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Ortega Ceballos PA, Rivera Rivera L, Reynales Shigematsu LM, Austria Corrales F, Toledano-Toledano F, Pérez Amezcua B. Psychological distress, intimate partner violence and substance use in a representative sample from Mexico: A structural equation model. Front Public Health 2023; 11:1101487. [PMID: 36935665 PMCID: PMC10018179 DOI: 10.3389/fpubh.2023.1101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/23/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Intimate Partner Violence (IPV) is a public health concern associated with multiple adverse health outcomes, including psychological distress (PD). Objective To assess the association of IPV and psychological distress, and the mediation of tobacco and alcohol consumption in a national representative sample from Mexico. Material and methods Data from the Encuesta Nacional de Consumo de Drogas, Tabaco y Alcohol (ENCODAT) were analyzed. The sample included 34,864 people between the ages of 12 and 65 with a partner. Using Structural Equation Modeling (SEM), the association between IPV, use alcohol, tobacco and psychological distress was measured. Results The population was composed of women (51.9%) and men (48.1%); 15.1% (women = 18.2% and men = 11.9%) reported IPV in the last year. The prevalence of psychological distress in the last year was 3.3%, being 3.8% in women, and 2.7% in men. Results from the SEM in women indicated a direct positive effect of the IPV construct on psychological distress (β = 0.298, p < 0.01); these findings confirmed that IPV tended to systematically increase psychological distress. Likewise, the presence of IPV increased the consumption of tobacco (β = 0.077, p < 0.01) and alcohol (β = 0.072, p < 0.01). The SEM results in men showed that alcohol and tobacco consumption tended to increase in the presence of IPV (β = 0.121, p < 0.01, and β = 0.086, p < 0.01, respectively), and in turn, alcohol consumption and tobacco tended to increase psychological distress (β = 0.024, p < 0.01, and β = 0.025, p < 0.01, respectively). Conclusion This study indicated that in women, IPV had a direct effect on psychological distress and on alcohol and tobacco consumption. Meanwhile in men, alcohol and tobacco consumption had a mediating effect between IPV and psychological distress. The empirical findings of this study will contribute toward the design of public health policies for the prevention and attention of IPV, alcohol and tobacco consumption, and consequently address the mental health consequences derived from these problems.
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Affiliation(s)
| | - Leonor Rivera Rivera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | | | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
- Unidad de Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Berenice Pérez Amezcua
- Centro de Investigación Transdisciplinar en Psicología, Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, Mexico
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Barksdale CL, Pérez-Stable E, Gordon J. Innovative Directions to Advance Mental Health Disparities Research. Am J Psychiatry 2022; 179:397-401. [PMID: 35599539 DOI: 10.1176/appi.ajp.21100972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disparities in mental health have persisted or worsened despite our awareness of their existence, increased understanding of their causes, and efforts at reduction and mitigation. Although much is known, there is still much to be done in mental health research to meaningfully impact disparities. In November 2020, the National Institute of Mental Health (NIMH) and the National Institute of Minority Health and Health Disparities (NIMHD) co-sponsored a virtual workshop to explore the complexities of mental health disparities, which revealed several gaps and opportunities for the field to pursue to advance mental health disparities research. This article, the introduction to a Special Issue on Mental Health Disparities, provides a frame for four articles that stem from and are inspired by the virtual NIMH/NIMHD workshop, all of which illustrate innovative research on understanding the complex mechanisms of disparities and how this knowledge can be translated into effective intervention development that advances mental health equity.
