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Algrim K, Keita M, Herbert C, Moreno F, Boxer P. Perceptions of police as a moderator between negative experiences and mental health symptoms. JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 52:1163-1178. [PMID: 39126676 DOI: 10.1002/jcop.23141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/04/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
Negative experiences with police present serious risks for mental health. However, interpretation plays a meaningful and little understood role in the effects of those experiences. This study expands on previous work exploring coping responses to negative police experiences and investigates the relation between negative experiences with police and mental health outcomes. Participants (N = 198) were from a diverse sample of young adults at a minority-serving institution. Black/African American, Hispanic/Latinx, and Middle Eastern/North African participants reported significantly more negative police experiences than White and Asian/Asian American participants. Black/African American and Hispanic/Latinx also showed more negative perceptions of police. Negative police experiences were positively related to depression but not posttraumatic stress symptoms. There were also meaningful interactive effects between negative experiences and perceptions of police on levels of posttraumatic stress and depression, suggesting negative perceptions of police may buffer negative effects of negative police experiences. Our findings point to the importance of addressing negative encounters with police as mental health stressors, as well as effects of crucial differences in perceptions of police by race. This research contributes to a growing understanding of the complex nature and effects of experiences with police on mental health.
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Affiliation(s)
- Kaylise Algrim
- Department of Psychology, Rutgers University, Newark, New Jersey, USA
| | - Mamadee Keita
- Department of Psychology, Rutgers University, Newark, New Jersey, USA
| | - Christian Herbert
- Department of Psychology, Rutgers University, Newark, New Jersey, USA
| | - Franklin Moreno
- Department of Criminal Justice, Temple University, Philadelphia, Pennsylvania, USA
| | - Paul Boxer
- Department of Psychology, Rutgers University, Newark, New Jersey, USA
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Song S, Martin MJ, Wang Z. School belonging mediates the longitudinal effects of racial/ethnic identity on academic achievement and emotional well-being among Black and Latinx adolescents. J Sch Psychol 2024; 106:101330. [PMID: 39251307 DOI: 10.1016/j.jsp.2024.101330] [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: 04/12/2023] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 09/11/2024]
Abstract
Social Identity Theory proposes that a positive in-group social identification fosters students' academic motivation and psychological well-being. The present study, grounded in Social Identity Theory, investigated the roles of racial/ethnicity identity (REI) in the development of school adjustment among Black and Latinx youth as well as the psychological mechanisms underlying these longitudinal associations. We hypothesized that REI would positively predict the development of academic achievement and emotional symptoms. In addition, we hypothesized that the development of school belonging would mediate the predictive effects of REI on the growth of academic achievement and emotional symptoms. Participants were 475 (n = 182 Black, 48.9% female; 293 Latinx, 47.8% female) students in Grades 7-9. Students self-reported their REI, school belonging, and emotional symptoms. Academic achievement was assessed using standardized achievement test scores. The longitudinal mediation models indicated that REI indirectly predicted the development of academic achievement and emotional symptoms through students' sense of school belonging. Specifically, higher REI embedded achievement and lower REI awareness of racism predicted higher school belonging in Grade 7. Higher Grade 7 school belonging in turn predicted faster academic growth in Grade 7 to Grade 9 as well as lower emotional symptoms in Grade 7. In addition, the three dimensions of REI also directly predicted the growth of academic achievement and emotional symptoms in Grades 7-9. The mediated effects were smaller in size than the direct effects. These findings highlight the importance of fostering positive REI and a strong sense of school belonging in promoting school adjustment among racial/ethnic minoritized, academically at-risk youth.
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Affiliation(s)
- Seowon Song
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock, TX, USA
| | - Monica J Martin
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock, TX, USA
| | - Zhe Wang
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA.
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3
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Liu Y, Ge X, Wang Y, Qiao S, Cai Y. How race and socioeconomic status moderate the association between moderate-to-vigorous physical activity and depressive symptoms: a cross-sectional study with compositional data. Br J Sports Med 2024:bjsports-2024-108290. [PMID: 38925888 DOI: 10.1136/bjsports-2024-108290] [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: 06/11/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES This study explored how race and socioeconomic status (SES) moderated the association between moderate-to-vigorous physical activity (MVPA) and depressive symptoms with compositional data. METHODS Participants were 2803 US adults from the 2005-2006 cycle of the National Health and Nutrition Examination Survey. Accelerometers were used to measure MVPA, light-intensity physical activity (LPA) and sedentary behaviours (SB). Participants self-reported sleep duration and depressive symptoms. SES was derived by latent class analysis using household income level, education attainment and occupation. The association between the relative time of MVPA and depressive symptoms and the moderating effects of race and SES were investigated through compositional data analysis. Isotemporal substitution analysis was employed to estimate the association of time reallocation from other movement behaviours to MVPA with depressive symptoms. RESULTS Increased time spent in MVPA relative to time spent in LPA, SB and sleep was inversely associated with depressive symptoms (OR (95% CI)=0.679 (0.538-0.855)). The relative time of MVPA significantly interacted with race and SES for depressive symptoms (P for interaction <0.05). Reallocating 10-30 min from sleep, SB or LPA to MVPA was associated with lower odds of depressive symptoms solely among non-Hispanic white individuals and those with higher SES. CONCLUSION This study used compositional data to reveal a reverse association between MVPA and depressive symptoms among white individuals and those with higher SES. Our results provide evidence of how race and SES moderate the relationship between MVPA and depressive symptoms. Future research is needed to further explore these racial and socioeconomic differences.
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Affiliation(s)
- Yujie Liu
- Public Health Department, Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Ge
- Public Health Department, Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wang
- Public Health Department, Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, Shanghai, China
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yong Cai
- Public Health Department, Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
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Perazzo SI, Hoge MK, Shaw RJ, Gillispie-Bell V, Soghier L. Improving parental mental health in the perinatal period: A review and analysis of quality improvement initiatives. Semin Perinatol 2024; 48:151906. [PMID: 38664078 DOI: 10.1016/j.semperi.2024.151906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Parental mental health is an essential sixth vital sign that, when taken into consideration, allows clinicians to improve clinical outcomes for both parents and infants. Although standards exist for screening, referral, and treatment for perinatal mood and anxiety disorders (PMADs), they are not reliably done in practice, and even when addressed, interventions are often minimal in scope. Quality improvement methodology can accelerate the implementation of interventions to address PMADs, but hurdles exist, and systems are not well designed, particularly in pediatric inpatient facilities. In this article, we review the effect of PMADs on parents and their infants and identify quality improvement interventions that can increase screening and referral to treatment of parents experiencing PMADs.
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Affiliation(s)
- Sofia I Perazzo
- Division of Neonatology, Children's National Hospital, Washington DC, USA; The George Washington University School of Medicine and Health Sciences, USA
| | - Margaret K Hoge
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Lamia Soghier
- Division of Neonatology, Children's National Hospital, Washington DC, USA; The George Washington University School of Medicine and Health Sciences, USA.
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Romm KF, Berg CJ. Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:191-200. [PMID: 38258814 DOI: 10.1177/29767342231218081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied. METHODS Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education). RESULTS Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes. CONCLUSIONS Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.
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Affiliation(s)
- Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
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Fossa AJ, D'Souza J, Bergmans R, Zivin K, Adar SD. Residential greenspace and major depression among older adults living in urban and suburban areas with different climates across the United States. ENVIRONMENTAL RESEARCH 2024; 243:117844. [PMID: 38061587 DOI: 10.1016/j.envres.2023.117844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/04/2023] [Accepted: 11/30/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND AND AIM Residential greenspace could alleviate depression - a leading cause of disability. Fewer studies of depression and greenspace have considered major depression, and, to our knowledge, none have considered how climate, which determines vegetation abundance and type, may change the impacts of greenspace. Our aim was to investigate whether residential greenspace is associated with major depression among older adults and explore effect modification by climate. METHODS We used biennial interviews between 2008 and 2016 from the Health and Retirement Study. We calculated greenness within walking distance of home addresses as the maximum NDVI for the year of each participant interview averaged within a 1 km buffer. Reflecting clinical criteria, a score of ≥5 on the CIDI-SF indicated major depression in the preceding 12-months. We characterized climate using Köppen-Geiger classifications. To estimate prevalence ratios, we used Poisson regression. Our models adjusted for sociodemographic characteristics, geography, annual sunshine, and bluespace. RESULTS The 21,611 eligible participants were 65 ± 10 years old on average, 55% female, 81% White, 12% Black, 10% Hispanic/Latino, and 31% had at least a 4-year college degree. The 12-month prevalence of a major depression was 8%. In adjusted models, more residential greenspace was associated with a lower prevalence of major depression (prevalence ratio per IQR, 0.91; 95% CI, 0.84 to 0.98). There was evidence of effect modification by climate (P forinteraction, 0.062). We observed stronger associations in tropical (prevalence ratio per IQR 0.69; 95% CI, 0.47 to 1.01) and cold (prevalence ratio per IQR, 0.83; 95% CI, 0.74 to 0.93) climates compared to arid (prevalence ratio per IQR 0.99; 95% CI, 0.90 to 1.09) and temperate (prevalence ratio per IQR 0.98; 95% CI, 0.86 to 1.11) climates. CONCLUSIONS Residential greenspace may help reduce major depression. However, climate may influence how people benefit from greenspace.
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Affiliation(s)
- Alan J Fossa
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States.
| | - Jennifer D'Souza
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
| | - Rachel Bergmans
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, United States
| | - Kara Zivin
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, United States; VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Sara D Adar
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
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Raposa ME, Smithers DJ, Coleman CM, Harlow BL. Depression and help-seeking behaviors among college students: Findings from the Healthy Minds Study 2018-2019. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38227913 DOI: 10.1080/07448481.2023.2299397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To determine the likelihood of using formal and informal mental health services among college students according to prior history of depression diagnosis and presence of depression symptoms. PARTICIPANTS College students from 79 universities in the U.S. and Canada who participated in the Healthy Minds Study, 2018-2019. METHODS Odds ratios and 95% confidence intervals via logistic regression were estimated for the likelihood of using informal and formal mental health services stratified by depression diagnosis and severity of depression symptoms and further stratified by race/ethnicity. RESULTS We report increased odds of using formal mental health services with increasing depression severity symptoms and increased odds of using formal mental health services among students without a clinical depression diagnosis. The odds of service utilization varied by race/ethnicity. CONCLUSIONS The likelihood of seeking mental health services differs depending on the history of formal depression diagnosis, current symptoms, and race/ethnicity among college students.
