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Müller F, Munagala A, Arnetz JE, Achtyes ED, Alshaarawy O, Holman HT. Racial disparities in emergency department utilization among patients with newly diagnosed depression. Gen Hosp Psychiatry 2023; 85:163-170. [PMID: 37926052 DOI: 10.1016/j.genhosppsych.2023.10.018] [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: 08/25/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To test the hypothesis that racial and ethnic minorities have increased emergency department visit rates, despite being established with a primary care provider. METHODS In this retrospective cohort study, ED visits without hospital admission in a 12-month period among patients with a new primary care provider-issued diagnosis of depression were assessed. Electronic medical record (EMR) data was obtained from 47 family medicine clinics in a large Michigan-based healthcare system. General linear regression models with Poisson distribution were used to predict frequency of ED visits. RESULTS A total of 4159 patients were included in the analyses. In multivariable analyses, Black / African American race was associated with an additional 0.90 (95% CI 0.64, 1.16) ED visits and American Indian or Alaska Native race was associated with an additional 1.39 (95% CI 0.92, 1.87) ED visits compared to White or Caucasians (null value 0). These risks were only exceeded by patients who received a prescription for a typical antipsychotic drug agent. CONCLUSION Despite being established patients at primary care providers and having follow-up encounters, Black / African American and American Indian or Alaska Native patients with depression were considerably more likely to seek ED treatment compared to White/Caucasian patients with depression.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA; Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.
| | - Akhilesh Munagala
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Judith E Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Harland T Holman
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA.
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Ajayi KV, Panjwani S, Garney W, McCord CE. Sociodemographic factors and perceived patient-provider communication associated with healthcare avoidance among women with psychological distress. PEC INNOVATION 2022; 1:100027. [PMID: 37213787 PMCID: PMC10194386 DOI: 10.1016/j.pecinn.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 05/23/2023]
Abstract
Objective To establish the extent to which psychological distress influences health avoidance behavior among women, controlling for patient provider communication and sociodemographic characteristics. Methods Data from the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3) was analyzed to obtain healthcare avoidance behavior among women aged 18 and older (n = 2788). Weighted descriptive, bivariate, and multivariable logistic regression models were conducted. Results Approximately 649 women or 1 in 4 women (26.7% weighted prevalence; 95% Confidence Interval [CI] 0.23%-0.29%) avoided healthcare in the past 12 months. Non-Hispanic white (62.8%) and married (55.4%) women represented a higher proportion of the sample. Bivariate analysis revealed that the odds of reporting healthcare avoidance among women with mild, moderate, and severe psychological distress (Odds Ratio [OR]: 2.26, 95% CI: 1.45-3.53, p = 0.001; OR: 3.88, 95% CI: 2.29-6.56, p < 0.001; OR: 3.08, 95% CI: 1.81-5.23, p < 0.001) was significantly higher compared to those with none-minimal psychological distress. In the adjusted model, women with moderate and severe psychological distress (Adjusted OR [AOR]:3.15, 95% CI: 1.55-6.38, p = 0.002; AOR: 2.24, 95% CI: 1.10-4.92, p = 0.044) were more likely to report healthcare avoidance than those experiencing none-minimal psychological distress. Furthermore, increasing patient-provider communication score (AOR: 0.91, 95% CI: 0.87-0.96, p < 0.001) reduced the likelihood of healthcare avoidance. Among the sociodemographic variables assessed, being younger (18-49 years) and having less than a high school degree significantly increased the chances of avoiding healthcare. Conclusion A high proportion of women with psychological distress avoid necessary healthcare. Patient-provider communication quality, increasing age, and being a high school student contribute to healthcare avoidance in women. Innovation Strategies to improve health service utilization must address healthcare avoidance by developing effective health communication targeted at women with psychological distress.
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Affiliation(s)
- Kobi V. Ajayi
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
- Laboratory of Community Health Evaluation Science and Systems (CHESS), Texas A&M University, College Station, TX, United States
- Educating, Directing, Empowerment & Nurturing (EDEN) Foundation, Abuja, Nigeria
| | - Sonya Panjwani
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
- Laboratory of Community Health Evaluation Science and Systems (CHESS), Texas A&M University, College Station, TX, United States
| | - Whitney Garney
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
- Laboratory of Community Health Evaluation Science and Systems (CHESS), Texas A&M University, College Station, TX, United States
| | - Carly E. McCord
- Department of Psychiatry, College of Medicine, Texas A&M University, Bryan, TX, United States
- Department of Educational Psychology, College of Education, Texas A&M University, College Station, TX, United States
- Corresponding author at: Department of Psychiatry, Department of Educational Psychology, Texas A&M University, 8441 Riverside Parkway, Clinical Building 1, Suite 2580, Bryan, TX 77807, United States.
