1
|
Conroy K, Kehrer SM, Georgiadis C, Hare M, Ringle VM, Shaw AM. Learning from Adolescents and Caregivers to Enhance Acceptability and Engagement Within Virtual Dialectical Behavior Therapy for Adolescents Skills Groups: A Qualitative Study. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01641-7. [PMID: 38183575 DOI: 10.1007/s10578-023-01641-7] [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] [Accepted: 11/14/2023] [Indexed: 01/08/2024]
Abstract
Despite the significant increase in adolescent mental health challenges in recent years, structural barriers continue to limit access to and engagement in mental health services. As such, opportunities to learn directly from adolescents and their families on how to best structure and deliver services are paramount. The current study assumes a multi-informant approach and reports on adolescents' and caregivers' (N = 33) experiences in an adapted telehealth/hybrid Dialectical Behavior Therapy for Adolescents (DBT-A) program. Focus groups were conducted across two cohorts of families who participated in DBT-A skills groups, to collect family-centered data on the acceptability of program modifications, engagement in the adapted telehealth/hybrid DBT-A, and recommendations for improvement. Participants were predominately Latine White and were from a broad range of socioeconomic backgrounds. Additionally, 45.5% of the adolescents identified as LGBTQ + . Focus group findings emphasized how the telehealth platform was both convenient and disengaging, and how in-person sessions offered improved group connection and content engagement. Participants underscored the importance of balancing multi-family group sessions with adolescent- and caregiver-only group sessions in the program, and adolescents emphasized a need for the DBT-A program to better center adolescents' unique experiences and voices throughout sessions. Both adolescents and caregivers suggested modifications to synthesize the content and improve generalizability of the DBT-A skills to their real lives. Overall, these findings add to a new and evolving branch of DBT-A qualitative inquiry, as well as the growing body of work that recommends incorporating the voices of people with lived experiences into the development and modification of psychological services.
Collapse
Affiliation(s)
- Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Sabrina M Kehrer
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
| | - Christopher Georgiadis
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
- The Warren Alpert Medical School, Department of Psychiatry, Brown University, Providence, RI, USA
| | - Megan Hare
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Vanesa Mora Ringle
- Counseling Psychology Program, Department of Education and Human Services, Lehigh University, Bethlehem, PA, USA
| | - Ashley M Shaw
- School of Social and Behavioral Sciences, University of New England, Biddeford, ME, USA
| |
Collapse
|
2
|
Saulnier KG, Panaite V, Ganoczy D, Kim HM, Zivin K, Hofer T, Piette JD, Pfeiffer PN. Depression symptom outcomes and re-engagement among VA patients who discontinue care while symptomatic. Gen Hosp Psychiatry 2023; 85:87-94. [PMID: 37862961 DOI: 10.1016/j.genhosppsych.2023.10.008] [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: 03/02/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Evaluate outcomes of Veterans who discontinued treatment with at least moderate ongoing depressive symptoms. METHOD Veterans with elevated depression symptoms from 29 Department of Veterans Affairs facilities completed baseline surveys and follow-up assessments for one year. Analyses examined rates and predictors of treatment discontinuation, treatment re-engagement, and subsequent symptoms among patients who remained out of care. RESULTS A total of 242 (17.8%; n = 1359) participants discontinued treatment while symptomatic, with Black participants, participants with less severe depression, and participants receiving only psychotherapy (versus combined psychotherapy and antidepressant medications) discontinuing at higher rates. Among all participants who discontinued treatment (n = 445), 45.8% re-engaged within the following six months with participants receiving combined treatment re-engaging at higher rates. Of participants who discontinued while symptomatic within the first 6 months of the study and did not return to care (n = 112), 68.8% remained symptomatic at 12 months. Lower baseline treatment expectancy and greater depression symptom severity were associated with remaining symptomatic while untreated. CONCLUSIONS Black race, lower symptom severity, and treatment modality may help identify patients at higher risk for discontinuing care while symptomatic, whereas patients with lower treatment expectations may be at greater risk for remaining out of care despite continuing symptoms.
Collapse
Affiliation(s)
- K G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA.
| | - V Panaite
- James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - D Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - H M Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Consulting for Statistics, Computing, and Analytics Research, Ann Arbor, MI, USA
| | - K Zivin
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - T Hofer
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - J D Piette
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - P N Pfeiffer
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Livingston WS, Tannahill HS, Meter DJ, Fargo JD, Blais RK. The Association of Military Sexual Harassment/Assault With Suicide Ideation, Plans, Attempts, and Mortality Among US Service Members/Veterans: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:2616-2629. [PMID: 35763372 DOI: 10.1177/15248380221109790] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Suicide rates continue to increase among service members/veterans. Military sexual harassment/assault (MSH/A) may increase risk of suicide, but little is known about the collective magnitude of associations between MSH/A and suicide outcomes, including ideation, plan, attempt, and mortality. The current meta-analysis addressed this literature gap while testing potential moderators of gender, marital status, discharge status, and military branch. PsycINFO, PubMed, Dissertations/Theses, relevant citation lists, and conference brochures were reviewed for papers that included quantitative analyses in English, U.S. military samples, and measures of MSH/A and suicide ideation/plan/attempt/mortality. The search resulted in 22 studies (N = 10,898,875) measuring the association of MSH/A with suicide ideation (k = 15), plans (k = 1), attempts (k = 14), and mortality (k = 2), with papers published from 2007-2021. MSH/A was associated with suicide ideation (r ¯ = .14) and attempts (r ¯ = .11, ps < .05). The association of MSH/A and suicide ideation and attempts was higher among women relative to men, those identifying as married versus not married, those actively serving compared to discharged, and those reporting service in the Air Force relative to all other branches. The association of MSH/A with suicide plans and mortality was not calculated due to the small number of studies reporting those effect sizes (ks = 1-2). The effect sizes observed suggest MSH/A is part of a larger network of risk factors for suicide. Moderators indicate that suicide risk is higher among specific groups, and prevention strategies would be most effective if they targeted these individuals. This research area would be strengthened by additional studies of plans and mortality.
Collapse
Affiliation(s)
| | | | - Diana J Meter
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Jamison D Fargo
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
- Psychology Department, Arizona State University,Tempe, AZ, USA
| |
Collapse
|
4
|
Cardona ND, Ametaj AA, Cassiello-Robbins C, Tirpak JW, Olesnycky O, Sauer-Zavala S, Farchione TJ, Barlow DH. Outcomes of People of Color in an Efficacy Trial of Cognitive-Behavioral Treatments for Anxiety, Depression, and Related Disorders: Preliminary Evidence. J Nerv Ment Dis 2023; 211:711-720. [PMID: 37432031 PMCID: PMC10524474 DOI: 10.1097/nmd.0000000000001692] [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: 07/12/2023]
Abstract
ABSTRACT Although evidence-based psychological treatments such as cognitive behavioral therapy (CBT) have strong empirical support for reducing anxiety and depression symptoms, CBT outcome research often does not report race and ethnicity variables, or assess how well CBT works for people from historically excluded racial and ethnic groups. This study presents post hoc analyses comparing treatment retention and symptom outcomes for participants of color ( n = 43) and White participants ( n = 136) from a randomized controlled efficacy trial of CBT. χ 2 tests and one-way ANCOVA showed no observable differences between the two samples on attrition or on clinician-rated measures of anxiety and depression at posttreatment and follow-up. Moderate to large within-group effect sizes on anxiety and depression were found for Black, Latinx, and Asian American participants at almost all time points. These preliminary findings suggest that CBT for anxiety and comorbid depression may be efficacious for Black, Asian American, and Latinx individuals.
Collapse
Affiliation(s)
- Nicole D Cardona
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Amantia A Ametaj
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts
| | | | | | - Olenka Olesnycky
- Department of Psychology, Hofstra University, Hempstead, New York
| | | | - Todd J Farchione
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - David H Barlow
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| |
Collapse
|
5
|
Mallonee J, Escalante R, Robles EH, Tucker C. "Something very taboo": a qualitative exploration of beliefs, barriers, and recommendations for improving mental health care and access for Hispanic adults in the Paso del Norte U.S.-Mexico border region. Front Public Health 2023; 11:1134076. [PMID: 37325326 PMCID: PMC10267351 DOI: 10.3389/fpubh.2023.1134076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Hispanic adults with mental health conditions in the United States experience disproportionate access to and utilization of professional mental health treatment. This is believed to be in part due to systemic barriers and challenges, difficulty accessing care, cultural factors, and stigma. Studies to date have failed to examine these specific factors within the unique context of the Paso del Norte U.S.-Mexico border region. Methods For this study, 25 Hispanic adults identifying primarily of Mexican descent participated in four focus groups exploring these topics. Three groups were facilitated in Spanish and one group in both English and Spanish. Focus groups followed a semi-structured format eliciting perspectives on mental health and mental illness, help-seeking, barriers and facilitators of help-seeking and treatment access, and recommendations for mental health agencies and providers. Results Qualitative data analysis yielded the following themes: understanding of mental health and help-seeking; barriers to accessing care; mental health treatment facilitators; and recommendations for agencies, providers, and researchers. Conclusion Findings from this study support the need for innovative mental health engagement strategies to reduce stigma, increase understanding of mental health, foster support systems, reduce individual and systemic barriers to seeking and accessing care, and to continue to engage communities in mental health outreach and research.
