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Miola RE, Morgan MR, Green MN, Ross RN. Post-Traumatic Stress Across Color Lines: A History of Anti-Black Exclusion & PTSD. Community Ment Health J 2025:10.1007/s10597-025-01450-3. [PMID: 39849220 DOI: 10.1007/s10597-025-01450-3] [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: 07/20/2024] [Accepted: 01/02/2025] [Indexed: 01/25/2025]
Abstract
Black Americans with Posttraumatic Stress Disorder have less access to mental healthcare compared to White Americans. Many factors contribute to this inequity, including broader disparities within the healthcare system driven by systemic racism, and an underutilization of mental health services by Black Americans due to provider bias and stigma around mental health care. These disparities are rooted in a racist historical context of exclusion and abuse of the Black community by the White psychiatric establishment, and a perpetration of further trauma on Black clients, a context that is largely missing from traditional mental health education and literature on Black mental health today. This article aims to provide a necessary historical context of how the U.S. mental health care system has excluded Black Americans from trauma treatment. We use a contemporary trauma lens to demonstrate the ways in which Black trauma has existed throughout U.S. history, but how White psychiatry has cast trauma symptoms as evidence of racial inferiority, has excluded Black individuals from treatment, and has abused Black patients, thereby increasing Black trauma. The purpose of this review is to inform and educate mental health providers about our collective history, to counter a narrative of amnesia which identifies Black underutilization of services but forgets the exclusion from and abuse of Black people within the mental health system. We conclude with recommendations that providers can utilize to engage in antiracist practice and create an affirmative space for Black Americans to utilize trauma treatment and mental health care freely.
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Affiliation(s)
- Rose E Miola
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA.
| | - Matthew R Morgan
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - McKenzie N Green
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Rayelle N Ross
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
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2
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van der Ven E, Olino TM, Diehl K, Nuñez SM, Thayer G, Bridgwater MA, Ereshefsky S, Musket C, Lincoln SH, Rogers RT, Klaunig MJ, Soohoo E, DeVylder JE, Grattan RE, Schiffman J, Ellman LM, Niendam TA, Anglin DM. Ethnoracial Risk Variation Across the Psychosis Continuum in the US: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:447-455. [PMID: 38381422 PMCID: PMC10882506 DOI: 10.1001/jamapsychiatry.2023.5497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/26/2023] [Indexed: 02/22/2024]
Abstract
Importance Studies suggest a higher risk of schizophrenia diagnoses in Black vs White Americans, yet a systematic investigation of disparities that include other ethnoracial groups and multiple outcomes on the psychosis continuum is lacking. Objective To identify ethnoracial risk variation in the US across 3 psychosis continuum outcomes (ie, schizophrenia and other psychotic disorders, clinical high risk for psychosis [CHR-P], and psychotic symptoms [PSs] and psychotic experiences [PEs]). Data Sources PubMed, PsycINFO and Embase were searched up to December 2022. Study Selection Observational studies on ethnoracial differences in risk of 3 psychosis outcomes. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Using a random-effects model, estimates for ethnoracial differences in schizophrenia and PSs/PEs were pooled and moderation by sampling and setting was determined, along with the assessment of heterogeneity and risk of bias. Main Outcomes and Measures Risk of schizophrenia and other psychotic disorder, CHR-P, and conversion to psychosis among CHR-P and PSs/PEs. Results Of 64 studies in the systematic review, 47 were included in the meta-analysis comprising 54 929 people with schizophrenia and 223 097 with data on PSs/PEs. Compared with White individuals, Black individuals had increased risk of schizophrenia (pooled odds ratio [OR], 2.07; 95% CI, 1.64-2.61) and PSs/PEs (pooled standardized mean difference [SMD], 0.10; 95% CI, 0.03-0.16), Latinx individuals had higher risk of PSs/PEs (pooled SMD, 0.15; 95% CI, 0.08-0.22), and individuals classified as other ethnoracial group were at significantly higher risk of schizophrenia than White individuals (pooled OR, 1.81; 95% CI, 1.31-2.50). The results regarding CHR-P studies were mixed and inconsistent. Sensitivity analyses showed elevated odds of schizophrenia in Asian individuals in inpatient settings (pooled OR, 1.84; 95% CI, 1.19-2.84) and increased risk of PEs among Asian compared with White individuals, specifically in college samples (pooled SMD, 0.16; 95% CI, 0.02-0.29). Heterogeneity across studies was high, and there was substantial risk of bias in most studies. Conclusions and Relevance Findings of this systematic review and meta-analysis revealed widespread ethnoracial risk variation across multiple psychosis outcomes. In addition to diagnostic, measurement, and hospital bias, systemic influences such as structural racism should be considered as drivers of ethnoracial disparities in outcomes across the psychosis continuum in the US.
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Affiliation(s)
- Els van der Ven
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Thomas M. Olino
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Katharina Diehl
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Stephanie M. Nuñez
- Department of Psychology, The City College of New York, City University of New York, New York
| | - Griffin Thayer
- Department of Psychology, The City College of New York, City University of New York, New York
| | | | - Sabrina Ereshefsky
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Christie Musket
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Sarah Hope Lincoln
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - R. Tyler Rogers
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Mallory J. Klaunig
- Department of Psychological Science, University of California, Irvine, Irvine
| | - Emily Soohoo
- Department of Biological Sciences, San Jose State University, San Jose, California
| | | | - Rebecca E. Grattan
- School of Psychology, Victoria University of Wellington–Te Herenga Waka, Wellington, New Zealand
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine
| | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Deidre M. Anglin
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
- The Graduate Center, City University of New York, New York
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3
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Gooding DC, Mohrbacher DA, Umucu E, Van Hulle CA, Lewis JP, Carter FP, Gleason CE. Ethnoracialized group differences in attitudes and knowledge about schizophrenia and willingness to engage in biomarker research: The UBIGR Study. Psychiatry Res 2024; 334:115776. [PMID: 38377801 PMCID: PMC11835010 DOI: 10.1016/j.psychres.2024.115776] [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: 11/21/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
Although there is renewed optimism in biomarker research in schizophrenia, there is also need for greater inclusion of historically underrepresented groups in the research. In the present study, we surveyed 599 African American, 352 American Indian/Alaska Native, and 725 NonHispanic White participants about their attitudes toward research, knowledge and attitudes about schizophrenia, and willingness to engage in biomarker testing. Attitudes toward research were examined using the standardized 7-item Research Attitudes Questionnaire (RAQ) measure. Using structural equation modeling (SEM), we tested our predictive model of the likelihood of willingness to engage in biomarker testing for schizophrenia risk. Members of historically underrepresented groups were less willing to engage in biomarker testing. Overall, attitudes toward research, particularly trust, influenced biomarker testing willingness. These findings suggest that factors influencing willingness to engage in schizophrenia biomarker testing may be modifiable by outreach engagement and education.
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Affiliation(s)
- Diane Carol Gooding
- Department of Psychology, UW-Madison, Madison, WI, USA; Department of Psychiatry, SMPH, UW-Madison, Madison, WI, USA; Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA.
| | - Denise A Mohrbacher
- Department of Population Health Sciences, SMPH, UW-Madison, Madison, WI, USA
| | - Emre Umucu
- Department of Public Health Sciences, University of Texas - El Paso, TX, USA
| | - Carol A Van Hulle
- Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA
| | - Jordan P Lewis
- Memory Keepers Medical Discovery Team, Dept of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth campus, MN, USA
| | - Fabu P Carter
- Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA
| | - Carey E Gleason
- Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA; Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial VA Hospital, UW-Madison, WI, USA
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4
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Li K, Richards E, Goes FS. Racial differences in the major clinical symptom domains of bipolar disorder. Int J Bipolar Disord 2023; 11:17. [PMID: 37166695 PMCID: PMC10175527 DOI: 10.1186/s40345-023-00299-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Across clinical settings, black individuals are disproportionately less likely to be diagnosed with bipolar disorder compared to schizophrenia, a traditionally more severe and chronic disorder with lower expectations for remission. The causes of this disparity are likely multifactorial, ranging from the effects of implicit bias, to developmental and lifelong effects of structural racism, to differing cultural manifestations of psychiatric symptoms and distress. While prior studies examining differences have found a greater preponderance of specific psychotic symptoms (such as persecutory delusions and hallucinations) and a more dysphoric/mixed mania presentation in Black individuals, these studies have been limited by a lack of systematic phenotypic assessment and small sample sizes. In the current report, we have combined data from two large multi-ethnic studies of bipolar disorder with comparable semi-structured interviews to investigate differences in symptoms presentation across the major clinical symptom domains of bipolar disorder. RESULTS In the combined meta-analysis, there were 4423 patients diagnosed with bipolar disorder type I, including 775 of self-reported as Black race. When symptom presentations were compared in Black versus White individuals, differences were found across all the major clinical symptom domains of bipolar disorder. Psychotic symptoms, particularly persecutory hallucinations and both persecutory and mood-incongruent delusions, were more prevalent in Black individuals with bipolar disorder type I (ORs = 1.26 to 2.45). In contrast, Black individuals endorsed fewer prototypical manic symptoms, with a notably decreased likelihood of endorsing abnormally elevated mood (OR = 0.44). Within depression associated symptoms, we found similar rates of mood or cognitive related mood symptoms but higher rates of decreased appetite (OR = 1.32) and weight loss (OR = 1.40), as well as increased endorsement of initial, middle, and early-morning insomnia (ORs = 1.73 to 1.82). Concurrently, we found that black individuals with BP-1 were much less likely to be treated with mood stabilizers, such as lithium (OR = 0.45), carbamazepine (OR = 0.37) and lamotrigine (OR = 0.34), and moderately more likely to be on antipsychotic medications (OR = 1.25). CONCLUSIONS In two large studies spanning over a decade, we found highly consistent and enduring differences in symptoms across the major clinical symptom domains of bipolar disorder. These differences were marked by a greater burden of mood-incongruent psychotic symptoms, insomnia and irritability, and fewer prototypical symptoms of mania. While such symptoms warrant better recognition to reduce diagnostic disparities, they may also represent potential targets of treatment that can be addressed to mitigate persistent disparities in outcome.