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Mitchell KAR, Brassil KJ, Osborne ML, Lu Q, Brown RF. Understanding racial-ethnic differences in patient-centered care (PCC) in oncology through a critical race theory lens: A qualitative comparison of PCC among Black, Hispanic, and White cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2346-2354. [PMID: 34857428 PMCID: PMC9117574 DOI: 10.1016/j.pec.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Patient-centered care (PCC) experiences can vary by race and ethnicity and likely contribute to cancer care disparities. We compared PCC concepts between Non-Hispanic White (White), Hispanic, and Non-Hispanic Black (Black) cancer patients utilizing Critical Race Theory (CRT) to understand the relationships between racial-ethnic identity and PCC. METHODS A thematic analysis and in-depth CRT-informed analysis of individual interviews exploring patient values, unmet needs, preferences, and priorities were performed. RESULTS Participants were aged> 25 yrs old, 53% male, and included 5 Hispanic, 4 Black and 6 White cancer patients. Unmet needs for time to make decisions, and provider interaction between visits and the value for finding meaning in the illness emerged among Blacks and Whites. The unmet need for a long-term treatment plan emerged among Blacks, and the preference of research participation among Whites. A value for optimism was observed among Hispanics and Whites. Racial-ethnic variations in patient descriptions and experiences of their values, unmet needs, preferences, and priorities were identified. CONCLUSIONS Underrepresented groups face subtle but significant challenges in feeling cared for and understood, voicing concerns, and obtaining quality care. PRACTICE IMPLICATIONS Increased mutual understanding and provider knowledge of unique PCC experiences among underrepresented cancer patients are needed.
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Affiliation(s)
| | | | | | - Qian Lu
- Department of Health Disparities Research, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Expectations and Preferences for Psychotherapy Among African American and White Young Adults. J Racial Ethn Health Disparities 2020; 8:678-689. [PMID: 32729105 DOI: 10.1007/s40615-020-00827-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/22/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study examined beliefs, expectations, and preferences related to mental health problems and treatment in a sample of young adults who are in a developmental period when many types of psychopathology emerge. Prior studies on this topic have primarily included samples that are older and predominately White. It is not clear whether results from that research generalize to diverse samples of young adults. METHODS Participants were 370 undergraduate students (41.3% African American; 76.5% female) who completed questionnaires about expectations and preferences for psychotherapy and therapists. RESULTS Findings regarding racial differences include African Americans having less experience with mental health services and different goals for psychotherapy than did Whites. Additionally, African Americans, relative to Whites, demonstrated stronger preferences for couple, family, and group psychotherapy, a male therapist their same race, and a therapist who is assertive and structured in session. CONCLUSIONS The results of this study provide information about young adults' perceptions, expectations, and preferences related to mental health problems and psychotherapy. Findings suggest some barriers to treatment that might be addressed to improve treatment engagement and utilization of psychological services among young adults in general and among African American young adults specifically.
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Üzar‐Özçetin YS, Tee S. A PRISMA‐Drıven Systematıc Revıew for Determınıng Cross‐Cultural Mental Health Care. Int J Nurs Knowl 2020; 31:150-159. [DOI: 10.1111/2047-3095.12273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/05/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Stephen Tee
- Faculty of Health and Social Sciences, The Business SchoolBournemouth University Poole UK
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Takasaki H, Miki T, Hall T. Development of the Working Alliance Inventory-Short Form Japanese version through factor analysis and test-retest reliability. Physiother Theory Pract 2018; 36:444-449. [PMID: 29913071 DOI: 10.1080/09593985.2018.1487492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Working alliance between the physiotherapist and patient is important for successful treatment in physiotherapy. Working alliance can be measured by a 12-item self-reporting measure with 7-point Likert scale, the Working Alliance Inventory Short-Form Client (WAI-SC). Objectives: To develop a shorter version of the Japanese WAI-SC through examination of factor structure and test-retest reliability. Design: Survey. Method: A convenience sample of 118 outpatients with musculoskeletal disorders completed the WAI-SC immediately after the third consultation and 101 of them completed the WAI-SC immediately before the fourth consultation. Results/findings: Through investigations of internal consistency, test-retest reliability, and factor structure, a single structure was detected by excluding Item 4 and Item 10. Score calculation was also modified to dichotomous variables (Score 7 or other scores) due to serious ceiling effects, where >50% of responses were Score 7. A five-item questionnaire with dichotomous score rating (Modified WAI-SC Japanese musculoskeletal version) was developed through consideration of internal consistency and item-total correlation analysis. This questionnaire demonstrated adequate internal consistency (Cronbach's α = 0.88) and excellent test-retest reliability for each item (Cohen's κ for all > 0.4) and total scores (intraclass correlation coefficient = 0.84). Conclusions: The five-item Modified WAI-SC Japanese musculoskeletal version was developed with a single factor structure showing adequate internal consistency and excellent test-retest reliability.