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Affiliation(s)
- Madison E Raposa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Daniel J Smithers
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Chad M Coleman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Gonsalves MA, White TL, Barredo J, DeMayo MM, DeLuca E, Harris AD, Carpenter LL. Cortical glutamate, Glx, and total N-acetylaspartate: potential biomarkers of repetitive transcranial magnetic stimulation treatment response and outcomes in major depression. Transl Psychiatry 2024; 14:5. [PMID: 38184652 PMCID: PMC10771455 DOI: 10.1038/s41398-023-02715-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for individuals with major depressive disorder (MDD) who have not improved with standard therapies. However, only 30-45% of patients respond to rTMS. Predicting response to rTMS will benefit both patients and providers in terms of prescribing and targeting treatment for maximum efficacy and directing resources, as individuals with lower likelihood of response could be redirected to more suitable treatment alternatives. In this exploratory study, our goal was to use proton magnetic resonance spectroscopy to examine how glutamate (Glu), Glx, and total N-acetylaspartate (tNAA) predict post-rTMS changes in overall MDD severity and symptoms, and treatment response. Metabolites were measured in a right dorsal anterior cingulate cortex voxel prior to a standard course of 10 Hz rTMS to the left DLPFC in 25 individuals with MDD. MDD severity and symptoms were evaluated via the Inventory of Depression Symptomatology Self-Report (IDS-SR). rTMS response was defined as ≥50% change in full-scale IDS-SR scores post treatment. Percent change in IDS-SR symptom domains were evaluated using principal component analysis and established subscales. Generalized linear and logistic regression models were used to evaluate the relationship between baseline Glu, Glx, and tNAA and outcomes while controlling for age and sex. Participants with baseline Glu and Glx levels in the lower range had greater percent change in full scale IDS-SR scores post-treatment (p < 0.001), as did tNAA (p = 0.007). Low glutamatergic metabolite levels also predicted greater percent change in mood/cognition symptoms (p ≤ 0.001). Low-range Glu, Glx, and tNAA were associated with greater improvement on the immuno-metabolic subscale (p ≤ 0.003). Baseline Glu predicted rTMS responder status (p = 0.025) and had an area under the receiving operating characteristic curve of 0.81 (p = 0.009), demonstrating excellent discriminative ability. Baseline Glu, Glx, and tNAA significantly predicted MDD improvement after rTMS; preliminary evidence also demonstrates metabolite association with symptom subdomain improvement post-rTMS. This work provides feasibility for a personalized medicine approach to rTMS treatment selection, with individuals with Glu levels in the lower range potentially being the best candidates.
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Affiliation(s)
- Meghan A Gonsalves
- Neuroscience Graduate Program, Brown University, Providence, RI, USA.
- Butler Hospital Neuromodulation Research Facility, Providence, RI, USA.
- Center of Biomedical Research Excellence (COBRE) for Neuromodulation, Butler Hospital, Providence, RI, USA.
| | - Tara L White
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- Carney Institute for Brain Sciences, Brown University, Providence, RI, USA
| | - Jennifer Barredo
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
- Providence VA Medical Center, Providence, RI, USA
- Clinical Neuroimaging Research Core, Brown University, Providence, RI, USA
| | - Marilena M DeMayo
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Emily DeLuca
- Clinical Neuroimaging Research Core, Brown University, Providence, RI, USA
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Linda L Carpenter
- Butler Hospital Neuromodulation Research Facility, Providence, RI, USA
- Center of Biomedical Research Excellence (COBRE) for Neuromodulation, Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
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Monahan Z, Shores D, Mack A, Bray N, Ford A, Hartwell M. Prevalence of depression among caregivers based on the condition and relationship of care recipient. J Affect Disord 2023; 340:442-447. [PMID: 37582463 DOI: 10.1016/j.jad.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Caregiver distress is the strain experienced by individuals providing care for people with chronic conditions which limit their self-sufficiency for tasks of daily living. Over 1 in 5 Americans are caregivers-a number expected to increase with an aging population. METHODS We performed a cross-sectional analysis using the 2021 Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC) to determine rates of depressive disorders among caregivers and associations between demographic and relational aspects of the care recipient. RESULTS The included sample size for analysis was 32,676, representing 17,274,935 US caregivers. We found that caregivers who were female, American Indian/Alaskan Native, race-not-listed, earning less than $15,000 a year, or did not complete high school, had higher rates of depression diagnosis. The rates of depression were higher among caregivers if the recipient had a mental or chronic respiratory condition, or if the recipient was their live-in partner. Rates of depression were lower for caregivers of their mother-in-law or spouse. LIMITATIONS Results were based on self-reported survey data, which are susceptible to social desirability bias. Diagnoses of depression may also be over or under reported across several demographic variables, which may confound results. CONCLUSION Our findings add to previous research showing that specific groups of caregivers are at higher risk for caregiver stress. Future qualitative research may elucidate underlying causes of depression among caregivers. Analysis into the risk factors for depression among caregivers is vital in providing effective therapeutic options for the caregiver.
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Affiliation(s)
- Zach Monahan
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America; Oklahoma State University Center for Health Sciences, Department of Healthcare Administration, Master of Science in Global Health Program, Tulsa, OK, United States of America.
| | - Dyani Shores
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Alyson Mack
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Natasha Bray
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Alicia Ford
- Oklahoma State University Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Tulsa, OK, United States of America
| | - Micah Hartwell
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America; Oklahoma State University Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Tulsa, OK, United States of America
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Sharland E, Rzepnicka K, Schneider D, Finning K, Pawelek P, Saunders R, Nafilyan V. Socio-demographic differences in access to psychological treatment services: evidence from a national cohort study. Psychol Med 2023; 53:7395-7406. [PMID: 37194490 PMCID: PMC10721408 DOI: 10.1017/s0033291723001010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/11/2023] [Accepted: 03/28/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Since 2008, the Improving Access to Psychological Therapies (IAPT) programme has offered adults in England evidence-based psychological treatments for common mental disorders (CMDs) such as depression and anxiety disorders. However, inequalities in access have not been explored at the national level. METHODS Using a unique individual patient dataset that linked 2011 Census information of English residents to national IAPT data collected between April 2017 and March 2018, we estimated the rate of access by a wide range of socio-demographic characteristics that are not routinely available. A large household survey was used to estimate the prevalence of probable CMDs by these socio-demographic characteristics. We estimated the probability of access to IAPT amongst people with CMDs by comparing the rates of access from IAPT data and the estimates of prevalence of CMDs from the household survey. Both unadjusted and adjusted (for important patient characteristics) access rates were estimated in logistic regression models. RESULTS As a proportion of those with a probable CMD, access to IAPT varied markedly by socio-demographic characteristics. Older adults, males, people born outside of the UK, people with religious beliefs, people from Asian ethnic backgrounds, people reporting a disability and those without any academic or professional qualifications were underrepresented in IAPT services nationally, in adjusted models. CONCLUSIONS The identification of patients who may be underrepresented in IAPT provides an opportunity for services to target outreach and engagement with these groups. Further understanding of barriers to access should help increase equity in access.
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Affiliation(s)
| | | | | | | | | | - Rob Saunders
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, London, UK
| | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- Department for Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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McNicholas E, Boama-Nyarko E, Julce C, Nunes AP, Flahive J, Byatt N, Moore Simas TA. Understanding Perinatal Depression Care Gaps by Examining Care Access and Barriers in Perinatal Individuals With and Without Psychiatric History. J Womens Health (Larchmt) 2023; 32:1111-1119. [PMID: 37582274 PMCID: PMC10541927 DOI: 10.1089/jwh.2022.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: Depression affects one in seven perinatal individuals and remains underdiagnosed and undertreated. Individuals with a psychiatric history are at an even greater risk of perinatal depression, but it is unclear how their experiences with the depression care pathway may differ from individuals without a psychiatric history. Methods: We conducted a secondary analysis evaluating care access and barriers to care in perinatal individuals who screened positive for depression using the Edinburgh Postnatal Depression Scale (N = 280). Data were analyzed from the PRogram in Support of Moms (PRISM) study, a cluster randomized controlled trial of two interventions for perinatal depression. Results: Individuals with no prepregnancy psychiatric history (N = 113), compared with those with a history (N = 167), were less likely to be screened for perinatal depression, and less likely to be offered a therapy referral, although equally likely to attend if referred. When examining how these differences affected outcomes, those without a psychiatric history had 46% lower odds of attending therapy (95% confidence interval [CI]: 0.19-1.55), 79% lower odds of taking medication (95% CI: 0.08-0.54), and 80% lower odds of receiving any depression care (95% CI: 0.08-0.47). Barriers were similar across groups, except for concerns regarding available treatments and beliefs about self-resolution of symptoms, which were more prevalent in individuals without a psychiatric history. Conclusions: Perinatal individuals without a prepregnancy psychiatric history were less likely to be screened, referred, and treated for depression. Differences in screening and referrals resulted in missed opportunities for care, reinforcing the urgent need for universal mental health screening and psychoeducation during the perinatal period. Clinical Trial Registration No.: NCT02935504.
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Affiliation(s)
- Eileen McNicholas
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Esther Boama-Nyarko
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Clevanne Julce
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Anthony P. Nunes
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Julie Flahive
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Nancy Byatt
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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12
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Enslow MR, Galfalvy HC, Sajid S, Pember RS, Mann JJ, Grunebaum MF. Racial and ethnic disparities in time to first antidepressant medication or psychotherapy. Psychiatry Res 2023; 326:115324. [PMID: 37390599 PMCID: PMC10530353 DOI: 10.1016/j.psychres.2023.115324] [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: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
Time from first DSM4 major depressive episode (MDE) until treatment in the community was compared across racial/ethnic groups. This secondary analysis used structured baseline data from a depression research clinic (N = 260). Chi-square and survival analyses compared rates and delays to antidepressant medication and psychotherapy. Non-Hispanic Black and Hispanic (any race) participants had lower rates of both antidepressant medication and psychotherapy and longer delays to antidepressant medication compared with non-Hispanic White participants. The results underscore the need to reduce these disparities.
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Affiliation(s)
- Meghan R Enslow
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Hanga C Galfalvy
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Sumra Sajid
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | | | - J John Mann
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Michael F Grunebaum
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States.
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13
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Asher BlackDeer Msw PhD Candidate A, Patterson Silver Wolf PhD DA, Maguin PhD E, Beeler-Stinn PhD S. Depression and anxiety among college students: Understanding the impact on grade average and differences in gender and ethnicity. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1091-1102. [PMID: 34242525 DOI: 10.1080/07448481.2021.1920954] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/08/2021] [Accepted: 04/18/2021] [Indexed: 05/31/2023]
Abstract
Objective: Psychiatric disorders, such as depression and anxiety, can hinder academic performance among college-age individuals. Participants: Mental health among college students is a growing public health concern, with some scholars describing collegiate mental health as a crisis (Chen et al., Psychiatr Serv. 2019;70(6):442-449). Methods: This study analyzes data from four annual administrations of the American College Health Association (ACHA)'S NCHA (n = 117,430). Results: Overall, anxiety and depression were the most common conditions, at 9.2% and 8.7%, respectively. Of students reporting the focal symptom, 17.87% were treated for depression and 12.91% were treated for anxiety. Compared to not-treated students, diagnosed only students, had significantly lower grade averages, with effect sizes of -0.30 and -0.20 for depression and anxiety, respectively. Conclusions: Given the prevalence of depression and anxiety among college-aged students, continued research into help seeking behaviors and their effects on outcomes like grade average is an essential part of understanding the toll these disorders take.