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Affiliation(s)
- Crystal L Barksdale
- Office for Disparities Research and Workforce Diversity, NIMH, Bethesda, Md. (Barksdale); National Institute on Minority Health and Health Disparities, NIH, Bethesda, Md. (Barksdale, Pérez-Stable); NIMH, Bethesda, Md. (Gordon)
| | - Eliseo Pérez-Stable
- Office for Disparities Research and Workforce Diversity, NIMH, Bethesda, Md. (Barksdale); National Institute on Minority Health and Health Disparities, NIH, Bethesda, Md. (Barksdale, Pérez-Stable); NIMH, Bethesda, Md. (Gordon)
| | - Joshua Gordon
- Office for Disparities Research and Workforce Diversity, NIMH, Bethesda, Md. (Barksdale); National Institute on Minority Health and Health Disparities, NIH, Bethesda, Md. (Barksdale, Pérez-Stable); NIMH, Bethesda, Md. (Gordon)
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3
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Toussaint E, Roby D, Yue D, Franzini L, Sehgal N. Estimating a Model for Mental Healthcare Utilization Using Subjective Unmet Need and Psychological Distress Measures. J Behav Health Serv Res 2022; 49:500-512. [PMID: 35534693 DOI: 10.1007/s11414-022-09797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
The objective of this study is to assess the predictive value of self-reported need and psychological distress in mental healthcare service use across racial and ethnic groups in California. Using 2014-2018 data for adults aged 18-64 in the California Health Interview Survey, both logistic and Poisson regression models are used to estimate mental healthcare utilization. Patient-reported outcome measures, such as psychological distress, are commonly used to evaluate healthcare utilization patterns. The Kessler-6 screener for psychological distress is frequently used as a tool for determining whether someone's level of distress necessitates evaluation by a mental healthcare professional. Serious psychological distress has been widely studied as a predictor of higher healthcare expenditures and use; however, moderate distress and self-reported need has been less examined in the literature. Seventy-two percent of individuals with moderate psychological distress felt like they needed to see a professional for their mental or emotional needs compared to 4% of individuals with serious psychological distress. Individuals with moderate psychological distress had 34% of all healthcare visits for mental or emotional needs during the study period, compared to 17% for those with serious psychological distress. Subjective unmet need for mental healthcare was reported by 77% of those who utilized mental healthcare during the study period. Studying subjective unmet need, in addition to moderate and serious distress, provides additional understanding of the need for mental healthcare and mental healthcare utilization.
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Affiliation(s)
| | - Dylan Roby
- University of California, Irvine, CA, USA
| | - Dahai Yue
- University of Maryland, College Park, MD, USA
| | | | - Neil Sehgal
- University of Maryland, College Park, MD, USA
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NeMoyer A, Cruz-Gonzalez M, Alvarez K, Kessler RC, Sampson NA, Green JG, Alegría M. Reducing racial/ethnic disparities in mental health service use among emerging adults: community-level supply factors. ETHNICITY & HEALTH 2022; 27:749-769. [PMID: 32877232 PMCID: PMC7921204 DOI: 10.1080/13557858.2020.1814999] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives: Emerging adulthood-spanning 18-29 years of age-is associated with the highest risk for onset of certain behavioral health disorders (e.g. major depression, bipolar disorder, psychosis, substance use disorders) and high prevalence of many behavioral health disorders. Yet, rates of mental health service use remain low in this age range. Racial/ethnic minorities are particularly impacted by individual, cultural/linguistic, and community-level barriers to mental health care. This study examined community-level factors associated with mental health service use and investigated whether these associations varied by race/ethnicity.Design: This study analyzed individual- and county-level data for emerging adults in the United States (N=3,294) from the nationally representative Collaborative Psychiatric Epidemiological Surveys (CPES). Using the Andersen Model of Health Care Utilization, analyses examined predisposing, enabling, and need factors utilized in prior studies with adult samples as well as novel community characteristics hypothesized to impact service use among emerging adults of diverse racial/ethnic backgrounds. Past-year use of both specialty and any mental health services were assessed, controlling for individual- and community-level variables, and adjusting for presence of past-year mental health disorder, overall health status, and functional impairment. Differences between racial/ethnic minority groups and Non-Latino Whites were tested through a multilevel model incorporating random intercepts logistic regression, with analysis focusing on the interaction between race/ethnicity and community-level supply variables.Results: For past-year use of specialty mental health services, density of hospitals with child wellness programs was linked to service use among Black emerging adults, whereas density of hospitals with linguistic/translation services was linked to service use among Latino emerging adults.Conclusions: This study expands on previous research in behavioral health disparities to examine ways to improve behavioral health services for an emerging adult population with unmet service needs and identifies specific community-level factors that can improve mental health for racial/ethnic minority emerging adults.
