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Feng A, O'Neill S, Rostain AL. Contributors to Underdiagnosis of ADHD among Asian Americans: A Narrative Review. J Atten Disord 2024; 28:1499-1519. [PMID: 39082427 DOI: 10.1177/10870547241264113] [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: 09/15/2024]
Abstract
OBJECTIVE Rates of ADHD are lowest among Asian American children (1-6.1%) compared to all other major ethnic and racial groups in the US, but there is limited literature on reasons for the disparity in estimated prevalence rates. METHOD We conducted a narrative review to integrate the literature on ADHD in children in Asian countries with that on ADHD among Asian American youth to highlight potential explanations for disparities in ADHD diagnosis and treatment among Asian American children relative to other racial and ethnic groups. RESULTS Factors possibly contributing to the low estimated prevalence rates of ADHD among Asian American children include: a higher proportion of Inattentive ADHD presentation among Chinese, Malaysian, and Indian children; racial bias and the influence of the Model Minority Myth; cultural differences in classroom identification; mental health stigma in Asian American communities; parent perception of ADHD as misbehavior rather than a neurodevelopmental disorder; and parent support for children's academic activities that may mask impairment. CONCLUSION We offer recommendations to inform individual and community-level psychoeducation, and new directions for research to address this health disparity.
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Affiliation(s)
- Ashley Feng
- Psychology Department, The City College of New York, City University of New York, New York, NY, USA
| | - Sarah O'Neill
- Psychology Department, The City College of New York, City University of New York, New York, NY, USA
- Psychology Department, The Graduate Center, City University of New York, New York, NY, USA
| | - Anthony L Rostain
- Department of Psychiatry, Cooper Medical School of Rowan University, Camden, NJ, USA
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2
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Mathieu J, Roy K, Robert MÈ, Akeblersane M, Descarreaux M, Marchand AA. Sociodemographic determinants of health inequities in low back pain: a narrative review. Front Public Health 2024; 12:1392074. [PMID: 39324158 PMCID: PMC11422063 DOI: 10.3389/fpubh.2024.1392074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/29/2024] [Indexed: 09/27/2024] Open
Abstract
Background Health equity is defined as the absence of unjust and avoidable disparities in access to healthcare, quality of care, or health outcomes. The World Health Organization (WHO) has developed a conceptual framework that outlines the main causes of health inequalities and how these contribute to health inequities within a population. Despite the WHO implementing health equity policies to ensure accessibility and quality of healthcare services, disparities persist in the management of patients suffering from low back pain (LBP). The objective of this study was to review the existing evidence on the impact of health inequities on the care trajectories and treatments provided to individuals with LBP. Methods A narrative review was performed, which included a literature search without language and study design restrictions in MEDLINE Ovid database, from January 1, 2000, to May 15, 2023. Search terms included free-text words for the key concepts of "low back pain," "health inequities," "care pathways," and "sociodemographic factors." Results Studies have revealed a statistically significant association between the prevalence of consultations for LBP and increasing age. Additionally, a significant association between healthcare utilization and gender was found, revealing that women were more likely to seek medical attention for LBP compared to men. Furthermore, notable disparities related to race and ethnicity were identified, more specifically in opioid prescriptions, spinal surgery recommendations, and access to complementary and alternative medical approaches for LBP. A cross-sectional analysis found that non-Hispanic White individuals with chronic LBP were more likely to be prescribed one or more pharmacological treatments. Lower socioeconomic status and level of education, as well as living in lower-income areas were also found to be associated with greater risks of receiving non-guideline concordant care, including opioid and MRI prescriptions, before undergoing any conservative treatments. Conclusion Persistent inequalities related to sociodemographic determinants significantly influence access to care and care pathways of patients suffering from LBP, underscoring the need for additional measures to achieve equitable health outcomes. Efforts are needed to better understand the needs and expectations of patients suffering from LBP and how their individual characteristics may affect their utilization of healthcare services.
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Affiliation(s)
- Janny Mathieu
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Kamille Roy
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Marie-Ève Robert
- Faculty of Medecine, Université de Montréal, Montréal, QC, Canada
| | - Meriem Akeblersane
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, Bahrain
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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3
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dosReis S, Espinal Pena D, Fincannon A, Gorman EF, Amill-Rosario A. Discrete Choice Experiments to Elicit Patient Preferences for the Treatment of Major Depressive Disorder: A Systematic Review. THE PATIENT 2024:10.1007/s40271-024-00706-6. [PMID: 38969878 DOI: 10.1007/s40271-024-00706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Individual preferences for treatment options for major depressive disorder can impact therapeutic decision making, adherence, and ultimately outcomes. OBJECTIVES This systematic review of discrete choice experiments (DCEs) on patient preferences for major depressive disorder treatment assessed the range of DCE applications in major depressive disorder to document patient stakeholder involvement in DCE development and to identify the relative importance of treatment attributes. METHODS We searched MEDLINE via Ovid (1946-present), EMBASE (Elsevier interface), Cochrane Central Register of Controlled Trials (Wiley interface), and PsycINFO (EBSCO interface) databases on 29 May, 2024. Covidence software facilitated the review, which four members completed independently. The review was conducted in two phases: title and abstract and then a full-text review. We used an established quality reporting tool to evaluate selected articles. The Covidence extraction tool was adapted for this study. RESULTS A total of 19 articles were included in this review. Most studies elicited preferences for depression treatment (63.2%) and care delivery (10.5%). Two assessed willingness to pay. Individuals prefer a combination of medicine and counseling over each treatment alone. Treatment efficacy, relapse prevention, and symptom relief were among the most important attributes. Individuals were willing to accept larger risks to achieve symptom improvement. Few studies examined preference heterogeneity with latent subgroups. CONCLUSIONS Discrete choice experiments for major depressive disorder treatment preferences enable an assessment of trade-offs for first-line therapeutic options. Patient stakeholders are infrequently involved as collaborators in the DCE development. Few examined preference heterogeneity among subgroups.
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Affiliation(s)
- Susan dosReis
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA.
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, PAVE Center, Baltimore, MD, USA.
| | - Dafne Espinal Pena
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | - Alexandra Fincannon
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland Baltimore, Baltimore, MD, USA
| | - Alejandro Amill-Rosario
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, PAVE Center, Baltimore, MD, USA
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4
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Pinheiro LC, An A, Zeng C, Walker D, Mercurio AM, Hershman DL, Rosenberg SM. Racial and Ethnic Differences in Psychosocial Care Use Among Adults With Metastatic Breast Cancer: A Retrospective Analysis Across Six New York City Health Systems. JCO Oncol Pract 2024; 20:984-991. [PMID: 38466926 DOI: 10.1200/op.23.00528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/07/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024] Open
Abstract
PURPOSE A metastatic breast cancer (mBC) diagnosis can affect physical and emotional well-being. However, racial and ethnic differences in receipt of outpatient psychosocial care and supportive care medications in adults with mBC are not well described. METHODS Adults with mBC were identified in the INSIGHT-Clinical Research Network, a database inclusive of >12 million patients receiving care across six New York City health systems. Outpatient psychosocial care was operationalized using Common Procedure Terminology codes for outpatient psychotherapy or counseling. Psychosocial/supportive care medications were defined using Rx Concept Unique Identifier codes. Associations between race/ethnicity and outpatient care and medication use were evaluated using logistic regression. RESULTS Among 5,429 adults in the analytic cohort, mean age was 61 years and <1% were male; 53.6% were non-Hispanic White (NHW), 21.4% non-Hispanic Black (NHB), 15.9% Hispanic, 6.1% Asian/Native Hawaiian/Pacific Islander (A/NH/PI), and 3% other or unknown. Overall, 4.1% had ≥one outpatient psychosocial care visit and 63.4% were prescribed ≥one medication. Adjusted for age, compared with NHW, Hispanic patients were more likely (odds ratio [OR], 2.14 [95% CI, 1.55 to 2.92]) and A/NH/PI patients less likely (OR, 0.35 [95% CI, 0.12 to 0.78]) to have an outpatient visit. NHB (OR, 0.59 [95% CI, 0.51 to 0.68]) and Asian (OR, 0.36 [95% CI, 0.29 to 0.46]) patients were less likely to be prescribed medications. CONCLUSION Despite the prevalence of depression, anxiety, and distress among patients with mBC, we observed low utilization of psychosocial outpatient care. Supportive medication use was more prevalent, although differences observed by race/ethnicity suggest that unmet needs exist.
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Affiliation(s)
- Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Anjile An
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Caroline Zeng
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | | | - Dawn L Hershman
- Division of Medical Oncology, Columbia University Medical Center, New York, NY
| | - Shoshana M Rosenberg
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Peterson A, Borsellino P, Davidson R, Ezeanolue E, Lagasca G, Diaz J, Batra K, Weisman A. The Effectiveness of Mind-Body Intervention on Psychological Well-Being during the COVID-19 Pandemic: A Pilot Pre-Post Interventional Study. Healthcare (Basel) 2024; 12:1125. [PMID: 38891201 PMCID: PMC11172229 DOI: 10.3390/healthcare12111125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/09/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
The pandemic highlighted the need for alternative, more accessible access to mental health interventions that can be readily administered remotely. The purpose of this pre-post-interventional study was to evaluate the effectiveness of a virtual mind-body medicine training course on stress, anxiety, and depression levels. University employees and members of the Las Vegas community were recruited via self-selection and snowball sampling and subjected to online mind-body practice sessions in December of 2020. Stress, anxiety, depression, and quality of life were assessed pre- and post-intervention using standardized psychometric valid tools. The paired t-test and related samples marginal homogeneity tests were used for continuous and categorical outcomes, respectively. Depression and stress scores were significantly decreased (p < 0.001). Mean scores of professional quality of life improved post-intervention compared to pre-intervention (p = 0.03). A significantly larger proportion of participants reported no depression or stress post-intervention compared with pre-intervention (p < 0.001, p = 0.003, respectively.) This study suggests that virtual mind-body practices had a pronounced impact on stress and depression levels during the pandemic. These findings support virtual, online-guided mind-body medicine training as an effective intervention that can be administered virtually to reduce stress and depression symptoms.