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Affiliation(s)
| | | | - Eugene Maguin PhD
- Research Scientist, Buffalo Center for Social Research, Buffalo, New York, USA
| | - Sara Beeler-Stinn PhD
- PhD Candidate, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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14
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DeLaney EN, Williams CD, Jones SCT, Hood KB, Cage J, Coston BE, Hawn SE, Santana A, Dick DM. Sexual Victimization and Mental Health Among LGBQ + College Students: Examining Social Support and Trauma-Related Drinking as Mediators. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-022-00997-6] [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: 01/25/2023] Open
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15
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Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018. J Affect Disord 2023; 320:263-267. [PMID: 36179783 PMCID: PMC9675712 DOI: 10.1016/j.jad.2022.09.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/04/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Antenatal depression and suicidal ideation represent serious pregnancy-related complications, yet comprehensive estimates of the prevalence and predictors of these diagnoses among birthing people remain unclear. OBJECTIVE This study aimed to characterize trends in the prevalence of depression and suicidal ideation diagnoses identified among pregnant individuals prior to giving birth. METHODS This study included 536,647 individuals aged 15-44 years continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. The primary outcomes included depression or suicidal ideation based on identification of the relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. RESULTS Rates (95 % CIs) of depression increased by 39 % from 540 (520-560) per 10,000 individuals in 2008 to 750 (730-770) per 10,000 individuals in 2018. Suicidal ideation increased by 100 % from 15 (12-18) per 10,000 individuals in 2008 to 44 (39-50) per 10,000 individuals in 2018. Black birthing people experiencing the sharpest proportional increases. CONCLUSIONS The prevalence of depression and suicidal ideation occurring during pregnancy substantially increased over a ten-year period. Further, suicidal ideation diagnosis increased the most for among Black birthing people compared to all groups, resulting in a need for future studies in this area to determine the reasons for an increase in diagnosis and any change in resulting treatment of follow up.
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16
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Anyanwu MC, Ohamadike O, Wilson LE, Meernik C, Huang B, Pisu M, Liang M, Previs RA, Joshi A, Ward KC, Tucker T, Schymura MJ, Berchuck A, Akinyemiju T. Race, Affordability and Utilization of Supportive Care in Ovarian Cancer Patients. J Pain Symptom Manage 2022; 64:537-545. [PMID: 36058401 PMCID: PMC10083071 DOI: 10.1016/j.jpainsymman.2022.08.021] [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: 05/05/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Lack of access to supportive care (SC) among cancer patients have been well documented. However, the role of affordability in this disparity among ovarian cancer (OC) patients remain poorly understood. METHODS Patients with OC between 2008 and 2015 were identified from the SEER-Medicare dataset. Racial disparities in utilization of SC medications within the six months of OC diagnosis among patients with Medicare Part D coverage was examined. Multivariable log-binomial regression models were used to examine the associations of race, affordability and SC medications after adjusting for clinical covariates among all patients and separately among patients with advanced-stage disease. RESULTS The study cohort included 3697 patients: 86% non-Hispanic White (NHW), 6% non-Hispanic Black (NHB), and 8% Hispanic. In adjusted models, NHB and Hispanic patients were less likely to receive antidepressants compared to NHW patients (NHB: aOR 0.46; 95% CI 0.33-0.63 and Hispanic: aOR 0.79; 95% CI 0.63-0.99). This association persisted for NHB patients with advanced-stage disease (aOR 0.42; 95% CI 0.28-0.62). Patients dual enrolled in Medicaid were more likely to receive antidepressants (overall: aOR 1.34; 95% CI 1.17-1.53 and advanced-stage: aOR 1.29; 95% CI 1.10-1.52). However, patients residing in areas with higher vs. lower proportions of lower educated adults (overall: aOR 0.82; 95% CI 0.70-0.97 and advanced-stage: aOR 0.82; 95% CI 0.68-0.99) were less likely to receive antidepressants. CONCLUSION Black OC patients and those living in lower educated areas were less likely to receive antidepressants as SC. Given the importance of post-primary treatment quality of life for cancer patients, interventions are needed to enhance equitable access to SC.
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Affiliation(s)
- Mercy C Anyanwu
- Department of Internal Medicine (M.C.A.), Pennsylvania Hospital of the University of Pennsylvania, Pennsylvania, USA
| | - Onyinye Ohamadike
- Duke University School of Medicine (O.O.), Durham, North Carolina, USA
| | - Lauren E Wilson
- Department of Population Health Sciences (L.E.W., C.M., A.J., T.A.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Clare Meernik
- Department of Population Health Sciences (L.E.W., C.M., A.J., T.A.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Bin Huang
- Department of Biostatistics and Kentucky Cancer Registry (B.H., T.T.), University of Kentucky, Lexington Kentucky, USA
| | - Maria Pisu
- Division of Preventive Medicine and O'Neal Comprehensive Cancer Center (M.P., M.L.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Margaret Liang
- Division of Preventive Medicine and O'Neal Comprehensive Cancer Center (M.P., M.L.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (M.L.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rebecca A Previs
- Division of Gynecologic Oncology (R.A.P., A.B.), Duke Cancer Institute, Duke University School of Medicine, Durham North Carolina, USA
| | - Ashwini Joshi
- Department of Population Health Sciences (L.E.W., C.M., A.J., T.A.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin C Ward
- Georgia Cancer Registry (K.C.W.), Emory University, Atlanta Georgia, USA
| | - Tom Tucker
- Department of Biostatistics and Kentucky Cancer Registry (B.H., T.T.), University of Kentucky, Lexington Kentucky, USA
| | - Maria J Schymura
- New York State Cancer Registry, New York State Department of Health (M.J.S.), Albany New York, USA
| | - Andrew Berchuck
- Division of Gynecologic Oncology (R.A.P., A.B.), Duke Cancer Institute, Duke University School of Medicine, Durham North Carolina, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences (L.E.W., C.M., A.J., T.A.), Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine (T.A.), Durham, North Carolina, USA.
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17
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Associations Between Implementation of the Collaborative Care Model and Disparities in Perinatal Depression Care. Obstet Gynecol 2022; 140:204-211. [PMID: 35852270 PMCID: PMC9307131 DOI: 10.1097/aog.0000000000004859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/28/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate whether perinatal collaborative care model implementation was associated with a reduction in racial disparities in depression care. METHODS This retrospective cohort study included pregnant and postpartum people who self-identified as either Black or White, and received prenatal care at academic faculty offices affiliated with an urban quaternary medical center. Individuals were divided into two cohorts to reflect the epochs of implementation. The primary outcome was the frequency of depression screening. The secondary outcome was the frequency of provision of a treatment recommendation for those with a positive depression screen. Antenatal and postpartum care were analyzed separately. A propensity score was used in multivariable models to control for confounders chosen a priori across implementation epoch. Interaction terms were created between race and implementation epoch to identify whether effect modification was present. Subgroup analyses were performed for outcomes with significant race-by-epoch interaction terms. RESULTS Of the 4,710 individuals included in these analyses, 4,135 (87.8%) self-identified as White and 575 (12.2%) self-identified as Black. Before implementation, Black individuals were more likely to receive screening (adjusted odds ratio [aOR] 2.44) but less likely to have a treatment recommended when a positive screen was identified (aOR 0.05). In multivariable models, race-by-epoch interaction terms were significant for both antenatal screening (P<.001) and antenatal treatment recommendation (P=.045), demonstrating that implementation of the perinatal collaborative care model was associated with reductions in extant racial disparities. After implementation, there were no significant differences by race (referent=White) in screening for antenatal depression (aOR 1.22, 95% CI 0.89-1.68) or treatment recommendations for those who screened positive (aOR 0.64, 95% CI 0.27-1.53). Race-by-epoch interaction terms were not significant in multivariable models for either postpartum screening or treatment recommendation. CONCLUSION Implementation of the perinatal collaborative care model is associated with a mitigation of racial disparities in antenatal depression care and may be an equity-promoting intervention for maternal health.
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18
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Guo Y, Qin W, Lee HY. Social participation and depressive symptoms in older African American cancer survivors: a comparison with non-cancer subjects. Aging Ment Health 2022; 26:1558-1563. [PMID: 34284681 DOI: 10.1080/13607863.2021.1950619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES African Americans are differentially affected by most cancers compared to other racial groups. Social participation has demonstrated beneficial effects on mental health in older adults with a history of cancer. The purpose of the present study is to examine and compare the effects of specific social participation activities on depressive symptoms among older African Americans with and without a history of cancer. METHOD The study sample included 2,000 older African Americans selected from the National Health and Aging Trends Study. Waves from 2011 to 2018 were used. Mixed-effects logistic regressions were applied to examine the effects of four social participation activities on depressive symptoms among older African Americans with or without a history of cancer. RESULTS Among older African American who had a history of cancer, visiting family and friends and attending religious services were related to lower odds of depressive symptoms. However, among older African Americans without a history of cancer, joining organized activities and going out for enjoyment predicted lower odds of depressive symptoms. CONCLUSION Older African Americans with a history of cancer tend to benefit from visiting family and friends and attending religious services in coping with depressive symptoms. Mental health services for this group could focus interventions on promoting social participation activities with family, friends, and religious congregants.
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Affiliation(s)
- Yuqi Guo
- School of Social Work, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Weidi Qin
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
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19
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Tieu L, Walton QL, Sherbourne CD, Miranda JM, Wells KB, Tang L, Williams P, Anderson GL, Booker-Vaughns J, Pulido E, Carr T, Heller SM, Bromley E. Life Events, Barriers to Care, and Outcomes Among Minority Women Experiencing Depression: A Longitudinal, Mixed-Method Examination. J Nerv Ment Dis 2022; 210:596-606. [PMID: 35184128 PMCID: PMC9338920 DOI: 10.1097/nmd.0000000000001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The long-term course of depression is not well-understood among minority women. We assessed depression trajectory, barriers to depression care, and life difficulties among minority women accessing health and social service programs as part of the Community Partners in Care study. Data include surveys ( N = 339) and interviews ( n = 58) administered at 3-year follow-up with African American and Latina women with improved versus persistent depression. The majority of the sample reported persistent depression (224/339, 66.1%), ≥1 barrier to mental health care (226/339, 72.4%), and multiple life difficulties (mean, 2.7; SD, 2.3). Many barriers to care ( i.e. , related to stigma and care experience, finances, and logistics) and life difficulties ( i.e. , related to finances, trauma, and relationships) were more common among individuals reporting persistent depression. Results suggest the importance of past experiences with depression treatment, ongoing barriers to care, and negative life events as contributors to inequities in depression outcomes experienced by minority women.