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Affiliation(s)
- Kevin Li
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA
| | - Erica Richards
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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5
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Bommersbach TJ, Rhee TG, Stefanovics EA, Rosenheck RA. Comparison of Black and white individuals who report diagnoses of schizophrenia in a national sample of US adults: Discrimination and service use. Schizophr Res 2023; 253:22-29. [PMID: 34088549 DOI: 10.1016/j.schres.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND While there is increasing recognition of disparities in healthcare for Black Americans, there have been no comparisons in a nationally representative U.S. sample of Black and White adults with clinical diagnoses of schizophrenia. METHODS Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, we compared Black (n = 240, 36.2%) and White (n = 423, 63.8%) adults who report having been told by a physician that they have schizophrenia. Due to the large sample size, effect sizes (risk ratios and Cohen's d), rather than p-values, were used to identify the magnitude of differences in sociodemographic and clinical characteristics, including experiences of discrimination and service use. Multivariate analyses were used to identify independent factors. RESULTS Black individuals with diagnoses of schizophrenia reported multiple sociodemographic disadvantages, including lower rates of employment, educational attainment, income, marriage, and social support, with little difference in incarceration, violent behavior, and quality of life. They reported much higher scores on a general lifetime discrimination scale (Cohen's d = 0.75) and subscales representing job discrimination (d = 0.85), health system discrimination (d = 0.70), and public race-based abuse (d = 0.55) along with higher rates of past year alcohol and drug use disorders, but lower rates of co-morbid psychiatric disorders. Multivariable-adjusted regression analyses highlighted the independent association of Black race with measures of discrimination and religious service attendance; less likelihood of receiving psychiatric treatment (p = 0.02) but no difference in substance use treatment. CONCLUSION Black adults with schizophrenia report numerous social disadvantages, especially discrimination, but religious service attendance may be an important social asset.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA
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6
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Psychotic Misdiagnosis of Racially Minoritized Patients: A Case-Based Ethics, Equity, and Educational Exploration. Harv Rev Psychiatry 2023; 31:28-36. [PMID: 36608081 DOI: 10.1097/hrp.0000000000000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The overdiagnosis and misdiagnosis of racially minoritized groups as having a primary psychotic disorder is one of psychiatry's longest-standing inequities born of real-time clinician racial bias. Evidence suggests that providers assign a diagnosis of schizophrenia and/or schizoaffective disorder according to race more than any other demographic variable, and this inequity persists even in the absence of differences in clinician symptom ratings. This case report describes the journey of one young Black woman through her racialized misdiagnosis of schizophrenia and the process by which interdisciplinary, health equity-minded providers across the spectrum of medical education and practice joined together to provide a culturally informed, systematic rediagnosis of major depressive disorder and post-traumatic stress disorder. Expert discussion is provided by three Black academic psychiatrists with expertise in social justice and health equity. We provide an evidence-based exploration of mechanisms of clinician racial bias and detail how the psychosis misdiagnosis of racially minoritized groups fails medical ethics and perpetuates iatrogenic harm to patients who truly need help with primary mood, trauma, and substance use disorders.
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7
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Browne J, Mohamed S. The Impact of Mental Health Intensive Case Management on Functioning and Clinical Outcomes of Older Black and White Veterans With Serious Mental Illness. Am J Geriatr Psychiatry 2022; 30:1183-1194. [PMID: 35365385 DOI: 10.1016/j.jagp.2022.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To examine differences in service delivery, functioning, and clinical outcomes between older Black and White veterans participating in a national Veterans Health Administration (VHA) program of intensive case management. DESIGN Secondary analysis of national program evaluation data. SETTING VHA Intensive Community Mental Health Recovery (ICMHR) program. PARTICIPANTS Black (n = 1327) and White (n = 4402) veterans age 55 and older who enrolled in ICMHR between 2000-2013. MEASUREMENTS Measures evaluated sociodemographic factors, service delivery, functioning, and clinical outcomes. ANOVA and chi-squares were used to evaluate differences in enrollment characteristics and service delivery between Black and White veterans. Regression analyses were used to examine changes in outcomes over 6 months controlling for confounding baseline differences and service delivery. Cohen's d of .20 was used as a threshold for a clinically meaningful effect. RESULTS Black veterans were more likely to be diagnosed with schizophrenia, alcohol use disorder, and drug use disorder. Although case managers spent significantly less time with Black veterans, there was no difference in the frequency of contacts. Medication management and substance use treatment were more often provided to Black veterans. Black veterans experienced substantially greater improvement in anxiety/depression than White veterans with a small effect size (Cohen's d =-0.25). Changes in all other outcome measures did not meet criteria for clinically meaningful differences. CONCLUSIONS Black veterans experienced meaningfully greater improvements than White veterans on anxiety/depression but not on other measures. Provision of high-intensity services in an equal-access setting may reduce health disparities between Black and White older adults with serious mental illness.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center (JB), Durham VA Health Care System, Durham, NC
| | - Somaia Mohamed
- VA New England Mental Illness Research, Education and Clinical Center, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT.
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8
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Anglin DM, Ereshefsky S, Klaunig MJ, Bridgwater MA, Niendam TA, Ellman LM, DeVylder J, Thayer G, Bolden K, Musket CW, Grattan RE, Lincoln SH, Schiffman J, Lipner E, Bachman P, Corcoran CM, Mota NB, van der Ven E. From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States. Am J Psychiatry 2021; 178:599-610. [PMID: 33934608 PMCID: PMC8655820 DOI: 10.1176/appi.ajp.2020.20071091] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors examine U.S.-based evidence that connects characteristics of the social environment with outcomes across the psychosis continuum, from psychotic experiences to schizophrenia. The notion that inequitable social and economic systems of society significantly influence psychosis risk through proxies, such as racial minority and immigrant statuses, has been studied more extensively in European countries. While there are existing international reviews of social determinants of psychosis, none to the authors' knowledge focus on factors in the U.S. context specifically-an omission that leaves domestic treatment development and prevention efforts incomplete and underinformed. In this review, the authors first describe how a legacy of structural racism in the United States has shaped the social gradient, highlighting consequential racial inequities in environmental conditions. The authors offer a hypothesized model linking structural racism with psychosis risk through interwoven intermediary factors based on existing theoretical models and a review of the literature. Neighborhood factors, cumulative trauma and stress, and prenatal and perinatal complications were three key areas selected for review because they reflect social and environmental conditions that may affect psychosis risk through a common pathway shaped by structural racism. The authors describe evidence showing that Black and Latino people in the United States suffer disproportionately from risk factors within these three key areas, in large part as a result of racial discrimination and social disadvantage. This broad focus on individual and community factors is intended to provide a consolidated space to review this growing body of research and to guide continued inquiries into social determinants of psychosis in U.S. contexts.
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Affiliation(s)
- Deidre M Anglin
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Sabrina Ereshefsky
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Mallory J Klaunig
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Miranda A Bridgwater
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Tara A Niendam
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Lauren M Ellman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Jordan DeVylder
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Griffin Thayer
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Khalima Bolden
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Christie W Musket
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Rebecca E Grattan
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Sarah Hope Lincoln
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Jason Schiffman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Emily Lipner
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Peter Bachman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Cheryl M Corcoran
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Natália B Mota
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Els van der Ven
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
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9
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Black Parker C, McCall WV, Spearman-McCarthy EV, Rosenquist P, Cortese N. Clinicians' Racial Bias Contributing to Disparities in Electroconvulsive Therapy for Patients From Racial-Ethnic Minority Groups. Psychiatr Serv 2021; 72:684-690. [PMID: 33730880 DOI: 10.1176/appi.ps.202000142] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients from racial-ethnic minority groups undergo disparate electroconvulsive therapy (ECT) treatment compared with Caucasian peers. One leading hypothesis is that clinicians may unknowingly display racial bias when considering ECT for patients of color. Studies have consistently shown that patients of color face numerous racially driven, provider-level interpersonal and perceptual biases that contribute to clinicians incorrectly overdiagnosing them as having a psychotic-spectrum illness rather than correctly diagnosing a severe affective disorder. A patient's diagnosis marks the entry to evidence-based service delivery, and ECT is best indicated for severe affective disorders rather than for psychotic disorders. As a consequence of racially influenced clinician misdiagnosis, patients from racial-ethnic minority groups are underrepresented among those given severe affective diagnoses, which are most indicated for ECT referral. Evidence also suggests that clinicians may use racially biased treatment rationales when considering ECT after they have given a diagnosis of a severe affective or psychotic disorder, thereby producing secondary inequities in ECT referral. Increasing the use of gold-standard treatment algorithms when considering ECT for patients of color is contingent on clinicians transcending the limitations posed by aversive racism to develop culturally unbiased, clinically indicated diagnostic and treatment rationales.
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Affiliation(s)
- Carmen Black Parker
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - William V McCall
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - E Vanessa Spearman-McCarthy
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - Peter Rosenquist
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - Niayesh Cortese
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
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10
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Chen E, Bazargan-Hejazi S, Ani C, Hindman D, Pan D, Ebrahim G, Shirazi A, Banta JE. Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost. Medicine (Baltimore) 2021; 100:e25206. [PMID: 33847618 PMCID: PMC8052007 DOI: 10.1097/md.0000000000025206] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45-64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71-9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790-1142/100,000 admissions, while the US 2010 census standardized rates were 380-552/100,000 from 2005-2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations' overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005-2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.