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Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan.,Department of Rehabilitation, Aoki Chuo Clinic, Kawaguchi, Japan
| | - Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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Cavalier J, Hampton SB, Langford R, Symes L, Young A. The Influence of Race and Gender on Nursing Care Decisions: A Pain Management Intervention. Pain Manag Nurs 2018; 19:238-245. [DOI: 10.1016/j.pmn.2017.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
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Alegria M, Nakash O, Johnson K, Ault-Brutus A, Carson N, Fillbrunn M, Wang Y, Cheng A, Harris T, Polo A, Lincoln A, Freeman E, Bostdorf B, Rosenbaum M, Epelbaum C, LaRoche M, Okpokwasili-Johnson E, Carrasco M, Shrout PE. Effectiveness of the DECIDE Interventions on Shared Decision Making and Perceived Quality of Care in Behavioral Health With Multicultural Patients: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:325-335. [PMID: 29466533 PMCID: PMC5875387 DOI: 10.1001/jamapsychiatry.2017.4585] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/17/2017] [Indexed: 01/27/2023]
Abstract
Importance Few randomized clinical trials have been conducted with ethnic/racial minorities to improve shared decision making (SDM) and quality of care. Objective To test the effectiveness of patient and clinician interventions to improve SDM and quality of care among an ethnically/racially diverse sample. Design, Setting, and Participants This cross-level 2 × 2 randomized clinical trial included clinicians at level 2 and patients (nested within clinicians) at level 1 from 13 Massachusetts behavioral health clinics. Clinicians and patients were randomly selected at each site in a 1:1 ratio for each 2-person block. Clinicians were recruited starting September 1, 2013; patients, starting November 3, 2013. Final data were collected on September 30, 2016. Data were analyzed based on intention to treat. Interventions The clinician intervention consisted of a workshop and as many as 6 coaching telephone calls to promote communication and therapeutic alliance to improve SDM. The 3-session patient intervention sought to improve SDM and quality of care. Main Outcomes and Measures The SDM was assessed by a blinded coder based on clinical recordings, patient perception of SDM and quality of care, and clinician perception of SDM. Results Of 312 randomized patients, 212 (67.9%) were female and 100 (32.1%) were male; mean (SD) age was 44.0 (15.0) years. Of 74 randomized clinicians, 56 (75.7%) were female and 18 (4.3%) were male; mean (SD) age was 39.8 (12.5) years. Patient-clinician pairs were assigned to 1 of the following 4 design arms: patient and clinician in the control condition (n = 72), patient in intervention and clinician in the control condition (n = 68), patient in the control condition and clinician in intervention (n = 83), or patient and clinician in intervention (n = 89). All pairs underwent analysis. The clinician intervention significantly increased SDM as rated by blinded coders using the 12-item Observing Patient Involvement in Shared Decision Making instrument (b = 4.52; SE = 2.17; P = .04; Cohen d = 0.29) but not as assessed by clinician or patient. More clinician coaching sessions (dosage) were significantly associated with increased SDM as rated by blinded coders (b = 12.01; SE = 3.72; P = .001; Cohen d = 0.78). The patient intervention significantly increased patient-perceived quality of care (b = 2.27; SE = 1.16; P = .05; Cohen d = 0.19). There was a significant interaction between patient and clinician dosage (b = 7.40; SE = 3.56; P = .04; Cohen d = 0.62), with the greatest benefit when both obtained the recommended dosage. Conclusions and Relevance The clinician intervention could improve SDM with minority populations, and the patient intervention could augment patient-reported quality of care. Trial Registration clinicaltrials.gov Identifier: NCT01947283.