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Affiliation(s)
- Lina Tieu
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
| | - Quenette L. Walton
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd Room 110HA, Houston, TX, USA
| | | | - Jeanne M. Miranda
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Kenneth B. Wells
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
- RAND Corporation, 1776 Main St, Santa Monica, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Pluscedia Williams
- Department of Social and Preventive Medicine: Community Engagement, Charles R. Drew University of Medicine & Science,1731 E. 120th St, Los Angeles, CA, USA
| | - Gera L. Anderson
- Asian Americans for Community Involvement, 2400 Moorpark Ave, San Jose, CA, USA
| | - Juanita Booker-Vaughns
- Department of Social and Preventive Medicine: Community Engagement, Charles R. Drew University of Medicine & Science,1731 E. 120th St, Los Angeles, CA, USA
| | - Esmeralda Pulido
- University of Washington Medical Center, 1959 N.W. Pacific St, Seattle, WA, USA
| | - Themba Carr
- Autism Discovery Institute, Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA, USA
| | - S. Megan Heller
- Department of Anthropology, University of California, Los Angeles, 375 Portola Plaza, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
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20
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Zare H, Fugal A, Azadi M, Gaskin DJ. How Income Inequality and Race Concentrate Depression in Low-Income Women in the US; 2005-2016. Healthcare (Basel) 2022; 10:1424. [PMID: 36011080 PMCID: PMC9408115 DOI: 10.3390/healthcare10081424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Aim: To estimate the association between income and depressive symptoms in adult women, ages 20 years and older. Methods: Data for this study came from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). We measured the presence of depressive symptoms by using a 9-item PHQ (Public Health Questionnaire, PHQ-9) and the Poverty to Income Ratio (PIR) as a proxy for income. We employed Negative Binomial Regression (NBRG) and logistic regression models in a sample of 11,420 women. We adjusted models by age, racial/ethnic groups, marital status, education, health insurance, comorbidity, and utilization of mental health professionals. We calculated the Gini Coefficient (GC) as a measure of income inequality, using PIR. Results: Between 2005 and 2016, 20.1% of low-PIR women suffered from depression (PHQ ≥10) compared with 12.0% of women in medium-PIR and 5.0% in high-PIR. The highest probabilities of being depressed were in Black Non-Hispanics (BNH) and Hispanics (12.0%), and then in White NH (WNH; 9.1%). The results of NBRG have shown that women in medium-PIR (0.90 [CI: 0.84-0.97]) and high-PIR 0.76 (CI: 0.70-0.82) had a lower incidence-rate ratio than women in low-PIR. The logistic regression results showed that income is protective in High-PIR groups (OR = 0.56, CI [0.43-0.73]). Conclusion: Policies to treat depression should prioritize the needs of low-income women of all racial groups and women.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, School of Business, University of Maryland Global Campus (UMGC), 624 N. Broadway, Hampton House 337, Baltimore, MD 21205, USA
| | - Adriele Fugal
- Utah County Health Department, The University of Utah, Provo, UT 84601, USA;
| | - Mojgan Azadi
- School of Business, University of Maryland Global Campus (UMGC), Largo, MD 20774, USA;
| | - Darrell J. Gaskin
- Hopkins Center for Health Disparities Solutions, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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21
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Moodie EEM, Coulombe J, Danieli C, Renoux C, Shortreed SM. Privacy-preserving estimation of an optimal individualized treatment rule: a case study in maximizing time to severe depression-related outcomes. LIFETIME DATA ANALYSIS 2022; 28:512-542. [PMID: 35499604 PMCID: PMC10805063 DOI: 10.1007/s10985-022-09554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Estimating individualized treatment rules-particularly in the context of right-censored outcomes-is challenging because the treatment effect heterogeneity of interest is often small, thus difficult to detect. While this motivates the use of very large datasets such as those from multiple health systems or centres, data privacy may be of concern with participating data centres reluctant to share individual-level data. In this case study on the treatment of depression, we demonstrate an application of distributed regression for privacy protection used in combination with dynamic weighted survival modelling (DWSurv) to estimate an optimal individualized treatment rule whilst obscuring individual-level data. In simulations, we demonstrate the flexibility of this approach to address local treatment practices that may affect confounding, and show that DWSurv retains its double robustness even when performed through a (weighted) distributed regression approach. The work is motivated by, and illustrated with, an analysis of treatment for unipolar depression using the United Kingdom's Clinical Practice Research Datalink.
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Affiliation(s)
- Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada.
| | - Janie Coulombe
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Coraline Danieli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Christel Renoux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Susan M Shortreed
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, Seattle, USA
- Biostatistics Department, University of Washington, Seattle, USA
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22
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Pester MS, Gonzalez A, Schmaus JA, Wohlgemuth W, McCabe PM, Iacobellis G, Schneiderman N, Hurwitz BE. Sex differences in the association of vital exhaustion with regional fat deposition and subclinical cardiovascular disease risk. J Psychosom Res 2022; 157:110785. [PMID: 35366516 PMCID: PMC10986308 DOI: 10.1016/j.jpsychores.2022.110785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Vital exhaustion (VE) is more strongly associated with cardiovascular disease (CVD) risk for women than men. This study examined whether sex differences in associations of VE with CVD risk markers are accounted for by unique associations of VE with regional adiposity. METHODS The study enrolled 143 persons (18-55 years) without diagnosed conditions. VE was assessed by the Maastricht questionnaire. CVD indices were measured using the euglycemic-hyperinsulinemia clamp, resting blood pressure, and blood draws. Regional adiposity was measured using computed tomography and 2-D echocardiography. This cross-sectional study employed a path analysis approach, including relevant covariates. RESULTS Of the cohort, aged 38.7 ± 8.4 years, 65% were men, and 41% were obese. The final model had excellent fit (χ2(36) = 36.5, p = .45; RMSEA = 0.009, CFI = 0.999). For women, but not men, the model indicated paths from VE to: 1) lower insulin sensitivity (B = -0.10, p = .04), and higher total cholesterol to HDL ratio (B = 0.12, p = .09), triglycerides (B = 0.10, p = .08), and C-reactive protein (B = 0.08, p = .09) through visceral adiposity; 2) higher mean arterial pressure (B = 0.14, p = .04), lower insulin sensitivity (B = -0.09, p = .08), and higher C-reactive protein (B = 0.12, p = .07) through subcutaneous adiposity; 3) lower insulin sensitivity (B = -0.07, p = .08) and higher total cholesterol to HDL ratio (B = 0.16, p = .03) through liver adiposity; and 4) higher C-reactive protein (B = 0.08, p = .09) through epicardial adiposity. CONCLUSION Results extend prior evidence by showing that the association of VE with CVD risk in women is linked with specific regional adiposity elevation. Further study of adiposity-related mechanisms in women who experience early decline in vitality may inform clinical targets for CVD prevention.
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Affiliation(s)
- Mollie S Pester
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Alex Gonzalez
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA.
| | - Jennifer A Schmaus
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - William Wohlgemuth
- Psychology and Neurology Service, Bruce W. Carter Medical Center, Miami VA Healthcare System, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA.
| | - Philip M McCabe
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Gianluca Iacobellis
- Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Neil Schneiderman
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA; Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Barry E Hurwitz
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Coral Gables, FL, USA; Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Capuano AW, Shah RC, Blanche P, Wilson RS, Barnes LL, Bennett DA, Arvanitakis Z. Derivation and validation of the Rapid Assessment of Dementia Risk (RADaR) for older adults. PLoS One 2022; 17:e0265379. [PMID: 35299231 PMCID: PMC8929636 DOI: 10.1371/journal.pone.0265379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is no practical dementia risk score in the clinical setting. OBJECTIVE To derive and validate a score obtained by a rapid and simple assessment, which guides primary care providers in predicting the risk of dementia among older adults. DESIGN A total of 4178 participants from three longitudinal cohorts (mean age at baseline = 76.8 [SD = 7.6] years), without baseline dementia, followed annually for a median of 10 years (IQR: 5 to16 years, Reverse Kaplan-Meier). PARTICIPANTS To derive the score, we used data from 1,780 participants from the Rush Memory and Aging Project (93% White). To validate the score, we used data from 1,299 participants from the Religious Order Study (92% White), and to assess generalizability, 679 participants from the Minority Aging Research Study (100% Black). MEASUREMENTS Clinician-based dementia diagnosis at any time after baseline and predictive variables associated with dementia risk that can be collected in a primary care setting: demographics, clinical indicators, medical history, memory complaints, cognitive and motor tests, and questions to assess functional disability, depressive symptoms, sleep, social isolation, and genetics (APOE e4 and AD polygenic risk score). RESULTS At baseline, age, memory complaint, the ability to handle finances, the recall of the month, recall of the room, and recall of three words, were associated with the cumulative incidence of dementia, in the derivation cohort. The discrimination of the RADaR (Rapid Risk Assessment of Dementia) was good for the derivation and external-validation cohorts (AUC3 years = 0.82-0.86), compared to the overall discrimination of age alone (AUC3 years = 0.73), a major risk factor for dementia. Adding genetic data did not increase discrimination. LIMITATIONS Participants were volunteers, may not represent the general population. CONCLUSIONS The RADaR, derived from community-dwelling older persons, is a brief and valid tool to predict dementia risk at 3 years in older White and Black persons.
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Affiliation(s)
- Ana W. Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, United States of America
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Internal Medicine, Rush Medical College, Chicago, Illinois, United States of America
| | - Paul Blanche
- Section of Biostatistics, Øster Farimagsgade, University of Copenhagen, Copenhagen, Denmark
- Denmark Department of Cardiology, Herlev and Gentofte University Hospital, University of Copenhagen, Hellerup, Denmark
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, United States of America
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, United States of America
| | - Zoe Arvanitakis
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, United States of America
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Quist AJL, Han X, Baird DD, Wise LA, Wegienka G, Woods-Giscombe CL, Vines AI. Life Course Racism and Depressive Symptoms among Young Black Women. J Urban Health 2022; 99:55-66. [PMID: 35031943 PMCID: PMC8760080 DOI: 10.1007/s11524-021-00574-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
The objective of this study is to evaluate the life course effects of racism on depressive symptoms in young Black women and to identify particularly sensitive periods. Guided by life-course theory and using logistic regression, we analyzed baseline data on racism frequency and stress from racism at two time periods (before age 20 and during the 20s) and follow-up data (at approximate 20-month intervals) on depressive symptoms (using a modified 11-item Center for Epidemiologic Studies Depression Scale, CES-D) among 1612 Black women participants aged 23-34 years living in Detroit, MI. Of the 1612 women, 65% reported experiencing some racism at baseline, and 36.5% had high depressive symptoms at follow-up. Those who experienced high frequency of racism before age 20 had an increased risk for high depressive symptoms (RR = 1.26, 95% CI: 1.07, 1.46) compared to participants in the low racism frequency group. We observed similar associations for high vs. low stress from racism (RR = 1.30, 95% CI : 1.06, 1.54) and high vs. low combination of racism frequency and stress (RR = 1.38, 95% CI: 1.13, 1.64). These findings did not hold or were weaker when assessing racism during the 20s. Among women who experienced high racism across the two time periods, the risk of high depressive symptoms was higher than those who experienced low racism during both periods (RR = 1.49, 95% CI: 1.14, 1.86). The slightly stronger associations between racism and depressive symptoms in childhood and adolescence than in young adulthood suggest that early life might be a sensitive period for experiencing racism.