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Affiliation(s)
- Ethan Chen
- Charles Drew University of Medicine and Science and David Geffen School of Medicine at University of California at Los Angeles (UCLA)
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry; Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California at Los Angeles (UCLA)
| | - Chizobam Ani
- Department of Internal Medicine, Charles Drew University of Medicine and. Science & University
| | - David Hindman
- Department of Psychiatry; Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California at Los Angeles (UCLA)
- Department of Psychiatry; Charles Drew University of Medicine and Science
| | - Deyu Pan
- Charles Drew University of Medicine and Science
| | - Gul Ebrahim
- Department of Psychiatry; Charles Drew University of Medicine and Science
| | - Anaheed Shirazi
- Department of Psychiatry, University of California at San Diego
| | - Jim E. Banta
- Health Policy and Leadership, School of Public Health, Loma Linda University, Los Angeles CA
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11
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Bounds DT, Winiarski DA, Otwell CH, Tobin V, Glover AC, Melendez A, Karnik NS. Considerations for working with youth with socially complex needs. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:209-220. [PMID: 32691491 PMCID: PMC7970826 DOI: 10.1111/jcap.12288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/26/2020] [Accepted: 07/05/2020] [Indexed: 12/01/2022]
Abstract
TOPIC The presence of adverse childhood experiences offers a glimpse into the social complexity in the lives of youth. Thus far, youth have been categorized as "at-risk" or "vulnerable,"-identifiers which highlight a deficits-based framework and continue to stigmatize youth. To combat this systemic marginalization, we propose using the term youth with socially complex needs. These youth, often minority ethnic/racial and/or sexual/gender minorities, experience repeated adversity and discrimination. PURPOSE The purpose of this paper is to conceptualize the unique considerations of working with youth with socially complex needs-who have an increased vulnerability for social marginalization. SOURCES USED Given the adversity experienced and challenges inherent in working with youth with socially complex needs, ethical principles, and relevant care delivery models were explored. CONCLUSIONS Delivering mental health care and/or conducting research in collaboration with youth with socially complex needs requires thoughtful consideration of ethical principles and models of care. In conclusion, we propose a strengths-based, individualized approach to working with youth with socially complex needs that requires a dynamic, fluid, multisystemic approach to care and research.
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Affiliation(s)
- Dawn T. Bounds
- Rush University College of Nursing, Chicago, IL, USA
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Dominka A. Winiarski
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Caitlin H. Otwell
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Valerie Tobin
- Rush University College of Nursing, Chicago, IL, USA
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Angela C. Glover
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Adrian Melendez
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Niranjan S. Karnik
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
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12
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Suokas K, Koivisto AM, Hakulinen C, Kaltiala R, Sund R, Lumme S, Kampman O, Pirkola S. Association of Income With the Incidence Rates of First Psychiatric Hospital Admissions in Finland, 1996-2014. JAMA Psychiatry 2020; 77:274-284. [PMID: 31851325 PMCID: PMC6990744 DOI: 10.1001/jamapsychiatry.2019.3647] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE The association between income and mental health has long been a question of interest. Nationwide register data provide means to examine trends and patterns of these associations. OBJECTIVES To compare income-specific trends in the incidence rates of first psychiatric hospital admissions and to evaluate whether an income gradient exists in the incidence rates at all levels of household income. DESIGN, SETTING, AND PARTICIPANTS This population-based open cohort study used linked registry data from nationwide Finnish Hospital Discharge and Statistics Finland population registers to determine annual incidence rates of first psychiatric hospital admissions. All Finnish citizens (N = 6 258 033) living in the country at any time from January 1, 1996, through December 31, 2014, contributed to 96 184 614 person-years at risk of first inpatient treatment for mental disorders. The analyses were conducted from August 1, 2018, through September 30, 2019. EXPOSURES Equivalized disposable income, sex, age group, reduction in income decile in the previous 3 years, urbanicity, educational level, and living alone status. MAIN OUTCOMES AND MEASURES Annual percentage changes in the age-standardized incidence rates and incidence rate ratios (IRRs). RESULTS Altogether, 186 082 first psychiatric inpatient treatment episodes occurred (93 431 [50.2%] men), with overall age-standardized incidence rates per 1000 person-years varying from 1.59 (95% CI, 1.56-1.63) in 2014 to 2.11 (95% CI, 2.07-2.15) in 2008. In the highest income deciles, a continuous mean decrease per year of 3.71% (95% CI, 2.82%-4.59%) in men and 0.91% (95% CI, 0.01%-1.80%) in women occurred throughout the study period, in contrast to the lowest deciles, where the trends first increased (1.31% [95% CI, 0.62%-2.01%] increase in men from 1996 to 2007 and 5.61% [95% CI, 2.36%-8.96%] increase in women from 1996 to 2001). In the adult population, an income gradient was observed at all levels of household income: the lower the income decile, the higher the adjusted IRRs compared with the highest decile. The IRRs in the lowest decile varied from 2.94 (95% CI, 2.78-3.11) to 4.46 (95% CI, 4.17-4.76). In other age groups, the gradient did not persist at the highest income deciles. Diagnosis-specific income gradient was steepest in schizophrenia and related psychotic disorders, with estimated IRRs of the lowest income decile of 5.89 (95% CI, 5.77-6.02). CONCLUSIONS AND RELEVANCE In this cohort study, clear negative income gradient in the incidence rates of first hospital-treated mental disorders was observed in the adult population of Finland. These findings suggest that reduction in the use of inpatient care has not taken place equally between different income groups.
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Affiliation(s)
- Kimmo Suokas
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland,Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sonja Lumme
- Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Olli Kampman
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Psychiatry, Pirkanmaa Hospital District, Tampere, Finland
| | - Sami Pirkola
- Faculty of Social Sciences, Tampere University, Tampere, Finland,Department of Psychiatry, Pirkanmaa Hospital District, Tampere, Finland
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13
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Akinhanmi M, El-Amin S, Balls-Berry JE, Vallender EJ, Ladner M, Geske J, Coombes B, Biernacka J, Kelsoe J, Frye MA. Decreased core symptoms of mania and utilization of lithium/mood stabilizing anticonvulsants in U.S. bipolar I patients of African vs European ancestry. J Affect Disord 2020; 260:361-365. [PMID: 31539671 DOI: 10.1016/j.jad.2019.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/06/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Misdiagnosis is common in bipolar disorder and disproportionally affects racial and ethnic minorities. There is interest in better understanding the contribution of differential symptomatic illness presentation to misdiagnosis. METHODS Utilizing the Genetic Association Information Network (GAIN) public database, this study compared clinical phenomenology between bipolar patients of African vs European ancestry (AA = 415 vs EA = 480). The Diagnostic Interview for Genetic Studies (DIGS) was utilized to evaluate symptom endorsement contributing to diagnostic confirmation of bipolar I disorder (BPI) and lifetime medication use. RESULTS Elevated/euphoric mood was less endorsed in AA vs EA participants (p = 0.03). During the most severe episode of mania, AA participants, in comparison to EA participants, had a lower sum of manic symptoms (p = 0.006) and a higher rate of hallucinations (p = 0.01). During lifetime psychosis, AA participants, in comparison to EA participants, had a higher lifetime sum of delusions (p = 0.01) and hallucinations (p < 0.0001). AA participants reported lower use of lithium (p < 0.0001) and mood stabilizing anticonvulsants (p = 0.0003). CONCLUSIONS The differential rate of manic and psychotic symptom endorsement from a semi-structured diagnostic interview may represent differential illness presentation based on biological differences or racial or study biases (e.g. ascertainment). Increased minority recruitment in bipolar research is therefore a necessary future direction. LIMITATIONS Recall and interviewer bias may affect study results, but are likely diminished by the alignment of symptom endorsement and medication use.
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Affiliation(s)
- Margaret Akinhanmi
- Clinical & Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Suliman El-Amin
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First ST SW, Rochester, MN, 55905, USA
| | - Joyce E Balls-Berry
- Mayo Clinic College of Medicine and Science, Rochester, MN,; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Eric J Vallender
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Mark Ladner
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennifer Geske
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Brandon Coombes
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Joanna Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First ST SW, Rochester, MN, 55905, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - John Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First ST SW, Rochester, MN, 55905, USA.
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14
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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: 129] [Impact Index Per Article: 18.4] [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.
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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
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15
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Hamilton JE, Heads AM, Meyer TD, Desai PV, Okusaga OO, Cho RY. Ethnic differences in the diagnosis of schizophrenia and mood disorders during admission to an academic safety-net psychiatric hospital. Psychiatry Res 2018; 267:160-167. [PMID: 29908484 DOI: 10.1016/j.psychres.2018.05.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/24/2018] [Accepted: 05/18/2018] [Indexed: 01/26/2023]
Abstract
U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (n = 5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication.
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Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; UTHealth Harris County Psychiatric Center, Houston, TX, USA.
| | - Angela M Heads
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pratikkumar V Desai
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Olaoluwa O Okusaga
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
| | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
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16
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Akinhanmi MO, Biernacka JM, Strakowski SM, McElroy SL, Balls Berry JE, Merikangas KR, Assari S, McInnis MG, Schulze TG, LeBoyer M, Tamminga C, Patten C, Frye MA. Racial disparities in bipolar disorder treatment and research: a call to action. Bipolar Disord 2018; 20. [PMID: 29527766 PMCID: PMC6175457 DOI: 10.1111/bdi.12638] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Health disparities between individuals of African and European ancestry are well documented. The disparities in bipolar disorder may be driven by racial bias superimposed on established factors contributing to misdiagnosis, including: evolving empirically based diagnostic criteria (International Classification of Diseases [ICD], Research Diagnostic Criteria [RDC] and Diagnostic and Statistical Manual [DSM]), multiple symptom domains (i.e. mania, depression and psychosis), and multimodal medical and additional psychiatric comorbidity. METHODS For this paper, we reviewed the phenomenological differences between bipolar individuals of African and European ancestry in the context of diagnostic criteria and clinical factors that may contribute to a potential racial bias. RESULTS Published data show that bipolar persons of African ancestry, compared with bipolar persons of non-African ancestry, are more often misdiagnosed with a disease other than bipolar disorder (i.e. schizophrenia). Additionally, studies show that there are disparities in recruiting patients of African ancestry to participate in important genomic studies. This gap in biological research in this underrepresented minority may represent a missed opportunity to address potential racial differences in the risk and course of bipolar illness. CONCLUSION A concerted effort by the research community to increase inclusion of diverse persons in studies of bipolar disorder through community engagement may facilitate fully addressing these diagnostic and treatment disparities in bipolar individuals of African ancestry.