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Affiliation(s)
- Aaron Peterson
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 625 Shadow Lane, Las Vegas, NV 89106, USA; (P.B.); (R.D.); (E.E.); (G.L.); (J.D.)
| | - Philip Borsellino
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 625 Shadow Lane, Las Vegas, NV 89106, USA; (P.B.); (R.D.); (E.E.); (G.L.); (J.D.)
| | - Ryder Davidson
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 625 Shadow Lane, Las Vegas, NV 89106, USA; (P.B.); (R.D.); (E.E.); (G.L.); (J.D.)
| | - Edozie Ezeanolue
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 625 Shadow Lane, Las Vegas, NV 89106, USA; (P.B.); (R.D.); (E.E.); (G.L.); (J.D.)
| | - Gemma Lagasca
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 625 Shadow Lane, Las Vegas, NV 89106, USA; (P.B.); (R.D.); (E.E.); (G.L.); (J.D.)
| | - Jared Diaz
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 625 Shadow Lane, Las Vegas, NV 89106, USA; (P.B.); (R.D.); (E.E.); (G.L.); (J.D.)
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 625 Shadow Lane, Las Vegas, NV 89106, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 1701 West Charleston Blvd, Las Vegas, NV 89102, USA
| | - Anne Weisman
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, 625 Shadow Lane, Las Vegas, NV 89106, USA; (P.B.); (R.D.); (E.E.); (G.L.); (J.D.)
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6
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Wofford N, Rausch CR, Elkins GR. Aging Adults' Willingness, Preferences, and Access to Self-Hypnosis for Sleep: A Cross-Sectional Survey. Int J Clin Exp Hypn 2024:1-16. [PMID: 38446038 DOI: 10.1080/00207144.2024.2324167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/30/2023] [Indexed: 03/07/2024]
Abstract
Sleep disturbance is a public health problem among aging adults (age 45 and older). While aging adults are at an elevated risk for sleep disturbance, many also have high rates of mistrust toward psychological interventions, such as self-hypnosis, which may be beneficial for sleep. The purpose of the study was to assess factors that may impact utilization of self-hypnosis for sleep, including willingness, preferences, and access among informed aging adults. 244 aging adults were recruited. After reading an information sheet on self-hypnosis for sleep, participants completed questionnaires assessing sleep related worry, stress, and perceptions of self-hypnosis for sleep, including willingness, benefits, barriers, preferences, and access. The findings indicated that informed aging adults were willing to engage in self-hypnosis for sleep, regardless of their race or gender. Furthermore, they preferred technological delivery methods (i.e. telehealth or smartphone apps) with flexible scheduling options. However, very few participants endorsed having access to self-hypnosis.
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Affiliation(s)
- Nathan Wofford
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Carolyn R Rausch
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Gary R Elkins
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
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7
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Alai J, Callen EF, Clay T, Goodman DW, Adler LA, Faraone SV. Differences in Primary Care Management of Patients With Adult Attention Deficit Hyperactivity Disorder (ADHD) Based on Race and Ethnicity. J Atten Disord 2024; 28:923-935. [PMID: 38214134 DOI: 10.1177/10870547231218038] [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: 01/13/2024]
Abstract
OBJECTIVE Examine differences in care patterns around adult ADHD between race (White/Non-White) and ethnic (Hispanic/Non-Hispanic) groups utilizing existing quality measures (QMs), concerning diagnosis, treatment, and medication prescribing. METHODS The AAFP National Research Network in partnership with SUNY Upstate Medical used an EHR dataset to evaluate achievement of 10 ADHD QMs. The dataset was obtained from DARTNet Institute and includes 4 million patients of 873 behavioral and primary care practices with at least 100 patients from 2010 to 2020. Patients 18-years or older with adult ADHD were included in this analysis. RESULTS White patients and Non-Hispanic/Latinx patients were more likely to achieve these QMs than Non-White patients and Hispanic/Latinx patients, respectively. Differences between groups concerning medication and monitoring demonstrate a disparity for Non-White and Hispanic/Latinx populations. CONCLUSIONS Using QMs in EHR data can help identify gaps in ADHD research. There is a need to continue investigating disparities of quality adult ADHD care.
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Affiliation(s)
- Jillian Alai
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Elisabeth F Callen
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Tarin Clay
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - David W Goodman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Lenard A Adler
- Departments of Psychiatry and Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Ramirez O. Predictors of Symptoms of Depression Among Black Seventh-Day Adventists in the United States. JOURNAL OF RELIGION AND HEALTH 2024; 63:567-576. [PMID: 37318669 DOI: 10.1007/s10943-023-01847-y] [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] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to estimate a regression model that best predict symptoms of depression among Black Seventh-day Adventists in the United States. The sample (n = 3,570) was drawn from the Biopsychosocial Religion and Health Study, a sub-study of the larger Adventist Health Study-2 consisting of a random sample (n = 10,998) of Adventists. The results of the study showed that poor sleep quality, hostility, stress, and perceived discrimination were all predictors of symptoms of depression, while religious involvement decreased the likelihood of experiencing those symptoms.
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Affiliation(s)
- Octavio Ramirez
- Department of Social Work, Fort Hays State University, 600 Park St., Hays, KS, 67601, USA.
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Powell SK, Serafini RA, Frere JJ, De Pins A, Saali A, Sultana SA, Ali M, Dale B, Datta D, Aaronson C, Meah Y, Katz CL, Gluhoski V. Provision of Cognitive Behavior Therapy for Depression and Anxiety Disorders by Medical Student Trainees. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:10-17. [PMID: 37770702 DOI: 10.1007/s40596-023-01873-8] [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: 03/21/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE The purpose of the article is to evaluate an innovative education program in which medical students were trained in cognitive behavior therapy (CBT) and provided CBT treatments under supervision to uninsured individuals with depressive, anxiety, adjustment, and trauma-based disorders. METHODS The authors assessed improvements in trainees' CBT knowledge using the Cognitive Therapy Awareness Scale before and after their didactic training. CBT supervisors rated trainees' clinical competencies utilizing standardized checklist evaluations based upon supervision reports. The authors employed mixed effects ANOVA and regression modeling to test the association between the addition of CBT to treatment as usual (TAU) and improvements in patients' depressive and anxious symptom severity. The authors collected feedback and self-assessment of functioning with a Psychotherapy Feedback Questionnaire. RESULTS Medical students showed increases in CBT knowledge that were maintained six months later and demonstrated satisfactory competency in CBT techniques. The addition of CBT to TAU was associated with greater improvements in depressive, but not anxious, symptom severity. However, among the TAU + CBT group, there was an association between the number of CBT sessions received and the magnitude of improvement in anxious symptoms from baseline. Patients gave positive feedback to medical student CBT providers and reported improvements in broad domains of psychosocial functioning. CONCLUSIONS Medical students can provide competent and clinically beneficial CBT treatments for depression and anxiety disorders. These findings have implications for medical training and support the use of medical students to deliver care for individuals with limited access to psychotherapy.
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Affiliation(s)
| | | | - Justin J Frere
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Agathe De Pins
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Muhammad Ali
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brandon Dale
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debjyoti Datta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cindy Aaronson
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yasmin Meah
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Craig L Katz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vicki Gluhoski
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Steinman L, Xing J, Court B, Coe NB, Yip A, Hill C, Rector B, Baquero B, Weiner BJ, Snowden M. Can a Home-Based Collaborative Care Model Reduce Health Services Utilization for Older Medicaid Beneficiaries Living with Depression and Co-occurring Chronic Conditions? A Quasi-experimental Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:712-724. [PMID: 37233831 DOI: 10.1007/s10488-023-01271-0] [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] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
Depression remains a major public health issue for older adults, increasing risk of costly health services utilization. While home-based collaborative care models (CCM) like PEARLS have been shown to effectively treat depression in low-income older adults living with multiple chronic conditions, their economic impact is unclear. We conducted a quasi-experimental study to estimate PEARLS effect on health service utilization among low-income older adults. Our secondary data analysis merged de-identified PEARLS program data (N = 1106), home and community-based services (HCBS) administrative data (N = 16,096), and Medicaid claims and encounters data (N = 164) from 2011 to 2016 in Washington State. We used nearest neighbor propensity matching to create a comparison group of social service recipients similar to PEARLS participants on key determinants of utilization guided by Andersen's Model. Primary outcomes were inpatient hospitalizations, emergency room (ER) visits, and nursing home days; secondary outcomes were long-term supports and services (LTSS), mortality, depression and health. We used an event study difference-in-difference (DID) approach to compare outcomes. Our final dataset included 164 older adults (74% female, 39% people of color, mean PHQ-9 12.2). One-year post-enrollment, PEARLS participants had statistically significant improvements in inpatient hospitalizations (69 fewer hospitalizations per 1000 member months, p = 0.02) and 37 fewer nursing home days (p < 0.01) than comparison group participants; there were no significant improvements in ER visits. PEARLS participants also experienced lower mortality. This study shows the potential value of home-based CCM for participants, organizations and policymakers. Future research is needed to examine potential cost savings.
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Affiliation(s)
- Lesley Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA.