Collapse
Affiliation(s)
- Jason Mallonee
- Department of Social Work, College of Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | - Rosa Escalante
- Department of Social Work, College of Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | - Eden Hernandez Robles
- Worden School of Social Service, Our Lady of the Lake University, San Antonio, TX, United States
| | - Christal Tucker
- The Kelly Center for Hunger Relief, El Paso, TX, United States
| |
Collapse
|
6
|
Kovachy B, Chang T, Vogeli C, Tolland S, Garrels S, Forester BP, Fung V. Does use of primary care-based behavioral health programs differ by race and ethnicity? Evidence from a multi-site collaborative care model. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100676. [PMID: 36731158 PMCID: PMC10257753 DOI: 10.1016/j.hjdsi.2023.100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/18/2022] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Collaborative care models (CoCM) that integrate mental health and primary care improve outcomes and could help address racial and ethnic mental health disparities. We examined whether use of these programs differs by race/ethnicity. METHODS This retrospective study examined two CoCM interventions implemented across primary care clinics in a large health system in Massachusetts: 1) a primary care-based behavioral health program for depression or anxiety (IMPACT model) and 2) referral to community-based specialty care services (Resource-finding). Outcomes included enrollment, non-completion, and symptom screening rates, and discharge status for Black, Hispanic and White patients referred for CoCM, 2017-2019. RESULTS Black and Hispanic vs. White patients referred to CoCM (n = 17,280) were more likely to live in high poverty ZIP codes (34% and 40% vs. 9%). Rates of program enrollment, non-completion, and symptom screening were similar across groups (e.g., 76%, 77%, and 75% of Black, Hispanic, and White patients enrolled). Hispanic vs. White patients were more likely to be enrolled in IMPACT (56%) vs. Resource-finding (43%). Among those completing IMPACT, Hispanic vs. White patients were more likely to be stepped to psychiatry vs. discharged to their primary care provider (51% vs. 20%, aOR = 1.55, 95% CI: 1.02-2.35). CONCLUSIONS Black and Hispanic patients referred to CoCM were similarly likely to use the program as White patients. Hispanic patients completing IMPACT were more frequently referred to psychiatry. IMPLICATIONS These results highlight the promise of CoCMs for engaging minority populations in mental healthcare. Hispanic patients may benefit from additional intervention or earlier linkage to specialty care.
Collapse
Affiliation(s)
- Benjamin Kovachy
- Stanford University School of Medicine, USA; Harvard Medical School, USA
| | - Trina Chang
- Harvard Medical School, USA; Massachusetts General Hospital, USA
| | - Christine Vogeli
- Harvard Medical School, USA; Massachusetts General Hospital, USA
| | | | | | - Brent P Forester
- Harvard Medical School, USA; Mass General Brigham, USA; McLean Hospital, USA
| | - Vicki Fung
- Harvard Medical School, USA; Massachusetts General Hospital, USA.
| |
Collapse
|
7
|
Elansary M, Kistin CJ, Antonio J, Fernández-Pastrana I, Lee-Parritz A, Cabral H, Miller ES, Silverstein M. Effect of Immediate Referral vs a Brief Problem-solving Intervention for Screen-Detected Peripartum Depression: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2313151. [PMID: 37171819 PMCID: PMC10182435 DOI: 10.1001/jamanetworkopen.2023.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance The US Preventive Services Task Force recommends screening adults for depression in settings with programs in place to ensure receipt of appropriate care. Best practices regarding how to ensure such care are unknown, particularly for pregnant and postpartum persons. Objective To compare the effectiveness of 2 strategies for the initial management of screen-detected peripartum depressive symptoms. Design, Setting, and Participants This randomized comparative effectiveness trial was performed from February 1, 2018, to June 30, 2020, at the prenatal clinic, postpartum unit, and pediatric clinic within an urban safety-net hospital. Participants included peripartum persons with positive depression screen results. Data were analyzed from July 6, 2020, to September 21, 2022, based on intention to treat. Interventions Engagement-focused care coordination (EFCC), which used shared decision-making and motivational techniques to refer patients to outside mental health services, and problem-solving education (PSE), a brief cognitive-behavioral program delivered at the screening site. Main Outcomes and Measures The primary outcome consisted of severity of depressive symptoms; secondary outcomes included severity of anxiety symptoms and engagement with care, each measured bimonthly over 12 months. Rates of symptom elevations were modeled using negative binomial regression; rates of symptom trajectories were modeled using treatment × time interactions. Results Among the 230 participants (mean [SD] age, 29.8 [5.8] years), 125 (54.3%) were Black and 101 (43.9%) were Hispanic or Latina. At baseline, 117 participants (50.9%) reported at least moderately severe depressive symptoms (Quick Inventory of Depressive Symptomatology score ≥11), and 56 (24.3%) reported clinically significant anxiety symptoms (Beck Anxiety Inventory score ≥21). Across 6 assessment time points, the mean (SD) number of moderately severe depressive symptom episodes in EFCC was 2.2 (2.2), compared with 2.2 (2.1) in PSE, for an adjusted rate ratio (aRR) of 0.95 (95% CI, 0.77-1.17). The mean (SD) number of anxiety symptom elevations in EFCC was 1.1 (1.8), compared to 1.1 (1.6) in PSE, for an aRR of 0.98 (95% CI, 0.69-1.39). There were significant treatment × time interactions relative to mean depressive symptom scores (-0.34 [95% CI, -0.60 to -0.08]; P = .009 for interaction term), favoring EFCC. There were no differences in engagement with care. Conclusions and Relevance In this randomized comparative effectiveness trial, there were no differences in depressive or anxiety symptom burden across comparators; however, the evidence suggested improved depressive symptom trajectory with immediate referral. Further work is necessary to guide approaches to management following depression screening for peripartum persons. Trial Registration ClinicalTrials.gov Identifier: NCT03221556.
Collapse
Affiliation(s)
- Mei Elansary
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Caroline J Kistin
- Brown University School of Public Health and Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Jocelyn Antonio
- Brown University School of Public Health and Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Ivys Fernández-Pastrana
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Aviva Lee-Parritz
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael Silverstein
- Brown University School of Public Health and Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| |
Collapse
|
8
|
Terrazas-Carrillo E, Garcia E, Rodriguez K, Malagon A, Gonzalez M, Garcia S. Telehealth Psychoeducational Groups With Latinx College Students: Findings From Focus Groups. Int J Group Psychother 2023; 73:75-115. [PMID: 38446566 DOI: 10.1080/00207284.2022.2159414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The literatures examining psychoeducational groups and telehealth services have demonstrated positive results but less is known about the efficacy of psychoeducational telehealth groups. This study examines the perspectives of 105 Latinx college students who participated in an 8-session psychoeducational group via a telehealth platform during the COVID-19 pandemic. The research questions included (a) What was the experience of these Latinx college students participating in telehealth psychoeducational groups? and (b) What were the potential perceived advantages and disadvantages of implementing telehealth psychoeducational groups? Postintervention, a total of 16 focus groups were convened with a total of 105 Latinx college students (average number of participants per group = 6). Interviews were coded using conventional qualitative analysis and yielded four main themes: (1) group cohesion, which involved group members feeling that they were connected and that the group was a safe space; (2) group leaders, which involved leaders' preparation and knowledge and their ability to foster a safe environment); (3) cultural issues, which involved cultural values and acculturative and first-generation stress.; and (4) telehealth implementation, wherein participants described advantages and disadvantages of the telehealth approach. We discuss study limitations and directions for future research.
Collapse
|
9
|
Bond GR, Mascayano F, Metcalfe JD, Riley J, Drake RE. Access, retention, and effectiveness of individual placement and support in the US: Are there racial or ethnic differences? JOURNAL OF VOCATIONAL REHABILITATION 2023. [DOI: 10.3233/jvr-230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: Increased federal attention to advancing racial equity and support for underserved communities suggests the need for data on racial and ethnic differences in evidence-based employment services for people with serious mental illness. Individual Placement and Support (IPS) is an evidence-based model of supported employment for this population. OBJECTIVE: The objective was to identify differences based on race and ethnicity in IPS services. METHODS: This narrative review examined the empirical literature on IPS services in the U.S., assessing evidence of differences in access, retention, and outcomes for Black and Hispanic IPS clients, relative to non-Hispanic Whites. RESULTS: We identified 12 studies examining racial and ethnic differences in access (4 studies), retention (3 studies), and effectiveness (6 studies). The findings for access to IPS were mixed, with two studies showing no differences, one finding less access for Blacks, and another finding greater access for Blacks but less access for Hispanics. Three studies found better retention rates for clients enrolled in IPS regardless of race or ethnicity. Compared to clients receiving usual vocational services, all studies found better employment outcomes for IPS clients regardless of race or ethnicity. CONCLUSION: Unlike for most of health care, few racial and ethnic differences have been found for IPS employment services in the U.S. Access to IPS is inadequate for all groups, with conflicting evidence whether Blacks and Hispanics have even less access. Based on the available evidence, Black and Hispanic clients have comparable retention and employment outcomes in IPS as non-Hispanic White clients. State and local mental health leaders responsible for monitoring IPS outcomes should routinely report statistics on race and ethnicity. They should also give active attention to client needs and equity. Research designs should answer multifaceted questions regarding disparities for historically underserved populations.