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Affiliation(s)
- Margaret O Akinhanmi
- Clinical and Translational ScienceMayo Clinic Graduate School of Biomedical SciencesRochesterMNUSA
| | - Joanna M Biernacka
- Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMNUSA,Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
| | - Stephen M Strakowski
- Department of PsychiatryDell Medical SchoolThe University of Texas at AustinAustinTXUSA
| | - Susan L McElroy
- Lindner Center of HOPEMasonOHUSA,Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Joyce E Balls Berry
- Mayo Clinic Center for Clinical & Translational Science (CCaTS)RochesterMNUSA,Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | | | - Shervin Assari
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | | | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG)University HospitalLMUMunichGermany
| | - Marion LeBoyer
- Department of PsychiatryMondor HospitalUniversité Paris Est, AP‐HPCréteil, ParisFrance,Inser U955Institute for Biomedical Research Faculté de MédecineCréteil, Paris France
| | - Carol Tamminga
- Southwestern Department of PsychiatryUniversity of TexasDallasTXUSA
| | - Christi Patten
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA,Mayo Clinic Center for Clinical & Translational Science (CCaTS)RochesterMNUSA
| | - Mark A Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
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17
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Stock EM, Stamey JD, Zeber JE, Thompson AW, Copeland LA. A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records. COMPUTATIONAL PSYCHIATRY 2018; 2:1-10. [PMID: 30090859 PMCID: PMC6067824 DOI: 10.1162/cpsy_a_00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 06/26/2017] [Indexed: 11/09/2022]
Abstract
Schizophrenia is a debilitating serious mental illness characterized by a complex array of symptoms with varying severity and duration. Patients may seek treatment only intermittently, contributing to challenges diagnosing the disorder. A misdiagnosis may potentially bias and reduce study validity. Thus we developed a statistical model to assess the risk of 1-year hospitalization for patients diagnosed with schizophrenia, accounting for when schizophrenia is underreported in administrative databases. A retrospective study design identified patients seeking care during 2010 within an integrated health care system from the Health Maintenance Organization Research Network located in the southwestern United States. Bayesian analysis addressed the problem of underdiagnosed schizophrenia with a statistical measurement error model assuming varying rates of underreporting. Results were then compared to classical multivariable logistic regression. Assuming no underreporting, there was an 87% greater relative odds of hospitalization associated with schizophrenia, OR = 1.87, CI [1.08, 3.23]. Effect sizes and interval estimates representing the association between hospitalization and schizophrenia were reduced with the Bayesian approach accounting for underdiagnosis, suggesting that less severe patients may be underrepresented in studies of schizophrenia. The analytical approach has useful applications in other contexts where the identification of patients with a given condition may be underreported in administrative records.
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Affiliation(s)
- Eileen M Stock
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Departmentof Veterans Affairs, Perry Point, Maryland, USA.,Center for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scottand White Health, Temple, Texas, USA.,Texas A&M Health Science Center, Bryan, Texas, USA
| | - James D Stamey
- Department of Statistical Science, Baylor University, Waco, Texas, USA
| | - John E Zeber
- Center for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scottand White Health, Temple, Texas, USA.,Texas A&M Health Science Center, Bryan, Texas, USA
| | - Alexander W Thompson
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Laurel A Copeland
- Center for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scottand White Health, Temple, Texas, USA.,Texas A&M Health Science Center, Bryan, Texas, USA
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18
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Scheel MJ, Stabb SD, Cohn TJ, Duan C, Sauer EM. Counseling Psychology Model Training Program. COUNSELING PSYCHOLOGIST 2018. [DOI: 10.1177/0011000018755512] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The counseling psychology Model Training Program (MTP) was written to reflect new developments in counseling psychology, the American Psychological Association, and the world. The updated MTP is aspirational, intended to guide the development and maintenance of counseling psychology programs. The MTP conforms to the American Psychological Association’s and the Society of Counseling Psychology’s standards and guidelines. A strategic task group appointed by 2015 Society president James W. Lichtenberg sought feedback from the field to assist in its formulation, and the executive boards of the Society and the Council of Counseling Psychology Training Programs approved the final version. The 2017 MTP consists of four core values (i.e., growth toward full potential, holistic and contextual, diversity and social justice, communitarian perspective) as well as 20 principles grouped into six clusters: counseling psychology identity; multiculturalism, diversity, and social justice; health service psychology; developmental, prevention, and strengths orientation; science–practice integration; and relationships within and between professional communities.
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19
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Abstract
Musculoskeletal disorders (MSDs) are highly prevalent, painful, and costly disorders. The MSD Cohort was created to characterize variation in pain, comorbidities, treatment, and outcomes among patients with MSD receiving Veterans Health Administration care across demographic groups, geographic regions, and facilities. We searched electronic health records to identify patients treated in Veterans Health Administration who had ICD-9-CM codes for diagnoses including, but not limited to, joint, back, and neck disorders, and osteoarthritis. Cohort inclusion criteria were 2 or more outpatient visits occurring within 18 months of one another or one inpatient visit with an MSD diagnosis between 2000 and 2011. The first diagnosis is the index date. Pain intensity numeric rating scale (NRS) scores, comorbid medical and mental health diagnoses, pain-related treatments, and other characteristics were collected retrospectively and prospectively. The cohort included 5,237,763 patients; their mean age was 59, 6% were women, 15% identified as black, and 18% reported severe pain (NRS ≥ 7) on the index date. Nontraumatic joint disorder (27%), back disorder (25%), and osteoarthritis (21%) were the most common MSD diagnoses. Patients entering the cohort in recent years had more concurrent MSD diagnoses and higher NRS scores. The MSD Cohort is a rich resource for collaborative pain-relevant health service research.
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20
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Murdoch M, Spoont MR, Kehle-Forbes SM, Harwood EM, Sayer NA, Clothier BA, Bangerter AK. Persistent Serious Mental Illness Among Former Applicants for VA PTSD Disability Benefits and Long-Term Outcomes: Symptoms, Functioning, and Employment. J Trauma Stress 2017; 30:36-44. [PMID: 28099769 PMCID: PMC6487633 DOI: 10.1002/jts.22162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/21/2016] [Accepted: 09/14/2016] [Indexed: 11/11/2022]
Abstract
UNLABELLED Millions of U.S. veterans have returned from military service with posttraumatic stress disorder (PTSD), for which a substantial number receive U.S. Department of Veterans Affairs (VA) disability benefits. Although PTSD is treatable, comorbid serious mental illness (defined here as schizophrenia, schizoaffective disorder, and bipolar spectrum disorders) could complicate these veterans' recovery. Using VA administrative data, we examined the burden of persistent serious mental illness in a nationally representative cohort of 1,067 men and 1,513 women who applied for VA PTSD disability benefits between 1994 and 1998 and served during or after the Vietnam conflict. Self-reported outcomes were restricted to the 713 men and 1,015 women who returned surveys at each of 3 collection points. More than 10.0% of men and 20.0% of women had persistent serious mental illness; of these, more than 80.0% also had persistent PTSD. On repeated measures modeling, those with persistent serious mental illness consistently reported more severe PTSD symptoms and poorer functioning in comparison to other participants (ps < .001); their employment rate did not exceed 21.0%. Interactions between persistent serious mental illness and PTSD were significant only for employment (p = .002). Persistent serious mental illness in this population was almost 2 to 19 times higher than in the general U.S. POPULATION The implications of these findings are discussed.
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Affiliation(s)
- Maureen Murdoch
- Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis MN, USA,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michele Roxanne Spoont
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA,National Centers for PTSD, Pacific Islands Division, Department of Veterans Affairs, Honolulu, HI, USA,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Shannon Marie Kehle-Forbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eileen Mae Harwood
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis MN, USA
| | - Nina Aileen Sayer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Barbara Ann Clothier
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Ann Kay Bangerter
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
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21
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Kilbourne AM, Barbaresso MM, Lai Z, Nord KM, Bramlet M, Goodrich DE, Post EP, Almirall D, Bauer MS. Improving Physical Health in Patients With Chronic Mental Disorders: Twelve-Month Results From a Randomized Controlled Collaborative Care Trial. J Clin Psychiatry 2017; 78:129-137. [PMID: 27780336 PMCID: PMC5272777 DOI: 10.4088/jcp.15m10301] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/09/2015] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. METHODS This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a midwestern Veterans Affairs urban outpatient mental health clinic. Patients (N = 293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least 1 cardiovascular disease risk factor provided informed consent and were randomized (February 24, 2010, to April 29, 2015) to Life Goals (n = 146) or usual care (n = 147). A total of 287 completed baseline assessments, and 245 completed 12-month follow-up assessments. Life Goals included 5 weekly sessions that provided semistructured guidance on managing physical and mental health symptoms through healthy behavior changes, augmented by ongoing care coordination. The primary outcome was change in physical health-related quality of life score (Veterans RAND 12-item Short Form Health Survey [VR-12] physical health component score). Secondary outcomes included control of cardiovascular risk factors from baseline to 12 months (blood pressure, lipids, weight), mental health-related quality of life, and mental health symptoms. RESULTS Among patients completing baseline and 12-month outcomes assessments (N = 245), the mean age was 55.3 years (SD = 10.8; range, 25-78 years), and 15.4% were female. Intent-to-treat analysis revealed that compared to those in usual care, patients randomized to Life Goals had slightly increased VR-12 physical health scores (coefficient = 3.21; P = .01). CONCLUSIONS Patients with chronic mental disorders and cardiovascular disease risk who received Life Goals had improved physical health-related quality of life. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT01487668 and NCT01244854.
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Affiliation(s)
- Amy M. Kilbourne
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA,Author for correspondence: Amy M. Kilbourne, PhD, MPH, VA Center for Clinical Management Research, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105. Voice: 734-845-3452; fax: 734-222-7503,
| | | | - Zongshan Lai
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristina M. Nord
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - David E. Goodrich
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Edward P. Post
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Mark S. Bauer
- VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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22
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Ramsey C, Dziura J, Justice AC, Altalib HH, Bathulapalli H, Burg M, Decker S, Driscoll M, Goulet J, Haskell S, Kulas J, Wang KH, Mattocks K, Brandt C. Incidence of Mental Health Diagnoses in Veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn, 2001-2014. Am J Public Health 2016; 107:329-335. [PMID: 27997229 DOI: 10.2105/ajph.2016.303574] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate gender, age, and race/ethnicity as predictors of incident mental health diagnoses among Operations Iraqi Freedom, Enduring Freedom, and New Dawn veterans. METHODS We used US Veterans Health Administration (VHA) electronic health records from 2001 to 2014 to examine incidence rates and sociodemographic risk factors for mental health diagnoses among 888 142 veterans. RESULTS Posttraumatic stress disorder (PTSD) was the most frequently diagnosed mental health condition across gender and age groups. Incidence rates for all mental health diagnoses were highest at ages 18 to 29 years and declined thereafter, with the exceptions of major depressive disorder (MDD) in both genders, and PTSD among women. Risk of incident bipolar disorder and MDD diagnoses were greater among women; risk of incident schizophrenia, and alcohol- and drug-use disorders diagnoses were greater in men. Compared with Whites, risk incident PTSD, MDD, and alcohol-use disorder diagnoses were lower at ages 18 to 29 years and higher at ages 45 to 64 years for both Hispanics and African Americans. CONCLUSIONS Differentiating high-risk demographic and gender groups can lead to improved diagnosis and treatment of mental health diagnoses among veterans and other high-risk groups.