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Affiliation(s)
- Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States
- Department of Medicine, Harvard Medical School, 21 Shattuck Street, Boston, MA, 02115, United States
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States
- Department of Medicine, Harvard Medical School, 21 Shattuck Street, Boston, MA, 02115, United States
- Corresponding author: Kiara Alvarez, 50 Staniford Street Suite 830 Boston, MA 02114; telephone: +1-617-724-1237;
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States
| | - Jennifer Greif Green
- Wheelock College of Education and Human Development, Boston University, 2 Silber Way, Boston, MA 02215, United States
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States
- Department of Medicine, Harvard Medical School, 21 Shattuck Street, Boston, MA, 02115, United States
- Department of Psychiatry, Harvard Medical School, 21 Shattuck Street, Boston, MA, 02115, United States
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Parker MA, Cordoba-Grueso WS, Streck JM, Goodwin RD, Weinberger AH. Intersectionality of serious psychological distress, cigarette smoking, and substance use disorders in the United States: 2008-2018. Drug Alcohol Depend 2021; 228:109095. [PMID: 34601273 PMCID: PMC8595675 DOI: 10.1016/j.drugalcdep.2021.109095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/13/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Serious psychological distress (SPD) is common among adults who smoke cigarettes and among adults with substance use disorders (SUD). It is unknown whether the burden of SPD is even greater among individuals with both cigarette smoking and SUDs. This study examined the intersectionality of SPD, cigarette smoking, and SUD over time. METHODS Data came from annual, cross-sectional, nationally representative samples of the United States (US) National Survey on Drug Use and Health (individuals age 12+). Past-month SPD prevalences were estimated each year from 2008 to 2018 for adults age 18+ with current daily, current non-daily, former, and never cigarette smoking by SUD status (combined n = 441,286). Logistic regression models examined linear time trends of SPD. RESULTS In 2018, SPD was significantly more prevalent among adults in each smoking group with SUD versus those without SUD (daily 29.1% vs. 9.0%, non-daily 23.2% vs. 8.6%, former 19.5% vs. 3.2%, never 16.4% vs. 4.3%). After adjusting for sociodemographics, SPD prevalence increased over time across smoking statuses with a larger change for persons with SUD (AOR=1.07; 95% CI: 1.06, 1.09) vs. no SUD (AOR=1.03; 95% CI: 1.02. 1.04). CONCLUSIONS SPD was more than twice as common among adults with SUD who smoke cigarettes compared to those without SUD who do not smoke cigarettes, with the highest prevalence among adults with both SUD and daily smoking. While SPD has increased over time, differences depended on SUD status beyond the effect of cigarette smoking. These results provide further evidence for treating smoking and mental health problems together.
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Affiliation(s)
- Maria A. Parker
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, USA
| | - Whitney S. Cordoba-Grueso
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, USA
| | - Joanna M. Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Renee D. Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York School of Public Health, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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6
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Chiu M, Saxena FE, Kurdyak P, Wilton AS, Vigod SN. Health Service Use among Individuals with Depression and Psychological Distress: A Population-Based Cohort Study in Ontario, Canada: Utilisation des services de santé par les personnes souffrant de dépression et de détresse psychologique : une étude de cohorte dans la population de l'Ontario, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:641-651. [PMID: 32458758 PMCID: PMC7485038 DOI: 10.1177/0706743720927826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Relatively little is known about how health-care utilization differs among individuals with psychological distress compared to those with major depressive disorder (MDD). METHODS Ontario participants of the Canadian Community Health Survey Cycle 1.2 (2002) were linked to health administrative data to follow their health-care utilization patterns for up to 15 years. Based on their survey responses, we classified individuals hierarchically into Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria MDD, psychological distress (Kessler-6: 8 to 24), or an unexposed group with neither condition. We compared the rates of outpatient and acute care mental and nonmental health-related visits across the 3 groups over time using Poisson regression. RESULTS Among the 430 individuals with MDD, 668 with psychological distress, and 9,089 in the unexposed group, individuals with MDD and psychological distress had higher rates of health-care utilization than the unexposed overall and across time. The rates of psychiatrist visits for the MDD group were significantly higher than the other groups initially but declined over the follow-up. Conversely, the rates of psychiatrist visits among the psychological distress group increased over time and converged with that of the MDD group by the end of follow-up (rate ratioMDD vs. psychological distress at 1 year: 4.20 [1.97 to 11.40]; at 15 years: 1.53 [0.54 to 4.08]). Acute care visits were similar between the MDD and psychological distress groups at all time points. CONCLUSIONS Individuals with psychological distress required mental health care rivalling that of individuals with MDD over time, suggesting that even a cross-sectional assessment of significant psychological distress is a serious clinical concern.