- Hans Rosling Center, University of Washington, 3980 15th Avenue NE, UW Mailbox 351621, Seattle, WA, 98195, USA.
| | - Jingping Xing
- Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, USA
| | - Beverly Court
- Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, USA
| | - Norma B Coe
- Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Andrea Yip
- Seattle-King County Aging and Disability Services, Seattle, USA
| | - Clara Hill
- Department of Human Development, Washington State University, Pullman, USA
| | - Bea Rector
- Washington State Department of Social and Health Services, Aging and Long-Term Support Administration, Lacey, USA
| | - Barbara Baquero
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, USA
| | - Mark Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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11
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Lin C, Pham H, Hser YI. Mental Health Service Utilization and Disparities in the U.S: Observation of the First Year into the COVID Pandemic. Community Ment Health J 2023; 59:972-985. [PMID: 36609783 PMCID: PMC11329229 DOI: 10.1007/s10597-022-01081-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Abstract
This study examined mental health service utilization and disparities during the first year of COVID. We analyzed data from all adult respondents with any mental illness in the past year (n = 6967) in the 2020 National Survey on Drug Use and Health to evaluate if mental health service utilization differed by geographic areas, race/ethnicity, and age groups. Only 46% of individuals with any mental illness had received mental health treatment. Compared to non-Hispanic Whites, Asian and Hispanics were less likely to receive outpatient services and prescription medicine. Rural residents received less outpatient treatment compared to large metropolitan residents. No difference was found in telemedicine utilization across area types and race/ethnicity groups. Older individuals were less likely to utilize telemedicine services. Our findings highlighted continued mental health treatment disparities among race/ethnic minorities and other sub-populations during COVID. Targeted strategies are warranted to allow older populations to benefit from telemedicine.
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Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA.
| | - Huyen Pham
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Yih-Ing Hser
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
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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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13
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Lamontagne SJ, Duda JM, Madarasmi S, Rogers VA, Yu E, Pizzagalli DA, Schroder HS. Limited impacts of biogenetic messaging on neural correlates of cognitive control and beliefs about depression. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:383-399. [PMID: 36869258 PMCID: PMC9984246 DOI: 10.3758/s13415-023-01073-9] [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] [Accepted: 01/26/2023] [Indexed: 03/05/2023]
Abstract
During the past 60 years, perceptions about the origins of mental illness have shifted toward a biomedical model, depicting depression as a biological disorder caused by genetic abnormalities and/or chemical imbalances. Despite benevolent intentions to reduce stigma, biogenetic messages promote prognostic pessimism, reduce feelings of agency, and alter treatment preferences, motivations, and expectations. However, no research has examined how these messages influence neural markers of ruminative activity or decision-making, a gap this study sought to fill. In this pre-registered, clinical trial (NCT03998748), 49 participants with current or past depressive experiences completed a sham saliva test and were randomly assigned to receive feedback that they either have (gene-present; n = 24) or do not have (gene-absent; n = 25) a genetic predisposition to depression. Before and after receiving the feedback, resting-state activity and neural correlates of cognitive control (error-related negativity [ERN] and error positivity [Pe]) were measured using high-density electroencephalogram (EEG). Participants also completed self-report measures of beliefs about the malleability and prognosis of depression and treatment motivation. Contrary to hypotheses, biogenetic feedback did not alter perceptions or beliefs about depression, nor did it alter EEG markers of self-directed rumination nor neurophysiological correlates of cognitive control. Explanations of these null findings are discussed in the context of prior studies.
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Affiliation(s)
| | | | | | | | - Esther Yu
- Harvard University, Cambridge, MA, USA
| | | | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Office 1752, Ann Arbor, MI, 48109, USA.
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14
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Steinman LE, Parrish AT, Kohn MJ, Wu S, Hara-Hubbard KK, Brown L, Imam S, Baquero B, Hannon PA, Snowden MB. Partnering with community-based organizations to improve equitable access to depression care for underserved older adults in the U.S.: Qualitative formative research. Front Public Health 2023; 10:1079082. [PMID: 36793362 PMCID: PMC9922751 DOI: 10.3389/fpubh.2022.1079082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/29/2022] [Indexed: 02/03/2023] Open
Abstract
Background Embedding evidenced-based programs (EBPs) like PEARLS outside clinical settings can help reduce inequities in access to depression care. Trusted community-based organizations (CBOs) reach older adults who are underserved; however, PEARLS adoption has been limited. Implementation science has tried to close this know-do gap, however a more intentional focus on equity is needed to engage CBOs. We partnered with CBOs to better understand their resources and needs in order to design more equitable dissemination and implementation (D&I) strategies to support PEARLS adoption. Methods We conducted 39 interviews with 24 current and potential adopter organizations and other partners (February-September 2020). CBOs were purposively sampled for region, type, and priority older populations experiencing poverty (communities of color, linguistically diverse, rural). Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; CBO capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. During COVID-19, interviews also addressed remote PEARLS delivery and changes in priorities. We conducted thematic analysis of transcripts using the rapid framework method to describe the needs and priorities of older adults who are underserved and the CBOs that engage them, and strategies, collaborations, and adaptations to integrate depression care in these contexts. Results During COVID-19, older adults relied on CBO support for basic needs such as food and housing. Isolation and depression were also urgent issues within communities, yet stigma remained for both late-life depression and depression care. CBOs wanted EBPs with cultural flexibility, stable funding, accessible training, staff investment, and fit with staff and community needs and priorities. Findings guided new dissemination strategies to better communicate how PEARLS is appropriate for organizations that engage older adults who are underserved, and what program components are core and what are adaptable to better align with organizations and communities. New implementation strategies will support organizational capacity-building through training and technical assistance, and matchmaking for funding and clinical support. Discussion Findings support CBOs as appropriate depression care providers for older adults who are underserved, and suggest changes to communications and resources to better fit EBPs with the resources and needs of organizations and older adults. We are currently partnering with organizations in California and Washington to evaluate whether and how these D&I strategies increase equitable access to PEARLS for older adults who are underserved.
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Affiliation(s)
- Lesley E. Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Amanda T. Parrish
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Marlana J. Kohn
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Sherry Wu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - KeliAnne K. Hara-Hubbard
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Lori Brown
- Southeast Washington Aging and Long-Term Care, Yakima, WA, United States
| | - Syed Imam
- Union for Pan Asian Communities (UPAC) Positive Solutions Program, San Diego, CA, United States
| | - Barbara Baquero
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Peggy A. Hannon
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Mark B. Snowden
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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15
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Public Stigma Toward Schizophrenia Within Latino Communities in the United States. Community Ment Health J 2023; 59:915-928. [PMID: 36617355 PMCID: PMC9826702 DOI: 10.1007/s10597-022-01075-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/13/2022] [Indexed: 01/09/2023]
Abstract
Public stigma toward those experiencing symptoms of schizophrenia in the general population is high; yet research into such stigma within the diverse Latino communities remains under-investigated. This study employed a randomized experimental vignette methodology to assess various domains of public stigma toward individuals experiencing psychosis and/or diabetes within Latino communities. A communitybased sample of 243 Latino adults participated. Contrary to our expectations, respondents who were more sympathetic toward those with mental health problems tended to score higher on public stigma. The belief that a person was responsible for their own mental health problems was associated with higher levels of stigma. Results indicate that perceptions of dangerousness toward someone experiencing psychosis were common, and the perception that a person was responsible for their mental health problems was associated with higher levels of stigma Results emphasize the complex nature of stigma within the diverse Latino communities and the need for ongoing research.
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16
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Olfson M, Zuvekas SH, McClellan C, Wall MM, Hankerson SH, Blanco C. Racial-Ethnic Disparities in Outpatient Mental Health Care in the United States. Psychiatr Serv 2023:appips20220365. [PMID: 36597696 DOI: 10.1176/appi.ps.20220365] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The authors aimed to compare national rates and patterns of use of outpatient mental health care among Hispanic, non-Hispanic Black, and non-Hispanic White individuals. METHODS Data from the 2018-2019 Medical Expenditure Panel Survey, a nationally representative survey of U.S. households, were analyzed, focusing on use of any outpatient mental health care service by non-Hispanic White (N=29,126), non-Hispanic Black (N=7,965), and Hispanic (N=12,640) individuals ages ≥4 years (N=49,731). Among individuals using any mental health care, analyses focused on those using psychotropic medications, psychotherapy, or both and on receipt of minimally adequate mental health care. RESULTS The annual rate per 100 persons of any outpatient mental health service use was more than twice as high for White (25.3) individuals as for Black (12.2) or Hispanic (11.4) individuals. Among those receiving outpatient mental health care, Black (69.9%) and Hispanic (68.4%) patients were significantly less likely than White (83.4%) patients to receive psychotropic medications, but Black (47.7%) and Hispanic (42.6%) patients were significantly more likely than White (33.3%) patients to receive psychotherapy. Among those treated for depression, anxiety, attention-deficit hyperactivity disorder, or disruptive behavior disorders, no significant differences were found in the proportions of White, Black, or Hispanic patients who received minimally adequate treatment. CONCLUSIONS Large racial-ethnic gaps in any mental health service use and smaller differences in patterns of treatment suggest that achieving racial-ethnic equity in outpatient mental health care delivery will require dedicated efforts to promote greater mental health service access for Black and Hispanic persons in need.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Olfson, Wall); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas, McClellan); Department of Psychiatry and Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City (Hankerson); National Institute on Drug Abuse, Bethesda (Blanco)
| | - Samuel H Zuvekas
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Olfson, Wall); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas, McClellan); Department of Psychiatry and Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City (Hankerson); National Institute on Drug Abuse, Bethesda (Blanco)
| | - Chandler McClellan
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Olfson, Wall); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas, McClellan); Department of Psychiatry and Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City (Hankerson); National Institute on Drug Abuse, Bethesda (Blanco)
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Olfson, Wall); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas, McClellan); Department of Psychiatry and Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City (Hankerson); National Institute on Drug Abuse, Bethesda (Blanco)
| | - Sidney H Hankerson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Olfson, Wall); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas, McClellan); Department of Psychiatry and Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City (Hankerson); National Institute on Drug Abuse, Bethesda (Blanco)
| | - Carlos Blanco
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Olfson, Wall); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas, McClellan); Department of Psychiatry and Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City (Hankerson); National Institute on Drug Abuse, Bethesda (Blanco)
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17
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Jimenez DE, Park M, Rosen D, Joo JH, Garza DM, Weinstein ER, Conner K, Silva C, Okereke O. Centering Culture in Mental Health: Differences in Diagnosis, Treatment, and Access to Care Among Older People of Color. Am J Geriatr Psychiatry 2022; 30:1234-1251. [PMID: 35914985 PMCID: PMC9799260 DOI: 10.1016/j.jagp.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 01/25/2023]
Abstract
Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.