Collapse
|
10
|
Rivera R, Capers T, Chandler M, Matthews E, Rzewinski J, Rees J, Israel S, Lushin V. Socioeconomic Stability Buffers Racial Discrimination Effect on Depression in a Marginalized Community. J Racial Ethn Health Disparities 2023; 10:130-140. [PMID: 35040107 DOI: 10.1007/s40615-021-01203-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
Depression disproportionately burdens poverty-affected minority communities. Racism and racial discrimination are well-known determinants of depression among members of marginalized minority communities. Less is known about potential buffers of the discrimination effects on depression, particularly those that could serve as targets for efficient community-based policies and interventions. Our secondary analysis of data from a community needs assessment survey (N = 677) in an urban minority neighborhood of low socio-economic status revealed that high school completion and current employment significantly weakened the association between discrimination and depression. Our findings frame community-level efforts to foster high school completion and employment as potential strategies to reduce the footprint of racism on the mental health of marginalized community members. Implications for future research and policy are discussed.
Collapse
Affiliation(s)
- Rebecca Rivera
- Long Island University Brooklyn Campus, Brooklyn, NY, USA
| | - Tracey Capers
- Bedford Stuyvesant Restoration Corporation, Brooklyn, NY, USA
| | | | | | | | - Jo Rees
- School of Health Professions, Long Island University Brooklyn Campus, Brooklyn, NY, USA
| | - Shimonah Israel
- Bedford Stuyvesant Restoration Corporation, Brooklyn, NY, USA
| | - Victor Lushin
- Long Island University Brooklyn Campus, Brooklyn, NY, USA.
| |
Collapse
|
11
|
Sorkhou M, Rashid T, Dere J, Uliaszek A. Psychological Distress in Treatment-Seeking University Students: An Intersectional Examination of Asian Identity and Gender Identity. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2022. [DOI: 10.1080/87568225.2022.2145252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Maryam Sorkhou
- Addictions Division, Center for Addictions and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Tayyab Rashid
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Jessica Dere
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Amanda Uliaszek
- Addictions Division, Center for Addictions and Mental Health, Toronto, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Dean KE, Long ACJ, Trinh NH, McClendon J, Buckner JD. Treatment Seeking for Anxiety and Depression Among Black Adults: A Multilevel and Empirically Informed Psycho-Sociocultural Model. Behav Ther 2022; 53:1077-1091. [PMID: 36229108 DOI: 10.1016/j.beth.2022.04.005] [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: 03/01/2021] [Revised: 02/24/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
Black adults with anxiety and/or depressive disorders underutilize outpatient psychotherapy and pharmacological treatment compared to White adults. Notably, anxiety and depressive disorders tend to be chronic and Black individuals with these disorders experience greater functional impairment than White individuals. Documented racial disparities in mental health treatment initiation indicate a need for research that addresses culture-specific barriers to treatment. This review paper critically evaluates existing theoretical models of treatment seeking among Black adults to inform a novel integrated, culturally contextualized model. This model extends previous ones by incorporating factors relevant to treatment seeking among Black adults (e.g., racial identity, perceived discrimination, medical mistrust) and critically examines how these factors intersect with key factors at three levels of influence of the treatment seeking process: the individual level, the community level, and the societal level. We posit interactions among factors at the three levels of influence and how these may impact treatment seeking decisions among Black adults. This model informs suggestions for enhancing interventions designed to support outpatient service use among Black adults.
Collapse
Affiliation(s)
| | | | - Nhi-Ha Trinh
- Massachusetts General Hospital/Harvard Medical School
| | | | | |
Collapse
|
13
|
Mitchell EA, Roberson PNE, Amer Z, Garcia DJ, Cordova JV, Gordon KC. Couple variables predicting retention in a brief intervention and research. FAMILY PROCESS 2022; 61:1180-1194. [PMID: 35605638 DOI: 10.1111/famp.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
Therapy is an effective form of treatment for couple distress; yet, research shows that 20%-60% of couples terminate treatment prematurely. Predictors of couple retention in therapy and research are unclear, particularly for couples from marginalized populations, which has important implications for the quality and generalizability of research results, and the benefits derived from therapy are limited when participants are not retained. The purpose of this study (N = 1310) was to identify couple-level variables that predict (1) retention in a brief, two-session couple intervention (The Relationship Checkup) delivered as a home visitation program and (2) retention in research participation at 1- and 6-month follow-up. Hypotheses were tested using a two-level multi-level model. Couples are significantly less likely to be retained in the brief intervention if (1) at least one partner identifies as Asian, Pacific Islander, or Native American, (2) at least one partner identifies as Hispanic/Latinx, or (3) both partners report mental or emotional health as a concern in their relationship. Couples are significantly less likely to be retained in research if (1) at least one partner identifies as Asian, Pacific Islander, or Native American (1 month only), (2) at least one partner identifies as Hispanic/Latinx (1 and 6 months), (3) if either partner reports clinically significant relationship distress at baseline (1 and 6 months), or (4) if either partner reports relationship aggression at baseline (6 months only). These findings are discussed with relevance to clinicians and researchers to recruit and retain more diverse and marginalized participants in couple interventions and follow-up research.
Collapse
Affiliation(s)
- Erica A Mitchell
- College of Education, Health, and Human Sciences, The University of Tennessee, Knoxville, Tennessee, USA
| | | | - Zahra Amer
- Psychology Department, The University of Tennessee, Knoxville, Tennessee, USA
| | - Darren J Garcia
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - James V Cordova
- Francis L. Hiatt Department of Psychology, Clark University, Worchester, Massachusetts, USA
| | - Kristina Coop Gordon
- College of Education, Health, and Human Sciences, The University of Tennessee, Knoxville, Tennessee, USA
| |
Collapse
|
14
|
Blackmore MA, Patel UB, Stein D, Carleton KE, Ricketts SM, Ansari AM, Chung H. Collaborative Care for Low-Income Patients From Racial-Ethnic Minority Groups in Primary Care: Engagement and Clinical Outcomes. Psychiatr Serv 2022; 73:842-848. [PMID: 35139653 DOI: 10.1176/appi.ps.202000924] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess model impact and opportunities for improvement, this study examined collaborative care model (CoCM) engagement and clinical outcomes among low-income patients from racial-ethnic minority groups with depression and anxiety. METHODS Starting in 2015, the CoCM was implemented in seven primary care practices of an urban academic medical center serving patients from racial-ethnic minority backgrounds, predominantly Medicaid beneficiaries. Eligible individuals scored positive for depressive or anxiety symptoms (or both) on the Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 and the Generalized Anxiety Disorder Scale-2 (GAD-2) and GAD-7 during systematic screening in primary care settings. Screening rates and yield, patient characteristics, and CoCM engagement and outcomes were examined. Clinical improvement was measured by the difference in PHQ-9 and GAD-7 scores at baseline and at 10-to-14-week follow-up. RESULTS High rates of screening (87%, N=88,236 of 101,091) and identification of individuals with depression or anxiety (13%, N=11,886) were observed, and 58% of 3,957 patients who engaged in minimally adequate CoCM treatment had significant clinical improvement. Nevertheless, only 56% of eligible patients engaged in the model, and 25% of those individuals did not return for at least one follow-up appointment. Being female with clinically significant comorbid anxiety and depressive symptoms and having Medicaid or commercial insurance increased the likelihood of CoCM engagement. CONCLUSIONS CoCM can help engage vulnerable patients in behavioral health care and improve clinical symptoms. However, significant opportunity exists to advance the model's impact in treating depressive and anxiety disorders and decreasing health disparities by addressing engagement barriers.
Collapse
Affiliation(s)
- Michelle A Blackmore
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Urvashi B Patel
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Dana Stein
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Kelly E Carleton
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Sarah M Ricketts
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Asif M Ansari
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Henry Chung
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| |
Collapse
|
15
|
Mulalint T, Seeherunwong A, Wanitkun N, Tongsai S. Determinants of continuing mental health service use among older persons diagnosed with depressive disorders in general hospitals: latent class analysis and GEE. BMC Health Serv Res 2022; 22:899. [PMID: 35818042 PMCID: PMC9275052 DOI: 10.1186/s12913-022-08250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Prevalence of depression in older persons was a leading cause of disability. This group has the lowest access to service and retention in care compared to other age groups. This study aimed to explore continuing mental health service use and examined the predictive power of the mental health service delivery system and individual factors on mental health service use among older persons diagnosed with depressive disorders. Methods We employed an analytic cross-sectional study design of individual and organizational variables in 12 general hospitals selected using multi-stratified sampling. There were 3 clusters comprising community hospitals, advanced and standard hospitals, and university hospitals. Participants in each group were 150 persons selected by purposive sampling. We included older persons with a first or recurring diagnosis of a depressive disorder in the last 6 to 12 months of the data collection date. Data at the individual level included socio-demographic characteristics, Charlson Comorbidity Index, Attitude toward Depression and its treatment, and perceived social support. Data at the organizational level had hospital level, nurse competency, nurse-patient ratio, and appointment reminders. Descriptive statistics, Pearson chi-square test, latent class analysis (LCA), and marginal logistic regression model using generalized estimating equation (GEE) were used to analyze the data. Results The continuing mental health service use among older persons diagnosed with depressive disorders was 54%. The latent class analysis of four variables in the mental health services delivery organization yielded distinct and interpretable findings in two groups: high and low resource organization. The marginal logistic multivariable regression model using GEE found that organizational group and attitude toward depression and its treatment were significantly associated with mental health service use (p-value = 0.046; p-value = 0.003). Conclusions The findings suggest that improving continuing mental health services use in older persons diagnosed with depressive disorders should emphasize specialty resources of the mental health services delivery system and attitude toward depression and its treatment.