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Affiliation(s)
- Maria Chiu
- 50010ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Paul Kurdyak
- 50010ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Simone N Vigod
- 50010ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
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7
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Miles LW, Williams N, Luthy KE, Eden L. Adult Vaccination Rates in the Mentally Ill Population: An Outpatient Improvement Project. J Am Psychiatr Nurses Assoc 2020; 26:172-180. [PMID: 30866701 DOI: 10.1177/1078390319831763] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Adults who suffer with severe and persistent mental illness (SPMI) rarely access medical care to receive preventive vaccines. Aims: To increase the rate of vaccines among the SPMI population in an outpatient community mental health center (CMHC). Methods: A review of the literature identified a gap between the general population and SPMI clients in receiving preventive vaccinations. An initial mixed-method convenience survey of SPMI clients (n = 392) provided information on current vaccination status, demographics, beliefs, and interest in receiving vaccines. A vaccination program was developed to address identified barriers and increase vaccination rates. Postintervention data were collected through a mixed-method convenience survey of SPMI clients (n = 60) who participated in immunizations clinics to evaluate client satisfaction. A partnership between the health department and CMHC was developed to deliver vaccines in a nontraditional site. Vaccines administered included annual influenza; hepatitis A; hepatitis B; herpes zoster; measles, mumps, and rubella; pneumococcal; and tetanus, diphtheria, and pertussis (Tdap). Results: More than 1,000 vaccines were administered in the first 8 months, with a significant increase in vaccination rates over baseline for individual vaccines ranging from 18.75% to 83%. Postintervention survey results found a 95% satisfaction rate. Conclusions: Implementation of a vaccination program in a nontraditional site that facilitates access for SPMI clients can promote an overwhelming increase in the vaccination rates for this underserved population. Results suggest that the integration of mental health and CMHC services can have a profound positive effect on SPMI population health.
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Affiliation(s)
- Leslie W Miles
- Leslie W. Miles, DNP, APRN, PMHNP-BC, Brigham Young University, Provo, UT, USA
| | - Nathalia Williams
- Nathalia Williams, MS, FNP, Brigham Young University, Provo, UT, USA
| | - Karlen E Luthy
- Karlen E. Luthy, DNP, FNP, Brigham Young University, Provo, UT, USA
| | - Lacey Eden
- Lacey Eden, MS, FNP, Brigham Young University, Provo, UT, USA
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8
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Shen S, Kusunoki Y. Intimate Partner Violence and Psychological Distress Among Emerging Adult Women: A Bidirectional Relationship. J Womens Health (Larchmt) 2019; 28:1060-1067. [PMID: 31166827 PMCID: PMC6709941 DOI: 10.1089/jwh.2018.7405] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Intimate partner violence (IPV) and psychological distress (PD) are major public health concerns among emerging adult women. Emerging adulthood presents a complex set of new experiences and challenges that pose a risk to normative development. In particular, an increased prevalence of IPV and PD during this time period may lead to long-term health consequences. Methods: Data from the Relationship Dynamics and Social Life study, a longitudinal study of a racially and socioeconomically diverse population-representative random sample of 726 partnered women, aged 18-19, residing in a Michigan county, and followed for 2.5 years, were used to investigate the relationship between IPV and PD. Logistic regression models predicted each measure of PD (depression, stress, loneliness, self-esteem) as a function of past IPV (none, psychological violence only, any physical violence), and multinomial logistic regression models predicted subsequent weekly IPV as a function of each measure of PD. Results: PD and IPV were prevalent among emerging adult women. Past psychological IPV was associated with experiencing all four distress measures. Past physical IPV was also associated with depression, stress, and loneliness, but not self-esteem. Women with each PD were more likely to subsequently experience psychological violence, and women who reported stress were more likely to subsequently experience any physical violence. Conclusions: The IPV-PD relationship is bidirectional. Women who experienced past IPV were more likely to report PD. Conversely, women who experienced PD were at a greater risk of subsequent IPV.