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Affiliation(s)
- Christine Ramsey
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - James Dziura
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Amy C Justice
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Hamada Hamid Altalib
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Harini Bathulapalli
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Matthew Burg
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Suzanne Decker
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Mary Driscoll
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Joseph Goulet
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Sally Haskell
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Joseph Kulas
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Karen H Wang
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Kristen Mattocks
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Cynthia Brandt
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
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Jones AL, Mor MK, Cashy JP, Gordon AJ, Haas GL, Schaefer JH, Hausmann LRM. Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders. J Gen Intern Med 2016; 31:1435-1443. [PMID: 27325318 PMCID: PMC5130946 DOI: 10.1007/s11606-016-3776-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/12/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient-Centered Medical Homes (PCMH) may be effective in managing care for racial/ethnic minorities with mental health and/or substance use disorders (MHSUDs). How such patients experience care in PCMH settings is relatively unknown. OBJECTIVE We aimed to examine racial/ethnic differences in experiences with primary care in PCMH settings among Veterans with MHSUDs. DESIGN We used multinomial regression methods to estimate racial/ethnic differences in PCMH experiences reported on a 2013 national survey of Veterans Affairs patients. PARTICPANTS Veterans with past-year MHSUD diagnoses (n = 65,930; 67 % White, 20 % Black, 11 % Hispanic, 1 % American Indian/Alaska Native[AI/AN], and 1 % Asian/Pacific Island[A/PI]). MAIN MEASURES Positive and negative experiences from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) PCMH Survey. RESULTS Veterans with MHSUDs reported the lowest frequency of positive experiences with access (22 %) and the highest frequency of negative experiences with self-management support (30 %) and comprehensiveness (16 %). Racial/ethnic differences (as compared to Whites) were observed in all seven healthcare domains (p values < 0.05). With access, Blacks and Hispanics reported more negative (Risk Differences [RDs] = 2 .0;3.6) and fewer positive (RDs = -2 .3;-2.3) experiences, while AI/ANs reported more negative experiences (RD = 5.7). In communication, Blacks reported fewer negative experiences (RD = -1.3); AI/ANs reported more negative (RD = 3.6) experiences; and AI/ANs and APIs reported fewer positive (RD = -6.5, -6.7) experiences. With office staff, Hispanics reported fewer positive experiences (RDs = -3.0); AI/ANs and A/PIs reported more negative experiences (RDs = 3.4; 3.7). For comprehensiveness, Blacks reported more positive experiences (RD = 3.6), and Hispanics reported more negative experiences (RD = 2.7). Both Blacks and Hispanics reported more positive (RDs = 2.3; 4.2) and fewer negative (RDs = -1.8; -1.9) provider ratings, and more positive experiences with decision making (RDs = 2.4; 3.0). Blacks reported more positive (RD = 3.9) and fewer negative (RD = -5.1) experiences with self-management support. CONCLUSIONS In a national sample of Veterans with MHSUDs, potential deficiencies were observed in access, self-management support, and comprehensiveness. Racial/ethnic minorities reported worse experiences than Whites with access, comprehensiveness, communication, and office staff helpfulness/courtesy.
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Affiliation(s)
- Audrey L Jones
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA, 15240-1001, USA.
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - John P Cashy
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gretchen L Haas
- VISN4 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James H Schaefer
- Department of Veterans Affairs Office of Analytics and Business Intelligence, Durham, NC, USA
| | - Leslie R M Hausmann
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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24
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Coleman KJ, Stewart C, Waitzfelder BE, Zeber JE, Morales LS, Ahmed AT, Ahmedani BK, Beck A, Copeland LA, Cummings JR, Hunkeler EM, Lindberg NM, Lynch F, Lu CY, Owen-Smith AA, Trinacty CM, Whitebird RR, Simon GE. Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network. Psychiatr Serv 2016; 67:749-57. [PMID: 27079987 PMCID: PMC4930394 DOI: 10.1176/appi.ps.201500217] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to characterize racial-ethnic variation in diagnoses and treatment of mental disorders in large not-for-profit health care systems. METHODS Participating systems were 11 private, not-for-profit health care organizations constituting the Mental Health Research Network, with a combined 7,523,956 patients age 18 or older who received care during 2011. Rates of diagnoses, prescription of psychotropic medications, and total formal psychotherapy sessions received were obtained from insurance claims and electronic medical record databases across all health care settings. RESULTS Of the 7.5 million patients in the study, 1.2 million (15.6%) received a psychiatric diagnosis in 2011. This varied significantly by race-ethnicity, with Native American/Alaskan Native patients having the highest rates of any diagnosis (20.6%) and Asians having the lowest rates (7.5%). Among patients with a psychiatric diagnosis, 73% (N=850,585) received a psychotropic medication. Non-Hispanic white patients were significantly more likely (77.8%) than other racial-ethnic groups (odds ratio [OR] range .48-.81) to receive medication. In contrast, only 34% of patients with a psychiatric diagnosis (N=548,837) received formal psychotherapy. Racial-ethnic differences were most pronounced for depression and schizophrenia; compared with whites, non-Hispanic blacks were more likely to receive formal psychotherapy for their depression (OR=1.20) or for their schizophrenia (OR=2.64). CONCLUSIONS There were significant racial-ethnic differences in diagnosis and treatment of psychiatric conditions across 11 U.S. health care systems. Further study is needed to understand underlying causes of these observed differences and whether processes and outcomes of care are equitable across these diverse patient populations.
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Affiliation(s)
- Karen J Coleman
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Christine Stewart
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Beth E Waitzfelder
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - John E Zeber
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Leo S Morales
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Ameena T Ahmed
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Brian K Ahmedani
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Arne Beck
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Laurel A Copeland
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Janet R Cummings
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Enid M Hunkeler
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Nangel M Lindberg
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Frances Lynch
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Christine Y Lu
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Ashli A Owen-Smith
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Connie Mah Trinacty
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Robin R Whitebird
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
| | - Gregory E Simon
- Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota
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Kugelmass H. "Sorry, I'm Not Accepting New Patients": An Audit Study of Access to Mental Health Care. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:168-83. [PMID: 27251890 DOI: 10.1177/0022146516647098] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Through a phone-based field experiment, I investigated the effect of mental help seekers' race, class, and gender on the accessibility of psychotherapists. Three hundred and twenty psychotherapists each received voicemail messages from one black middle-class and one white middle-class help seeker, or from one black working-class and one white working-class help seeker, requesting an appointment. The results revealed an otherwise invisible form of discrimination. Middle-class help seekers had appointment offer rates almost three times higher than their working-class counterparts. Race differences emerged only among middle-class help-seekers, with blacks considerably less likely than whites to be offered an appointment. Average appointment offer rates were equivalent across gender, but women were favored over men for appointment offers in their preferred time range.
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Abstract
BACKGROUND Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians may consider serious mental illness (SMI) a significant concern in organ transplantation. However, little empirical evidence exists regarding posttransplantation outcomes for patients with SMI. METHODS This study analyzed health services data to evaluate posttransplantation 3-year survival by SMI status in a nationwide cohort of patients in the Veterans Health Administration (VHA). RESULTS A total of 960 recipients of solid organ or bone marrow transplants were identified from Veterans Health Administration administrative data extracts for fiscal years 2006 to 2009. Of these, 164 (17%) had an SMI diagnosis before transplantation (schizophrenia, posttraumatic stress, major depressive, and bipolar disorders); 301 (31%) had some other mental illness diagnosis (such as anxiety, adjustment reactions, or substance abuse); and 495 (52%) had no mental health diagnosis. Twenty-two patients (2%) required retransplantation and 208 patients (22%) died during follow-up. Data on whether these were primary or repeat transplantations were unavailable. Rates of attendance at postoperative outpatient visits and number of months for which immunosuppressive drugs fills were recorded were similar among mental illness groups, as were rates of diagnosed immunological rejection. Three-year mortality was equivalent among mental health groups: no mental health (19%) versus other mental illness (23%) versus SMI (27%; χ(2) = 5.11; df = 2; P = .08). In adjusted survival models, no effect of mental health status was observed. CONCLUSIONS Serious mental illness diagnosis does not appear to be associated with adverse transplantation outcomes over the first 3 years; however, a potentially diverging survival curve may portend higher mortality at 5 years.
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Trautmann J, Alhusen J, Gross D. Impact of deployment on military families with young children: A systematic review. Nurs Outlook 2015; 63:656-79. [DOI: 10.1016/j.outlook.2015.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
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Koo KH, Hebenstreit CL, Madden E, Seal KH, Maguen S. Race/ethnicity and gender differences in mental health diagnoses among Iraq and Afghanistan veterans. Psychiatry Res 2015; 229:724-31. [PMID: 26282226 DOI: 10.1016/j.psychres.2015.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 11/18/2022]
Abstract
Veterans who served in Operation Enduring Freedom (OEF; predominantly in Afghanistan) and Operations Iraqi Freedom and New Dawn (OIF and OND; predominantly in Iraq) and are enrolled in the VA are comprised of a growing cohort of women and higher proportions of racial/ethnic minorities than civilians. To compare rates of mental health disorders by race/ethnicity and gender for this diverse cohort, we conducted a retrospective analysis of existing records from OEF/OIF/OND veterans who were seen at the VA 10/7/01-8/1/2013 (N=792,663). We found that race/ethnicity was related to diagnoses of mental health disorders. Asian/Pacific Islanders (A/PIs) were diagnosed with all disorders at lower rates than whites, and American Indian/Alaska Native (AI/AN) males were diagnosed with most disorders at higher rates than white males. Research is needed to identify contributing factors to differential rates of diagnoses based on race/ethnicity and gender. A/PIs and AI/ANs have unique patterns of mental health diagnoses indicating they should be considered separately to present a comprehensive picture of veteran mental health.