Collapse
Affiliation(s)
- Thida Mulalint
- D.N.S. Candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Acharaporn Seeherunwong
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Napaporn Wanitkun
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sasima Tongsai
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
16
|
Gross GM, Smith N, Holliday R, Rozek DC, Hoff R, Harpaz-Rotem I. Racial Disparities in Clinical Outcomes of Veterans Affairs Residential PTSD Treatment Between Black and White Veterans. Psychiatr Serv 2022; 73:126-132. [PMID: 34369806 DOI: 10.1176/appi.ps.202000783] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Racial disparities across various domains of health care are a long-standing public health issue that affect a variety of clinical services and health outcomes. Mental health research has shown that prevalence rates of posttraumatic stress disorder (PTSD) are high for Black veterans compared with White veterans, and some studies suggest poorer clinical outcomes for Black veterans with PTSD. The aim of this study was to examine the impact of racial disparities longitudinally in the U.S. Department of Veterans Affairs (VA) residential rehabilitation treatment programs (RRTPs). METHODS Participants included 2,870 veterans treated nationally in VA PTSD RRTPs in fiscal year 2017. Veterans provided demographic data upon admission to the program. Symptoms of PTSD and depression were collected at admission, discharge, and 4-month follow-up. Hierarchical linear modeling was used to examine symptom change throughout and after treatment. RESULTS Black veterans experienced attenuated PTSD symptom reduction during treatment as well as greater depression symptom recurrence 4 months after discharge, relative to White veterans. CONCLUSIONS This study adds to the body of literature that has documented poorer treatment outcomes for Black compared with White veterans with PTSD. Although both Black and White veterans had an overall reduction in symptoms, future research should focus on understanding the causes, mechanisms, and potential solutions to reduce racial disparities in mental health treatment.
Collapse
Affiliation(s)
- Georgina M Gross
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Noelle Smith
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Ryan Holliday
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - David C Rozek
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Rani Hoff
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| |
Collapse
|
17
|
Machado RDS, Vieira IS, Mondin TC, Scaini CR, Molina ML, Jansen K, de Mattos Souza LD, Duarte MR, Simjanoski M, da Silva RA. Dropout in brief psychotherapy for Major Depressive Disorder: Randomized Clinical Trial. Clin Psychol Psychother 2021; 29:1080-1088. [PMID: 34806246 DOI: 10.1002/cpp.2693] [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: 01/26/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022]
Abstract
The aim of this paper is to analyze the factors associated with the dropout from brief psychotherapy for adults with Major Depressive Disorder (MDD) treated at a mental health outpatient clinic. This is a randomized clinical trial with two models of psychotherapy: Cognitive Behavioral Therapy (CBT) and Supportive Expressive Dynamic Psychotherapy (SEDP). MDD and Anxiety Disorders were evaluated through the Mini International Neuropsychiatric Interview - Plus. The Personality Disorders were evaluated by the Millon Clinical Multiaxial Inventory-III. The severity of depressive symptoms was measured using the Beck Depression Inventory-II and resilience through Resilience Scale. Of the 215 participants, 41.9% abandoned psychotherapy (n=90), and, of these, 54,4% (n=49) abandoned after the fourth session. The proportion of psychotherapy dropout was higher among those with non-white skin color, belonging to economic classes C and D, who had children and whose depressive symptoms were moderate. Presence of obsessive-compulsive personality trait was protective against dropout. The damage caused by this abrupt interruption is evident for all those involved in the psychotherapeutic process, so the clinician should pay attention to the predictors found in this study in order to develop strategies that promote therapeutic adherence.
Collapse
Affiliation(s)
| | - Igor Soares Vieira
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Thaise C Mondin
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.,Department of Psychology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Mariane Lopez Molina
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.,Department of Psychology, Faculdade Anhanguera do Rio Grande, Rio Grande, Brazil
| | - Karen Jansen
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Malu Ribeiro Duarte
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Mario Simjanoski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | | |
Collapse
|
18
|
Ilagan GS, Heatherington L. Advancing the understanding of factors that influence client preferences for race and gender matching in psychotherapy. COUNSELLING PSYCHOLOGY QUARTERLY 2021. [DOI: 10.1080/09515070.2021.1960274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
19
|
Peer Support in Behavioral Health care: why it can work in the Latinx context. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2021. [DOI: 10.33881/2027-1786.rip.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Las personas de origenes latinoamericanos son menos propensas a comprometerse con el cuidado de salud mental y la participación en servicios de salud mental, comparado a otros grupos raciales y étnicos. Las bajas tasas de participación en servicios de salud mental en parte de la comunidad Latinx en los Estados Unidos (EE. UU.) se puede atribuir parcialmente alfuncionamiento de los sistemas de cuidado, los cuales no son sensibles a la cultura Latinx o al español como lengua. Las Investigaciones han demostrado que intervenciones centradas en la cultura, que promueven los valores culturales de la comunidad Latinx, informan una mayor participación y satisfacción en el tratamiento y los servicios de salud mental. Un enfoque efectivo, informado por la cultura, que puede mejorar la participación de la comunidad Latinx en servicios de salud mental es el apoyo de compañerxs. En el enfoque de apoyo de pares, se contrata a personas con experiencias vividas en salud mental y adicciones como compañeros de apoyo para ayudar a quienes han vivido experiencias similares. Los estudios de investigación que miden la efectividad de los enfoques de apoyo entre pares han mostrado mejoras en las vidas de quienes reciben el apoyo, ayudando con el sentido de esperanza, calidad de vida, y bienestar. Los resultados también han demostrado disminución de hospitalizaciones, visitas a la sala de emergencia y menor uso de sustancias y participación en actividades criminales. El apoyo entre compañerxs en el contexto Latinx parece un ajuste natural dados sus valores colectivos compartidos (p. ej., simpatía, personalismo, respeto, confianza, familismo). Este articulo discute como los valores de apoyo entre compañerxs se relacionan con los valores colectivistas; y como se pueden infundir más los valores Latinx en el entrenamiento, desarrollo y supervisión de los compañerxs de apoyo para mejorar el cuidado de salud mental informado por la cultura.
Collapse
|
20
|
Gaias LM, Arnold KT, Liu FF, Pullmann MD, Duong MT, Lyon AR. Adapting strategies to promote implementation reach and equity (ASPIRE) in school mental health services. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Larissa M. Gaias
- Department of Psychology University of Massachusetts Lowell Lowell Massachusetts USA
| | - Kimberly T. Arnold
- Department of Psychiatry, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Freda F. Liu
- Psychiatry and Behavioral Medicine Seattle Children's Hospital Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
| | - Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
| | - Mylien T. Duong
- Education, Research & Impact Committee for Children Seattle WA USA
| | - Aaron R. Lyon
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
| |
Collapse
|
21
|
Progovac AM, Cortés DE, Chambers V, Delman J, Delman D, McCormick D, Lee E, De Castro S, Sánchez Román MJ, Kaushal NA, Creedon TB, Sonik RA, Quinerly CR, Rodgers CRR, Adams LB, Nakash O, Moradi A, Abolaban H, Flomenhoft T, Nabisere R, Mann Z, Hou SSY, Shaikh FN, Flores M, Jordan D, Carson NJ, Carle AC, Lu F, Tran NM, Moyer M, Cook BL. Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences. QUALITATIVE HEALTH RESEARCH 2020; 30:1833-1850. [PMID: 32713258 PMCID: PMC10797602 DOI: 10.1177/1049732320937663] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.