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Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY.
| | - Mijung Park
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Daniel Rosen
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Jin Hui Joo
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - David Martinez Garza
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Elliott R Weinstein
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Kyaien Conner
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Caroline Silva
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Olivia Okereke
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
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18
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Leung LB, Ziobrowski HN, Puac-Polanco V, Bossarte RM, Bryant C, Keusch J, Liu H, Pigeon WR, Oslin DW, Post EP, Zaslavsky AM, Zubizarreta JR, Kessler RC. Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration. J Gen Intern Med 2022; 37:3235-3241. [PMID: 34613577 PMCID: PMC8493943 DOI: 10.1007/s11606-021-07136-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes. OBJECTIVE To examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment. DESIGN Patient self-report surveys at treatment initiation linked to medical records. SETTING Veterans Health Administration (VA) clinics nationally, 2018-2020. PARTICIPANTS A total of 2582 patients (76.7% male, mean age 48.7 years, 62.3% Non-Hispanic White) MAIN MEASURES: Patient self-reported preferences for medication and psychotherapy on 0-10 self-anchoring visual analog scales (0="completely unwilling"; 10="completely willing"). Treatment receipt and adherence (refilling medications; attending 3+ psychotherapy sessions) over 3 months. Logistic regression models controlled for socio-demographics and geographic variables. KEY RESULTS More patients reported strong preferences (10/10) for psychotherapy than medication (51.2% versus 36.7%, McNemar χ21=175.3, p<0.001). A total of 32.1% of patients who preferred (7-10/10) medication and 21.8% who preferred psychotherapy did not receive these treatments. Patients who strongly preferred medication were substantially more likely to receive medication than those who had strong negative preferences (odds ratios [OR]=17.5; 95% confidence interval [CI]=12.5-24.5). Compared with patients who had strong negative psychotherapy preferences, those with strong psychotherapy preferences were about twice as likely to receive psychotherapy (OR=1.9; 95% CI=1.0-3.5). Patients who strongly preferred psychotherapy were more likely to adhere to psychotherapy than those with strong negative preferences (OR=3.3; 95% CI=1.4-7.4). Treatment preferences were not associated with medication or combined treatment adherence. Patients in primary care settings had lower odds of receiving (but not adhering to) psychotherapy than patients in specialty mental health settings. Depression severity was not associated with treatment receipt or adherence. CONCLUSIONS Mismatches between treatment preferences and treatment type received were common and associated with worse treatment adherence for psychotherapy. Future research could examine ways to decrease mismatch between patient preferences and treatments received and potential effects on patient outcomes.
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Affiliation(s)
- Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Division of General Internal Medicine, and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | | | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Robert M Bossarte
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA.,Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA
| | - Corey Bryant
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Janelle Keusch
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.,Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - David W Oslin
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward P Post
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Jose R Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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19
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Rogojanski J, Zeifman RJ, Antony MM, Walker JR, Monson CM. Evaluation of a decision aid for the treatment of depression among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1634-1643. [PMID: 32924861 DOI: 10.1080/07448481.2020.1817034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Objective: Depression, and its treatment, is a concern among college students. Research indicates decision aids (DA) improve patients' treatment knowledge, decision making, and decisional conflict; however, it is unknown whether they are helpful for disseminating depression treatment information to college students. This study evaluated a DA for depression and its impact on college students' knowledge and treatment decision making. Methods: College students (N = 144) completed questionnaires pre-, post-, and at 1-month follow-up after reviewing an evidence-based DA for depression. Results: Participants rated the DA as highly acceptable and useful, and their knowledge increased at post-treatment and follow-up. However, treatment option presentation order influenced decision making. Conclusions: This DA is a useful and acceptable decision-making tool, and increased knowledge of depression and its treatment among college students. This study proposes a novel tool for educating college students about depression treatment, furthering our understanding of factors influencing treatment preferences.
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Affiliation(s)
| | | | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, Canada
| | - John R Walker
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
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20
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Gearing RE, Washburn M, Brewer KB, Yu M, Bjugstad A, Torres LR. Predictors of Help-Seeking for Mental Health Treatment Among Latinos. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01370-y. [DOI: 10.1007/s40615-022-01370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
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21
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Paula CS, Ziebold C, Ribeiro WS, Pan PM, Mari JJ, Bressan R, Miguel EC, Rohde LA, Salum GA, Evans-Lacko S. THE INFLUENCE OF CAREGIVER ATTITUDES AND SOCIO-ECONOMIC GROUP ON FORMAL AND INFORMAL MENTAL HEALTH SERVICE USE AMONGST YOUTH. Eur Psychiatry 2022; 65:e34. [PMID: 35684952 PMCID: PMC9251818 DOI: 10.1192/j.eurpsy.2022.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cristiane Silvestre Paula
- Programa de Pós-Graduação em Distúrbios do Desenvolvimento e Centro Mackenzie de Pesquisa sobre a Infância e Adolescência-Universidade Presbiteriana Mackenzie (UPM), São Paulo-SP, Brazil
| | - Carolina Ziebold
- Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Wagner S Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science-LSE
| | - Pedro Mario Pan
- Laboratório de Neurociências Integrativas (LiNC), Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Jair Jesus Mari
- Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Rodrigo Bressan
- LiNC - Lab Integrative Neuroscience, Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP); Instituto Ame Sua Mente. São Paulo-SP, Brazil
| | | | - Luiz Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil
| | - Giovanni A Salum
- Section on Negative Affect and Social Processes - Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; National Institute of Developmental Psychiatry
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science-LSE
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22
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FAISAL-CURY A, RODRIGUES DMDO. Prevalence and associated factors with Traditional, Complementary and Integrative Medicine in Brazil: a population-based study. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Kim E, Washington TR. Community agency directors' attitudes on depression treatment among older Korean Americans and barriers to providing services. Aging Ment Health 2022; 26:1053-1060. [PMID: 33724112 DOI: 10.1080/13607863.2021.1897522] [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: 10/21/2022]
Abstract
Objectives: The purpose of this study is to explore Korean agency directors' attitudes about depression treatment and their current efforts and barriers to providing services for older Korean Americans.Methods: Interviews were conducted with 11 agency directors, providing services from ethnic community centers and health care agencies. A constant comparative approach was applied to detect emerging themes.Results: Findings revealed that the agency directors had a negative attitude about using antidepressants and counseling. Based on these beliefs, they were less likely to recommend individuals with depression to use medical treatment or counseling; instead, they recommended informal ways of treating depression, including reliance on peers, family, and religious activities. A lack of educational training, funding, collaboration, and Korean-speaking professionals were perceived to be barriers to providing services.Discussion: Findings indicate the importance of educational training to increase understanding of depression treatment and to support the agency directors in offering services for older Korean Americans.
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Affiliation(s)
- Eunhye Kim
- Department of Social Science, Augusta University, Augusta, USA
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24
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Hernandez-Ramos R, Altszyler E, Figueroa CA, Avila-Garcia P, Aguilera A. Linguistic analysis of Latinx patients’ responses to a text messaging adjunct during cognitive behavioral therapy for depression. Behav Res Ther 2022; 150:104027. [DOI: 10.1016/j.brat.2021.104027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
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25
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Kieseppä V, Markkula N, Taipale H, Holm M, Jokela M, Suvisaari J, Tanskanen A, Gissler M, Lehti V. Antidepressant use among immigrants with depressive disorder living in Finland: A register-based study. J Affect Disord 2022; 299:528-535. [PMID: 34953922 DOI: 10.1016/j.jad.2021.12.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to examine differences in the initiation and discontinuation of antidepressants between immigrants and the Finnish-born population diagnosed with depression in specialized health care. METHODS The study utilized register-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression during 2011-2014 (immigrants n = 2244, Finnish-born n = 2773). Their antidepressant use was studied for a one-year period from initiation. A logistic regression was used to predict initiation and a Cox regression was used to predict discontinuation. RESULTS Immigrants were more likely to initiate the use of antidepressants than the Finnish-born controls (adjusted OR = 1.25, 95% CI = 1.07-1.46), but they also discontinued the medication earlier than the Finnish-born controls (adjusted HR = 1.48, 95% CI = 1.31-1.68). Immigrants from Sub Saharan Africa, the Middle East and Northern Africa were most likely to discontinue antidepressants earlier. More severe depression, a longer length of residence in Finland and more intensive psychiatric treatment were associated with decreased risk of discontinuation. LIMITATIONS The registers do not provide information on the perceived reasons for the discontinuation. CONCLUSIONS Immigrants with depression initiate antidepressants more often than the Finnish-born population, but they also discontinue them earlier. Early discontinuation may be a sign of insufficient treatment suggesting that there could be a need for improvement in mental health care for immigrants in Finland.