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Affiliation(s)
- Kelly H Koo
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, Department of Psychiatry, San Francisco, CA 94122, USA.
| | - Claire L Hebenstreit
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, Department of Psychiatry, San Francisco, CA 94122, USA
| | - Erin Madden
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, Department of Psychiatry, San Francisco, CA 94122, USA
| | - Karen H Seal
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, Department of Psychiatry, San Francisco, CA 94122, USA
| | - Shira Maguen
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, Department of Psychiatry, San Francisco, CA 94122, USA
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Cook TB, Reeves GM, Teufel J, Postolache TT. Persistence of racial disparities in prescription of first-generation antipsychotics in the USA. Pharmacoepidemiol Drug Saf 2015; 24:1197-206. [PMID: 26132170 DOI: 10.1002/pds.3819] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/21/2015] [Accepted: 05/27/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to estimate the prevalence of first-generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits. METHODS The study sample included all outpatient visits (N = 8154) among patients aged 18-69 years where a prescription for one or more antipsychotics was recorded across 6 years of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005-2010). Use of FGA was compared by race/ethnicity using multiple logistic regression models accounting for patient and clinical characteristics stratified by neighborhood poverty rate. Frequency of EPS was determined by use of benztropine to reduce or prevent EPS. RESULTS Black patients were significantly more likely than White patients to use FGA (odds ratio = 1.48, p = 0.040) accounting for psychiatric and neurological diagnoses, treatment setting, metabolic factors, neighborhood poverty, and payer source. Black patients were more than twice as likely as White patients to receive higher-potency FGA (haloperidol or fluphenazine), particularly in higher-poverty areas (odds ratio = 2.50, p < 0.001). Use of FGA, higher among Black than White patients, was positively associated with use of benztropine to reduce EPS. CONCLUSIONS Racial disparities in the pharmacological treatment of severe mental disorders persist 30 years after the introduction of second-generation antipsychotics. The relatively high frequency of FGA of use among Black patients compared with White patients despite more Food and Drug Administration-approved indications and lower EPS risk for second-generation antipsychotics requires additional research.
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Affiliation(s)
- Thomas B Cook
- Department of Public Health, Mercyhurst Institute of Public Health, Mercyhurst University, Erie, PA, USA
| | - Gloria M Reeves
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James Teufel
- Department of Public Health, Mercyhurst Institute of Public Health, Mercyhurst University, Erie, PA, USA
| | - Teodor T Postolache
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.,Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Rocky Mountain MIRECC, Denver, CO, USA
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Phillips KL, Copeland LA, Zeber JE, Stock EM, Tsan JY, MacCarthy AA. Racial/Ethnic disparities in monitoring metabolic parameters for patients with schizophrenia receiving antipsychotic medications. Am J Geriatr Psychiatry 2015; 23:596-606. [PMID: 25154537 DOI: 10.1016/j.jagp.2014.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/21/2014] [Accepted: 07/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Patients with schizophrenia experience risks for metabolic dysregulation from medications and lifestyle behaviors. Although most patients with schizophrenia in the Veterans Health Administration (VA) receive antipsychotics, variation in monitoring metabolic dysregulation by race/ethnicity has not been assessed. This study analyzed differential monitoring of metabolic parameters by minority status. METHODS This retrospective study approximated the five components of metabolic syndrome (fasting glucose, high-density-lipoprotein cholesterol, triglycerides, blood pressure, and large waistline) using archival data, substituting body mass index for waistline. VA patients with schizophrenia age 50 or older were followed from October 1, 2001 through September 2009 (N = 30,258). Covariates included age, gender, race (white, black), Hispanic ethnicity, region, marital status, VA priority status, comorbidity, and antipsychotic type. Repeated-measures analysis assessed the association of race/ethnicity with metabolic monitoring. RESULTS Average patients age was 59 years (standard deviation: 9; range: 50-101), 97% were men, 70% white, 30% black, and 8% Hispanic. At baseline, 6% were monitored on all five metabolic components; this increased to 29% by 2005. In adjusted models, blacks were less likely to be monitored on all parameters, whereas Hispanics were less likely to have glucose and high-density-lipoprotein cholesterol monitored but more likely to have triglycerides tested. By 2009, lab assays were similar across race and ethnicity. CONCLUSION Guideline-concordant monitoring metabolic parameters appear to be equitable but low and somewhat at odds with racial/ethnic risk among older patients with schizophrenia. Physicians should discuss lipids, weight, and glucose with patients at risk for developing heart disease, diabetes, and other sequelae of the metabolic syndrome.
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Affiliation(s)
| | - Laurel A Copeland
- Center for Applied Health Research, Central Texas Veterans Health Care System, jointly with Scott & White Healthcare, Temple, TX.
| | - John E Zeber
- Center for Applied Health Research, Central Texas Veterans Health Care System, jointly with Scott & White Healthcare, Temple, TX
| | - Eileen M Stock
- Center for Applied Health Research, Central Texas Veterans Health Care System, jointly with Scott & White Healthcare, Temple, TX
| | - Jack Y Tsan
- Central Texas Veterans Health Care System, Temple, TX
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Breland JY, Chee CP, Zulman DM. Racial Differences in Chronic Conditions and Sociodemographic Characteristics Among High-Utilizing Veterans. J Racial Ethn Health Disparities 2015; 2:167-75. [PMID: 26863335 PMCID: PMC6200449 DOI: 10.1007/s40615-014-0060-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/29/2014] [Accepted: 10/03/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE African-Americans are disproportionally represented among high-risk, high-utilizing patients. To inform program development for this vulnerable population, the current study describes racial variation in chronic conditions and sociodemographic characteristics among high-utilizing patients in the Veterans Affairs Healthcare System (VA). METHODS We identified the 5 % most costly Veterans who used inpatient or outpatient care at the VA during fiscal year 2010 (N = 237,691) based on costs of inpatient and outpatient care, pharmacy services, and VA-sponsored contract care. Patient costs and characteristics were abstracted from VA outpatient and inpatient data files. Racial differences in sociodemographic characteristics (age, sex, marital support, homelessness, and health insurance status) were assessed with chi-square tests. Racial differences in 32 chronic condition diagnoses were calculated as relative risk ratios. RESULTS African-Americans represented 21 % of high-utilizing Veterans. African-Americans had higher rates of homelessness (26 vs. 10 %, p < 0.001) and lower rates of supplemental health insurance (44 vs. 58 %, p < 0.001). The mean number of chronic conditions was similar across race. However, there were racial differences in the prevalence of specific chronic conditions, including a higher prevalence of HIV/AIDS (95 % confidence interval (CI) 4.86, 5.50) and schizophrenia (95 % CI 1.94, 2.07) and a lower prevalence of ischemic heart disease (95 % CI 0.57, 0.59) and bipolar disorder (95 % CI 0.78, 0.85) among African-American high-utilizing Veterans. CONCLUSION Racial disparities among high-utilizing Veterans may differ from those found in the general population. Interventions should devote attention to social, environmental, and mental health issues in order to reduce racial disparities in this vulnerable population.
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Affiliation(s)
- Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94304, USA.
| | - Christine Pal Chee
- Department of Veterans Affairs, Health Economics Resource Center, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, 616 Serra Street, Stanford, CA, 94305, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
- Division of General Medical Disciplines, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94304, USA
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Johnson CE, Bush RL, Harman J, Bolin J, Evans Hudnall G, Nguyen AM. Variation in Utilization of Health Care Services for Rural VA Enrollees With Mental Health-Related Diagnoses. J Rural Health 2015; 31:244-53. [PMID: 25599892 DOI: 10.1111/jrh.12105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Rural-dwelling Department of Veterans Affairs (VA) enrollees are at high risk for a wide variety of mental health-related disorders. The objective of this study is to examine the variation in the types of mental and nonmental health services received by rural VA enrollees who have a mental health-related diagnosis. METHODS The Andersen and Aday behavioral model of health services use and the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey (MEPS) data were used to examine how VA enrollees with mental health-related diagnoses accessed places of care from 1999 to 2009. Population survey weights were applied to the MEPS data, and logit regression was conducted to model how predisposing, enabling, and need factors influence rural veteran health services use (measured by visits to different places of care). Analyses were performed on the subpopulations: rural VA, rural non-VA, urban VA, and urban non-VA enrollees. FINDINGS For all types of care, both rural and urban VA enrollees received care from inpatient, outpatient, office-based, and emergency room settings at higher odds than urban non-VA enrollees. Rural VA enrollees also received all types of care from inpatient, office-based, and emergency room settings at higher odds than urban VA enrollees. Rural VA enrollees had higher odds of a mental health visit of any kind compared to urban VA and non-VA enrollees. CONCLUSIONS Based on these variations, the VA may want to develop strategies to increase screening efforts in inpatient settings and emergency rooms to further capture rural VA enrollees who have undiagnosed mental health conditions.
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Affiliation(s)
- Christopher E Johnson
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Ruth L Bush
- College of Medicine, Texas A&M Health Science Center, Round Rock, Texas
| | - Jeffrey Harman
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Jane Bolin
- Southwest Rural Health Research Center, Texas A&M Health Science Center, College Station, Texas
| | - Gina Evans Hudnall
- South Central Mental Illness, Research, Education and Clinical Center and Houston Center for Quality of Care and Utilization Studies, Michael E. Debakey VA Medical Center, Houston, Texas.,Health Services Research and Development Section, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ann M Nguyen
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
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Schwartz RC, Blankenship DM. Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World J Psychiatry 2014; 4:133-140. [PMID: 25540728 PMCID: PMC4274585 DOI: 10.5498/wjp.v4.i4.133] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/03/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
Psychotic disorder diagnoses are common in the United States and internationally. However, racial disparities in rates of psychotic disorder diagnoses have been reported across time and mental health professions. This literature review provides an updated and comprehensive summary of empirical research on race and diagnosis of psychotic disorders spanning a 24-year period. Findings reveal a clear and pervasive pattern wherein African American/Black consumers show a rate of on average three to four higher than Euro-American/White consumers. Latino American/Hispanic consumers were also disproportionately diagnosed with psychotic disorders on average approximately three times higher compared to Euro-American/White consumers. In addition, a trend among international studies suggests that immigrant racial minority consumers receiving mental health services may be assigned a psychotic disorder diagnosis more frequently than native consumers sharing a majority racial background. Potential explanations for this phenomenon are discussed, including possible clinical bias and sociological causes such as differential access to healthcare and willingness to participate in mental health services. Directions for future research should include the exploration of disproportionate diagnoses according to race through qualitative interviewing as well as empirical investigation.