Collapse
Affiliation(s)
- Ana M. Progovac
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dharma E. Cortés
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jonathan Delman
- University of Massachusetts Medical School, Worcester, USA
- Massachusetts Mental Health Center, Boston, USA
| | | | - Danny McCormick
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Esther Lee
- Cambridge Health Alliance, Massachusetts, USA
- Columbia Mailman School of Public Health, New York City, New York, USA
| | | | - María José Sánchez Román
- Cambridge Health Alliance, Massachusetts, USA
- George Washington University, District of Columbia, USA
| | | | | | - Rajan A. Sonik
- Cambridge Health Alliance, Massachusetts, USA
- AltaMed Institute for Health Equity, Los Angeles, California, USA
| | - Catherine Rodriguez Quinerly
- The Transformation Center, Roxbury, Massachusetts, USA
- Dr. Solomon Carter Fuller Mental Health Center, Boston, Massachusetts, USA
| | | | - Leslie B. Adams
- Cambridge Health Alliance, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Ora Nakash
- Smith College School for Social Work, Northampton, Massachusetts, USA
| | - Afsaneh Moradi
- Cambridge Health Alliance, Massachusetts, USA
- Blair Athol Medical Center, South Australia, Australia
| | - Heba Abolaban
- Cambridge Health Alliance, Massachusetts, USA
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Tali Flomenhoft
- Cambridge Health Alliance, Massachusetts, USA
- Brandeis University, Waltham, Massachusetts, USA
| | | | - Ziva Mann
- Cambridge Health Alliance, Massachusetts, USA
- Ascent Leadership Networks, New York City, New York, USA
| | - Sherry Shu-Yeu Hou
- Cambridge Health Alliance, Massachusetts, USA
- McGill University, Montreal, Quebec, Canada
| | | | | | | | - Nicholas J. Carson
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Adam C. Carle
- James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA
| | - Frederick Lu
- Cambridge Health Alliance, Massachusetts, USA
- Boston University School of Medicine, Massachusetts, USA
| | | | - Margo Moyer
- Cambridge Health Alliance, Massachusetts, USA
| | - Benjamin L. Cook
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Jones AL, Cochran SD, Rafferty J, Taylor RJ, Mays VM. Lifetime and Twelve-Month Prevalence, Persistence, and Unmet Treatment Needs of Mood, Anxiety, and Substance Use Disorders in African American and U.S. versus Foreign-Born Caribbean Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197007. [PMID: 32992680 PMCID: PMC7579446 DOI: 10.3390/ijerph17197007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
There is growing diversity within the Black population in the U.S., but limited understanding of ethnic and nativity differences in the mental health treatment needs of Black women. This study examined differences in the prevalence of psychiatric disorders, their persistence, and unmet treatment needs among Black women in the U.S. Data were from the National Survey of American Life, a nationally representative survey that assessed lifetime and twelve-month mood, anxiety, and substance use disorders according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria, and mental health service use among those meeting disorder criteria. One in three African American women met criteria for a lifetime disorder, compared to one in three Caribbean women born within the U.S. and one in five Caribbean women born outside the U.S. About half of African American women with a lifetime disorder had a persistent psychiatric disorder, compared to two in five Caribbean women born within the U.S. and two in three Caribbean women born outside the U.S. African Americans had more persisting dysthymia and panic disorder and less persisting social phobia compared to foreign-born Caribbean women. Of the three groups, Caribbean women born within the U.S. were most likely to seek mental health treatment during their lifetime. These results demonstrate, despite a lower prevalence of psychiatric disorders in Black women, that there is a great likelihood their disorders will be marked by persistence and underscores the need for culturally specific treatment approaches. As Black immigrants in the United States are increasing in number, adequate mental health services are needed.
Collapse
Affiliation(s)
- Audrey L. Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
- Correspondence:
| | - Susan D. Cochran
- Departments of Epidemiology and Statistics, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA;
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions (BRITE), Los Angeles, CA 90095, USA;
| | - Jane Rafferty
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA; (J.R.); (R.J.T.)
| | - Robert Joseph Taylor
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA; (J.R.); (R.J.T.)
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
| | - Vickie M. Mays
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions (BRITE), Los Angeles, CA 90095, USA;
- Departments of Psychology and Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
| |
Collapse
|
23
|
Alves-Bradford JM, Trinh NH, Bath E, Coombs A, Mangurian C. Mental Health Equity in the Twenty-First Century: Setting the Stage. Psychiatr Clin North Am 2020; 43:415-428. [PMID: 32773071 DOI: 10.1016/j.psc.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Significant mental health disparities persist in screening, diagnosis, and treatment for racial and ethnic minorities compared with non-Latinx white people. Reducing mental health disparities, and ultimately achieving mental health equity, requires understanding the wide range of factors that influence health outcomes at multiple levels. Components of an effective strategy to achieve mental health equity include increasing population-based care; increasing community-based health care services; addressing the social determinants of health; engaging the community; enhancing the pipeline; and supporting a diverse, structurally competent workforce.
Collapse
Affiliation(s)
- Jean-Marie Alves-Bradford
- New York State Psychiatric Institute, Washington Heights Community Service, Columbia University Department of Psychiatry, 1051 Riverside Drive, Box 112, New York, NY 10032, USA.
| | - Nhi-Ha Trinh
- Department of Psychiatry Center for Diversity, MGH Depression Clinical and Research Program (DCRP), Harvard Medical School (HMS), HMS, Massachusetts General Hospital (MGH), One Bowdoin Square, 6th Floor, Boston, MA 02114-2790, USA
| | - Eraka Bath
- Child Forensic Services; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Department of Psychiatry, 760 Westwood Plaza, Room A8-228 Los Angeles, CA 90024, USA
| | - Angela Coombs
- Columbia University Department of Psychiatry; Washington Heights Community Service, New York State Psychiatric Institute
| | - Christina Mangurian
- UCSF Department of Psychiatry, 1001 Potrero Avenue, Room 7M20, UCSF Box 0852, San Francisco, CA 94110, USA
| |
Collapse
|
24
|
Carleton KE, Patel UB, Stein D, Mou D, Mallow A, Blackmore MA. Enhancing the scalability of the collaborative care model for depression using mobile technology. Transl Behav Med 2020; 10:573-579. [DOI: 10.1093/tbm/ibz146] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The collaborative care model (CoCM) has substantial support for improving behavioral health care in primary care. However, large-scale CoCM adoption relies on addressing operational and financial implementation challenges across health care settings with varying resources. An academic medical center serving socioeconomically and racially diverse patients implemented the CoCM in seven practices. A smartphone application was introduced to facilitate CoCM care management during depression treatment (app-augmented CoCM). App features included secure texting, goal/appointment reminders, symptom monitoring, and health education material. A nonrandomized convenience patient sample (N = 807) was enrolled in app-augmented CoCM and compared with patients in standard CoCM (N = 3,975). Data were collected on clinical contact frequency, engagement, and clinical outcomes. App-augmented CoCM patients received more health care team contacts (7.9 vs. 4.9, p < .001) and shorter time to follow up compared with the standard CoCM sample (mean = 11 vs. 19 days, p < .001). App-augmented CoCM patients had clinical outcomes similar to the standard CoCM group (47% vs. 46% with ≥50% depression improvement or score <10), despite app-augmented patients having more prior depression treatment episodes. Further, the app-augmented group with greater app engagement demonstrated increased behavioral health appointment compliance, including more completed appointments and fewer no shows, and greater depression symptom improvement than those with less app engagement. App-augmented CoCM may improve patient engagement in treatment and provide opportunities to implement key CoCM elements without overburdening practice resources. CoCM sustainability and scalability in primary care may be enhanced by using this technology.
Collapse
Affiliation(s)
| | | | | | - David Mou
- Smartphone Application Vendor, Brooklyn, NY
| | | | | |
Collapse
|
25
|
Jacoby SF, Rich JA, Webster JL, Richmond TS. 'Sharing things with people that I don't even know': help-seeking for psychological symptoms in injured Black men in Philadelphia. ETHNICITY & HEALTH 2020; 25:777-795. [PMID: 29607675 PMCID: PMC6167172 DOI: 10.1080/13557858.2018.1455811] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/06/2018] [Indexed: 05/29/2023]
Abstract
Objectives: Psychological distress is common in survivors of traumatic injury, yet across United States' trauma systems, it is rare that standard injury care integrates psychological evaluation and professional mental healthcare. The purpose of this study was to explore help-seeking for psychological symptoms in injured Black men living in Philadelphia. Design: A subset of a cohort of 551 injured Black men admitted to a Trauma Center in Philadelphia participated in qualitative interviews that explored their perceptions of psychological symptoms after injury and the factors that guided their decision to seek professional mental health help. Data from 32 participants were analyzed for narrative and thematic content. Results: Three overarching themes emerged: (1) facilitators of help-seeking, (2) barriers to help-seeking, and (3) factors underlying the decision not to consider professional help. Five participants felt that their injury-related psychological distress was severe enough to merit professional help despite any perceived barriers. Seventeen participants identified systemic and interpersonal obstacles to professional help that prevented them from seeking this kind of care. These included: financial constraints, limited access to mental healthcare services, and fear of the judgments of mental healthcare professionals. Ten participants would not consider professional help; these men perceived a lack of need and sufficiency in their existing social support networks. Conclusions: Research is needed to inform or identify interventions that diminish the impact of barriers to care, and identify from whom, where, and how professional mental health help might be more effectively offered to injured Black men in recovery environments like Philadelphia.
Collapse
Affiliation(s)
- Sara F. Jacoby
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John A. Rich
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Jessica L. Webster
- Department of Biobehavioral Sciences, School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Therese S. Richmond
- Department of Biobehavioral Sciences, School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
26
|
Green JG, McLaughlin KA, Fillbrunn M, Fukuda M, Jackson JS, Kessler RC, Sadikova E, Sampson NA, Vilsaint C, Williams DR, Cruz-Gonzalez M, Alegría M. Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:606-616. [PMID: 32076886 PMCID: PMC7260099 DOI: 10.1007/s10488-020-01021-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.
Collapse
Affiliation(s)
- Jennifer Greif Green
- Wheelock College of Education & Human Development, Boston University, 2 Silber Way, Boston, MA, 02215, USA.
| | | | - Mirko Fillbrunn
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James S Jackson
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ekaterina Sadikova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Corrie Vilsaint
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
27
|
Torres Stone RA, Cardemil EV, Keefe K, Bik P, Dyer Z, Clark KE. A Community Mental Health Needs Assessment of a Racially and Ethnically Diverse Population in New England: Narratives from Community Stakeholders. Community Ment Health J 2020; 56:947-958. [PMID: 32006294 DOI: 10.1007/s10597-020-00562-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/26/2020] [Indexed: 12/16/2022]
Abstract
Despite the existence of numerous efficacious treatments for mental disorders, many individuals in need do not receive adequate treatment particularly racial and ethnic minorities. Community stakeholders can provide: (1) a more nuanced understanding of community mental health needs, and in (2) informing the planning and provision of mental health services. Qualitative data for this mental health needs assessment come from 61 individuals who represent local residents and/or consumers of mental health services, Executive Directors, providers of mental health and non-mental health community based services. We identified systems-related and psychosocial barriers to seeking mental health services: difficulty navigating the mental health system, language barriers, dearth of culturally competent providers; and mental health stigma and mental health literacy and non-Western notions of mental health. Collaborative efforts across stakeholders are called for to address the mental health needs of racial and ethnic minorities in a local community.
