several settings, BHCs had a significant support role for staff self-care.ConclusionThe COVID-19 pandemic, and its subsequent shelter-in-place mandates and telehealth care provision, has altered standard integrated behavioural health practice, yet harnessed the accessible, generalist and team-based spirit to meet the increasing behavioural health needs in this community.
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Luo J, Kibriya MG, Zakin P, Craver A, Connellan L, Tasmin S, Polonsky T, Kim K, Ahsan H, Aschebrook-Kilfoy B. Urban Spatial Accessibility of Primary Care and Hypertension Control and Awareness on Chicago's South Side: A Study From the COMPASS Cohort. Circ Cardiovasc Qual Outcomes 2022; 15:e008845. [PMID: 36065817 PMCID: PMC9489645 DOI: 10.1161/circoutcomes.121.008845] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding the relationship between hypertension and spatial accessibility of primary care can inform interventions to improve hypertension control and awareness, especially among disadvantaged populations. This study aims to investigate the association between spatial accessibility of primary care and hypertension control and awareness. METHODS Participant data from the COMPASS (Chicago Multiethnic Prevention and Surveillance Study) between 2013 and 2019 were analyzed. All participants were geocoded. Locations of primary care providers in Chicago were obtained from MAPSCorps. A score was generated for spatial accessibility of primary care using an enhanced 2-step floating catchment area method. A higher score indicates greater accessibility. Measured hypertension was defined as systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg. Logistic regression was used to estimate odds ratio and 95% CI for hypertension status in relation to accessibility score quartiles. RESULTS Five thousand ninety-six participants (mean age, 53.4±10.8) were included. The study population was predominantly non-Hispanic black (84.0%), over 53% reported an annual household income <$15 000, and 37.3% were obese. Measured hypertension prevalence was 78.7% in this population, among which 37.7% were uncontrolled and 41.0% were unaware. A higher accessibility score was associated with lower measured hypertension prevalence. In fully adjusted models, compared with the first (lowest) quartile of accessibility score, the odds ratio strengthened from 0.82 (95% CI, 0.67-1.01) for the second quartile to 0.75 (95% CI, 0.62-0.91) for the third quartile, and further to 0.73 (95% CI, 0.60-0.89) for the fourth (highest) quartile. The increasing trend had a P<0.01. Similar associations were observed for both uncontrolled and unaware hypertensions. When stratified by neighborhood socioeconomic status, a higher accessibility score was associated with lower rates of unaware hypertension in both disadvantaged and nondisadvantaged neighborhoods. CONCLUSIONS Better spatial accessibility of primary care is associated with improved hypertension awareness and control.
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Affiliation(s)
- Jiajun Luo
- Institute for Population and Precision Health, the University of Chicago, Chicago, IL, USA
| | - Muhammad G. Kibriya
- Institute for Population and Precision Health, the University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, the University of Chicago, Chicago, IL, USA
| | - Paul Zakin
- Institute for Population and Precision Health, the University of Chicago, Chicago, IL, USA
| | - Andrew Craver
- Institute for Population and Precision Health, the University of Chicago, Chicago, IL, USA
| | - Liz Connellan
- Institute for Population and Precision Health, the University of Chicago, Chicago, IL, USA
| | - Saira Tasmin
- Institute for Population and Precision Health, the University of Chicago, Chicago, IL, USA
| | - Tamar Polonsky
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Karen Kim
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Habibul Ahsan
- Institute for Population and Precision Health, the University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, the University of Chicago, Chicago, IL, USA
| | - Briseis Aschebrook-Kilfoy
- Institute for Population and Precision Health, the University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, the University of Chicago, Chicago, IL, USA
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Mills JA, Suresh V, Chang L, Mayes T, Croarkin PE, Trivedi MH, Strawn JR. Socioeconomic Predictors of Treatment Outcomes Among Adults With Major Depressive Disorder. Psychiatr Serv 2022; 73:965-969. [PMID: 35354325 PMCID: PMC9629028 DOI: 10.1176/appi.ps.202100559] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In this study, the authors sought to examine the impact of socioeconomic variables on outcomes of pharmacotherapy treatments for major depressive disorder in analyses that controlled for treatment access and level of care. METHODS The authors used data from the Combining Medications to Enhance Depression Outcomes study, a prospective clinical trial conducted from March 2008 to April 2014 with 665 adults who had major depressive disorder and were randomly assigned to three pharmacotherapeutic treatments, to develop Bayesian hierarchical models of treatment trajectories for change in Quick Inventory of Depressive Symptomatology-Self-Report ratings. Posterior tail probabilities were used to evaluate the effects of education, income, race-ethnicity, and employment on treatment outcomes. RESULTS After sex, age, and treatment type were controlled for in the analyses, not having a college education (<16 years of schooling), being unemployed, or being non-White were each associated with slower and less improvement. At the end of treatment (week 12), not having a college degree reduced treatment responses by 9.6% (p=0.045), being unemployed by 6.6% (p=0.007), and being non-White by 11.3% (p<0.001). Treatment response was significantly related to income; having an income at the 25th percentile of the income distribution decreased improvement by 4.8% compared with having an income at the 75th percentile (p=0.018). CONCLUSIONS Within a short-term, randomized controlled trial, socioeconomic factors had a critical role in the acute response of patients to pharmacotherapy for major depression.