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Copeland LA, McIntyre RT, Stock EM, Zeber JE, MacCarthy DJ, Pugh MJ. Prevalence of suicidality among Hispanic and African American veterans following surgery. Am J Public Health 2014; 104 Suppl 4:S603-8. [PMID: 25100427 PMCID: PMC4151897 DOI: 10.2105/ajph.2014.301938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated factors associated with suicidal behavior and ideation (SBI) during 3 years of follow-up among 89,995 Veterans Health Administration (VHA) patients who underwent major surgery from October 2005 to September 2006. METHODS We analyzed administrative data using Cox proportional hazards models. SBI was ascertained by International Classification of Disease, 9th Revision codes. RESULTS African Americans (18% of sample; 16,252) were at an increased risk for SBI (hazard ratio [HR] = 1.21; 95% confidence interval [CI] = 1.10, 1.32), whereas Hispanics were not (HR = 1.10; 95% CI = 0.95, 1.28). Other risk factors included schizophrenia, bipolar disorder, depression, posttraumatic stress disorder, pain disorders, postoperative new-onset depression, and postoperative complications; female gender and married status were protective against SBI. CONCLUSIONS The postoperative period might be a time of heightened risk for SBI among minority patients in the VHA. Tailored monitoring and postoperative management by minority status might be required to achieve care equity.
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Affiliation(s)
- Laurel A Copeland
- Laurel A. Copeland, Raphael T. McIntyre, Eileen M. Stock, and John E. Zeber are with the Center for Applied Health Research, Central Texas Veterans Health Care System jointly with Scott & White Healthcare, Temple. Daniel J. MacCarthy is with University of Texas Health Science Center, San Antonio. Mary Jo Pugh is with the South Texas Veterans Health Care System, San Antonio
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Long JA, Wang A, Medvedeva EL, Eisen SV, Gordon AJ, Kreyenbuhl J, Marcus SC. Glucose control and medication adherence among veterans with diabetes and serious mental illness: does collocation of primary care and mental health care matter? Diabetes Care 2014; 37:2261-7. [PMID: 24879839 DOI: 10.2337/dc13-0051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Persons with serious mental illness (SMI) may benefit from collocation of medical and mental health healthcare professionals and services in attending to their chronic comorbid medical conditions. We evaluated and compared glucose control and diabetes medication adherence among patients with SMI who received collocated care to those not receiving collocated care (which we call usual care). RESEARCH DESIGN AND METHODS We performed a cross-sectional, observational cohort study of 363 veteran patients with type 2 diabetes and SMI who received care from one of three Veterans Affairs medical facilities: two sites that provided both collocated and usual care and one site that provided only usual care. Through a survey, laboratory tests, and medical records, we assessed patient characteristics, glucose control as measured by a current HbA1c, and adherence to diabetes medication as measured by the medication possession ration (MPR) and self-report. RESULTS In the sample, the mean HbA1c was 7.4% (57 mmol/mol), the mean MPR was 80%, and 51% reported perfect adherence to their diabetes medications. In both unadjusted and adjusted analyses, there were no differences in glucose control and medication adherence by collocation of care. Patients seen in collocated care tended to have better HbA1c levels (β = -0.149; P = 0.393) and MPR values (β = 0.34; P = 0.132) and worse self-reported adherence (odds ratio 0.71; P = 0.143), but these were not statistically significant. CONCLUSIONS In a population of veterans with comorbid diabetes and SMI, patients on average had good glucose control and medication adherence regardless of where they received primary care.
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Affiliation(s)
- Judith A Long
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PADepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Wang
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
| | - Elina L Medvedeva
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
| | - Susan V Eisen
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MABoston University School of Public Health, Boston, MA
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PAMental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PAUniversity of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Julie Kreyenbuhl
- Mental Illness Research, Education and Clinical Center, VA Capitol Health Care Network, Baltimore, MDDivision of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Steven C Marcus
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PAPenn School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
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Abstract
This article explored the origins and implications of the underdiagnosis of affective disorders in African-Americans. MEDLINE and old collections were searched using relevant key words. Reference lists from the articles that were gathered from this procedure were reviewed. The historical record indicated that the psychiatric perception of African-Americans with affective disorders changed significantly during the last 200 years. In the antebellum period, the mental disorders of slaves mostly went unnoticed. By the early 20th century, African-Americans were reported to have high rates of manic-depressive disorder compared with whites. By the mid-century, rates of manic-depressive disorder in African-Americans plummeted, whereas depression remained virtually nonexistent. In recent decades, diagnosed depression and bipolar disorder, whether in clinical or research settings, were inexplicably low in African-Americans compared with whites. Given these findings, American psychiatry needs to appraise the deep-seated effects of historical stereotypes on the diagnosis and treatment of African-Americans.
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Katz G, Grunhaus L, Deeb S, Shufman E, Bar-Hamburger R, Durst R. A comparative study of Arab and Jewish patients admitted for psychiatric hospitalization in Jerusalem: the demographic, psychopathologic aspects, and the drug abuse comorbidity. Compr Psychiatry 2012; 53:850-3. [PMID: 22197215 DOI: 10.1016/j.comppsych.2011.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 11/07/2011] [Accepted: 11/08/2011] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The influence of ethnicity on different aspects of psychiatric hospitalization is far from clear. THE AIM OF THE STUDY The main aim of the study was to compare the Arab and the Jewish inpatients, at the time of admission, for the demographic factors, severity of psychotic, and affective psychopathology and comorbid drug abuse rate. POPULATION, METHOD, AND TOOLS: Among 250 consecutively admitted patients in the Jerusalem Mental Health Center-Kfar Shaul Hospital, 202 Jews and 42 Arabs (aged 18-65 years) were examined within 48 hours after admission. The psychiatric diagnoses were made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. For the differential measurement of psychopathologic severity, the following rating scales were used: 21-item Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale. Urine tests for Δ9-tetrahydrocannabinol (THC), cocaine, opiates, amphetamines, and methamphetamine were performed using the Sure Step TM kits (Applied Biotech, Inc, San Diego, CA, USA). The Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for drug abuse were applied based on self-report and results of urine analysis. RESULTS The comparison of the 2 population showed that among the Arab inpatients, there were more males (81% vs 67.4%; P < .005). No significant difference in psychiatric diagnosis was observed. The overall severity of positive symptoms (PANSS positive) in Arab group was higher, but only slightly so (P = .05). No significant difference was observed for total rates of PANSS negative subscale. The rates of PANSS-general were also similar. The Arab patients were significantly less depressive according to 21-item Hamilton Depression Rating Scale (P = .032), and the total score of Hamilton Anxiety Rating Scale for the Jewish group was significantly higher (P = .001). No significant difference in general severity of manic symptoms for 2 groups was detected according to Young Mania Rating Scale. The rate of comorbid drug abuse for Jewish inpatients was borderline higher (P = .068). CONCLUSIONS The issue of referral to psychiatric hospitalization could be culturally influenced; it may be the result of disparities in demographic, psychopathologic, and drug abuse comorbid presenting symptoms, which are demonstrated upon admission by patients of different ethnic origins.
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Affiliation(s)
- Gregory Katz
- The Jerusalem Mental Health Center-Kfar Shaul Hospital, Jerusalem, Israel.
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Haeri S, Williams J, Kopeykina I, Johnson J, Newmark A, Cohen L, Galynker I. Disparities in diagnosis of bipolar disorder in individuals of African and European descent: a review. J Psychiatr Pract 2011; 17:394-403. [PMID: 22108396 DOI: 10.1097/01.pra.0000407962.49851.ef] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Over the past 3 decades, a wide range of studies in the United States and the United Kingdom has reported that white individuals are more likely to be diagnosed with bipolar and affective disorders, whereas black individuals appear to be at higher risk for schizophrenia spectrum diagnoses. Despite the pressing need for strategies aimed at eliminating racial and cultural disparities in diagnosis and treatment of bipolar disorder, no systematic review of the existing literature in this area has been done. This study draws together the disparate strands of information in a comprehensive overview of the research base in this area. METHODS An electronic literature search of the Medline and PsychINFO databases was conducted in October 2009, supplemented by a review of references in the identified articles, for a total of 51 articles included in this qualitative review. RESULTS Black patients have consistently been found to be more likely than white patients to be diagnosed with schizophrenia rather than bipolar disorder. Four factors were identified as potential contributors to racial disparities in diagnostic rates: clinical presentation and expression of symptoms, access to care, help-seeking behaviors, and clinician judgment. CONCLUSION Despite efforts to curtail the phenomenon, racial disparities in diagnosis of bipolar disorder persist. Racial and cultural elements may affect how patients manifest behaviors and symptoms and how these are interpreted and attributed by clinicians in the diagnostic process. As an appropriate diagnosis determines treatment options and is central to quality of care, incorrect diagnosis can potentially have a negative impact on treatment effectiveness and accuracy of prognosis.