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Affiliation(s)
- Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ora Nakash
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
- Baruch Ivcher School of Psychology Interdisciplinary Center, Herzliya, Israel
| | - Kirsten Johnson
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Andrea Ault-Brutus
- Mental Health Innovation Laboratory, New York City Department of Health and Mental Hygiene, New York City, New York
| | - Nicholas Carson
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Mirko Fillbrunn
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
| | - Alice Cheng
- Department of Psychology, University of Hartford, Hartford, Connecticut
| | - Treniece Harris
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Antonio Polo
- Department of Psychology, DePaul University, Chicago, Illinois
| | - Alisa Lincoln
- Department of Sociology and Heath Sciences, Institute on Urban Health Research, Northeastern University, Boston, Massachusetts
| | - Elmer Freeman
- Office of Urban Health Programs, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
- Center for Community Health Education Research and Service, Inc, Northeastern University, Boston, Massachusetts
| | | | | | - Claudia Epelbaum
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Martin LaRoche
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
| | | | | | - Patrick E. Shrout
- Department of Psychology, New York University, New York City, New York
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Villalobos O, Lynch S, DeBlieck C, Summers L. Utilization of a Mobile App to Assess Psychiatric Patients With Limited English Proficiency. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2017. [DOI: 10.1177/0739986317707490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The interactions in mental health involve a significant exchange of information to identify symptoms and formulate a working diagnosis. The inability of patients to communicate due to language limitations may lead to situations that will be detrimental, such as receiving the wrong diagnosis or treatment due to the inadequate translation from English to Spanish. A practice change was proposed where health care personnel utilized mobile technology such as the Canopy Translation App to assess the psychiatric symptoms of Spanish-speaking patients with limited English proficiency. Participants completed the System Usability Scale (SUS) to determine whether they found the Canopy Translation App useful during their assessments of Spanish-speaking patients. According to the SUS scores, participants found the Canopy Translation App useful during their interactions with Spanish-speaking patients. The findings emphasize the importance of exploring new resources and technologies to ameliorate language barriers.
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Bastemeijer CM, Voogt L, van Ewijk JP, Hazelzet JA. What do patient values and preferences mean? A taxonomy based on a systematic review of qualitative papers. PATIENT EDUCATION AND COUNSELING 2017; 100:871-881. [PMID: 28043713 DOI: 10.1016/j.pec.2016.12.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/16/2016] [Accepted: 12/17/2016] [Indexed: 05/11/2023]
Abstract
OBJECTIVE In order to deliver good healthcare quality, it should explicitly be taken into account what patients value in healthcare. This study reviews qualitative studies in which patients express what they value. Based on this body of literature a preliminary taxonomy is designed. METHODS A systematic review of qualitative papers on what patients' value. RESULTS 22 studies out of a total of 3259 met the inclusion criteria. After critical appraisal, data extraction was carried out by two researchers independently and revealed values related to 1) the individual patient; 2) the expected behavior of professionals and 3) the interaction between patients and professionals. Seven key elements were recognized on the bases of content analysis; 1) uniqueness, 2) autonomy, 3) compassion, 4) professionalism, 5) responsiveness, 6) partnership and 7) empowerment. CONCLUSION This study gives a rich insight into what patients value in various contexts and provides a promising taxonomy in line with patient centered based theories. The taxonomy needs further empirical research for a deeper insight and clarifaction in its elements. PRACTICE IMPLICATIONS This review and preliminary taxonomy contribute to the conceptualization of patient values as a bases for guidelines, policy and daily practice.
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Affiliation(s)
- Carla M Bastemeijer
- Department of Normative Professionalization, University of Humanistic Studies, Utrecht, The Netherlands.
| | - Lennard Voogt
- Department of Physical Therapy Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Johannes P van Ewijk
- Department of Normative Professionalization, University of Humanistic Studies, Utrecht, The Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Alvarez K, Wang Y, Alegria M, Ault-Brutus A, Ramanayake N, Yeh YH, Jeffries JR, Shrout PE. Psychometrics of shared decision making and communication as patient centered measures for two language groups. Psychol Assess 2016; 28:1074-86. [PMID: 27537002 PMCID: PMC5431590 DOI: 10.1037/pas0000344] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Shared decision making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient's perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of 2 patient-centered outcome measures, the Shared Decision-Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the 2 language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the 2 groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. (PsycINFO Database Record
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | | | - Natasha Ramanayake
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Yi-Hui Yeh
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
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12
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Keller AO, Valdez CR, Schwei RJ, Jacobs EA. Disclosure of Depression in Primary Care: A Qualitative Study of Women's Perceptions. Womens Health Issues 2016; 26:529-36. [PMID: 27531601 DOI: 10.1016/j.whi.2016.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Health care providers are better able to diagnose depression and initiate treatment when patients disclose symptoms. However, many women are reluctant to disclose depressive symptoms. Little is known about the experience of disclosing depression symptoms in primary care among racially and ethnically diverse women across the life course. We qualitatively explore experiences of disclosure of depressive symptoms to primary care providers among self-identified African American, Hispanic and non-Hispanic White women. METHODS Twenty-four women with depression were recruited for open-ended interviews. We recorded, transcribed, and coded interviews using inductive content analysis. FINDINGS Two distinct domains emerged: participant factors that hinder and facilitate disclosure and provider cues that encourage and dissuade discussing depression. Participants described perceptions about primary care not being the appropriate place, fear of not having a choice in treatment decisions, and the emotional cost of retelling as impediments to disclosure; perceiving an increased likelihood of getting help was described as a facilitator. Women identified provider behaviors of asking about depression and showing concern as facilitators, and provider time constraints as a barrier to disclosure. CONCLUSIONS Women perceive that primary care is not the appropriate place to disclose depression symptoms. Increased public education about behavioral health management in primary care, as well as more robust integration of the two, is needed. Efforts to improve depression disclosure in primary care must also encompass systematic use of depression screening tools and implementation of targeted interventions to cultivate provider empathy.