Collapse
Affiliation(s)
| | | | - Kristen Keefe
- Psychology Department, Clark University, Worcester, MA, 01655, USA
| | - Paige Bik
- New York City Alliance Against Sexual Assault, New York, NY, USA
| | - Zachary Dyer
- University of Massachusetts Medical School, Worcester, MA, 01610, USA
| | - Karyn E Clark
- City of Worcester Division of Public Health, Worcester, MA, 01655, USA
| |
Collapse
|
28
|
Waldman K, Stickley A, Araujo Dawson B, Oh H. Racial discrimination and disability among Asian and Latinx populations in the United States. Disabil Rehabil 2020; 44:96-105. [PMID: 32406760 DOI: 10.1080/09638288.2020.1760363] [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: 10/24/2022]
Abstract
Purpose: This study examined the association between perceived racial discrimination and disability among Asian and Latinx residents of the United States, as the link between discrimination and disability has gone largely ignored in analyses of these populations.Materials and methods: Nationally representative samples included 2046 Asian Americans and 2515 Latinx Americans from the National Latino and Asian American Study (NLAAS). We used multivariable logistic regression and multivariable negative binomial regression to analyze the association between racial discrimination and five different disability domains as well as racial discrimination and a count of simultaneous functional limitations, respectively. The disability domains included: self-care, cognition, mobility, time out of role, and social interaction.Results and conclusions: Perceived racial discrimination positively and significantly predicted impairments across a variety of disability domains for both Asian and Latinx populations. The estimated associations between racial discrimination and disability were heterogeneous across Asian and Latinx ethnicities. Racial discrimination may contribute to stress for Asians and Latinxs in the United States, potentially increasing the possibility these populations develop disabilities. Rehabilitation efforts should consider the social contexts in which people of color live, recognizing that discrimination may differentially affect risk profiles for disabilities across racial and ethnic groups.IMPLICATIONS FOR REHABILITATIONAcross Asian and Latinx populations, racial discrimination is associated with impairments in self-care, cognition, mobility, time out of role, and social interaction.Future translational research can explore the utility of brief racial discrimination screens in clinical settings to assess risk for disability in various domains.Professionals should attend to the stress and overall impact of racial discrimination, as it is conceivable that racial discrimination may result in the exclusion or hindrance of people of color who are pursuing meaningful participation in places of work, public spaces, and civic life.Society bears the collective obligation to reduce discrimination against Asian and Latinx populations, particularly against those who experience disability.
Collapse
Affiliation(s)
- Kyle Waldman
- Department of Sociology, Harvard University, Cambridge, MA, USA
| | - Andrew Stickley
- Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | | | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
29
|
Stafford AM, Garbuz T, Etter DJ, Adams ZW, Hulvershorn LA, Downs SM, Aalsma MC. The Natural Course of Adolescent Depression Treatment in the Primary Care Setting. J Pediatr Health Care 2020; 34:38-46. [PMID: 31548140 PMCID: PMC6910991 DOI: 10.1016/j.pedhc.2019.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Little is known about how adolescents receive depression follow-up in primary care. The purpose of this study was to describe the rates of symptom assessment and depression treatment over time in a group of adolescents screening positive for moderate or severe depression in the primary care setting. METHODS Retrospective chart reviews were conducted to gather information related to symptom reassessments, antidepressant prescriptions, psychotherapy referrals, and treatment discontinuation. Descriptive statistics were calculated, and a qualitative content analysis was conducted to determine the reasons for treatment discontinuation. RESULTS Eighty records were reviewed (mean age = 15.3, 73% female, 59% Black). Treatment was initiated for 83% (n = 66) of patients, and 45% (n = 30) of patients discontinued treatment during the review period for a variety of reasons. DISCUSSION To improve adolescents' adherence to depression treatment, providers should address factors that contribute to treatment discontinuation and use tools to manage depression follow-up care.
Collapse
|
30
|
Acculturative stress, disability, and health treatment utilization among Asian and Latin American immigrants in the United States. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1275-1284. [PMID: 30895354 DOI: 10.1007/s00127-019-01691-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Empirical research has largely ignored the potential links between immigration-related stress and disability as well as immigration-related stress and health service utilization despite increasing scholarship on the association between acculturative stress and health. This study examined the associations between acculturative stress, disability, and health treatment utilization among Asian and Latin American immigrants in the United States. METHODS Data were from the National Latino and Asian American Study (NLAAS), a nationally representative survey of Asians and Latinos living in the United States. The analytic sample contained 2653 immigrants. We utilized multivariable logistic regression and negative binomial regression analyses to examine the associations between acculturative stress and disability domains. We also examined the association between acculturative stress and treatment utilization, as this may have implications for how to best intervene to address any functional disability related to acculturative stress. RESULTS Acculturative stress was significantly associated with self-reported disability across five domains: self-care, cognition, mobility, time out of role, and social interaction. Additionally, acculturative stress was significantly associated with a greater frequency of disability domains. Acculturative stress was not significantly associated with utilization of services from mental health or general health sectors, but was significantly and positively associated with utilization of non-health care services. The findings were robust regarding the inclusion of everyday discrimination as well as demographic and socioeconomic covariates. CONCLUSIONS Acculturative stress may be an important yet overlooked correlate of disability among immigrants in the United States. Non-health care services may provide an effective pathway for intervening for these individuals.
Collapse
|
31
|
Quitting Mental Health Services among Racial and Ethnic Groups of Americans with Depression. J Behav Health Serv Res 2019; 45:269-279. [PMID: 28589245 DOI: 10.1007/s11414-017-9560-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Research on racial/ethnic differences in quitting mental health services has yet to examine the multiple forms of services offered and reasons why racial/ethnic groups quit. Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) examined whether race/ethnicity was related to quitting nine types of mental health services within a multivariate framework, and whether any racial/ethnic differences emerged among 16 assessed reasons for quitting mental health services (N = 437). Odds of quitting mental health services provided by social workers, non-medical health professionals, counselors, psychiatrists, and psychologists varied significantly by race/ethnicity. The most common reasons for quitting services included individuals wanting to handle the problem on their own, getting better, or not needing help anymore. The increased likelihood of quitting services represents an underexplored area for mental health service disparities and calls for improved efforts to retain racial and ethnic minorities in the mental health system.
Collapse
|
32
|
Oh H, Waldman K, Stubbs B, Koyanagi A. Psychotic experiences in the context of mood and anxiety disorders and their associations with health outcomes among people of color in the United States. J Psychosom Res 2019; 118:27-33. [PMID: 30782351 DOI: 10.1016/j.jpsychores.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Psychotic experiences appear to increase risk for health outcomes above and beyond mood/anxiety disorders. However, existing studies that have found this association were conducted mostly in low- and middle-income countries, calling for more studies to explore the association in other contexts, such as the U.S., where people of color face considerable health disparities. MATERIALS/METHODS Data from the National Latino and Asian American Survey, and the National Survey of American Life were analyzed. After restricting the analytic sample to individuals with at least one mood or anxiety disorder (N = 2929), multivariable logistic regression was used to examine the associations between psychotic experiences and health outcomes, disabilities, and help-seeking behaviors, adjusting for socio-demographic characteristics and psychiatric disorders. RESULTS Among people of color with mood/anxiety disorders, 16.58% (n = 519) of the weighted analytic sample reported psychotic experiences. Psychotic experiences were associated with 1.75 times greater odds (95% CI: 1.24-2.47) for reporting a lifetime health condition, with varying odds depending on the specific conditions (e.g. arthritis, heart disease, ulcers, and asthma), and specific disabilities (e.g. cognition, mobility, social interaction, and time out of role). Psychotic experiences were associated with 1.66 times the odds of seeking any treatment (95% CI: 1.20-2.29), and the perceived need for help among people who did not seek treatment (e.g. feeling the need for treatment, being encouraged to seek treatment by others). CONCLUSIONS Mental health practitioners serving people of color who have mood/anxiety disorders should routinely screen for psychotic experiences, which may suggest health problems and disabilities that warrant integrated healthcare.