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Affiliation(s)
- Jeffrey A Mills
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Vikram Suresh
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Lenisa Chang
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Taryn Mayes
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Paul E Croarkin
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Madhukar H Trivedi
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Jeffrey R Strawn
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
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Carrasco-Aguilar A, Galán JJ, Carrasco RA. Obamacare: A bibliometric perspective. Front Public Health 2022; 10:979064. [PMID: 36033824 PMCID: PMC9416003 DOI: 10.3389/fpubh.2022.979064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
Obamacare is the colloquial name given to the Affordable Care Act (ACA) signed into law by President Obama in the USA, which ultimately aims to provide universal access to health care services for US citizens. The aim of this paper is to provide an overview of the political-legal, economic, social, management (or administrative), and medical (or health) repercussions of this law, using a bibliometric methodology as a basis. In addition, the main contributors to research on ACA issues have been identified in terms of authors, organizations, journals, and countries. The downward trend in scientific production on this law has been noted, and it has been concluded that a balance has not yet been reached between the coexistence of private and public health care that guarantees broad social coverage without economic or other types of barriers. The law requires political consensus to be implemented in a definitive and global manner for the whole of the United States.
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Cummings JR, Zhang YX, Wilk AS, Marcus SC. Mental Health Clinic Administrators’ Perspectives on the Impact of Clinic-School Partnerships on Youth Mental Health Services Continuity and Quality. SCHOOL MENTAL HEALTH 2022; 14:1086-1097. [PMID: 35966403 PMCID: PMC9360675 DOI: 10.1007/s12310-022-09531-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 10/25/2022]
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Chartier KG, Bares CB, Prom-Wormley EC, Blondino C, Miles K, Lee AG, Karriker-Jaffe KJ. Effects of family history of alcohol problems on alcohol consumption: Stronger for medically underserved men. Prev Med 2022; 161:107093. [PMID: 35597304 DOI: 10.1016/j.ypmed.2022.107093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/22/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Family history (FH), informed by genetics and family environment, can be used by practitioners for risk prediction. This study compares the associations of FH with alcohol outcomes for medically underserved (MUS) men and women with the associations for non-underserved individuals to assess the utility of FH as a screening tool for this high-priority group. Data were from 29,993 adult lifetime drinkers in the Wave 1 (2001-2002) and Wave 2 (2004-2005) National Epidemiologic Survey on Alcohol and Related Conditions. All variables except FH were measured at Wave 2. Dependent variables were 12-month alcohol consumption and alcohol use disorder (AUD). FH scores (FH-SCORE) measured the proportion of first- and second-degree biological relatives with alcohol problems. MUS status was defined by household income at or below 100% of the federal poverty line and participants reporting no usual source of health care. Multivariate linear and logistic regression models tested main and interaction effects. Models showed a significant interaction of FH-SCORE with MUS status (p < .01), with a stronger effect of FH on alcohol consumption for the MUS group. This moderating effect was weaker for women than for men (FH-SCORE x MUS x Sex three-way interaction: p < .01). AUD models showed a significant positive association with FH-SCORE (p < .001) but no association with MUS status and no significant interaction effects. In this sample of lifetime drinkers, FH was associated with higher alcohol consumption, especially for MUS men. These results encourage additional validation of FH scores to prioritize MUS adults at high risk for alcohol problems to receive preventive interventions.