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Affiliation(s)
- Abiola O Keller
- Department of Physician Assistant Studies, Marquette University, Milwaukee, Wisconsin.
| | - Carmen R Valdez
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rebecca J Schwei
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Elizabeth A Jacobs
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Alegría M, Alvarez K, Ishikawa RZ, DiMarzio K, McPeck S. Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care. Health Aff (Millwood) 2016; 35:991-9. [PMID: 27269014 PMCID: PMC5027758 DOI: 10.1377/hlthaff.2016.0029] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite decades of research, racial and ethnic disparities in behavioral health care persist. The Affordable Care Act expanded access to behavioral health care, but many reform initiatives fail to consider research about racial/ethnic minorities. Mistaken assumptions that underlie the expansion of behavioral health care run the risk of replicating existing service disparities. Based on a review of relevant literature and numerous observational and field studies with minority populations, we identified the following three mistaken assumptions: Improvement in health care access alone will reduce disparities, current service planning addresses minority patients' preferences, and evidence-based interventions are readily available for diverse populations. We propose tailoring the provision of care to remove obstacles that minority patients face in accessing treatment, promoting innovative services that respond to patients' needs and preferences, and allowing flexibility in evidence-based practice and the expansion of the behavioral health workforce. These proposals should help meet the health care needs of a growing racial/ethnic minority population.
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Affiliation(s)
- Margarita Alegría
- Margarita Alegría is a professor of psychology in the Department of Psychiatry at Harvard Medical School and chief of the Disparities Research Unit, Department of Medicine, at Massachusetts General Hospital (MGH), both in Boston
| | - Kiara Alvarez
- Kiara Alvarez is a postdoctoral research fellow in the Disparities Research Unit, Department of Medicine, at MGH
| | - Rachel Zack Ishikawa
- Rachel Zack Ishikawa is project director in the Disparities Research Unit, Department of Medicine, at MGH
| | - Karissa DiMarzio
- Karissa DiMarzio is a research assistant in the Disparities Research Unit, Department of Medicine, at MGH
| | - Samantha McPeck
- Samantha McPeck is a research assistant in the Disparities Research Unit, Department of Medicine, at MGH
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Aggarwal NK, Cedeño K, Guarnaccia P, Kleinman A, Lewis-Fernández R. The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators. SPRINGERPLUS 2016; 5:384. [PMID: 27065092 PMCID: PMC4814393 DOI: 10.1186/s40064-016-2037-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Abstract
Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders. We conducted separate focus groups with patients, clinicians, and administrators from the psychiatry department at one community hospital and compared responses to hospital policies. Stakeholders defined cultural competence through group-based or person-centered traits despite policies recommended person-centered approaches. Administrators and clinicians named clinician techniques for psycho-education whereas patients named these techniques for enlistment in treatment planning as equals. All groups named patient cultural views and institutional challenges as barriers to care, but only patients and administrators additionally named clinician biases as possible barriers. We discuss these discrepant perceptions and possible solutions to improve research, practice, and policy on cultural competence in mental health.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University, 1051 Riverside Drive, Unit 11, New York, NY 10032 USA ; New York State Psychiatric Institute, New York, NY USA
| | - Kryst Cedeño
- New York State Psychiatric Institute, New York, NY USA
| | - Peter Guarnaccia
- Department of Human Ecology, Rutgers, The State University of New Jersey, Newark, NJ USA
| | - Arthur Kleinman
- Department of Social Medicine, Harvard University, Cambridge, MA USA
| | - Roberto Lewis-Fernández
- Columbia University Medical Center, New York, NY USA ; NYS Center of Excellence for Cultural Competence, and Hispanic Treatment Program, New York State Psychiatric Institute, New York, NY USA
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15
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The Influence of Race and Gender on Pain Management: A Systematic Literature Review. Pain Manag Nurs 2015; 16:968-77. [DOI: 10.1016/j.pmn.2015.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/22/2015] [Accepted: 06/29/2015] [Indexed: 11/24/2022]
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16
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Jensen NK, Johansen KS, Kastrup M, Krasnik A, Norredam M. Patient experienced continuity of care in the psychiatric healthcare system-a study including immigrants, refugees and ethnic danes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:9739-59. [PMID: 25233017 PMCID: PMC4199047 DOI: 10.3390/ijerph110909739] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/29/2014] [Accepted: 09/10/2014] [Indexed: 11/17/2022]
Abstract
Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. Conclusions: The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.