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Affiliation(s)
- Arbor J L Quist
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Xiaoxia Han
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Donna D Baird
- Epidemiology Branch, Women's Health Group, National Institute for Environmental Health Sciences, Research Triangle, NC, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | | | - Anissa Irvin Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Eneanya ND, Tiako MJN, Novick TK, Norton JM, Cervantes L. Disparities in Mental Health and Well-Being Among Black and Latinx Patients With Kidney Disease. Semin Nephrol 2022; 41:563-573. [PMID: 34973700 DOI: 10.1016/j.semnephrol.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Black and Latinx individuals in the United States are afflicted disproportionately with kidney disease. Because of structural racism, social risk factors drive disparities in disease prevalence and result in worse outcomes among these patient groups. The impact of social and economic oppression is pervasive in physical and emotional aspects of health. In this review, we describe the history of race and ethnicity among black and Latinx individuals in the United States and discuss how these politicosocial constructs impact disparities in well-being and mental health. Lastly, we outline future research, clinical considerations, and policy considerations to eliminate racial and ethnic disparities in well-being among black and Latinx individuals with kidney disease.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - Tessa K Novick
- Division of Nephrology, Department of Internal Medicine, University of Texas, Austin Dell Medical School, Austin, TX
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Lilia Cervantes
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
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Taylor NL, Su J, Dick DM. Depressive Symptoms and Drinking to Cope in Relation to Alcohol Use Outcomes among White and Black/African American College Students. Subst Use Misuse 2022; 57:708-718. [PMID: 35156525 DOI: 10.1080/10826084.2022.2034871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Prior research shows that Black/African American adults experience more negative alcohol use consequences than White adults, despite lower alcohol consumption. Research also shows that Black/African Americans experience higher rates of depression, which can increase risk for alcohol consumption and alcohol use disorder (AUD) through drinking to cope. We examined associations between depressive symptoms and drinking to cope with alcohol consumption and AUD symptoms among White and Black/African American college students. METHODS Participants completed an online survey during the fall and spring semester of their first year of college (N = 2,168, 62.8% female, 75.8% White). Path analyses were conducted to examine whether depressive symptoms and drinking to cope mediated the association between race/ethnicity and alcohol use outcomes, and whether race/ethnicity moderated the associations between depressive symptoms, drinking to cope, and alcohol use outcomes. RESULTS Results indicated that Black/African Americans had lower levels of depressive symptoms, which were associated with lower drinking to cope, and in turn associated with lower alcohol consumption and AUD symptoms. Multigroup analysis indicated that the pattern of associations between depressive symptoms, drinking to cope, and alcohol use outcomes were largely similar between White and Black/African American college students and between males and females, except that the association between depressive symptoms and drinking to cope appeared to be stronger for Whites than for Black/African American students. CONCLUSION Depressive symptoms and drinking to cope are risk factors in relation to alcohol use outcomes among White and Black/African American college students and partially account for the link between race/ethnicity and alcohol use outcomes. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2034871 .
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Affiliation(s)
- Nicole L Taylor
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Jinni Su
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | | | - Danielle M Dick
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
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Eken HN, Dee EC, Powers AR, Jordan A. Racial and ethnic differences in perception of provider cultural competence among patients with depression and anxiety symptoms: a retrospective, population-based, cross-sectional analysis. Lancet Psychiatry 2021; 8:957-968. [PMID: 34563316 PMCID: PMC10688309 DOI: 10.1016/s2215-0366(21)00285-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/04/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Racial and ethnic minorities face disparities in access to health care. Culturally competent care might lessen these disparities. Few studies have studied the patients' view of providers' cultural competence, especially in psychiatric care. We aimed to examine the associations of race, ethnicity, and mental health status with patient-reported importance of provider cultural competence. METHODS Our retrospective, population-based, cross-sectional study used data extracted from self-reported questionnaires of adults aged at least 18 years who participated in the US National Health Interview Survey (NHIS; 2017 cycle). We included data on all respondents who answered supplementary cultural competence questions and the Adult Functioning and Disability survey within the NHIS. We classified participants as having anxiety or depression if they reported symptoms at least once a week or more often, and responded that the last time they had symptoms the intensity was "somewhere between a little and a lot" or "a lot." Participant answers to cultural competency survey questions (participant desire for providers to understand or share their culture, and frequency of access to providers who share their culture) were the outcome variables. Multivariable ordinal logistic regressions were used to estimate adjusted odds ratios (aORs) for the outcome variables in relation to sociodemographic characteristics (including race and ethnicity), self-reported health status, and presence of symptoms of depression, anxiety, or both. FINDINGS 3910 people had available data for analysis. Mean age was 52 years (IQR 36-64). 1422 (39·2%, sample weight adjusted) of the participants were men and 2488 (60·9%) were women. 3290 (82·7%) were White, 346 (9·1%) were Black or African American, 31 (0·8%) were American Indian or Alaskan Native, 144 (4·8%) were Asian American, and 99 (2·6%) were Mixed Race. 380 (12·5%) identified as Hispanic ethnicity and 3530 (87·5%) as non-Hispanic. Groups who were more likely to express a desire for their providers to share or understand their culture included participants who had depression symptoms (vs those without depression or anxiety symptoms, aOR 1·57 [95% CI 1·13-2·19], p=0·008) and participants who were of a racial minority group (Black vs White, aOR 2·54 [1·86-3·48], p=0·008; Asian American vs White, aOR 2·57 [1·66-3·99], p<0·001; and Mixed Race vs White, aOR 1·69 [1·01-2·82], p=0·045) or ethnic minority group (Hispanic vs non-Hispanic, aOR 2·69 [2·02-3·60], p<0·001); these groups were less likely to report frequently being able to see providers who shared their culture (patients with depression symptoms vs those without depression or anxiety symptoms, aOR 0·63 (0·41-0·96); p=0·030; Black vs White, aOR 0·56 [0·38-0·84], p=0·005; Asian American vs White, aOR 0·38 [0·20-0·72], p=0·003; Mixed Race vs White, aOR 0·35 [0·19-0·64], p=0·001; Hispanic vs non-Hispanic, aOR 0·61 [0·42-0·89], p=0·010). On subgroup analysis of participants reporting depression symptoms, patients who identified their race as Black or African American, or American Indian or Alaskan Native, and those who identified as Hispanic ethnicity, were more likely to report a desire for provider cultural competence. INTERPRETATION Racial and ethnic disparities exist in how patients perceive their providers' cultural competence, and disparities are pronounced in patients with depression. Developing a culturally competent and humble approach to care is crucial for mental health providers. FUNDING None.
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Affiliation(s)
- Hatice Nur Eken
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ayana Jordan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Vrany EA, Polanka BM, Hsueh L, Hill-Briggs F, Stewart JC. Race/ethnicity moderates associations between depressive symptoms and diet composition among U.S. adults. Health Psychol 2021; 40:513-522. [PMID: 34618499 DOI: 10.1037/hea0001078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although depression is associated with poorer overall diet quality, few studies have examined its association with levels of particular macronutrients, and none have examined moderation by race/ethnicity. The present study examined (a) associations between depressive symptom severity and nine indices of diet composition and (b) whether race/ethnicity moderates these associations. METHOD Participants were 28,940 adults (mean age = 49 years, 52% female, 52% nonwhite) from NHANES 2005-2018. Depressive symptom severity was measured using the Patient Health Questionnaire-9 (PHQ-9). Nine diet composition indices were derived from the average of two 24-hr dietary recalls (e.g., total energy, total fat, saturated fat, total carbohydrate, sugar, fiber, and protein). RESULTS Separate linear regression analyses revealed that PHQ-9 total was positively associated with saturated fat and sugar and negatively associated with protein and fiber. Moderation by race/ethnicity was observed (interaction ps < .05). Among non-Hispanic Whites, PHQ-9 total was positively associated with sugar and negatively associated with protein and fiber. Among non-Hispanic Blacks, PHQ-9 total was positively associated with total energy, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, total carbohydrate, and sugar. Among Mexican Americans, PHQ-9 was positively associated with saturated fat. Among other Hispanics, PHQ-9 total was negatively associated with fiber, protein, and total, monounsaturated, and polyunsaturated fat. CONCLUSIONS Findings from this large, nationally representative sample demonstrate that associations between depressive symptom severity and diet composition vary by race/ethnicity. Critically, an unhealthy diet composition pattern may be one mechanism explaining the excess risk of obesity and cardiometabolic diseases in individuals with depression, especially in non-Hispanic Blacks. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Holm AKJ, Johnson AN, Clockston R, Oselinsky K, Lundeberg PJ, Rand K, Graham DJ. Intersectional health disparities: the relationships between sex, race/ethnicity, and sexual orientation and depressive symptoms. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1982756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Abby K. Johnson Holm
- Department of Psychology, Colorado State University, Fort Collins, CO, Larimer County, United States
| | - Ashlie N. Johnson
- Department of Psychology, Colorado State University, Fort Collins, CO, Larimer County, United States
| | - Raeven Clockston
- Department of Psychology, Colorado State University, Fort Collins, CO, Larimer County, United States
| | - Katrina Oselinsky
- Department of Psychology, Colorado State University, Fort Collins, CO, Larimer County, United States
| | - Pamela J. Lundeberg
- Department of Psychology, Aims Community College, Loveland, Co, Larimer County, United States
| | - Katelyn Rand
- Department of Psychology, Colorado State University, Fort Collins, CO, Larimer County, United States
| | - Daniel J. Graham
- Department of Psychology, Colorado State University, Fort Collins, CO, Larimer County, United States
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Martin R, Banaag A, Riggs DS, Koehlmoos TP. Minority Adolescent Mental Health Diagnosis Differences in a National Sample. Mil Med 2021; 187:e969-e977. [PMID: 34387672 DOI: 10.1093/milmed/usab326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/16/2021] [Accepted: 07/28/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Mental health disparities and differences have been identified amongst all age groups, including adolescents. However, there is a lack of research regarding adolescents within the Military Health System (MHS). The MHS is a universal health care system for military personnel and their dependents. Research has indicated that the MHS removes many of the barriers that contribute to health disparities. Additional investigations with this population would greatly contribute to our understanding of disparities and health services delivery without the barrier of access to care. MATERIALS AND METHODS This study analyzed the diagnostic trends of anxiety, depression, and impulse control disorders and differences within a national sample of adolescents of active-duty military parents. The study utilized 2006 to 2014 data in the MHS Data Repository for adolescents ages 13-18. The study identified 183,409 adolescents with at least one diagnosis. Multivariable logistic regressions were conducted to assess the differences and risks for anxiety, depression, and impulse control disorders in the identified sample. RESULTS When compared to White Americans, minority patients had a higher likelihood of being diagnosed with an impulse control disorder (odds ratio [OR] = 1.43; confidence interval [CI] 1.39-1.48) and a decreased likelihood of being diagnosed with a depressive disorder (OR = 0.98; CI 0.95-1.00) or anxiety disorder (OR = 0.80; CI 0.78-0.83). Further analyses examining the subgroups of minorities revealed that, when compared to White Americans, African American adolescents have a much higher likelihood of receiving a diagnosis of an impulse control disorder (OR = 1.66; CI 1.61-1.72) and a lower likelihood of receiving a diagnosis of a depressive disorder (OR = 0.93; CI 0.90-0.96) and an anxiety disorder (OR = 0.75; CI 0.72-0.77). CONCLUSION This study provides strong support for the existence of race-based differences in adolescent mental health diagnoses. Adolescents of military families are a special population with unique experiences and stressors and would benefit from future research focusing on qualitative investigations into additional factors mental health clinicians consider when making diagnoses, as well as further exploration into understanding how best to address this special population's mental health needs.