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Zeber JE, Miller AL, Copeland LA, McCarthy JF, Zivin K, Valenstein M, Greenwald D, Kilbourne AM. Medication adherence, ethnicity, and the influence of multiple psychosocial and financial barriers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:86-95. [PMID: 20549327 DOI: 10.1007/s10488-010-0304-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Medication adherence is critical for patients with bipolar disorder to avoid symptom exacerbation and diminished quality of life. Most analyses consider adherence barriers individually rather than conjointly, while neglecting potential ethnic differences. 435 patients in the Continuous Improvement for Veterans in Care--Mood Disorders study reported multiple financial and psychosocial factors influencing adherence. Logistic regression modeled adherence as a function of perceived barriers, including cost burden, access, binge drinking, poor therapeutic alliance, and medication beliefs. Nearly half the cohort experienced adherence difficulty, averaging 2.8 barriers, with minority veterans reporting lower adherence than white patients, particularly financial burden and treatment access. Total barriers were significantly associated with worse adherence (OR = 1.24 per barrier), notably poor medication beliefs, binge drinking, and difficulty accessing psychiatric specialists (ORs of 2.41, 1.95 and 1.73, respectively). Veterans with bipolar disorder experience numerous adherence barriers, with certain obstacles proving especially pernicious. Fortunately tailored clinical interventions can improve adherence, particularly by addressing modifiable risk factors.
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Affiliation(s)
- John E Zeber
- Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), 7400 Merton Minter Boulevard, San Antonio, TX 78229-4404, USA.
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Gutierrez J, Long JA. Reliability and validity of diabetes specific Health Beliefs Model scales in patients with diabetes and serious mental illness. Diabetes Res Clin Pract 2011; 92:342-7. [PMID: 21411173 PMCID: PMC3110594 DOI: 10.1016/j.diabres.2011.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 02/04/2011] [Accepted: 02/14/2011] [Indexed: 01/19/2023]
Abstract
AIMS In this study we evaluate the reliability and validity of existing Health Beliefs Model (HBM) scales developed to assess HBM domains in a population of patients with both diabetes and serious mental illness (SMI). While diabetes medication adherence has frequently been evaluated through the lens of the HBM, it is unclear if developed scales are reliable and valid in patients with SMI. METHODS We surveyed 152 veterans with diabetes and SMI. Domains of the HBM assessed included perceived benefits, side effects and barriers to diabetes medication taking, perceived susceptibility to and severity of diabetes, diabetes self-efficacy, diabetes locus of control, and perceived diabetes control. RESULTS HBM scales showed good internal reliability within a SMI population, with Cronbach alphas ranging between 0.73 and 0.86 for all scales assessed except one. HBM scales also showed associations with self reported diabetes medication adherences in six of the ten domains. CONCLUSION Scales assessing diabetes specific domains of the HBM exhibit both reliability and validity in patients with both diabetes and SMI.
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Affiliation(s)
- Jennifer Gutierrez
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, PA
| | - Judith A. Long
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, PA
- University of Pennsylvania’s Institute for Diabetes, Obesity, and Metabolism and Diabetes Endocrinology Research Center Philadelphia, PA
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
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Jarvis GE, Toniolo I, Ryder AG, Sessa F, Cremonese C. High rates of psychosis for black inpatients in Padua and Montreal: different contexts, similar findings. Soc Psychiatry Psychiatr Epidemiol 2011; 46:247-53. [PMID: 20165832 DOI: 10.1007/s00127-010-0187-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 01/15/2010] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study tested the hypothesis that despite differences in setting, specifically in Padua or Montreal, black psychiatric inpatients will have higher rates of assigned diagnosis of psychosis than their non-black counterparts. METHODS Data on psychotic patients admitted to the psychiatry ward were extracted from records of general hospitals in Padua and Montreal. Logistic regression analyses were conducted separately for each site to determine the relation between being black and receiving a diagnosis of psychosis, while controlling for sex and age. RESULTS Most black patients at both sites received a diagnosis of psychosis (76% in Padua and 81% in Montreal). Being black was independently and positively associated with being diagnosed with psychosis compared to patients from other groups. CONCLUSIONS Black patients admitted to psychiatry, whether in Padua or Montreal, were more likely to be assigned a diagnosis of psychosis than were other patients.
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Culture, Race/Ethnicity and Disparities: Fleshing Out the Socio-Cultural Framework for Health Services Disparities. HANDBOOK OF THE SOCIOLOGY OF HEALTH, ILLNESS, AND HEALING 2011. [DOI: 10.1007/978-1-4419-7261-3_19] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ethnicity and cultural issues. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:195084. [PMID: 22110911 PMCID: PMC3205671 DOI: 10.1155/2011/195084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 08/15/2011] [Indexed: 11/18/2022]
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Ethnic origin and increased risk for schizophrenia in immigrants to countries of recent and longstanding immigration. Acta Psychiatr Scand 2010; 121:325-39. [PMID: 20105146 DOI: 10.1111/j.1600-0447.2009.01535.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Compare the risk for schizophrenia in immigrants to countries of recent and longstanding immigration. Compare prevalence and incidence rates in black subjects under different conditions. METHOD An electronic literature search was complemented by review articles and cross-references. Studies reporting standard diagnosis and incidence or prevalence rates were included. RESULTS Immigrants had an increased risk for schizophrenia in countries of longstanding immigration, but with lower risk ratios than in those of recent immigration. The risk was higher in black immigrants and the black population living in the United States. But incidence and prevalence rates in Africa and the Caribbean were similar to those of international studies. CONCLUSION Comparing the most recent generation of immigrants with descendants of previous ones may account for the lower risk ratios observed in countries of longstanding vs. recent immigration. Two neurobiological hypotheses are proposed to explain the epidemiological findings in black populations and in immigrants.
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Flaskerud JH. Moods, attitudes, and presidential influence. Issues Ment Health Nurs 2010; 31:235-6. [PMID: 20144036 DOI: 10.3109/01612840903230115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jacquelyn H Flaskerud
- School of Nursing, University of California-Los Angeles, Los Angeles, California 90095-1702, USA.
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Schaffer A, Cairney J, Cheung A, Veldhuizen S, Kurdyak P, Levitt A. Differences in prevalence and treatment of bipolar disorder among immigrants: results from an epidemiologic survey. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:734-42. [PMID: 19961661 DOI: 10.1177/070674370905401103] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To add to the limited data on the prevalence, clinical characteristics, and treatment of bipolar disorder (BD) among immigrants. METHOD Data were obtained from a large epidemiologic survey, the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.2). Lifetime prevalence rates of BD were compared between immigrant and nonimmigrant respondents. Among BD subjects (n = 831), sociodemographic, clinical, and mental health treatment use variables were compared based on immigrant status. Logistic regression was used to determine the correlates of lifetime contact with a mental health professional and 12-month psychotropic medication use. RESULTS Lifetime prevalence rate of CCHS 1.2-defined BD was significantly lower among immigrant, compared with nonimmigrant, participants (1.50% and 2.27%, P = 0.01). There were few sociodemographic or clinical differences, yet immigrants with BD were significantly less likely to report any lifetime contact with mental health professionals (OR = 0.25, 95% CI 0.13 to 0.50, P < 0.001). Past-year psychotropic medication use was numerically lower among immigrants with BD (24.5% and 41.0%); however, this did not reach statistical significance when controlling for other factors (OR = 0.49, 95% CI 0.24 to 1.01, P = 0.05). CONCLUSIONS Based on the results of this study, there are in the range of 56 000 to 104 000 immigrants with BD in Canada. Further efforts are needed to better understand and address the barriers to mental health treatment use among immigrants who have BD.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Longitudinal patterns of health system retention among veterans with schizophrenia or bipolar disorder. Community Ment Health J 2008; 44:321-30. [PMID: 18401711 DOI: 10.1007/s10597-008-9133-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 02/29/2008] [Indexed: 10/22/2022]
Abstract
Inconsistent service use for schizophrenia and bipolar disorder is associated with poorer outcomes of care. We analyzed VHA National Psychosis Registry data for 164,150 veterans with these disorders to identify characteristics associated with 5-year patterns of survival and with retention in VHA care. Most cohort members (63%) survived the period with no break in VHA healthcare lasting over 12 months. Inconsistent utilization was associated with younger age, no service-connected disability, and less physical comorbidity, regardless of diagnosis. The influence of gender and ethnicity on attrition varied by diagnosis and gap-duration. Variation in attrition by gender and ethnicity warrants additional attention.
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Kilbourne AM, Welsh D, McCarthy JF, Post EP, Blow FC. Quality of care for cardiovascular disease-related conditions in patients with and without mental disorders. J Gen Intern Med 2008; 23:1628-33. [PMID: 18626722 PMCID: PMC2533391 DOI: 10.1007/s11606-008-0720-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 02/27/2008] [Accepted: 06/25/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We compared the quality of care for cardiovascular disease (CVD)-related risk factors for patients diagnosed with and without mental disorders. METHODS We identified all patients included in the fiscal year 2005 (FY05) VA External Peer Review Program's (EPRP) national random sample of chart reviews for assessing quality of care for CVD-related conditions. Using the VA's National Psychosis Registry and the National Registry for Depression, we assessed whether patients had received diagnoses of serious mental illness (schizophrenia, bipolar disorder, or other psychoses) or depression during FY05. Using multivariable logistic regression and generalized estimating equation analyses, we assessed patient and facility factors associated with receipt of guideline concordant care for hypertension (total N = 24,016), hyperlipidemia (N = 46,430), and diabetes (N = 10,943). RESULTS Overall, 70% had good blood pressure control, 90% received a cholesterol (hyperlipidemia) screen, 77% received a retinal exam for diabetes, and 63% received recommended renal tests for diabetes. After adjustment, compared to patients without SMI or depression, patients with SMI were less likely to be assessed for CVD risk factors, notably hyperlipidemia (OR = 0.58; p < 0.001), and less likely to receive recommended follow-up assessments for diabetes: foot exam (OR = 0.68; p < 0.001), retinal exam (OR = 0.65; p < 0.001), or renal testing (OR = 0.64; p < 0.001). Patients with depression were also significantly less likely to receive adequate quality of care compared to non-psychiatric patients, although effects were smaller than those observed for patients with SMI. CONCLUSIONS Quality of care for major chronic conditions associated with premature CVD-related mortality is suboptimal for VA patients with SMI, especially for procedures requiring care by a specialist.
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Affiliation(s)
- Amy M Kilbourne
- VA Ann Arbor National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA.
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Weeks WB, Wallace AE, West AN, Heady HR, Hawthorne K. Research on Rural Veterans: An Analysis of the Literature. J Rural Health 2008; 24:337-44. [DOI: 10.1111/j.1748-0361.2008.00179.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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