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Affiliation(s)
- Valentina Kieseppä
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki.
| | - Niina Markkula
- University of Helsinki and Helsinki University Hospital, Finland, Department of Psychiatry, Helsinki; Clínica Alemana Universidad del Desarrollo, Chile, Faculty of Medicine, Santiago
| | - Heidi Taipale
- Karolinska Institutet, Sweden, Department of Clinical Neuroscience, Stockholm; Niuvanniemi Hospital, Finland, Kuopio; University of Eastern Finland, Finland, School of Pharmacy, Kuopio
| | - Minna Holm
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki
| | - Markus Jokela
- University of Helsinki, Finland, Medicum, Department of Psychology and Logopedics, Helsinki
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki
| | - Antti Tanskanen
- Niuvanniemi Hospital, Finland, Kuopio; University of Eastern Finland, Finland, School of Pharmacy, Kuopio
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Finland, Information Services Department, Helsinki; University of Turku, Finland, Research Centre for Child Psychiatry, Turku; Region Stockholm, Sweden, Academic Primary Health Care Centre, Stockholm, and Karolinska Institute, Sweden, Department of Molecular Medicine and Surgery, Stockholm
| | - Venla Lehti
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki; University of Helsinki and Helsinki University Hospital, Finland, Department of Psychiatry, Helsinki
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26
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Allen-Watts K, Sims AM, Buchanan TL, DeJesus DJB, Quinn TL, Buford TW, Goodin BR, Rumble DD. Sociodemographic Differences in Pain Medication Usage and Healthcare Provider Utilization Among Adults With Chronic Low Back Pain. FRONTIERS IN PAIN RESEARCH 2022; 2:806310. [PMID: 35295517 PMCID: PMC8915740 DOI: 10.3389/fpain.2021.806310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic low back pain (cLBP) is the most common reason for individual suffering and health care utilization in adults. Ample evidence suggests sociodemographic variables and socioeconomic status (SES) influence pain. However, a framework informing associations on race, SES, and the utilization of pharmacologic therapies and provider type are limited—particularly in cLBP. Thus, this study examined the extent to which sociodemographic (i.e., age, race, and gender) and socioeconomic factors (i.e., national area deprivation index, NADI) influence pain treatment (i.e., NSAIDs, opioids, antidepressants, and non-NSAIDs) and provider utilization for cLBP (i.e., no provider care, primary care, or tertiary care). Eligible participants with cLBP completed a series of questionnaires. Of the 174 participants, 58% were women, 59% were non-Hispanic Black (NHB), and the mean age was 46.10 (SD 13.58). Based on NADI distributions by race, NHB participants lived in more socioeconomically disadvantaged neighborhoods (p < 0.001) than non-Hispanic White (NHW) adults. Results suggested that the use of one or more pharmacologic therapies was associated with race (p = 0.021). Specifically, NHW adults were two times more likely to take one or more pharmacologic therapies than NHBs (p = 0.009). NHWs were also more likely to use NSAIDs (p = 0.041) and antidepressants (p < 0.001) than NHBs. Furthermore, provider utilization was significantly associated with gender (p = 0.037) and age (p = 0.018); which suggests older women were more likely to use primary or tertiary care. Findings from this study expand on the existing literature as it relates to associations between disparities in access to healthcare providers and access to medications. Future research should seek to understand differences in age and utilization of primary or tertiary care providers and continue to examine the influence of sociodemographic and SES factors to cLBP and compare with other types of chronic pain.
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Affiliation(s)
- Kristen Allen-Watts
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Kristen Allen-Watts
| | - Andrew M. Sims
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Taylor L. Buchanan
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Danica J. B. DeJesus
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tammie L. Quinn
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas W. Buford
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Geriatric Research Education and Clinical Center, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, United States
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Deanna D. Rumble
- Department of Psychology and Counseling, University of Central Arkansas, Conway, AR, United States
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Manders OC, Xavier Hall CD, Vertamatti MAF, Evans DP, Campbell JC. We need to use words that we'd use in Brazil, right? A Community-Based Content Validation of a Translated Femicide Risk Assessment Instrument. Violence Against Women 2021; 28:2889-2908. [PMID: 34860627 DOI: 10.1177/10778012211051397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Danger Assessment (DA) is a widely-used risk assessment instrument designed to help women understand their risk of femicide. Currently, no validated tool exists in Brazilian Portuguese. The purpose of this study was to conduct a cross-cultural adaptation of the DA for use in the Brazilian context as a precursor to validation and broader testing among women in Brazil. This study describes a community participatory approach for translation and cultural adaptation of the DA from European to Brazilian Portuguese that engages the target population in the process. Using a three-step process, a final version of the DA-Brazil instrument was developed.
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Affiliation(s)
- Olivia C Manders
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Casey D Xavier Hall
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | | | - Dabney P Evans
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA
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28
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Taipale H, Niederkrotenthaler T, Tanskanen A, Cullen AE, Helgesson M, Berg L, Sijbrandij M, Klimek P, Mittendorfer-Rutz E. Persistence of antidepressant use among refugee youth with common mental disorder. J Affect Disord 2021; 294:831-837. [PMID: 34375210 DOI: 10.1016/j.jad.2021.07.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/18/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objective of this study was to investigate whether persistence of antidepressant use differs between refugee youth and Swedish-born youth after a diagnosis of a common mental disorder (CMD), and if clinical and sociodemographic factors are associated with antidepressant discontinuation. METHODS Youth aged 16-25 years, with an incident diagnosis of CMD (depression, post-traumatic stress disorder (PTSD), anxiety disorders) accessing specialized healthcare in Sweden 2006-2016 were included. New users were identified with a one-year washout period. Refugees (N=1575) were compared with Swedish-born youth (N=2319). Cox regression models [reported as adjusted Hazard Ratios (HRs) with 95% confidence intervals (CIs)] were used to investigate factors associated with discontinuation of antidepressant use. RESULTS Among youth (mean age 20.9 years, SD 2.7, 50% females), the median duration of antidepressant use differed considerably between refugee (101 days, IQR 31-243) and Swedish-born youth (252 days, IQR 101-558). Refugees were more likely to discontinue treatment (HR 1.61, 95% CI 1.47-1.77). Factors associated with an increased risk for discontinuation in refugees included ≤5 years duration of formal residency (HR 1.28, 95% CI 1.12-1.45), antidepressant type, and dispensing lag (time from prescription to dispensing) of >7 days (1.43, 1.25-1.64), whereas PTSD (0.78, 0.64-0.97) and anxiolytic use (0.79, 0.64-0.96) were associated with a lower discontinuation risk. LIMITATIONS Only persons treated in specialized healthcare could be included. CONCLUSION The relatively short treatment durations among refugee youth suggest that antidepressant treatment may not be optimal in CMD, and better monitoring of treatment as well as transcultural education of healthcare personnel are warranted.
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Affiliation(s)
- Heidi Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Niuvanniemi Hospital, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| | - Thomas Niederkrotenthaler
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Antti Tanskanen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Niuvanniemi Hospital, Kuopio, Finland
| | - Alexis E Cullen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Peter Klimek
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria; Complexity Science Hub Vienna, Vienna, Austria
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Silverman AL, Werntz A, Ko TM, Teachman BA. Implicit and Explicit Beliefs About the Effectiveness of Psychotherapy vs. Medication: A Large-Scale Examination and Replication. J Nerv Ment Dis 2021; 209:783-795. [PMID: 34238893 DOI: 10.1097/nmd.0000000000001384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT One exploratory study (N = 10,335) and one preregistered replication and extension study (N = 6648) evaluated implicit and explicit beliefs in the effectiveness of psychotherapy versus medication, and whether these beliefs vary as a function of demographics, mental health difficulties, and treatment experiences. Data were collected from a sample of visitors to a mental health research website who completed the Therapy vs. Medication Effectiveness Implicit Association Test (IAT). The IAT demonstrated evidence of convergent validity with two measures of explicit therapy versus medication effectiveness beliefs. Across both studies, individuals held greater implicit and explicit beliefs that therapy is more effective than medication, and individuals who were Black (versus all other races, excluding "other/unknown") and who had experienced past (versus current) mental health difficulties had stronger implicit and explicit beliefs in the effectiveness of therapy versus medication. More work is needed to understand how these differences in beliefs arise, as well as to evaluate the clinical utility of this novel measure.