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Affiliation(s)
- Sharon Shen
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yasamin Kusunoki
- Department of Systems, Populations and Leadership, School of Nursing, Survey Research Center, Institute for Social Research Population Studies Center, University of Michigan, Ann Arbor, Michigan
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9
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Gobeil-Lavoie AP, Chouinard MC, Danish A, Hudon C. Characteristics of self-management among patients with complex health needs: a thematic analysis review. BMJ Open 2019; 9:e028344. [PMID: 31129599 PMCID: PMC6538095 DOI: 10.1136/bmjopen-2018-028344] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE There is a gap of knowledge among healthcare providers on characteristics of self-management among patients with chronic diseases and complex healthcare needs. Consequently, the objective of this paper was to identify characteristics of self-management among patients with chronic diseases and complex healthcare needs. DESIGN Thematic analysis review of the literature. METHODS We developed search strategies for the MEDLINE and CINAHL databases, covering the January 2000-October 2018 period. All articles in English or French addressing self-management among an adult clientele (18 years and older) with complex healthcare needs (multimorbidity, vulnerability, complexity and frequent use of health services) were included. Studies that addressed self-management of a single disease or that did not have any notion of complexity or vulnerability were excluded. A mixed thematic analysis, deductive and inductive, was performed by three evaluators as described by Mileset al. RESULTS Twenty-one articles were included. Patients with complex healthcare needs present specific features related to self-management that can be exacerbated by deprived socioeconomic conditions. These patients must often prioritise care based on one dominant condition. They are at risk for depression, psychological distress and low self-efficacy, as well as for receiving contradictory information from healthcare providers. However, the knowledge and experiences acquired in the past in relation to their condition may help them improve their self-management skills. CONCLUSIONS This review identifies challenges to self-management for patients with complex healthcare needs, which are exacerbated in contexts of socioeconomic insecurity and proposes strategies to help healthcare providers better adapt their self-management support interventions to meet the specific needs of this vulnerable clientele.
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Affiliation(s)
- Annie-Pier Gobeil-Lavoie
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Alya Danish
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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10
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Weinberger AH, Pacek LR, Sheffer CE, Budney AJ, Lee J, Goodwin RD. Serious psychological distress and daily cannabis use, 2008 to 2016: Potential implications for mental health? Drug Alcohol Depend 2019; 197:134-140. [PMID: 30825793 PMCID: PMC6440801 DOI: 10.1016/j.drugalcdep.2019.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Daily cannabis use is increasing in the United States (US). Yet, it is not known whether daily cannabis use is disproportionately common, or whether it has increased differentially over time, by mental health status. This study estimated the prevalence of daily cannabis use among adults in the US with and without past-month serious psychological distress (SPD; measured by the Kessler Psychological Distress Scale (K6)) in 2016 and estimated trends in daily cannabis use by past-30-day SPD status from 2008 to 2016. METHODS Data were drawn from adults age 18 and older in the 2008-2016 National Survey on Drug Use and Health (combined total analytic sample n = 356,413). Linear time trends of daily cannabis use, stratified by SPD status, were assessed using logistic regression models with continuous year as the predictor. RESULTS In 2016, past-month daily cannabis use was significantly more common among those with past-month SPD (8.07%), compared to those without past-month SPD (2.66%). Daily cannabis use increased significantly from 2008 to 2016 among those both with and without SPD although use among those with SPD was persistently higher than use among those without SPD over the time period studied. CONCLUSIONS Daily cannabis use is significantly more common among persons with serious psychological distress and is increasing in this group, as well as among those without. Given this increase and the high prevalence of cannabis use among those with SPD, it may be important to consider potential consequences of this increased use for those with mental health vulnerabilities.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Alan J Budney
- Geisel School of Medicine at Dartmouth, Center for Technology and Behavioral Health, Lebanon, NH, USA.