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Affiliation(s)
- Raquel Martin
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Amanda Banaag
- Department of Preventive Medicine and Biostatistics, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD 20817, USA
| | - David S Riggs
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Tracey P Koehlmoos
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Ojagbemi A. HIV Associated Neurocognitive Disorders Subsidence Through Citalopram Addition in Anti-retroviral Therapy (HANDS-CARE): A Concept Note. Front Neurol 2021; 12:658705. [PMID: 34381409 PMCID: PMC8350562 DOI: 10.3389/fneur.2021.658705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
There is a pressing need to effectively manage HIV Associated Neurocognitive Disorders (HAND) in sub-Saharan Africa (SSA) where the burden is among the highest in the world. Contemporary approaches based on the use of Highly Active Antiretroviral Therapy (HAART) alone are inadequate interventions for HAND, especially in SSA where there is limited availability of the required combinations of HAART for effective central nervous system penetration and where many currently prescribed agents, including efavirenz, have neurotoxicity as a major drawback. This article reviews data supporting the rationale for additive citalopram in antiretroviral therapy as a latent approach to abate HAND. It proposes the conduct of a HIV Associated Neurocognitive Disorders Subsidence through Citalopram addition in Anti-Retroviral therapy (HANDS-CARE) pilot feasibility trial (RCT) to assess whether the adjunctive use of citalopram, a widely prescribed serotonergic antidepressant, will lead to a meaningful improvement in neurocognitive functioning and quality of life in patients with HAND who are receiving HAART. A preliminarily feasible and efficacy-suggesting HANDS-CARE trial could generate statistical, clinical and operational data necessary to design and conduct a future definitive RCT. If successful, this intervention will be applicable to resource-limited settings as well as developed countries. Effective management of HAND will improve the quality of life of HIV patients, and reduce the cost of managing the disease.
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Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health, Substance Abuse and Neuroscience, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Pamplin JR, Bates LM. Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence. Soc Sci Med 2021; 281:114085. [PMID: 34090157 PMCID: PMC8238891 DOI: 10.1016/j.socscimed.2021.114085] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
The Black-white Depression paradox, the lower prevalence of major depression among non-Hispanic Black (relative to non-Hispanic white) individuals despite their greater exposure to major life stressors, is a phenomenon that remains unexplained. Despite a decade plus of research, there is little clarity as to whether the paradoxical observations are an invalid finding, spuriously produced by selection bias, information bias, or confounding, or are a valid finding, representative of a true racial patterning of depression in the population. Though both artefactual and etiologic mechanisms have been tested, a lack of synthesis of the extant evidence has contributed towards an unclear picture of the validity of the paradox and produced challenges for researchers in determining which proposed mechanisms show promise, which have been debunked, and which require further study. The objective of this critical review is to assess the state of the literature regarding explanations for the Black-white depression paradox by examining some of the more prominent hypothesized explanatory mechanisms that have been proposed and assessing the state of the evidence in support of them. Included mechanisms were selected for their perceived dominance in the literature and the existence of at least one, direct empirical test using DSM major depression as the outcome. This review highlights the very limited evidence in support of any of the extant putative mechanisms, suggesting that investigators should redirect efforts towards identifying novel mechanisms, and/or empirically testing those which show promise but to date have been relatively understudied. We conclude with a discussion of the broader implications of the evidence for well-accepted social theories and raise questions regarding the use of DSM major depression to assess mental health burden in Black communities.
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Affiliation(s)
- John R Pamplin
- Center for Urban Science and Progress, New York University, New York, NY, USA; Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Lisa M Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Coulombe J, Moodie EEM, Shortreed SM, Renoux C. Can the Risk of Severe Depression-Related Outcomes Be Reduced by Tailoring the Antidepressant Therapy to Patient Characteristics? Am J Epidemiol 2021; 190:1210-1219. [PMID: 33295950 DOI: 10.1093/aje/kwaa260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 12/29/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for patients with unipolar depression, yet there is little guidance on which SSRI provides the most benefit to a patient, based on personal characteristics. In this work, we explore whether an individualized treatment strategy can be used by health-care providers to adapt their prescription pattern to reduce the risk of a severe depression-related outcome (SDO) when choosing between citalopram and fluoxetine, 2 commonly prescribed SSRIs. Our population-based cohort study used data from the Clinical Practice Research Datalink, the Hospital Episode Statistics repository, and the Office for National Statistics database in the United Kingdom to create a cohort of individuals diagnosed with depression who were prescribed citalopram or fluoxetine between April 1998 and December 2017. Patients were followed from treatment initiation until occurrence of the SDO outcome, treatment discontinuation, or end of study. To find an optimal treatment strategy, we used dynamic weighted survival modeling, considering patient features such as age, sex, body mass index, previous psychiatric diagnoses, and medications. Our findings suggest that using patient characteristics to tailor the antidepressant drug therapy is associated with an increase of 4 days in the median time to SDO (95% confidence interval: 2, 10 days).
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Németh R, Sik D, Katona E. The asymmetries of the biopsychosocial model of depression in lay discourses - Topic modelling online depression forums. SSM Popul Health 2021; 14:100785. [PMID: 33912649 PMCID: PMC8066842 DOI: 10.1016/j.ssmph.2021.100785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND One of the most comprehensive approaches to depression is the biopsychosocial model. From this wider perspective, social sciences have criticized the reductionist biomedical discourse, which has been dominating expert discourses for a long time. As these discourses determine the horizon of attributions and interventions, their lay interpretation plays a central role in the coping with depression. METHODS In order to map these patterns, online depression forums are analyzed with natural language processing methods, where computational tools are complemented with a qualitative approach. Latent Dirichlet Allocation topic model of depression-related posts from the most popular English-speaking online health discussion forums (N = ~70 000) reveals the monolog (attributions and self-disclosures) and interactive (consultations and quasi-therapeutic interactions) patterns. RESULTS Following the evaluation of various models 18 topics were differentiated: attributions referring to health, family, partnership and work issues; self-disclosures referring to contemplations, introducing the experience of suffering and well-being, along with diaries of everyday activities and hardships; consultations about psychotherapies, classifications, drugs and the experience; and quasi-therapeutic interactions relying on unconditional positive regards, recovery helpers experience or spirituality. These topics were evaluated from the perspective of the biopsychosocial model: the weight of each dimension was measured along with the discursive function. CONCLUSIONS Biomedical discourse is underrepresented in lay discussions, while psychological discourse plays an overall dominant role. Even if actors are initially aware of the social mechanisms contributing to depression, they neglect these factors when it comes to considering the countermeasures.
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Affiliation(s)
- Renáta Németh
- ELTE Eötvös Loránd University of Budapest, Faculty of Social Sciences, Research Center for Computational Social Science, Budapest, Pázmány Péter Sétány 1/a, 1117, Hungary
| | - Domonkos Sik
- ELTE Eötvös Loránd University of Budapest, Faculty of Social Sciences, Research Center for Computational Social Science, Budapest, Pázmány Péter Sétány 1/a, 1117, Hungary
| | - Eszter Katona
- ELTE Eötvös Loránd University of Budapest, Faculty of Social Sciences, Research Center for Computational Social Science, Budapest, Pázmány Péter Sétány 1/a, 1117, Hungary
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Mayman N, Stein LK, Erdman J, Kornspun A, Tuhrim S, Jette N, Dhamoon MS. Risk and Predictors of Depression Following Acute Ischemic Stroke in the Elderly. Neurology 2021; 96:e2184-e2191. [PMID: 33722998 DOI: 10.1212/wnl.0000000000011828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We sought to comprehensively evaluate predictors of poststroke depression (PSD) in the United States and to compare PSD to post-myocardial infarction (MI) depression to determine whether ischemic stroke uniquely elevates risk of depression. METHODS This is a retrospective cohort study of 100% deidentified inpatient, outpatient, and subacute nursing Medicare data from 2016 to 2017 for US patients ≥65 years of age from July 1, 2016, to December 31, 2017. We calculated Kaplan-Meier unadjusted cumulative risk of depression up to 1.5 years after the index admission. We performed Cox regression to report the hazard ratio for diagnosis of depression up to 1.5 years after stroke vs MI and independent predictors of PSD, and we controlled for patient demographics, comorbid conditions, length of stay, and acute stroke interventions. RESULTS In fully adjusted models, patients with stroke (n = 174,901) were ≈50% more likely than patients with MI (n = 193,418) to develop depression during the 1.5-year follow-up period (Kaplan-Meier cumulative risk 0.1596 ± 0.001 in patients with stroke vs 0.0973 ± 0.000778 in patients with MI, log-rank p < 0.0001). History of anxiety was the strongest predictor of PSD, while discharge home was most protective. Female patients, White patients, and patients <75 years of age were more likely to be diagnosed with depression after stroke. CONCLUSIONS Despite the similarities between MI and stroke, patients with stroke were significantly more likely to develop depression. There were several predictors of PSD, most significantly history of anxiety. Our findings lend credibility to a stroke-specific process causing depression and highlight the need for consistent depression screening in all patients with stroke.
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Affiliation(s)
- Naomi Mayman
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Laura Katherine Stein
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - John Erdman
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Alana Kornspun
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Stanley Tuhrim
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Nathalie Jette
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Mandip S Dhamoon
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia.
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Cerdeña I, Holloway T, Cerdeña JP, Wing A, Wasser T, Fortunati F, Rohrbaugh R, Li L. Racial and Ethnic Differences in Psychiatry Resident Prescribing: a Quality Improvement Education Intervention to Address Health Equity. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:13-22. [PMID: 33495966 PMCID: PMC9942699 DOI: 10.1007/s40596-021-01397-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Quality improvement (QI) tools can identify and address health disparities. This paper describes the use of resident prescriber profiles in a novel QI curriculum to identify racial and ethnic differences in antidepressant and antipsychotic prescribing. METHODS The authors extracted medication orders written by 111 psychiatry residents over an 18-month period from an electronic medical record and reformatted these into 6133 unique patient encounters. Binomial logistic models adjusted for covariates assessed racial and ethnic differences in antipsychotic or antidepressant prescribing in both emergency and inpatient psychiatric encounters. A multinomial model adjusted for covariates then assessed racial and ethnic differences in primary diagnosis. Models also examined interactions between gender and race/ethnicity. RESULTS Black (adjusted OR 0.66; 95% CI, 0.50-0.87; p < 0.01) and Latinx (adjusted OR, 0.65; 95% CI, 0.49-0.86; p < 0.01) patients had lower odds of receiving antidepressants relative to White patients despite diagnosis. Black and Latinx patients were no more likely to receive antipsychotics than White patients when adjusted for diagnosis. Black (adjusted OR 3.85; 95% CI, 2.9-5.2) and Latinx (adjusted OR 1.60; 95% CI, 1.1-2.3) patients were more likely to receive a psychosis than a depression diagnosis when compared to White patients. Gender interactions with race/ethnicity did not significantly change results. CONCLUSIONS Our findings suggest that racial/ethnic differences in antidepressant prescription likely result from alternatively higher diagnosis of psychotic disorders and prescription of antipsychotics in Black and Latinx patients. Prescriber profiles can serve as a powerful tool to promote resident QI learning around the effects of structural racism on clinical care.