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Affiliation(s)
| | | | - Tomohiro M Ko
- Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Bethany A Teachman
- Department of Psychology, University of Virginia, Charlottesville, Virginia
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30
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Amu H, Osei E, Kofie P, Owusu R, Bosoka SA, Konlan KD, Kim E, Orish VN, Maalman RSE, Manu E, Parbey PA, Saah FI, Mumuni H, Appiah PK, Komesuor J, Ayanore MA, Amenuvegbe GK, Kim S, Jung H, Adjuik M, Tarkang EE, Alhassan RK, Donkor ES, Zottor FB, Kweku M, Amuna P, Kim SY, Gyapong JO. Prevalence and predictors of depression, anxiety, and stress among adults in Ghana: A community-based cross-sectional study. PLoS One 2021; 16:e0258105. [PMID: 34624044 PMCID: PMC8500438 DOI: 10.1371/journal.pone.0258105] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Over the past two decades, there have been several global interventions including the Sustainable Development Goals (SDGs), aimed at improving health outcomes. Despite efforts by countries to achieve the SDG targets, mental health challenges remain major public health concerns globally. We examined the prevalence and predictors of depression, anxiety, and stress as well as the comorbidities of these mental health issues among adults. Materials and methods This was a community-based cross-sectional study conducted among 2456 adults in four districts of the Volta Region of Ghana using data from the UHAS-Yonsei University Partnership Project. We analysed the data using frequency, percentage, mean, standard deviation, correlation, and binary logistic regression. Results Overall, 51.8% of the participants had at least one of the mental health issues examined. The prevalence of a mental health issue was 25.2%, 53.3%, and 9.7% for depression, anxiety, and stress respectively. Participants constituting 8.3% experienced all three mental health issues as comorbidities. Participants’ level of formal education and income significantly predicted depression, anxiety, and stress respectively at the multivariable level. Adults with a tertiary level of education were, for instance, 68% (AOR = 0.32, 95%CI = 0.15–0.66), 65% (AOR = 0.35, 95%CI = 0.17–0.73), and 50% (AOR = 0.50, 95%CI = 0.33–0.76) less likely to experience depression, anxiety, and stress, respectively compared with those who had no formal education. Conclusion The majority of our study participants either experienced depression, anxiety, or stress. There were quite high comorbidities of the mental health issues among the adult population. To accelerate progress towards the achievement of SDG 3.4 target of promoting mental health and wellbeing for all by the year 2030, there is a need for effective implementation of the country’s 2012 Mental Health Act which makes provisions for the establishment of a Mental Health Fund. This could improve the financial circumstances of indigenes as income has been realised in the present study as an important factor influencing depression, anxiety, and stress among the adult population.
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Affiliation(s)
- Hubert Amu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- * E-mail:
| | - Eric Osei
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Philip Kofie
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Richard Owusu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Samuel Adolf Bosoka
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Kennedy Diema Konlan
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Eunji Kim
- Korean Foundation for International Healthcare, Seoul, Korea
| | | | | | - Emmanuel Manu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Phyllis Atta Parbey
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Hadiru Mumuni
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Prince Kubi Appiah
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
| | - Joyce Komesuor
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | | | - Siwoo Kim
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
| | - Hajun Jung
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
| | - Martin Adjuik
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Robert Kaba Alhassan
- Directorate of International Affairs, University of Health and Allied Sciences, Ho, Ghana
| | | | | | - Margaret Kweku
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Paul Amuna
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - So Yoo Kim
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
| | - John Owusu Gyapong
- Office of the Vice-Chancellor, University of Health and Allied Sciences, Ho, Ghana
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Fernald F, Snijder M, van den Born BJ, Lok A, Peters R, Agyemang C. Depression and hypertension awareness, treatment, and control in a multiethnic population in the Netherlands: HELIUS study. Intern Emerg Med 2021; 16:1895-1903. [PMID: 33811635 PMCID: PMC8502156 DOI: 10.1007/s11739-021-02717-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
Individuals belonging to ethnic minority groups are more susceptible to depression and comorbid hypertension than European host populations. Yet, data on how depression is related to hypertension in ethnic groups in Europe are lacking. Therefore, we studied the association between significant depressed mood (SDM) and hypertension prevalence, awareness, treatment, and control among ethnic groups. Data from the HELIUS study included 22,165 adults (aged 18-70) from six ethnic backgrounds in the Netherlands. Logistic regression analysis was used to explore the association between SDM and hypertension prevalence, awareness, treatment, and control with adjustment for age, sex, and for sensitivity analysis purposes also for anti-depressants. After adjustment for age and sex, Dutch with SDM had an increased odds of hypertension (OR 95% CI 1.67; 1.08-2.59). Among Turkish, SDM was associated with higher odds of hypertension awareness (2.09; 1.41-3.09), treatment (1.92; 1.27-2.90) and control (1.72; 1.04-2.83). Among Moroccans, SMD was associated with an increased odds of hypertension awareness (1.91; 1.14-3.21) but decreased odds of hypertension control (0.42; 0.20-0.89). Additional adjustment for anti-depressant medications did not change the results. There were no associations between SDM and hypertension, awareness, treatment and control in South-Asian Surinamese, African Surinamese and Ghanaian participants. The results underline significant differences in the association between SDM and hypertension awareness, treatment and control between ethnic groups. Our findings emphasize the necessity to further study ethnicity-related factors that may influence the association between SDM and hypertension to promote hypertension control especially, among Moroccans with SDM.
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Affiliation(s)
- Florence Fernald
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Marieke Snijder
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Bert-Jan van den Born
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron Peters
- Department of Cardiology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Castilla-Puentes R, Pesa J, Brethenoux C, Furey P, Gil Valletta L, Falcone T. Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre– and Mid–COVID-19 (Preprint). JMIR Form Res 2021; 6:e33637. [PMID: 35275834 PMCID: PMC9217151 DOI: 10.2196/33637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/25/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Ruby Castilla-Puentes
- Janssen Research & Development, LLC, Titusville, NJ, United States
- Center for Public Health Practice, Drexel University, Philadelphia, PA, United States
- Hispanic Organization for Leadership and Advancement, Johnson & Johnson, Employee Resource Group, New Brunswick, NJ, United States
| | - Jacqueline Pesa
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States
| | | | | | | | - Tatiana Falcone
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
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Spruill TM, Friedman D, Diaz L, Butler MJ, Goldfeld KS, O'Kula S, Montesdeoca J, Payano L, Shallcross AJ, Kaur K, Tau M, Vazquez B, Jongeling A, Ogedegbe G, Devinsky O. Telephone-based depression self-management in Hispanic adults with epilepsy: a pilot randomized controlled trial. Transl Behav Med 2021; 11:1451-1460. [PMID: 33963873 PMCID: PMC8320882 DOI: 10.1093/tbm/ibab045] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Depression is associated with adverse outcomes in epilepsy but is undertreated in this population. Project UPLIFT, a telephone-based depression self-management program, was developed for adults with epilepsy and has been shown to reduce depressive symptoms in English-speaking patients. There remains an unmet need for accessible mental health programs for Hispanic adults with epilepsy. The purpose of this study was to evaluate the feasibility, acceptability, and effects on depressive symptoms of a culturally adapted version of UPLIFT for the Hispanic community. Hispanic patients with elevated depressive symptoms (n = 72) were enrolled from epilepsy clinics in New York City and randomized to UPLIFT or usual care. UPLIFT was delivered in English or Spanish to small groups in eight weekly telephone sessions. Feasibility was assessed by recruitment, retention, and adherence rates and acceptability was assessed by self-reported satisfaction with the intervention. Depressive symptoms (PHQ-9 scores) were compared between study arms over 12 months. The mean age was 43.3±11.3, 71% of participants were female and 67% were primary Spanish speakers. Recruitment (76% consent rate) and retention rates (86–93%) were high. UPLIFT participants completed a median of six out of eight sessions and satisfaction ratings were high, but rates of long-term practice were low. Rates of clinically significant depressive symptoms (PHQ-9 ≥5) were lower in UPLIFT versus usual care throughout follow-up (63% vs. 72%, 8 weeks; 40% vs. 70%, 6 months; 47% vs. 70%, 12 months). Multivariable-adjusted regressions demonstrated statistically significant differences at 6 months (OR = 0.24, 95% CI, 0.06–0.93), which were slightly reduced at 12 months (OR = 0.30, 95% CI, 0.08–1.16). Results suggest that UPLIFT is feasible and acceptable among Hispanic adults with epilepsy and demonstrate promising effects on depressive symptoms. Larger trials in geographically diverse samples are warranted.
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Affiliation(s)
- Tanya M Spruill
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel Friedman
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Laura Diaz
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark J Butler
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.,Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Keith S Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Susanna O'Kula
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | | | - Leydi Payano
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Amanda J Shallcross
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Kiranjot Kaur
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael Tau
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Blanca Vazquez
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Amy Jongeling
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Gbenga Ogedegbe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.,Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Orrin Devinsky
- Department of Neurology, NYU Langone Health, New York, NY, USA
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Monsalve CS. Psychotherapy, Spanish, and Hispanic Patients With Limited English Proficiency. Am J Psychother 2021; 74:135-137. [PMID: 33934613 DOI: 10.1176/appi.psychotherapy.20200044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christian S Monsalve
- Rutgers New Jersey Medical School, Newark. Lisa O'Donnell, Ph.D., L.M.S.W., and Paula Ravitz, M.D., F.R.C.P.C., are editors of this section
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Faisal TI, Khaira N, Veri N, Magfirah M, Dewita D, Alchalidi A, Sari Y. The Effect of Walking Exercise and Consumption of Steeping Chamomile Flowers (Matricaria recutita) on Depression in the Elderly in Langsa City. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The population of the elderly is increasing rapidly in almost every part of the world. A common problem faced by the elderly is prolonged depression. One of the practical and economic efforts to reduce depression is by walking and consuming chamomile flowers.
AIM: The aim of this study is to analyzing the effect of walking exercise and consumption of chamomile (Matricaria recutita) flower infusion on depression in the elderly in Langsa City.
METHODS: We used a quasi-experimental design with a pretest-posttest control group design. This research was conducted from September to December 2020 in Karang Anyar Village, Langsa City. The population in this study were all elderly who met the inclusion criteria. The sample was selected as many as 24 elderly. The sample size of the study was calculated using the formula for the sample size for experimental research from Federer, namely (t–1) (r–1) ≥15). Data collection techniques in this study were interviews and observations using the Geriatric Depression Scale (GDS) questionnaire instrument, which was carried out twice, namely at the time before treatment and after treatment in four groups, namely, the control group, the walking exercise group, the chamomile flower consumption group and the combination group of walking and exercise. Consume chamomile flowers. Data analysis used paired t-test and one-way analysis of variance test to see the effect of the intervention on depression.