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Renee D Goodwin
- Institute for Implementation Science and Population Health, CUNY School of Public Health and Health Policy, New York, NY, USA; Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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11
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Hudon C, Chouinard MC, Dubois MF, Roberge P, Loignon C, Tchouaket É, Lambert M, Hudon É, Diadiou F, Bouliane D. Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study. Ann Fam Med 2018; 16:232-239. [PMID: 29760027 PMCID: PMC5951252 DOI: 10.1370/afm.2233] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/20/2017] [Accepted: 01/19/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation. METHODS We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients. RESULTS A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, P = .04), but did not have any significant effect on patient activation (P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health. CONCLUSIONS Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs.
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Affiliation(s)
- Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada .,Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Québec, Canada
| | - Maud-Christine Chouinard
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada.,Département des sciences de la santé, Université du Québec à Chicoutimi, Québec, Canada.,Centre de recherche de l'Hôpital Charles-LeMoyne, Québec, Canada
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Université de Sherbrooke, Québec, Canada
| | - Pasquale Roberge
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada.,Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Québec, Canada
| | - Christine Loignon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada
| | - Éric Tchouaket
- Département des sciences infirmières, Université du Québec en Outaouais, Québec, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Émilie Hudon
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada.,Département des sciences de la santé, Université du Québec à Chicoutimi, Québec, Canada
| | - Fatoumata Diadiou
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Danielle Bouliane
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
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12
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Prior Experiences of Behavioral Health Treatment among Uninsured Young Adults Served in a Psychiatric Crisis Setting. Community Ment Health J 2017; 53:782-792. [PMID: 28676940 DOI: 10.1007/s10597-017-0150-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
This study qualitatively explored the past treatment experiences of uninsured young adults who sought public emergency psychiatric care. Qualitative interviews were conducted with a racially diverse sample of 55 young adults (ages 18-25) using a semi-structured interview guide, and analyzed using a team-based open coding approach. Findings emerged in three broad areas-provider-related factors, treatment-related factors, and environmental factors. Young adults talked about the importance of providers respecting and listening to them, the perceived advantages and disadvantages of therapy and medication treatment, and aspects of the environment that resulted in positive and negative experiences, particularly in inpatient settings. Providers need to convey respect and caring that transcends job duties and provide tangible skills and supports.
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13
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Alhussain K, Meraya AM, Sambamoorthi U. Serious Psychological Distress and Emergency Room Use among Adults with Multimorbidity in the United States. PSYCHIATRY JOURNAL 2017; 2017:8565186. [PMID: 29085831 PMCID: PMC5612322 DOI: 10.1155/2017/8565186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/28/2017] [Accepted: 08/09/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES (1) To examine the association between serious psychological distress (SPD) and emergency room (ER) use in the past 12 months among adults with multimorbidity in the United States (US) and (2) to investigate the association between SPD and the reasons for ER use. METHODS The current study used a cross-sectional design with retrospective data from the 2015 National Health Interview Survey. Logistic regression models were used to assess the association between SPD and ER use among adults with multimorbidity. Among ER users, adjusted logistic regression models were conducted to examine the association between SPD and the reasons for the ER use. RESULTS After controlling for other variables, adults with multimorbidity and SPD were more likely to use ER than those with multimorbidity and no SPD (AOR = 1.61, 95% CI = 1.26, 2.04). Among ER users, there were no significant associations between SPD and the reasons for ER use after controlling for other variables. CONCLUSION Adults with multimorbidity and SPD were more likely to use ER as compared to those with multimorbidity and no SPD. Among adults with multimorbidity, routine screening for SPD may be needed to reduce the ER use.
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Affiliation(s)
- Khalid Alhussain
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, P.O. Box 9510, Morgantown, WV 26505, USA
| | - Abdulkarim M. Meraya
- Clinical Pharmacy Department, Faculty of Pharmacy, Jazan University, Jizan 45142, Saudi Arabia
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, P.O. Box 9510, Morgantown, WV 26505, USA
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14
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Behr JG, Diaz R. Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study. PLoS One 2016; 11:e0147116. [PMID: 26784515 PMCID: PMC4718591 DOI: 10.1371/journal.pone.0147116] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 12/29/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model. DATA SOURCE Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department. STUDY DESIGN Representative randomized sample of 1,443 adult patients triaged ESI levels 4-5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios. PRINCIPAL FINDINGS 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance. CONCLUSIONS Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.