Collapse
Affiliation(s)
- Hans Oh
- University of Southern California, Suzanne Dworak-Peck School of Social Work, CA, USA.
| | - Kyle Waldman
- University of Southern California, Suzanne Dworak-Peck School of Social Work, CA, USA.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| |
Collapse
|
33
|
Polo AJ, Makol BA, Castro AS, Colón-Quintana N, Wagstaff AE, Guo S. Diversity in randomized clinical trials of depression: A 36-year review. Clin Psychol Rev 2019; 67:22-35. [DOI: 10.1016/j.cpr.2018.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
|
34
|
Blanco C, Markowitz JC, Hellerstein DJ, Nezu AM, Wall M, Olfson M, Chen Y, Levenson J, Onishi M, Varona C, Okuda M, Hershman DL. A randomized trial of interpersonal psychotherapy, problem solving therapy, and supportive therapy for major depressive disorder in women with breast cancer. Breast Cancer Res Treat 2018; 173:353-364. [PMID: 30343455 DOI: 10.1007/s10549-018-4994-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 10/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Breast cancer (BC) is a risk factor for major depressive disorder (MDD), yet little research has tested the efficacy of different psychotherapies for depressed women with BC. This study, the largest to date, compared outcomes of three evidence-based, 12-week therapies in treating major depressive disorder among women with breast cancer. METHODS This randomized trial compared interpersonal psychotherapy (IPT), problem solving therapy (PST), and brief supportive psychotherapy (BSP). Conducted at the outpatient clinic of the New York State Psychiatric Institute/Columbia University, the trial offered bilingual treatment by treatment-specific psychotherapists supervised by treatment experts. The primary outcome was change in the Hamilton Depression Rating Scale (HAM-D) at 12 weeks. Secondary outcomes included other validated patient-reported outcomes for depression and quality of life. RESULTS Of 179 women with breast cancer screening positive for depression at the Columbia Cancer Center, 134 eligible patients signed informed treatment consent. Half of patients were Hispanic and economically disadvantaged. Most women had stage I (35.2%) or II (36.9%) BC; 9% had stage IV. The three brief psychotherapies showed similar improvements on the HAM-D, with large pre-post effect sizes (d ~ 1.0); a priori defined response rates were 35% for IPT, 50% for PST and 31% for BSP, and remission rates 25%, 30% and 27%, respectively. The three treatments also showed similar improvements in the Quality of Life Enjoyment and Satisfaction Questionnaire. Dropout was high, ranging from 37 to 52% across treatments. Predictors of dropout included having < 16 years of education and annual family income < $20,000. CONCLUSIONS Among patients who completed treatment, all three psychotherapies were associated with similar, meaningful improvements in depression. Physical distance between the oncology and psychiatric treatment sites might have contributed to high dropout. This study suggests various psychotherapy approaches may benefit patients with breast cancer and major depression.
Collapse
Affiliation(s)
- Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, 20892, USA.
| | - John C Markowitz
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - David J Hellerstein
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Arthur M Nezu
- Department of Psychology, Drexel University, Philadelphia, PA, 19104, USA
| | - Melanie Wall
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Ying Chen
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Jon Levenson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Maika Onishi
- Department of Hematology and Oncology, Palo Alto Medical Foundation, Sunnyvale, CA, 94086, USA
| | - Cindy Varona
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Mayumi Okuda
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Dawn L Hershman
- Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA
| |
Collapse
|
35
|
Maura J, Weisman de Mamani A. Mental Health Disparities, Treatment Engagement, and Attrition Among Racial/Ethnic Minorities with Severe Mental Illness: A Review. J Clin Psychol Med Settings 2018; 24:187-210. [PMID: 28900779 DOI: 10.1007/s10880-017-9510-2] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mounting evidence indicates that there are mental health disparities in the United States that disadvantage racial/ethnic minorities in medical and mental health settings. Less is known, however, about how these findings apply to a particularly vulnerable population, individuals with severe mental illness (SMI). The aim of this paper is to (1) provide a critical review of the literature on racial/ethnic disparities in mental health care among individuals with SMI; (2) identify factors which may contribute to the observed disparities; and (3) generate recommendations on how best to address these disparities. Specifically, this article provides an in-depth review of sociocultural factors that may contribute to differences in treatment engagement and rates of attrition from treatment among racial/ethnic minorities with SMI who present at medical and mental health facilities. This review is followed by a discussion of specific strategies that may promote engagement in mental health services and therefore reduce racial/ethnic disparities in SMI.
Collapse
Affiliation(s)
- Jessica Maura
- Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA.
| | - Amy Weisman de Mamani
- Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA
| |
Collapse
|
36
|
Wahby M, Soloski KL, Schleiden C. Evaluating Predictors of Treatment Seeking Behaviors Across Race. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1513311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
37
|
Psychotic experiences and disability: Findings from the Collaborative Psychiatric Epidemiology Surveys. Schizophr Res 2018; 193:343-347. [PMID: 28797526 PMCID: PMC5912340 DOI: 10.1016/j.schres.2017.07.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022]
Abstract
Psychotic experiences are associated with a number of poor clinical outcomes, including multimorbid psychopathology, suicidal behavior, and poor treatment response. We wished to investigate the relationship between psychotic experiences and disability, including the following domains: cognition, mobility, self-care, social interaction, role functioning, and days out of role. We used three nationally representative and racially/ethnically diverse samples of the general US adult population: the National Comorbidity Survey Replication (NCS-R), the National Latino and Asian American Survey (NLAAS), and the National Survey of American Life (NSAL). Multi-variable logistic regression analyses were used to assess the associations between lifetime psychotic experiences (visual and auditory hallucinatory experiences and delusional ideation; WHO Composite International Diagnostic Interview psychosis screen) and 30-day impairments in functioning across disability domains (using the WHO Disability Assessment Schedule II). In all three samples, models were adjusted for socio-demographics and co-occurring psychiatric disorders. In the NCS-R, models were also adjusted for chronic health conditions. Across all three studies, our adjusted models showed that people with disability had anywhere from about 1.5 to over 3 times the odds of reporting lifetime psychotic experiences, depending on the domain. This was true for each disability domain, except self-care in the NLAAS and in the NSAL. Psychotic experiences are markers of risk for disability across a wide range of domains. This may explain the elevated rates of service utilization among individuals who report psychotic experiences and supports the need to assess for and respond to psychotic experiences even in the absence of psychotic disorder.
Collapse
|
38
|
Barriers to and Correlates of Retention in Behavioral Health Treatment Among Latinos in 2 Different Host Countries: The United States and Spain. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:e20-e27. [PMID: 26910867 DOI: 10.1097/phh.0000000000000391] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Latino immigrants constitute a large portion of the Spanish and US immigrant populations, yet a dearth of research exists regarding barriers to retention in behavioral health care. OBJECTIVES To identify and compare perceived barriers related to behavioral health care among first- and second-generation Latinos in Boston, Madrid, and Barcelona, and evaluate whether the frequency of behavioral health care use in the last year was related to these barriers. DESIGN, SETTING, AND PARTICIPANTS Data were obtained from the International Latino Research Partnership project. First- or second-generation self-identified Latino immigrants aged 18 years and more who resided more than 1 year in the host country were recruited from community agencies and primary care, mental health, substance abuse, and HIV clinics. MAIN OUTCOME MEASURES Eleven barriers were assessed and compared across sites. The relationship between barriers and behavioral services visits within the last year was evaluated, adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors. RESULTS Wanting to handle the problem on one's own, thinking that treatment would not work, and being unsure of where to go or who to see were the most frequently reported barriers for Latino immigrants. Previous treatment failure, difficulties in transportation or scheduling, and linguistic barriers were more likely to be reported in Boston; trying to deal with mental health problems on one's own was more commonly reported in Barcelona and Madrid. Two barriers associated with the number of visits were concerns about the cost of services and uncertainty about where to go or who to see. CONCLUSIONS After adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors, barriers still differed significantly across sites. Efforts to improve behavioral health services must be tailored to immigrants' context, with attention to changing attitudes of self-reliance and outreach to improve access to and retention in care.
Collapse
|
39
|
Associations of Clinically Relevant Levels of Depressive Symptoms and Antidepressant Use With Mortality in African American Health. J Am Med Dir Assoc 2017; 18:1058-1062. [PMID: 29169735 DOI: 10.1016/j.jamda.2017.09.027] [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: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Institute of Medicine has highlighted unequal treatment for African American individuals in health care. We examined the association of underuse of antidepressants in African American individuals with increased mortality. METHODS We conducted a longitudinal cohort study in Metropolitan St Louis, Missouri, in a population-based study of community-dwelling African American individuals, aged 52 to 68 years. Medication evaluations and clinically relevant levels of depressive symptoms (CRLDS) assessments occurred in 2000 and 2004. The analytic sample included 830 (of 853 total, 97%) participants with complete data. CRLDS was defined as ≥9 on the 11-item Center for Epidemiologic Studies Depression scale. Antidepressant use was determined by in-home medication recording and in-center coding. Participants were placed into 4 exposure categories: persistent CRLDS-no antidepressant (n = 69); intermittent CRLDS-no antidepressant (n = 123); antidepressant treatment (n = 110); and no CRLDS-no antidepressant (n = 528). Logistic regression with backwards elimination of the 9 identified potential confounders was used to examine associations of exposures with all-cause mortality over 6 years (2004-2010). Five sensitivity analyses investigated robustness of the primary findings. RESULTS The antidepressant group was independently associated with reduced mortality compared with the persistent-no antidepressant group (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.08-0.44). Sensitivity analyses showed no substantive differences from the primary model; one indicated that the persistent CRLDS-no antidepressant group experienced significantly increased mortality compared with the no CRLDS-no antidepressant group (OR 2.12, 95% CI 1.10-4.09), whereas the intermittent-no antidepressant group did not (OR 0.83, 95% CI 0.44-1.58). CONCLUSIONS These results highlight that underuse of antidepressants in African American individuals is associated with increased mortality.
Collapse
|
40
|
Wallace LR, Weir AM, Smith MV. Policy Impact of Research Findings on the Association of Diaper Need and Mental Health. Womens Health Issues 2017; 27 Suppl 1:S14-S21. [DOI: 10.1016/j.whi.2017.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/28/2017] [Accepted: 09/01/2017] [Indexed: 11/24/2022]
|
41
|
Castro-Olivo SM. Introduction to Special Issue: Culturally Responsive School-Based Mental Health Interventions. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40688-017-0137-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Holliday RP, Holder ND, Williamson MLC, Surís A. Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD. Cogn Behav Ther 2017; 46:432-446. [PMID: 28485687 DOI: 10.1080/16506073.2017.1312511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.