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Affiliation(s)
- Natasja Koitzsch Jensen
- The Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, Copenhagen University, Øster Farimagsgade 5, Copenhagen 1014, Denmark.
| | - Katrine Schepelern Johansen
- KORA, The Danish Institute for Local and Regional Government Research, Købmagergade 22, Copenhagen 1150, Denmark.
| | - Marianne Kastrup
- Competence Center for Transcultural Psychiatry, Psychiatric Center Ballerup, Niels Andersens Vej 65, Hellerup 2900, Denmark.
| | - Allan Krasnik
- The Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, Copenhagen University, Øster Farimagsgade 5, Copenhagen 1014, Denmark.
| | - Marie Norredam
- The Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, Copenhagen University, Øster Farimagsgade 5, Copenhagen 1014, Denmark.
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17
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De Jesus M, Earl TR. Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care. Int J Qual Stud Health Well-being 2014; 9:22839. [PMID: 24461570 PMCID: PMC3901388 DOI: 10.3402/qhw.v9.22839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 11/14/2022] Open
Abstract
Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.
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Affiliation(s)
- Maria De Jesus
- School of International Service, Center on Health, Risk, and Society, American University, Washington, DC, USA;
| | - Tara R Earl
- ICF International, Inc., Division of Public Health and Survey Research, Atlanta, GA, USA; Cambridge Health Alliance, Center for Multicultural Mental Health Research, Harvard Medical School, MA, USA
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18
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Abstract
Despite federal focus on reducing mental health disparities for Black Americans, mental health disparities persist, resulting in reduced access to and benefit from mental health care. Amid calls for deeper examination of etiology, the current literature review introduces discrimination in the form of microaggressions at the institutional level as one changeable systemic cause for mental health disparities. In combining the mental health disparity and microaggression literatures, I first review the evidence regarding prevalence and contributing factors for current mental health disparities and microaggressions. Next, I examine the potential contributing role that microaggressions as a form of institutional betrayal within mental health care may play in perpetuating these disparities. Finally, I review implications regarding the particular role of mental health care systems, the field of psychology in general, and Black American psychologists specifically in systematically reducing mental health disparities for Black Americans.
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Keller AO, Gangnon R, Witt WP. The impact of patient-provider communication and language spoken on adequacy of depression treatment for U.S. women. HEALTH COMMUNICATION 2013; 29:646-655. [PMID: 24147987 PMCID: PMC3991757 DOI: 10.1080/10410236.2013.795885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many women with depression are untreated or undertreated for their condition. The quality of patient-provider communication may impact the receipt of depression treatment. We examine the relationship between patient-provider communication and receipt of adequate treatment for depression among women. The study sample consisted of women with depression who visited a provider in the previous 12 months in the 2002-2008 Medical Expenditure Panel Survey (N = 3,179). Multivariate regression was used to examine the independent contribution of sociodemographic characteristics, health care factors, patient-provider communication, and respondent language on depression treatment status (none, some, adequate). We found that more than one-third of women with depression in the United States did not receive adequate treatment. Women reporting that providers usually or always listened carefully were more likely to receive adequate treatment (OR = 1.59; 95% CI = 1.10-2.30 and OR = 1.55; 95% CI = 1.07-2.23, respectively). Non-English-speaking women were 50% less likely to receive adequate treatment (OR = 0.49; 95% CI = 0.30-0.80). Having a usual source of care was associated with an increased likelihood of receiving some and adequate treatment (OR = 1.84; 95% CI = 1.24-2.73 and OR = 2.22; 95% CI = 1.61-3.05, respectively). Effective provider listening behaviors may help increase the number of U.S. women with depression who receive adequate treatment. Efforts to improve language access for limited English-proficient women are likely critical for improving treatment outcomes in this population. Additionally, ensuring that women with depression have consistent access to health care services is important for obtaining adequate depression care.