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Affiliation(s)
- Karen G Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States of America.
| | - Cristina B Bares
- School of Social Work, The University of Michigan, Ann Arbor, MI, United States of America
| | - Elizabeth C Prom-Wormley
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Courtney Blondino
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Kia Miles
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Anna G Lee
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Katherine J Karriker-Jaffe
- Center for Behavioral Health Epidemiology, Implementation & Evaluation Research, RTI International, Berkeley, CA, United States of America
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Ramezani N, Breno AJ, Mackey BJ, Viglione J, Cuellar AE, Johnson JE, Taxman FS. The relationship between community public health, behavioral health service accessibility, and mass incarceration. BMC Health Serv Res 2022; 22:966. [PMID: 35906627 PMCID: PMC9336014 DOI: 10.1186/s12913-022-08306-6] [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: 01/30/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background The relationship between healthcare service accessibility in the community and incarceration is an important, yet not widely understood, phenomenon. Community behavioral health and the criminal legal systems are treated separately, which creates a competing demand to confront mass incarceration and expand available services. As a result, the relationship between behavioral health services, demographics and community factors, and incarceration rate has not been well addressed. Understanding potential drivers of incarceration, including access to community-based services, is necessary to reduce entry into the legal system and decrease recidivism. This study identifies county-level demographic, socioeconomic, healthcare services availability/accessibility, and criminal legal characteristics that predict per capita jail population across the U.S. More than 10 million individuals pass through U.S. jails each year, increasing the urgency of addressing this challenge. Methods The selection of variables for our model proceeded in stages. The study commenced by identifying potential descriptors and then using machine learning techniques to select non-collinear variables to predict county jail population per capita. Beta regression was then applied to nationally available data from all 3,141 U.S. counties to identify factors predicting county jail population size. Data sources include the Vera Institute’s incarceration database, Robert Wood Johnson Foundation’s County Health Rankings and Roadmaps, Uniform Crime Report, and the U.S. Census. Results Fewer per capita psychiatrists (z-score = -2.16; p = .031), lower percent of drug treatment paid by Medicaid (-3.66; p < .001), higher per capita healthcare costs (5.71; p < .001), higher number of physically unhealthy days in a month (8.6; p < .001), lower high school graduation rate (-4.05; p < .001), smaller county size (-2.66, p = .008; -2.71, p = .007; medium and large versus small counties, respectively), and more police officers per capita (8.74; p < .001) were associated with higher per capita jail population. Controlling for other factors, violent crime rate did not predict incarceration rate. Conclusions Counties with smaller populations, larger percentages of individuals that did not graduate high school, that have more health-related issues, and provide fewer community treatment services are more likely to have higher jail population per capita. Increasing access to services, including mental health providers, and improving the affordability of drug treatment and healthcare may help reduce incarceration rates.
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Affiliation(s)
- Niloofar Ramezani
- Department of Statistics, School of Computing, George Mason University, 4400 University Drive, Fairfax, VA, MS 4A7, USA.
| | - Alex J Breno
- Center for Advancing Correctional Excellence, Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Benjamin J Mackey
- Center for Advancing Correctional Excellence, Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jill Viglione
- Department of Criminal Justice, University of Central Florida, Orlando, FL, USA
| | - Alison Evans Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | | | - Faye S Taxman
- Center for Advancing Correctional Excellence, Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
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Cross RK, Keefer L. Chicken or Egg, Mental Health Disorders in Inflammatory Bowel Disease: Does It Matter? Gastroenterology 2022; 163:37-39. [PMID: 35500616 DOI: 10.1053/j.gastro.2022.04.041] [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: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Raymond K Cross
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Laurie Keefer
- Department of Medicine and Psychiatry, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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McBain RK, Cantor J, Kofner A, Stein BD, Yu H. Ongoing Disparities in Digital and In-Person Access to Child Psychiatric Services in the United States. J Am Acad Child Adolesc Psychiatry 2022; 61:926-933. [PMID: 34952198 PMCID: PMC9209557 DOI: 10.1016/j.jaac.2021.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/22/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the number and geographic distribution of children and adolescents in the United States who reside in counties with neither child and adolescent psychiatrists nor sufficient Internet broadband to support telepsychiatry services. METHOD This analysis combined data from the Health Resources and Services Administration's Area Health Resource Files on child psychiatrist workforce with Federal Communications Commission information on broadband coverage to generate a composite of in-person and digital access to child psychiatric services throughout the United States. Using multivariable fixed-effects Poisson regression analysis, we estimated the number of children and adolescents (aged 5-19 years) without access to psychiatric services and examined disparities across counties in the United States. RESULTS We estimate that 6,035,402 children and adolescents in the United States (approximately 10%) have inadequate in-person and digital availability of child psychiatric services within their counties. Although this was true for only 3% of children and adolescents in urban counties, this applied to more than half (51%) in rural counties (adjusted odds ratio [AOR] = 2.71; 95% CI = 1.94, 3.78; p < .001). Likewise, only 3% of children and adolescents in high-income counties had insufficient digital and physical access, compared to more than 4 in 10 children and adolescents (41%) in low-income counties (AOR = 0.43; 95% CI = 0.30-0.61; p < .001). Counties with a higher density of Black and Hispanic residents had greater likelihood of service availability (p < 0.001), potentially a function of living in metropolitan communities. CONCLUSION Although telehealth holds promise for promoting access to child and adolescent psychiatric services, large disparities in overall access to services persists in rural and low-income communities.