Collapse
Affiliation(s)
- Ryan P Holliday
- a Veterans Affairs North Texas Health Care System , Dallas , TX 75216 , USA.,b University of Texas Southwestern Medical Center , Dallas , TX 75390 , USA
| | - Nicholas D Holder
- a Veterans Affairs North Texas Health Care System , Dallas , TX 75216 , USA.,b University of Texas Southwestern Medical Center , Dallas , TX 75390 , USA
| | | | - Alina Surís
- a Veterans Affairs North Texas Health Care System , Dallas , TX 75216 , USA.,b University of Texas Southwestern Medical Center , Dallas , TX 75390 , USA
| |
Collapse
|
43
|
Hamilton JB, Stewart JM, Thompson K, Alvarez C, Best NC, Amoah K, Carlton-LaNey IB. Younger African American Adults' Use of Religious Songs to Manage Stressful Life Events. JOURNAL OF RELIGION AND HEALTH 2017; 56:329-344. [PMID: 27464642 DOI: 10.1007/s10943-016-0288-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to explore the use of religious songs in response to stressful life events among young African American adults. Fifty-five young African American adults aged 18-49 participated in a qualitative study involving criterion sampling and open-ended interviews. Data analysis included content analysis and descriptive statistics. Stressful life events were related to work or school; caregiving and death of a family member; and relationships. Religious songs represented five categories: Instructive, Communication with God, Thanksgiving and Praise, Memory of Forefathers, and Life after Death. The tradition of using religious songs in response to stressful life events continues among these young adults. Incorporating religious songs into health-promoting interventions might enhance their cultural relevance to this population.
Collapse
Affiliation(s)
- Jill B Hamilton
- Department of Community and Public Health, Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Jennifer M Stewart
- Department of Community and Public Health, Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Keitra Thompson
- Department of Community and Public Health, Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Carmen Alvarez
- Department of Community and Public Health, Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Nakia C Best
- School of Nursing, University of North Carolina, Chapel Hill, NC, 27510, USA
| | - Kevin Amoah
- Department of Biology, North Carolina Central University, Durham, NC, 27707, USA
| | - Iris B Carlton-LaNey
- School of Social Work, University of North Carolina, Chapel Hill, NC, 27510, USA
| |
Collapse
|
44
|
Eliacin J, Coffing JM, Matthias MS, Burgess DJ, Bair MJ, Rollins AL. The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 45:186-192. [DOI: 10.1007/s10488-016-0779-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Vannoy SD, Andrews BK, Srebnik D. Suicide After Evaluation for Involuntary Psychiatric Commitment-Who Gets Them and What Influences Survival Time? Suicide Life Threat Behav 2016; 46:634-646. [PMID: 26999443 DOI: 10.1111/sltb.12245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/23/2015] [Indexed: 01/08/2023]
Abstract
Although involuntary psychiatric hospitalizations are associated with suicide risk, little is known about the relationship between evaluation for involuntary detention and suicide. We analyzed data on 10,082 suicides from 2000 to 2011 to examine demographics related to evaluation for detention and the association between demographics and evaluation dispositions on survival time. Evaluation preceded 11% of suicides; 53.8% of deaths occurred within 365 days, 6.5 times the expected rate. Males and older individuals were least likely to have been evaluated. Minority status and referral disposition influence 30-day survival time. Risk is highly concentrated in the first year following evaluation.
Collapse
Affiliation(s)
| | | | - Debra Srebnik
- King County Department of Community and Human Services, Seattle, WA, USA
| |
Collapse
|
46
|
Abstract
The scarcity of accessible culturally competent service providers and a general sense of mistrust in Eurocentric-based mental health settings exacerbate the lack of help seeking and effective therapeutic engagement for Latinos. Thus, clinical interventions that account for diverse values and worldviews may be an important step in the helpful treatment of U.S. Latino populations. Behavioral activation (BA), an evidence-based intervention for the treatment of depression, was recently evaluated through a preliminary clinical trial study in a community clinic primarily serving Spanish-speaking Latinos, and the results were promising. A culturally adapted version of BA was developed for Latinos, which took into consideration the cultural value of familismo (a collectivist worldview and preference for maintaining close connections to family); however, BA has not been previously applied to Latino families. The current case study presents the clinical treatment of a Mexican American family living in the southwest of the United States experiencing numerous stressors resulting in depressive symptoms. Specifically, this family sought therapy having experienced many negative life events, including stressors associated with institutionalized racism, their financial situation, and acculturation process. This led to a disruption of the family hierarchy, anger, unhappiness, fear, and isolation among family members. Outcomes of the intervention include a decrease in depressive symptoms and improved family communication and relationships by their involvement in activities such as attending cultural events in their community, family outings, and the children’s participation in extracurricular activities.
Collapse
|
47
|
Aggarwal NK, Pieh MC, Dixon L, Guarnaccia P, Alegría M, Lewis-Fernández R. Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: A systematic review. PATIENT EDUCATION AND COUNSELING 2016; 99:198-209. [PMID: 26365436 PMCID: PMC4733416 DOI: 10.1016/j.pec.2015.09.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/04/2015] [Accepted: 09/01/2015] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment. METHODS Authors conducted electronic searches of published and grey literature databases from inception to November 2014, forward citation analyses, and backward bibliographic sampling of included articles. Included studies reported original data on clinician communication strategies to improve minority treatment engagement, defined as initiating, participating, and continuing services. RESULTS Twenty-three studies met inclusion criteria. Low treatment initiation and high treatment discontinuation were related to patient views that the mental health system did not address their understandings of illness, care or stigma. Treatment participation was based more on clinician language use, communication style, and discussions of patient-clinician differences. CONCLUSION Clinicians may improve treatment initiation and continuation by incorporating patient views of illness into treatment and targeting stigma. Clinicians may improve treatment participation by using simple language, tailoring communication to patient preferences, discussing differences, and demonstrating positive affect. PRACTICE IMPLICATIONS Lack of knowledge about the mental health system and somatic symptoms may delay treatment initiation. Discussions of clinician backgrounds, power, and communication style may improve treatment participation. Treatment continuation may improve if clinicians tailor communication and treatment plans congruent with patient expectations.
Collapse
Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University Department of Psychiatry and The Center of Excellence for Cultural Competence at The New York State Psychiatric Institute, New York, USA.
| | - Matthew C Pieh
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Lisa Dixon
- Columbia University Department of Psychiatry and The New York State Psychiatric Institute, New York, USA
| | - Peter Guarnaccia
- Institute for Health. Health Care Policy & Aging Research. Rutgers,The State University of New Jersey, New Brunswick, USA
| | - Margarita Alegría
- Center for Multicultural Mental Health Research and Harvard Medical School, Somerville, USA
| | - Roberto Lewis-Fernández
- Columbia University Department of Psychiatry and The Center of Excellence for Cultural Competence at The New York State Psychiatric Institute, New York, USA
| |
Collapse
|
48
|
Abstract
OBJECTIVES To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults. METHODS The study sample came from 1992-2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51-61 years old in 1992 with no CVD history. A score of ≥3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan-Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity. RESULTS Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27% (hazard ratio [HR] = 1.27, 95% confidence interval = 1.17-1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose-response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant. CONCLUSION Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population.
Collapse
Affiliation(s)
- Xiaoling Xiang
- a School of Social Work , University of Illinois at Urbana-Champaign , Urbana , IL , USA
| | | |
Collapse
|
49
|
Hunt TKA, Caldwell CH, Assari S. Family Economic Stress, Quality of Paternal Relationship, and Depressive Symptoms among African American Adolescent Fathers. JOURNAL OF CHILD AND FAMILY STUDIES 2015; 24:3067-3078. [PMID: 26617454 PMCID: PMC4659435 DOI: 10.1007/s10826-015-0112-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This study examined the association between perceived family economic stress, quality of father-son relationships, and depressive symptoms among African American adolescent fathers. Data were collected during pregnancy from 65 African American adolescents who were first-time fathers, ages 14-19. Results from multiple regression analyses indicated that higher paternal relationship satisfaction was associated with fewer depressive symptoms among adolescent fathers. Additionally, depressive symptoms were higher among adolescent fathers who reported experiencing higher levels of conflict with their fathers. Further, paternal conflict moderated the effect of perceived family economic stress on depressive symptoms. That is, among adolescent fathers experiencing low levels of conflict with their fathers, high perceived family economic stress was associated with more depressive symptoms. Study findings suggest that the risk for depressive symptoms is highest among adolescent fathers experiencing low family economic stress and highly conflictual relations with their fathers. These results highlight the complexities of paternal relationships and perceived economic stressors on depressive symptoms during pregnancy for African American adolescent fathers. The importance of expanding research on influential familial relationships and economic stressors on adolescent African American fathers is discussed.
Collapse
Affiliation(s)
- Tenah K A Hunt
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029
| | - Cleopatra H Caldwell
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029
| | - Shervin Assari
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029
| |
Collapse
|
50
|
Cooper AA, Conklin LR. Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials. Clin Psychol Rev 2015; 40:57-65. [DOI: 10.1016/j.cpr.2015.05.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/07/2015] [Accepted: 05/13/2015] [Indexed: 01/19/2023]
|