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Hikaka J, Jones R, Hughes C, Connolly MJ, Martini N. Ethnic Variations in the Quality Use of Medicines in Older Adults: Māori and Non-Māori in Aotearoa New Zealand. Drugs Aging 2021; 38:205-217. [PMID: 33432516 DOI: 10.1007/s40266-020-00828-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 11/28/2022]
Abstract
In Aotearoa New Zealand (NZ), ethnic inequities in health outcomes exist. Non-Māori experience better access to healthcare than Māori, including access to the quality use of medicines. Quality medicines use requires that medicines provide maximal therapeutic benefit with minimal harm. As older adults are more at risk of harm from medicines, and, because inequities are compounded with age, Māori older adults may be at more risk of medicines-related harm than younger and non-Māori populations. This narrative review examined ethnic variation in the quality use of medicines, including medicines utilisation and associated clinical outcomes, between Māori and non-Māori older adult populations in NZ. The review was structured around prevalence of medicine utilisation by medicine class and in particular disease states; high-risk medicines; polypharmacy; prevalence of potentially inappropriate prescribing (PIP); and association between PIP and clinical outcomes. 22 studies were included in the review. There is ethnic variation in the access to medicines in NZ, with Māori older adults often having reduced access to particular medicine types, or in particular disease states, compared with non-Māori older adults. Māori older adults are less likely than non-Māori to be prescribed medicines inappropriately, as defined by standardised tools; however, PIP is more strongly associated with adverse outcomes for Māori than non-Māori. This review identifies that inequities in quality medicines use exist and provides a starting point to develop pro-equity solutions. The aetiology of inequities in the quality use of medicines is multifactorial and our approaches to addressing the inequitable ethnic variation also need to be.
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Affiliation(s)
- Joanna Hikaka
- School of Pharmacy, University of Auckland, Auckland, New Zealand. .,Waitematā District Health Board, Auckland, New Zealand. .,Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.
| | - Rhys Jones
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | | | - Martin J Connolly
- Waitematā District Health Board, Auckland, New Zealand.,Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Nataly Martini
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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Perinatal depression screening practices in a large health system: identifying current state and assessing opportunities to provide more equitable care. Arch Womens Ment Health 2021; 24:133-144. [PMID: 32372299 PMCID: PMC7929950 DOI: 10.1007/s00737-020-01035-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/22/2020] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to assess the prevalence of prenatal and postpartum depression screening in a large health system and to identify covariates for screening, with a specific focus in understanding disparities in practice. A retrospective cohort of women with deliveries in 2016 was created using electronic health records. Primary outcomes were depression screening during pregnancy and the first 3 months postpartum. Generalized linear mixed models with women nested within clinic were used to determine the effect of maternal and clinical characteristics on depression screening. The sample included 7548 women who received prenatal care at 35 clinics and delivered at 10 hospitals. The postpartum sample included 7059 women who returned within 3 months for a postpartum visit. Of those, 65.1% were screened for depression during pregnancy, and 64.4% were screened postpartum. Clinic site was the strongest predictor of screening, accounting for 23-30% of the variability in screening prevalence. There were no disparities identified with regard to prenatal screening. However, several disparities were identified for postpartum screening. After adjusting for clinic, women who were African American, Asian, and otherwise non-white (Native American, multi-racial) were less likely to be screened postpartum than white women (AOR (CI)'s 0.81 (0.65, 1.01), 0.64 (0.53, 0.77), and 0.44 (0.21, 0.96), respectively). Women insured by Medicaid/Medicare, a proxy for low-income, were less likely to be screened postpartum than women who were privately insured (AOR (CI) 0.78 (0.68, 0.89)). National guidelines support universal depression screening of pregnant and postpartum women. The current study found opportunities for improvement in order to achieve universal screening and to deliver equitable care.
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Alves-Bradford JM, Trinh NH, Bath E, Coombs A, Mangurian C. Mental Health Equity in the Twenty-First Century: Setting the Stage. Psychiatr Clin North Am 2020; 43:415-428. [PMID: 32773071 DOI: 10.1016/j.psc.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Significant mental health disparities persist in screening, diagnosis, and treatment for racial and ethnic minorities compared with non-Latinx white people. Reducing mental health disparities, and ultimately achieving mental health equity, requires understanding the wide range of factors that influence health outcomes at multiple levels. Components of an effective strategy to achieve mental health equity include increasing population-based care; increasing community-based health care services; addressing the social determinants of health; engaging the community; enhancing the pipeline; and supporting a diverse, structurally competent workforce.
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Affiliation(s)
- Jean-Marie Alves-Bradford
- New York State Psychiatric Institute, Washington Heights Community Service, Columbia University Department of Psychiatry, 1051 Riverside Drive, Box 112, New York, NY 10032, USA.
| | - Nhi-Ha Trinh
- Department of Psychiatry Center for Diversity, MGH Depression Clinical and Research Program (DCRP), Harvard Medical School (HMS), HMS, Massachusetts General Hospital (MGH), One Bowdoin Square, 6th Floor, Boston, MA 02114-2790, USA
| | - Eraka Bath
- Child Forensic Services; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Department of Psychiatry, 760 Westwood Plaza, Room A8-228 Los Angeles, CA 90024, USA
| | - Angela Coombs
- Columbia University Department of Psychiatry; Washington Heights Community Service, New York State Psychiatric Institute
| | - Christina Mangurian
- UCSF Department of Psychiatry, 1001 Potrero Avenue, Room 7M20, UCSF Box 0852, San Francisco, CA 94110, USA
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Milani SA, Lloyd S, Cottler LB, Striley CW. Racial and Ethnic Differences in Alzheimer's Disease Knowledge Among Community-Dwelling Middle-Aged and Older Adults in Florida. J Aging Health 2020; 32:564-572. [PMID: 30913947 PMCID: PMC7027949 DOI: 10.1177/0898264319838366] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To compare Alzheimer's disease (AD) knowledge by race and ethnicity in a community sample of middle-aged and older adults aged 50 and over in Florida. Method: Data from HealthStreet, a University of Florida community engagement program, which uses community health workers to assess the health conditions, concerns, and knowledge of community members, was used (n = 842). A multivariate regression model was used to quantify differences in AD knowledge by race and ethnicity. Results: Older age and recruitment from Miami were associated with higher AD knowledge while being non-Hispanic Black, reporting male sex, having less than high school diploma, and reporting food insecurity were associated with lower AD knowledge. Discussion: Hispanics had comparable AD knowledge to non-Hispanic Whites and more knowledge than non-Hispanic Blacks after adjusting for other factors that could differentiate these groups. Almost half of the participants did not know hypertension is a risk factor for AD, highlighting a point of intervention.
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Gale M, Franco M, Reese E, Hutman H, Wang YW. Sociocultural Factors and Referral Outcome: An Exploratory Investigation. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2020. [DOI: 10.1080/87568225.2019.1592729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michael Gale
- Counseling Center, University of Maryland, College Park, MD, USA
| | - Marisa Franco
- Counseling Center, University of Maryland, College Park, MD, USA
| | - Erin Reese
- Counseling Center, University of Maryland, College Park, MD, USA
| | - Heidi Hutman
- Counseling Center, University of Maryland, College Park, MD, USA
| | - Yu-Wei Wang
- Counseling Center, University of Maryland, College Park, MD, USA
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Torres Stone RA, Cardemil EV, Keefe K, Bik P, Dyer Z, Clark KE. A Community Mental Health Needs Assessment of a Racially and Ethnically Diverse Population in New England: Narratives from Community Stakeholders. Community Ment Health J 2020; 56:947-958. [PMID: 32006294 DOI: 10.1007/s10597-020-00562-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/26/2020] [Indexed: 12/16/2022]
Abstract
Despite the existence of numerous efficacious treatments for mental disorders, many individuals in need do not receive adequate treatment particularly racial and ethnic minorities. Community stakeholders can provide: (1) a more nuanced understanding of community mental health needs, and in (2) informing the planning and provision of mental health services. Qualitative data for this mental health needs assessment come from 61 individuals who represent local residents and/or consumers of mental health services, Executive Directors, providers of mental health and non-mental health community based services. We identified systems-related and psychosocial barriers to seeking mental health services: difficulty navigating the mental health system, language barriers, dearth of culturally competent providers; and mental health stigma and mental health literacy and non-Western notions of mental health. Collaborative efforts across stakeholders are called for to address the mental health needs of racial and ethnic minorities in a local community.
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Affiliation(s)
| | | | - Kristen Keefe
- Psychology Department, Clark University, Worcester, MA, 01655, USA
| | - Paige Bik
- New York City Alliance Against Sexual Assault, New York, NY, USA
| | - Zachary Dyer
- University of Massachusetts Medical School, Worcester, MA, 01610, USA
| | - Karyn E Clark
- City of Worcester Division of Public Health, Worcester, MA, 01655, USA
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Lara-Cinisomo S, Akinbode TD, Wood J. A Systematic Review of Somatic Symptoms in Women with Depression or Depressive Symptoms: Do Race or Ethnicity Matter? J Womens Health (Larchmt) 2020; 29:1273-1282. [PMID: 32397866 DOI: 10.1089/jwh.2019.7975] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Racial and ethnic minority women in the United States have an elevated risk of depression or depressive symptoms compared with White women. There is evidence to suggest that these women are more likely to report somatic symptoms. The objective of this systematic review was to determine whether there are racial and ethnic differences in somatization in women with depression or depressive symptoms. Materials and Methods: The study focused on peer-reviewed, English-written publications of adult women that compared two or more racial or ethnic women and used reliable measures. Quantitative studies conducted in the United States were considered. Articles were reviewed from March 2017 to April 2019, with no publication start date. Results: Seven studies met the inclusion criteria. Results suggest that African American women were more likely to endorse somatic symptoms compared with White women and, in one instance Hispanic/Latinas. Three of four studies found that Hispanic/Latinas were significantly more likely to endorse somatic symptoms compared with White women; one study found that White women were significantly more likely to report somatic symptoms than Hispanic women. Another study found that White women endorsed significantly higher somatic symptoms than Chinese American women. One study did not find significant differences. Conclusions: A pattern emerged with African American and Hispanic/Latina women with depression or depressive symptoms more likely to report somatic symptoms compared with White women. However, it is not clear whether differences were a function of culturally acceptable presentation of symptoms or if the stress of being depressed increased somatization in minority women. Future studies should assess how depression/depressive symptoms affect racial and ethnic minority women to identify mechanisms involved in increased somatization.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Tanitoluwa Demilade Akinbode
- Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Jayme Wood
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
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Fernandes CSE, Lima MG, Barros MBDA. Emotional problems and the use of psychotropic drugs: investigating racial inequality. CIENCIA & SAUDE COLETIVA 2020; 25:1677-1688. [PMID: 32402020 DOI: 10.1590/1413-81232020255.33362019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/07/2019] [Indexed: 01/08/2023] Open
Abstract
The aim of the present study was to investigate the existence of racial inequalities in the prevalence of emotional problems, the search for healthcare services and the use of psychotropic drugs. A population-based, cross-sectional study was conducted with data from the 2014/15 Campinas Health Survey. Sample of 1953 individuals aged 20 years or older was analyzed. We estimated the prevalence of common mental disorders (CMDs), the reporting of emotional problems, insomnia, the search for and the use of healthcare services and the use of psychotropic drugs according to self-reported skin color (white and black/brown). Prevalence ratios were estimated using "Poisson" multiple regression. The prevalence of CMDs was higher among blacks/brown compared to whites but no difference was found regarding the reporting of emotional problems and insomnia. Whites sought healthcare services more due to emotional problems. The use of psychotropic drugs was also higher among whites. The results revealed racial inequalities in the presence of CMDs, the search for healthcare services and the use of psychotropics drugs, highlighting the need for actions to identify and overcome barriers that hinder access to mental health care by different racial segments of the population.