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Affiliation(s)
- Joshua G. Behr
- Virginia Modeling, Analysis and Simulation Center, Old Dominion University, Suffolk, Virginia, United States of America
- * E-mail:
| | - Rafael Diaz
- Zaragoza Logistics Center, Massachusetts Institute of Technology, Zaragoza, España
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15
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Drapeau A, Marchand A, Forest C. Gender differences in the age-cohort distribution of psychological distress in Canadian adults: findings from a national longitudinal survey. BMC Psychol 2014. [DOI: 10.1186/s40359-014-0025-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Stockbridge EL, Wilson FA, Pagán JA. Psychological distress and emergency department utilization in the United States: evidence from the Medical Expenditure Panel Survey. Acad Emerg Med 2014; 21:510-9. [PMID: 24842501 DOI: 10.1111/acem.12369] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/12/2013] [Accepted: 12/01/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Psychological distress not only has substantial health and social consequences, but is also associated with emergency department (ED) use. Previous studies have typically used cross-sectional data to focus on the relation between serious psychological distress and dichotomized ED utilization measures, without assessing the volume of ED use or examining nonserious levels of psychological distress. The objective of this study was to explore the association between ED utilization volume and the full spectrum of psychological distress. METHODS Data from Panel 14 of the Medical Expenditure Panel Survey (MEPS; 2009-2010, n = 9,743) provided a nationally representative sample of U.S. individuals. ED utilization volume and three specifications of the Kessler Psychological Distress Scale (K6) were analyzed: a dichotomous serious/no serious psychological distress measure, a five-category ordinal measure, and a scale measure with a range of 0 to 24. Negative binomial-logit hurdle regression models were used to analyze how the different specifications of the K6 psychological distress measure were related to ED use. RESULTS Adults with serious psychological distress in 2009 had 1.59 (95% confidence interval [CI] = 1.15 to 2.20) times greater adjusted odds of having one or more ED visits in 2010 than those without serious psychological distress. Nonserious psychological distress levels in 2009 were also associated with increased adjusted odds of having at least one ED visit in 2010. The K6 scores showed a dose-response relationship in terms of the adjusted odds of having one or more ED visits. The adjusted odds ratios (ORs) were 1.86 (95% CI = 1.37 to 2.54) for adults with K6 scores at or above 11, OR 1.76 (95% CI = 1.38 to 2.25) for adults with K6 scores between 6 and 10, OR 1.33 (95% CI = 1.05 to 1.68) for adults with K6 scores between 3 and 5, and OR 1.17 (95% CI = 0.92 to 1.48) for adults with K6 scores of 1 or 2. In addition, the adjusted odds of having one or more ED visits in 2010 significantly increased with increasing psychological distress in 2009 (OR = 1.04, 95% CI = 1.03 to 1.06). Each additional point added to the K6 scale results in an increase in the adjusted odds of an ED visit. CONCLUSIONS Even a low level of psychological distress, and not just serious psychological distress, may be an early indicator of future ED use. These results highlight the need to develop novel responses to better manage or avert ED use not only for adults with serious psychological distress but also for those who are experiencing even mild symptoms of psychological distress.