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Affiliation(s)
| | | | | | | | - Hao Yu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Racial/Ethnic disparities in drug use during the COVID 19 pandemic: Moderating effects of non-profit substance use disorder service expenditures. PLoS One 2022; 17:e0270238. [PMID: 35771840 PMCID: PMC9246210 DOI: 10.1371/journal.pone.0270238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 pandemic influenced individuals’ anxiety and depression across the United States over a short period, and some Americans relied on drugs for coping. This study examines American adults’ drug use trajectories in response to changing anxiety and depression levels during the COVID-19 pandemic and the moderating role of substance use disorder (SUD) services provided by non-profit facilities in anxiety/depression-induced drug use. Heterogeneity in such relationships is further explored based on race/ethnicity. This study used a nationally representative sample of 1,176 American adults who reported drug use between May 1, 2020, and June 30, 2021. Using individual-fixed effects Poisson estimators, the current study empirically modeled drug use changes according to changing anxiety/depression levels. Interaction terms between anxiety/depression levels and per capita spending by non-profit SUD facilities were used to explore the moderating effect of SUD service expenditures. Racial/ethnic disparities were explored in subgroup analyses on non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian samples. We found more frequent drug use in response to elevated anxiety and depression during the COVID-19 pandemic. Greater spending on SUD service by non-profit facilities at the county level was associated with reduced drug consumption associated with anxiety and depression, with greater benefits for racial/ethnic minorities. Findings provide important policy implications for distributing public funds for non-profit SUD facilities for mitigating SUD risks, especially among racial/ethnic minorities.
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Zare H, Meyerson NS, Nwankwo CA, Thorpe RJ. How Income and Income Inequality Drive Depressive Symptoms in U.S. Adults, Does Sex Matter: 2005-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6227. [PMID: 35627767 PMCID: PMC9140340 DOI: 10.3390/ijerph19106227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Depression is one of the leading causes of disability in the United States. Depression prevalence varies by income and sex, but more evidence is needed on the role income inequality may play in these associations. OBJECTIVE To examine the association between the Poverty to Income Ratio (PIR)-as a proxy for income-and depressive symptoms in adults ages 20 years and older, and to test how depression was concentrated among PIR. DESIGN Using the 2005-2016 National Health and Nutrition Examination Survey (NHANES), we employed Negative Binomial Regression (NBRG) in a sample of 24,166 adults. We used a 9-item PHQ (Public Health Questionnaire, PHQ-9) to measure the presence of depressive symptoms as an outcome variable. Additionally, we plotted a concentration curve to explain how depression is distributed among PIR. RESULTS In comparison with high-income, the low-income population in the study suffered more from greater than or equal to ten on the PHQ-9 by 4.5 and 3.5 times, respectively. The results of NBRG have shown that people with low-PIR (IRR: 1.30, 95% CI: 1.23-1.37) and medium-PIR (IRR: 1.55, 95% CI: 1.46-1.65) have experienced a higher relative risk ratio of having depressive symptoms. Women have a higher IRR (IRR: 1.29, 95% CI: 1.24-1.34) than men. We observed that depression was concentrated among low-PIR men and women, with a higher concentration among women. CONCLUSION AND RELEVANCE Addressing depression should target low-income populations and populations with higher income inequality.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD 20774, USA
| | - Nicholas S. Meyerson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
| | - Chineze Adania Nwankwo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
| | - Roland J. Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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Cantor J, McBain RK, Kofner A, Hanson R, Stein BD, Yu H. Telehealth Adoption by Mental Health and Substance Use Disorder Treatment Facilities in the COVID-19 Pandemic. Psychiatr Serv 2022; 73:411-417. [PMID: 34407631 PMCID: PMC10695271 DOI: 10.1176/appi.ps.202100191] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined temporal and geographic trends in telehealth availability at U.S. behavioral health treatment facilities and risk factors for not offering telehealth. METHODS Longitudinal data on 15,691 outpatient behavioral health treatment facilities were extracted daily from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Services Locator between January 20, 2020, and January 20, 2021. Facilities operated