RESULTS: This study’s results indicate that walking can significantly reduce the GDS depression score with a p-value of 0.025. This study indicates that consumption of chamomile Flower can significantly reduce the GDS score of the elderly with a p-value of 0.037. This study showed that the combination of walking and consumption of chamomile tea was able to significantly reduce the GDS depression score with a p-value of 0.017. When viewed from the p-value, this treatment group showed the most significant reduction in the GDS depression score than the other two treatment groups, namely walking and consumption of chamomile tea. In the walking exercise group, the chamomile flowers were the consumption treatment group combined treatment group walking and chamomile tea consumption. All three treatments had the same ability to reduce the GDS score, as evidenced by a p-value of 0.808 (p > 0.05).
CONCLUSION: Walking exercise and consumption of chamomile tea can significantly reduce the GDS score of the elderly in Langsa City.
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Waldron EM, Burnett-Zeigler I, Wee V, Ng YW, Koenig LJ, Pederson AB, Tomaszewski E, Miller ES. Mental Health in Women Living With HIV: The Unique and Unmet Needs. J Int Assoc Provid AIDS Care 2021; 20:2325958220985665. [PMID: 33472517 PMCID: PMC7829520 DOI: 10.1177/2325958220985665] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic
stress symptoms at higher rates than their male counterparts and more often than
HIV-unaffected women. These mental health issues affect not only the well-being
and quality of life of WLWH, but have implications for HIV management and
transmission prevention. Despite these ramifications, WLWH are under-treated for
mental health concerns and they are underrepresented in the mental health
treatment literature. In this review, we illustrate the unique mental health
issues faced by WLWH such as a high prevalence of physical and sexual abuse
histories, caregiving stress, and elevated internalized stigma as well as myriad
barriers to care. We examine the feasibility and outcomes of mental health
interventions that have been tested in WLWH including cognitive behavioral
therapy, mindfulness-based interventions, and supportive counseling. Future
research is required to address individual and systemic barriers to mental
health care for WLWH.
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Affiliation(s)
- Elizabeth M Waldron
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Victoria Wee
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Yiukee Warren Ng
- Department of Psychiatry, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Linda J Koenig
- Division of HIV/AIDS Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aderonke Bamgbose Pederson
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Evelyn Tomaszewski
- Department of Social Work, College of Health and Human Services, 49340George Mason University, Fairfax, VA, USA
| | - Emily S Miller
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
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Psychometric Properties of Three Measures of Stigma Among Hispanics with Depression. J Immigr Minor Health 2021; 23:946-955. [PMID: 34152503 DOI: 10.1007/s10903-021-01234-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
While many measures of mental illness stigma have been developed, few have been validated in Hispanic populations. This study examined the psychometric properties of three stigma measures (Stigma Concerns about Mental Health Care [SCMHC], Social Distance Scale [SDS], and Latino Scale for Antidepressant Stigma [LSAS]) among a depressed, Hispanic sample. Data were collected during baseline assessments for two studies taking place in primary care settings (N = 500). Psychometric and factor validity were tested for each measure. Confirmatory factor analyses indicated adequate model fit, and adequate internal consistency reliability was found for all three measures. Stigma scores significantly differed by education level and gender. Findings from this analysis provide support for the use of the SCMHC, SDS, and LSAS in a depressed, Hispanic population. Assessing barriers to depression treatment, including stigma, are critical in engaging Hispanics in care and eliminating disparities for the population.
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Lee M, Lu W, Mann-Barnes T, Nam JH, Nelson J, Ma GX. Mental Health Screening Needs and Preference in Treatment Types and Providers in African American and Asian American Older Adults. Brain Sci 2021; 11:597. [PMID: 34063018 PMCID: PMC8148007 DOI: 10.3390/brainsci11050597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
Older African Americans and Asian Americans in the U.S. underuse mental health services, despite their vulnerability to diverse mental health problems. This study examined their perspectives on the importance of various mental health problems, mental health treatment, and provider type preference. A total of 243 participants residing in Philadelphia were recruited through community-based organizations. Chi-square, ANOVA, and logistic regression were conducted to examine ethnic differences in demographic characteristics, mental health screening needs, and treatment preferences. African Americans were more likely to endorse the screening needs for depression (AOR: 3.77; 95% CI: 1.19-11.93, p < 0.05) and less likely to endorse the screening needs for suicide (AOR: 0.24; 95% CI: 0.08-0.76, p < 0.05) compared to Asian Americans. For treatment preferences, African Americans were more likely to seek help from primary care physicians (AOR: 8.26; 95% CI: 1.71-32.86, p < 0.01) and less likely to prefer medication as a treatment option (AOR: 0.36; 95% CI: 0.09-0.79, p < 0.05) than Asian Americans. African Americans and Asian Americans prioritized mental health screening needs differently and had different treatment preferences, indicating that matching community needs and preferences regarding mental health services is critical to improve mental service utilization rates in the targeted populations.
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Affiliation(s)
- Minsun Lee
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
| | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
| | - Tyrell Mann-Barnes
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
| | - Jin-Hyeok Nam
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
| | - Julie Nelson
- Philadelphia Senior Center, Philadelphia, PA 19147, USA;
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA 19140, USA; (M.L.); (W.L.); (T.M.-B.); (J.-H.N.)
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Philadelphia, PA 19140, USA
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Prevalence and predictors of work-related depression, anxiety, and stress among waiters: A cross-sectional study in upscale restaurants. PLoS One 2021; 16:e0249597. [PMID: 33857194 PMCID: PMC8049486 DOI: 10.1371/journal.pone.0249597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Poor mental health often interrupts people’s regular activities making them unable to work effectively resulting in poor performance and high turnover intention. We examined the prevalence and predictors of depression, anxiety and stress among waiters in upscale restaurants. Methods This descriptive cross-sectional study involved 384 waiters in upscale restaurants in the Accra Metropolis. Data were collected using a pre-tested questionnaire which embedded DASS-21 (Cronbach Alpha = 0.815). The analysis included descriptive and inferential statistics using STATA 15. Statistical significance was set at p-value <0.05 at 95% confidence interval. Results The prevalence of depression was 38.3%, while anxiety and stress were 52.3% and 34.4% respectively. Females (AOR = 1.69, 95%CI = 1.02–2.79), waiters who foresee a better remuneration (AOR = 3.09, 95%CI = 1.95–4.87), consume caffeine (AOR = 1.44, 95%CI = 0.90–2.32), and use non-prescription drugs (AOR = 2.22, 95%CI = 1.39–3.55) were more likely to have depression. Females (AOR = 1.86, 95%CI = 1.17–2.96), those who foresee better remuneration (AOR = 2.85, 95%CI = 1.82–4.49), and those who use non-prescription drugs (AOR = 2.13, 95%CI = 1.38–3.28) were more likely to have anxiety. Females (AOR = 1.74, 95%CI = 1.01–2.99), waiters who are positive of career success (AOR = 1.70, 95%CI = 0.99–2.91), who foresee better remuneration (AOR = 2.99, 95%CI = 1.85–4.83), consume caffeine (AOR = 1.54, 95%CI = 0.93–2.54), and who use non-prescription drugs (AOR = 3.16, 95%CI = 1.93–5.17) were more likely to be stressed. Conclusion There is a high prevalence of poor mental health among waiters. Urgent intervention by hospitality stakeholders is needed to improve their working conditions and psychosocial health to accelerate progress towards the Sustainable Development Goal of promoting mental health and wellbeing.
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Taipale H, Niederkrotenthaler T, Helgesson M, Sijbrandij M, Berg L, Tanskanen A, Mittendorfer-Rutz E. Initiation of antidepressant use among refugee and Swedish-born youth after diagnosis of a common mental disorder: findings from the REMAIN study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:463-474. [PMID: 32914300 PMCID: PMC7904723 DOI: 10.1007/s00127-020-01951-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/01/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE The objective of this study was to compare the initiation and type of antidepressant use between refugees and matched Swedish-born youth after a diagnosis of a common mental disorder (CMD) and assess sociodemographic and clinical factors associated with the initiation. METHODS The study cohort included youth aged 16-25 years, with an incident diagnosis of CMD based on specialized health care registers in Sweden 2006-2016, without prior antidepressant use during 1 year. One Swedish-born person was matched for each identified refugee youth (N = 3936 in both groups). Initiation of antidepressant use and factors associated with the initiation, were investigated with logistic regression yielding Odds ratios, OR, and 95% Confidence Intervals, CI. RESULTS Refugees were less likely to initiate antidepressant use compared with Swedish-born (40.5% vs. 59.6%, adjusted OR 0.43, 95% CI 0.39-0.48). Selective serotonin reuptake inhibitors (SSRIs) were less frequently initiated for refugees than Swedish-born (71.2% vs. 81.3% of initiations, p < 0.0001). Sertraline was the most commonly initiated antidepressant both for refugees (34.3%) and Swedish-born individuals (40.3%). Among refugees, factors associated with increased odds of antidepressant initiation were previous use of anxiolytics or hypnotics, previous sickness absence of < 90 days, cancer and older age (OR range 1.07-2.72), and less than 5 years duration of residency in Sweden was associated with decreased odds (OR 0.76, 95% CI 0.63-0.92). CONCLUSION Young refugees with a CMD seem to initiate antidepressants in general and those most effective considerably less often than their Swedish-born counterparts.