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Affiliation(s)
| | - Margareth Guimarães Lima
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil,
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Cobb S, Bazargan M, Sandoval JC, Wisseh C, Evans MC, Assari S. Depression Treatment Status of Economically Disadvantaged African American Older Adults. Brain Sci 2020; 10:brainsci10030154. [PMID: 32156089 PMCID: PMC7139636 DOI: 10.3390/brainsci10030154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background: It is known that depression remains largely untreated in underserved communities. Hence, it is desirable to gain more knowledge on the prevalence and correlates of untreated depression among African-American (AA) older adults in economically disadvantaged areas. This knowledge may have the public health benefit of improving detection of AA older adults with depression who are at high risk of not receiving treatment, thereby reducing this health disparity. Objective: To study health and social correlates of untreated depression among AA older adults in economically disadvantaged areas. Methods: Between 2015 and 2018, this cross-sectional survey was conducted in South Los Angeles. Overall, 740 AA older adults who were 55+ years old entered this study. Independent variables were age, gender, living arrangement, insurance type, educational attainment, financial strain, chronic medical conditions, and pain intensity. Untreated depression was the dependent variable. Logistic and polynomial regression models were used to analyze these data. Results: According to the polynomial regression model, factors such as number of chronic medical conditions and pain intensity were higher in individuals with depression, regardless of treatment status. As our binary logistic regression showed, age, education, and number of providers were predictive of receiving treatment for depression. Conclusion: Age, educational attainment, number of providers (as a proxy of access to and use of care) may be useful to detect AA older adults with depression who are at high risk of not receiving treatment. Future research may focus on decomposition of the role of individual-level characteristics and health system-level characteristics that operate as barriers and facilitators to AA older adults receiving treatment for depression.
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Affiliation(s)
- Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Jessica Castro Sandoval
- School of Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Cheryl Wisseh
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 91606, USA
| | - Meghan C. Evans
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Correspondence: ; Tel.: +1-734-363-2678
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Twumasi AA, Shao A, Dunlop-Thomas C, Drenkard C, Cooper HL. Exploring the Perceived Impact of the Chronic Disease Self-Management Program on Self-Management Behaviors among African American Women with Lupus: A Qualitative Study. ACR Open Rheumatol 2020; 2:147-157. [PMID: 32037683 PMCID: PMC7077773 DOI: 10.1002/acr2.11117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/20/2019] [Indexed: 01/11/2023] Open
Abstract
Objective To qualitatively explore the processes through which the Chronic Disease Self‐Management Program (CDSMP)—a peer‐led, group‐based educational intervention for people with chronic conditions—affects self‐management behaviors among African American women with systemic lupus erythematosus (SLE). Methods Using a longitudinal pre‐ and postintervention design, we conducted two waves of one‐on‐one, semistructured interviews with 24 purposefully sampled participants. Wave 1 interviews explored self‐management behaviors at baseline; wave 2 interviews focused on changes in these behaviors postintervention. Transcripts were analyzed using thematic analysis methods. Results Study participants perceived the CDSMP to be a valuable resource that helped them improve fundamental self‐management behaviors, including exercise, relaxation, diet, and medication adherence. We found, with few exceptions, that in this sample, women's reported changes in self‐management behaviors did not vary by participant age, education, SLE disease severity, or depression status. Our analysis suggests that the CDSMP had the most widespread perceived effects on relaxation and exercise. Strategies that generated improvements in relaxation and exercise included goal setting, action planning, encouragement to pursue low‐impact physical activity, and introduction of mindfulness techniques to better manage SLE symptoms. Conclusion Our findings suggest that African American women with SLE perceived the CDSMP as an effective educational self‐management intervention. The program can potentially catalyze improvements in self‐management behaviors in this population, regardless of demographic or disease characteristics.
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Affiliation(s)
- Abena A Twumasi
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anna Shao
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | | | - Hannah L Cooper
- Emory University Rollins School of Public Health, Atlanta, Georgia
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Vélez-Pastrana MC, González RA, Ramos-Fernández A, Ramírez Padilla RR, Levin FR, Albizu García C. Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity. Eur Addict Res 2020; 26:179-190. [PMID: 32615575 DOI: 10.1159/000508829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) are overrepresented among incarcerated populations. We examined whether ADHD was associated with increased severity of comorbid SUD and with increased psychiatric comorbidity among prisoners. METHODS Cross-sectional study of 500 randomly selected Latino male prisoners in the Puerto Rico Correctional System using validated diagnostic measures to assess Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ADHD and SUD diagnosis, antisocial personality disorder (ASP) and borderline personality disorder (BPD), major depression, and generalized anxiety disorder (GAD). We defined SUD severity by symptom count and by presence of at least 2 current SUD diagnoses (polysubstance). RESULTS Participants with ADHD had increased risk for lifetime (p < 0.05) and current (p < 0.01) SUDs, all comorbid psychiatric disorders, and suicidality (p < 0.001). They had more severe SUD, both in number of symptoms and number of SUD (polysubstance) diagnoses (p < 0.01). ADHD was associated with increased psychiatric comorbidity, as participants with ADHD were more likely to have a second diagnosis, and a greater number of comorbid disorders (p < 0.001). ASP, BPD, major depression, and GAD, but not ADHD, were significant predictors of SUD severity in adjusted models. CONCLUSIONS Findings highlight the complex mental health needs of incarcerated populations, where SUD, ADHD, and other psychiatric disorders are prevalent and interrelated.
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Affiliation(s)
- María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, .,Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA,
| | - Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Rafael R Ramírez Padilla
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Carmen Albizu García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
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Patient-level predictors of detection of depressive symptoms, referral, and uptake of depression counseling among chronic care patients in KwaZulu-Natal, South Africa. Glob Ment Health (Camb) 2020; 7:e18. [PMID: 32913657 PMCID: PMC7443607 DOI: 10.1017/gmh.2020.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Integration of depression treatment into primary care could improve patient outcomes in low-resource settings. Losses along the depression care cascade limit integrated service effectiveness. This study identified patient-level factors that predicted detection of depressive symptoms by nurses, referral for depression treatment, and uptake of counseling, as part of integrated care in KwaZulu-Natal, South Africa. METHODS This was an analysis of baseline data from a prospective cohort. Participants were adult patients with at least moderate depressive symptoms at primary care facilities in Amajuba, KwaZulu-Natal, South Africa. Participants were screened for depressive symptoms prior to routine assessment by a nurse. Generalized linear mixed-effects models were used to estimate associations between patient characteristics and service delivery outcomes. RESULTS Data from 412 participants were analyzed. Nurses successfully detected depressive symptoms in 208 [50.5%, 95% confidence interval (CI) 38.9-62.0] participants; of these, they referred 76 (36.5%, 95% CI 20.3-56.5) for depression treatment; of these, 18 (23.7%, 95% CI 10.7-44.6) attended at least one session of depression counseling. Depressive symptom severity, alcohol use severity, and perceived stress were associated with detection. Similar factors did not drive referral or counseling uptake. CONCLUSIONS Nurses detected patients with depressive symptoms at rates comparable to primary care providers in high-resource settings, though gaps in referral and uptake persist. Nurses were more likely to detect symptoms among patients in more severe mental distress. Implementation strategies for integrated mental health care in low-resource settings should target improved rates of detection, referral, and uptake.
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Qin H, Lin Z, Vásquez E, Xu L. The association between chronic psychological stress and uterine fibroids risk: A meta-analysis of observational studies. Stress Health 2019; 35:585-594. [PMID: 31452302 DOI: 10.1002/smi.2895] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/07/2019] [Accepted: 08/16/2019] [Indexed: 01/10/2023]
Abstract
The association between chronic psychological stress and uterine fibroids (UFs) risk remains unclear. In this study, a meta-analysis of observational studies was performed to explore the reported association between them. A literature search was performed in PubMed, EMBASE, and Web of Science to identify relevant published articles. A random-effect model was used to examine pooled odds ratio (OR) and 95% confidence interval (CI). Additionally, subgroup analyses and two-stage random-effect dose-response meta-analysis were performed. A total of six articles with seven studies were included in this meta-analysis. For the highest versus lowest category of chronic psychological stress, the pooled OR was 1.24 (95% CI [1.15, 1.34]; p = .000). Through subgroup analyses, we found a positive association between chronic psychological stress and UFs risk especially in non-Hispanic Blacks studies (OR, 1.24, 95% CI [1.14, 1.34], p = .000). When evaluating for a dose-response, we found a weak correlation between chronic psychological stress and UFs risk, especially for the severe (OR, 1.17, 95% CI [1.07, 1.29]) and very severe (OR, 1.23, 95% CI [1.07, 1.41]) categories. Our meta-analysis shows a statistically significant association between chronic psychological stress and UFs risk particularly for non-Hispanic Blacks. Interventions aiming to reduce chronic psychological stress may be useful to decrease the prevalence of UFs.
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Affiliation(s)
- Hao Qin
- School of Basic Medicine, Qingdao University, Qingdao, China.,School of Public Health & Management, Weifang Medical University, Weifang, China
| | - Zhijuan Lin
- Department of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Elizabeth Vásquez
- School of Public Health, University at Albany, State University of New York, New York
| | - Luo Xu
- School of Basic Medicine, Qingdao University, Qingdao, China
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50
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Levy ME, Monroe AK, Horberg MA, Benator DA, Molock S, Doshi RK, Powers Happ L, Castel AD. Pharmacologic Treatment of Psychiatric Disorders and Time With Unsuppressed HIV Viral Load in a Clinical HIV Cohort. J Acquir Immune Defic Syndr 2019; 82:329-341. [PMID: 31356466 PMCID: PMC6791752 DOI: 10.1097/qai.0000000000002138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH). SETTING The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC. METHODS Among PLWH ≥18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders. Associations between psychiatric disorders/treatments and the proportion of subsequent days with VL ≥200 copies/mL were assessed using multivariable Poisson regression with generalized estimating equations. RESULTS Among 5904 participants (median age 51; 70% men; 82% Black), 45% had ≥1 psychiatric disorder, including 38% with mood disorders (50% treated), 18% with anxiety or stress-/trauma-related disorders (64% treated), and 4% with psychotic disorders (52% treated). Untreated major depressive disorder (adjusted rate ratio = 1.17; 95% confidence interval: 1.00 to 1.37), untreated other/unspecified depressive disorder (1.23; 1.01 to 1.49), untreated bipolar disorder (1.39; 1.15 to 1.69), and treated bipolar disorder (1.25; 1.02 to 1.53) (vs. no mood disorder) predicted more time with VL ≥200 copies/mL. Treated anxiety disorders (vs. no anxiety disorder) predicted less time (0.78; 0.62 to 0.99). Associations were weaker and nonsignificant for treated depressive disorders (vs. no mood disorder) and untreated anxiety disorders (vs. no anxiety disorder). CONCLUSIONS PLWH with depressive and bipolar disorders, particularly when untreated, spent more time with unsuppressed VL than PLWH without a mood disorder. Treatment of mood disorders may be important for promoting sustained viral suppression.
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Affiliation(s)
- Matthew E Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Debra A Benator
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Sherry Molock
- Department of Psychology, The George Washington University, Washington, DC
| | - Rupali K Doshi
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Lindsey Powers Happ
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
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