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Affiliation(s)
- Erica L. Stockbridge
- The School of Public Health; Department of Health Management and Policy; University of North Texas Health Science Center; Fort Worth TX
- The Analytic Services Department; Magellan Health Services Maryland Heights; MO
| | - Fernando A. Wilson
- College of Public Health Department of Health Services Research & Administration; University of Nebraska Medical Center; Omaha NE
| | - José A. Pagán
- The Center for Health Innovation; The New York Academy of Medicine; New York NY
- The Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia PA
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17
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Shim RS, Druss BG, Zhang S, Kim G, Oderinde A, Shoyinka S, Rust G. Emergency department utilization among Medicaid beneficiaries with schizophrenia and diabetes: the consequences of increasing medical complexity. Schizophr Res 2014; 152:490-7. [PMID: 24380780 PMCID: PMC4127908 DOI: 10.1016/j.schres.2013.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 11/25/2013] [Accepted: 12/01/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Individuals with both physical and mental health problems may have elevated levels of emergency department (ED) service utilization either for index conditions or for associated comorbidities. This study examines the use of ED services by Medicaid beneficiaries with comorbid diabetes and schizophrenia, a dyad with particularly high levels of clinical complexity. METHODS Retrospective cohort analysis of claims data for Medicaid beneficiaries with both schizophrenia and diabetes from fourteen Southern states was compared with patients with diabetes only, schizophrenia only, and patients with any diagnosis other than schizophrenia and diabetes. Key outcome variables for individuals with comorbid schizophrenia and diabetes were ED visits for diabetes, mental health-related conditions, and other causes. RESULTS Medicaid patients with comorbid diabetes and schizophrenia had an average number of 7.5 ED visits per year, compared to the sample Medicaid population with neither diabetes nor schizophrenia (1.9 ED visits per year), diabetes only (4.7 ED visits per year), and schizophrenia only (5.3 ED visits per year). Greater numbers of comorbidities (over and above diabetes and schizophrenia) were associated with substantial increases in diabetes-related, mental health-related and all-cause ED visits. Most ED visits in all patients, but especially in patients with more comorbidities, were for causes other than diabetes or mental health-related conditions. CONCLUSION Most ED utilization by individuals with diabetes and schizophrenia is for increasing numbers of comorbidities rather than the index conditions. Improving care in this population will require management of both index conditions as well as comorbid ones.
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Affiliation(s)
- Ruth S Shim
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA; Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta, GA, USA.
| | - Benjamin G Druss
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shun Zhang
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA
| | - Giyeon Kim
- Center for Mental Health and Aging, The University of Alabama, Tuscaloosa, AL, USA; Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Adesoji Oderinde
- Department of Internal Medicine, Morehouse School of Medicine, USA
| | - Sosunmolu Shoyinka
- Department of Psychiatry, University of Missouri School of Medicine, USA
| | - George Rust
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA; Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, USA
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18
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Dallo FJ, Kindratt TB, Snell T. Serious psychological distress among non-Hispanic whites in the United States: the importance of nativity status and region of birth. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1923-30. [PMID: 23661150 DOI: 10.1007/s00127-013-0703-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 04/29/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE Serious psychological distress (SPD) is an understudied health topic. When studied, estimates for minority groups are compared to that of non-Hispanic whites. Non-Hispanic whites are heterogeneous, and comprise individuals from Europe, North Africa or the Middle East. The objectives of this study are to estimate and compare the sex- and age-adjusted prevalence of SPD first by nativity status and then by region of birth (Europe, Middle East and Russia) while controlling for potential confounders. METHODS The sample consisted of 196,483 participants, 18 years of age or older in the National Health Interview Survey (2000-2010). To measure SPD, Kessler's K6 Likert scale was used. Individuals with scores greater than or equal to 13 were considered to have SPD. RESULTS The age- and sex- adjusted prevalence of SPD was 3 % for foreign-born non-Hispanic whites. Of this, estimates were 6 % for those from the Middle East, 3 % for Europe and 2 % for Russia (p = 0.00). In the fully adjusted multivariable model, foreign-born non-Hispanic whites from the Middle East were more likely (OR = 1.76; 95 % CI = 1.01, 3.04) to report SPD when compared to US-born non-Hispanic whites. Within the foreign-born population, non-Hispanic whites from the Middle East were more than twice as likely to report SPD (OR = 2.43; 95 % CI = 1.15, 5.14) compared to foreign-born non-Hispanic whites from Europe after controlling for confounders. CONCLUSIONS This study's findings will help researchers understand which subgroups within non-Hispanic whites suffer most from SPD, which will facilitate tailored prevention intervention efforts.
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Affiliation(s)
- Florence J Dallo
- Wellness, Health Promotion and Injury Prevention, School of Health Sciences, Oakland University, Rochester, MI, 48309-4428, USA,
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