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Affiliation(s)
- Abiola O Keller
- a Center for Women's Health and Health Disparities Research and Health Innovation Program , University of Wisconsin-Madison
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20
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Thompson R, Dancy BL, Wiley TRA, Najdowski CJ, Perry SP, Wallis J, Mekawi Y, Knafl KA. African American families' expectations and intentions for mental health services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 40:371-83. [PMID: 22791083 PMCID: PMC3482279 DOI: 10.1007/s10488-012-0429-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A cross-sectional qualitative descriptive design was used to examine the links among expectations about, experiences with, and intentions toward mental health services. Individual face-to-face interviews were conducted with a purposive sample of 32 African American youth/mothers dyads. Content analysis revealed that positive expectations were linked to positive experiences and intentions, that negative expectations were not consistently linked to negative experiences or intentions, nor were ambivalent expectations linked to ambivalent experiences or intentions. Youth were concerned about privacy breeches and mothers about the harmfulness of psychotropic medication. Addressing these concerns may promote African Americans' engagement in mental health services.
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Affiliation(s)
- Richard Thompson
- Juvenile Protective Association, 1707 N Halsted, Chicago, IL 60614, USA.
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21
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Traeger L, Cannon S, Pirl WF, Park ER. Depression and undertreatment of depression: potential risks and outcomes in black patients with lung cancer. J Psychosoc Oncol 2013; 31:123-35. [PMID: 23514250 DOI: 10.1080/07347332.2012.761320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the United States, Black men are at higher risk than White men for lung cancer mortality whereas rates are comparable between Black and White women. This article draws from empirical work in lung cancer, mental health, and health disparities to highlight that race and depression may overlap in predicting lower treatment access and utilization and poorer quality of life among patients. Racial barriers to depression identification and treatment in the general population may compound these risks. Prospective data are needed to examine whether depression plays a role in racial disparities in lung cancer outcomes.
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Affiliation(s)
- Lara Traeger
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital, Boston, MA, USA.
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22
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Stone L. Making sense of medically unexplained symptoms in general practice: a grounded theory study. MENTAL HEALTH IN FAMILY MEDICINE 2013; 10:101-111. [PMID: 24427176 PMCID: PMC3822641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/24/2013] [Indexed: 06/03/2023]
Abstract
Background General practitioners often encounter patients with medically unexplained symptoms. These patients share many common features, but there is little agreement about the best diagnostic framework for describing them. Aims This study aimed to explore how GPs make sense of medically unexplained symptoms. Design Semi-structured interviews were conducted with 24 GPs. Each participant was asked to describe a patient with medically unexplained symptoms and discuss their assessment and management. Setting The study was conducted among GPs from teaching practices across Australia. Methods Participants were selected by purposive sampling and all interviews were transcribed. Iterative analysis was undertaken using constructivist grounded theory methodology. Results GPs used a variety of frameworks to understand and manage patients with medically unexplained symptoms. They used different frameworks to reason, to help patients make sense of their suffering, and to communicate with other health professionals. GPs tried to avoid using stigmatising labels such as 'borderline personality disorder', which were seen to apply a 'layer of dismissal' to patients. They worried about missing serious physical disease, but managed the risk by deliberately attending to physical cues during some consultations, and focusing on coping with medically unexplained symptoms in others. They also used referrals to exclude serious disease, but were wary of triggering a harmful cycle of uncoordinated care. Conclusion GPs were aware of the ethical relevance of psychiatric diagnoses, and attempted to protect their patients from stigma. They crafted helpful explanatory narratives for patients that shaped their experience of suffering. Disease surveillance remained an important role for GPs who were managing medically unexplained symptoms.
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Affiliation(s)
- Louise Stone
- General Practice Education and Training Ltd, Canberra, ACT, Australia
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23
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Gonçalves M, Cook B, Mulvaney-Day N, Alegría M, Kinrys G. Retention in mental health care of Portuguese-speaking patients. Transcult Psychiatry 2013; 50:92-107. [PMID: 23427258 PMCID: PMC3685501 DOI: 10.1177/1363461512474622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005-2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients.
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Affiliation(s)
- Marta Gonçalves
- Centre for Social Research and Intervention, Instituto Universitário de Lisboa, Lisbon, Portugal.
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Shim RS, Baltrus P, Bradford LD, Holden KB, Fresh E, Fuller LE. Characterizing depression and comorbid medical conditions in African American women in a primary care setting. J Natl Med Assoc 2013; 105:183-91. [PMID: 24079219 PMCID: PMC4039195 DOI: 10.1016/s0027-9684(15)30106-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND African American women are more likely to seek treatment for depression in primary care settings; however, few women receive guideline-concordant depression treatment in these settings. This investigation focused on the impact of depression on overall functioning in African American women in a primary care setting. METHODS Data was collected from a sample of 507 African American women in the waiting room of an urban primary care setting. The majority of women were well-educated, insured, and employed. The CESD-R was used to screen for depression, and participants completed the 36-Item Short-Form Survey to determine functional status. RESULTS Among the participants with depression, there was greater functional impairment for role-physical (z = -0.88, 95% CI = -1.13, -0.64) when compared to individuals with diabetes and hypertension. Individuals with depression also had greater role-emotional impairment (z = -1.12, 95% CI = -1.37, -0.87) than individuals with diabetes and hypertension. African American women with comorbid hypertension and depression had greater functional impairment in role-physical when compared to African American women with hypertension and no depression (t(124) = -4.22, p < 0.01). CONCLUSION African American women with depression are more likely to present with greater functional impairment in role function when compared to African American women with diabetes or hypertension. Because African American women often present to primary care settings for treatment of mental illness, primary care providers need to have a clear understanding of the population, as well as the most effective and appropriate interventions.