by the Department of Veterans Affairs were excluded. Bivariate analyses were used to assess trends in telehealth availability in 2020 and 2021. Multivariable regression analysis was used to examine facility- and county-level characteristics associated with telehealth availability in 2021. RESULTS Telehealth availability increased by 77% from 2020 to 2021 for mental health treatment facilities and by 143% for substance use disorder treatment facilities. By January 2021, 68% of outpatient mental health facilities and 57% of substance use disorder treatment facilities in the sample were offering telehealth. Mental health and substance use disorder treatment facilities that did not accept Medicaid as a form of payment were less likely to offer telehealth in 2021, compared with facilities that accepted Medicaid. Mental health and substance use disorder treatment facilities that accepted private insurance were more likely to offer telehealth in 2021, compared with facilities that did not accept private insurance. CONCLUSIONS Although 2020 saw a dramatic increase in telehealth availability at behavioral health treatment facilities, 32% of mental health treatment facilities and 43% of substance use disorder treatment facilities did not offer telehealth in January 2021, nearly 1 year into the pandemic.
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Affiliation(s)
- Jonathan Cantor
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Ryan K McBain
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Aaron Kofner
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Russell Hanson
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Bradley D Stein
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Hao Yu
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
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Gillespie C, Kleinberg F, Zogas A, Morreale A, Ourth H, Tran M, Moore T, Miller D, McCullough M. Perceptions of clinical pharmacy specialists' contributions in mental health clinical teams. Ment Health Clin 2022; 12:15-22. [PMID: 35116208 PMCID: PMC8788298 DOI: 10.9740/mhc.2022.01.015] [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: 02/10/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mental health (MH) clinical pharmacy specialists (CPS) are increasingly functioning as integral providers in MH care teams. MH providers may delegate many medication management tasks to the CPS. As there is a shortage of primary care and specialist MH providers, CPS are increasingly being utilized in MH care clinics. We assess provider and CPS perceptions of the contributions of CPS to MH clinical teams in the Veterans Health Administration. Methods We examined the roles and functions of CPS in MH clinics through surveys (n = 374) and semistructured interviews (n = 16) with MH CPS and other members of MH clinical teams (psychiatrists, nurse practitioners, registered nurses, social workers) to gain insight into how CPS were integrated in these settings. We assessed perceptions of CPS contributions to MH teams, interactions between CPS and other providers, and challenges of integrating CPS into MH clinical teams. Results Contributions of CPS in MH were received positively by clinical team members. Clinical pharmacy specialists providing comprehensive medication management were especially valuable in the management of clozapine. The knowledge and training of CPS reassured providers who frequently referred to them with questions about medication and medication therapy management. MH CPS were also perceived to be received well by patients. Discussion The integration of MH CPS into MH teams was well received by team members and patients alike. The MH CPS have become important members of the MH team and are widely viewed as being able to improve access, quality, and workflow.
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Affiliation(s)
| | - Felicia Kleinberg
- Health Science Specialist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts
| | - Anna Zogas
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts
| | - Anthony Morreale
- Associate Chief Consultant for Clinical Pharmacy, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Heather Ourth
- Assistant Chief Consultant for Clinical Pharmacy, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Michael Tran
- National Pharmacy Benefits Management Program Manager, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Tera Moore
- National Pharmacy Benefits Management Program Manager, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Donald Miller
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Research Health Scientist, University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health, Lowell, Massachusetts
| | - Megan McCullough
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Research Health Scientist, University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health, Lowell, Massachusetts
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