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Affiliation(s)
- Ruth S Shim
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA.
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Alegria M, Lin J, Chen CN, Duan N, Cook B, Meng XL. The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services. Health Serv Res 2012; 47:1322-44. [PMID: 22568675 PMCID: PMC3418830 DOI: 10.1111/j.1475-6773.2012.01403.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate whether racial/ethnic behavioral health service disparities are likely to be reduced through insurance expansion coverage expected through the Affordable Health Care Act. DATA SOURCES Pooled data from the nationally representative NIMH Collaborative Psychiatric Epidemiological Studies (2001-2003). STUDY DESIGN We employ a novel reweighting method to estimate service disparities in the presence and absence of insurance coverage. DATA COLLECTION Access to care was assessed by whether any behavioral health treatment was received in the past year. Need was determined by presence of prior year psychiatric disorder, psychiatric diagnoses, physical comorbidities, gender, and age. PRINCIPAL FINDINGS Improving patient education and availability of community clinics, combined with insurance coverage reduces service disparities across racial/ethnic groups.However, even with expanded insurance coverage, approximately 10 percent fewer African Americans with need for behavioral health services are likely to receive services compared to non-Latino whites while Latinos show no measurable disparity. CONCLUSIONS Expansion of insurance coverage might have different effects for racial/ethnic groups, requiring additional interventions to reduce disparities for all groups.
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Affiliation(s)
- Margarita Alegria
- Department of Psychiatry, Harvard Medical School and Cambridge Health Alliance, 120 Beacon St., 4th Floor, Somerville, MA 02143, USA.
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Rosen DC, Miller AB, Nakash O, Halpern L, Halperin L, Alegría M. Interpersonal complementarity in the mental health intake: a mixed-methods study. J Couns Psychol 2012; 59:185-96. [PMID: 22268575 DOI: 10.1037/a0027045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The study examined which socio-demographic differences between clients and providers influenced interpersonal complementarity during an initial intake session; that is, behaviors that facilitate harmonious interactions between client and provider. Complementarity was assessed using blinded ratings of 114 videotaped intake sessions by trained observers. Hierarchical linear models were used to examine how match between client and provider in race/ethnicity, sex, and age were associated with levels of complementarity. A qualitative analysis investigated potential mechanisms that accounted for overall complementarity beyond match by examining client-provider dyads in the top and bottom quartiles of the complementarity measure. Results indicated significant interactions between client's race/ethnicity (Black) and provider's race/ethnicity (Latino) (p = .036) and client's age and provider's age (p = .044) on the Affiliation axis. The qualitative investigation revealed that client-provider interactions in the upper quartile of complementarity were characterized by consistent descriptions between the client and provider of concerns and expectations as well as depictions of what was important during the meeting. Results suggest that differences in social identities, although important, may be overcome by interpersonal variables early in the therapeutic relationship. Implications for both clinical practice and future research are discussed, as are factors relevant to working across cultures.
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Affiliation(s)
- Daniel C Rosen
- Counseling and Health Psychology, Bastyr University, 14500 Juanita Drive NE, Kenmore, WA 98028-4966, USA. :
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Thompson R, Dancy BL, Wiley TRA, Perry SP, Najdowski CJ. The experience of mental health service use for African American mothers and youth. Issues Ment Health Nurs 2011; 32:678-86. [PMID: 21992259 DOI: 10.3109/01612840.2011.595534] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little is known about African American families' experiences with mental health services. A purposive sample of 40 dyads of African American youth (aged 13 to 19) and their mothers participated in a cross-sectional qualitative research design using semi-structured interviews that elicited information about their past experiences and satisfaction with mental health services. Though rarely received, group and family therapy were perceived favorably. However, both mothers and youth reported dissatisfaction centered on medication and lack of professionalism, confidentiality, and concern by providers. The failure of mental health services providers to meet basic standards of quality and professionalism may explain the low rate of service use by African Americans.
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