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Affiliation(s)
- Heidi Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Niuvanniemi Hospital, Kuopio, Finland.
| | - Thomas Niederkrotenthaler
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Antti Tanskanen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
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Renn BN, Areán PA, Raue PJ, Aisenberg E, Friedman EC, Popović Z. Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept. RESEARCH ON SOCIAL WORK PRACTICE 2021; 31:90-100. [PMID: 34321858 PMCID: PMC8315227 DOI: 10.1177/1049731520964854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This proof-of-concept study assessed the feasibility, acceptability, and effectiveness of an intelligent tutoring system (ITS) as a classroom adjunct to improve training bachelor of social work (BSW) students in client engagement strategies. METHODS We codeveloped the ITS with 11 undergraduate students and pilot tested it with six BSW students enrolled in a class on telephone-based cognitive behavioral therapy (tCBT). Student competencies in tCBT were assessed by expert review of role-plays. We also examined time spent using ITS and relation with competency. RESULTS The majority of students (81.8%) in Wave 1 and all of the students who submitted role-plays in Wave 2 passed the clinical skills role-play. Students advancing through the ITS more quickly had better tCBT competency ratings than those progressing more slowly. DISCUSSION One of the most challenging aspects of training is how to competently deliver evidence-based practices. ITS has the potential to streamline and scale such training.
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Affiliation(s)
- Brenna N. Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patrick J. Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Eugene Aisenberg
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Emily C. Friedman
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Zoran Popović
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA
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Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an effective treatment of depression and other psychiatric conditions. There are few comprehensive data on how many patients receive ECT in the United States or about the demographics of ECT recipients. This study characterizes the demographics of those receiving ECT and how these demographics may have changed with time. METHODS Freedom of information requests for all data from record keeping inception to January 2019 were sent to the Department of Health or equivalent agency of states that mandate reporting of ECT. Information on demographics and the number of treating facilities was extracted. RESULTS Data on 62,602 patients receiving treatment in 3 states (California, Illinois, Vermont) were obtained. Overall, 62.3% were women. Fewer than 1% of patients treated were younger than 18 years, whereas 30.3% were 65 years or older. White patients received a disproportionate proportion of treatments, with all other races underrepresented. The total number of facilities offering ECT in the 3 states declined over the study period. CONCLUSIONS Recipients of ECT are more likely to be female, more likely to be elderly, and more likely to be white than the average person in their state.
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Bajracharya R, Qato DM. Patterns of Psychoactive Medication Use in Community-Dwelling Older Adults in the US in 2016: A Descriptive Cross-Sectional Study. J Aging Health 2020; 33:86-100. [PMID: 32960115 DOI: 10.1177/0898264320959293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We aim to quantify any use and long-term use patterns of psychoactive medications and explore differences in use by sociodemographic factors in older adults (60-85 years) using the 2016 Medical Expenditure Panel Survey. Methods: Prevalence estimates of any use and long-term use were calculated. Chi-square and crude odds ratios were calculated to estimate differences in any use and long-term use of psychoactive medication by sociodemographic characteristics of respondents. Results: Thirty percent of older adults in the US reported any use of psychoactive medications. Long-term use was significantly higher in women (28.3% [95% confidence interval: 26.5, 30.2]), white (27.8 [26.1, 29.7]), presently unmarried (27.5 [25.4, 29.7]), and low-income (30.3 [27.7, 32.9]) subgroups than in men (20.5 [18.4, 22.5]), Black (14.7 [12.3, 17.1]), presently married (22.8 [20.7, 24.9]), and high-income (21.1 [19.1, 23.1]) subgroups, respectively. Discussion: Despite continued risks associated with use, long-term use of psychoactive medications is prevalent in the older adult population in the US. Given the increased complexity of pharmacotherapy regimens in this population, enhanced efforts at improving use of psychoactive medications should be intensified.
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Affiliation(s)
- Rashmita Bajracharya
- Division of Gerontology, School of Medicine, 12265University of Maryland Baltimore, Baltimore, MD, USA
| | - Danya M Qato
- Division of Gerontology, School of Medicine, 12265University of Maryland Baltimore, Baltimore, MD, USA.,School of Pharmacy, 12265University of Maryland Baltimore, Baltimore, MD, USA
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Markova V, Sandal GM, Pallesen S. Immigration, acculturation, and preferred help-seeking sources for depression: comparison of five ethnic groups. BMC Health Serv Res 2020; 20:648. [PMID: 32652988 PMCID: PMC7353801 DOI: 10.1186/s12913-020-05478-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 06/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Immigrants are more likely than the majority population to have unmet needs for public mental health services. This study aims to understand potential ethnic differences in preferred help-seeking sources for depression in Norway, and how such preferences relate to acculturation orientation. Methods A convenience sample of immigrants from Russia (n = 164), Poland (n = 127), Pakistan (n = 128), and Somalia (n = 114), and Norwegian students (n = 250) completed a survey. The sample was recruited from social media platforms, emails, and direct contact. The survey consisted of a vignette describing a moderately depressed person. Respondents were asked to provide advice to the person by completing a modified version of the General Help-Seeking Questionnaire. The immigrant sample also responded to questions about acculturation orientation using the Vancouver Index of Acculturation Scale. Results Significant differences were found in the endorsement of traditional (e.g., religious leader), informal (e.g., family), and semiformal (e.g., internet forum) help-sources between immigrant groups, and between immigrant groups and the Norwegian respondent group. Immigrants from Pakistan and Somalia endorsed traditional help sources to a greater extent than immigrants from Russia and Poland, and the Norwegian student sample. There were no ethnic differences in endorsement of formal mental help sources (e.g., a medical doctor). Maintenance of the culture of origin as the acculturation orientation was associated with preferences for traditional and informal help sources, while the adoption of mainstream culture was associated with semiformal and formal help-seeking sources. Conclusion Ethnic differences in help-seeking sources need to be considered when designing and implementing mental health services.
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Affiliation(s)
- Valeria Markova
- Department of Pulmonology, Haukeland University Hospital, Bergen, Norway.
| | - Gro M Sandal
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Optentia Research Focus Area, North-West University, Vanderbijlpark Campus, Vanderbijlpark, South Africa
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Eylem O, de Wit L, van Straten A, Steubl L, Melissourgaki Z, Danışman GT, de Vries R, Kerkhof AJFM, Bhui K, Cuijpers P. Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health 2020; 20:879. [PMID: 32513215 PMCID: PMC7278062 DOI: 10.1186/s12889-020-08964-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is a strong stigma attached to mental disorders preventing those affected from getting psychological help. The consequences of stigma are worse for racial and/or ethnic minorities compared to racial and/or ethnic majorities since the former often experience other social adversities such as poverty and discrimination within policies and institutions. This is the first systematic review and meta-analysis summarizing the evidence on the impact of differences in mental illness stigma between racial minorities and majorities. METHODS This systematic review and meta-analysis included cross-sectional studies comparing mental illness stigma between racial minorities and majorities. Systematic searches were conducted in the bibliographic databases of PubMed, PsycINFO and EMBASE until 20th December 2018. Outcomes were extracted from published reports, and meta-analyses, and meta-regression analyses were conducted in CMA software. RESULTS After screening 2787 abstracts, 29 studies with 193,418 participants (N = 35,836 in racial minorities) were eligible for analyses. Racial minorities showed more stigma than racial majorities (g = 0.20 (95% CI: 0.12 ~ 0.27) for common mental disorders. Sensitivity analyses showed robustness of these results. Multivariate meta-regression analyses pointed to the possible moderating role of the number of studies with high risk of bias on the effect size. Racial minorities have more stigma for common mental disorders when compared with majorities. Limitations included moderate to high risk of bias, high heterogeneity, few studies in most comparisons, and the use of non-standardized outcome measures. CONCLUSIONS Mental illness stigma is higher among ethnic minorities than majorities. An important clinical implication of these findings would be to tailor anti-stigma strategies related with mental illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach.
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Affiliation(s)
- Ozlem Eylem
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
- Centre for Psychiatry, Queen Mary University of London, London, UK.
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | | | - Gözde Topgüloğlu Danışman
- Faculty of Social Sciences, Centre for Family and Couple Therapy, Özyeğin University, İstanbul, Turkey
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ad J F M Kerkhof
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Kamaldeep Bhui
- Centre for Psychiatry, Queen Mary University of London, London, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
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The Association of Race/Ethnicity, Dietary Intake, and Physical Activity with Depression. J Racial Ethn Health Disparities 2020; 8:315-331. [PMID: 32488824 DOI: 10.1007/s40615-020-00784-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/07/2020] [Accepted: 05/23/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study investigated the association of race/ethnicity, dietary intake, and physical activity with depression and potential other barriers associated with the use of mental health services among depressed people. METHODS We used the nationally representative data, 2011-2016 National Health and Nutrition Examination Survey. Depression status was defined using a Patient Health Questionnaire. Multivariable logistic regressions were conducted on depression status and the use of mental health specialists among depressed adults, accounting for the complex sampling design. RESULTS The prevalence of depression was 8.3% with substantial racial/ethnic differences (8.0% for white, 3.1% for Asian, 9.2% for black, 7.6% for Mexican Hispanics, 13.0% for other Hispanics). Good/acceptable diet and a high level of physical activity were negatively associated with depression. Among depressed people, no significant racial/ethnic differences were observed in using mental health specialists. CONCLUSION Prevalence for depression was lower among people who have good or acceptable diet and moderate physical activity. These modifiable factors as well as race/ethnicity should be incorporated into psychotherapeutic interventions to improve depression.
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Jannati N, Mazhari S, Ahmadian L, Mirzaee M. Effectiveness of an app-based cognitive behavioral therapy program for postpartum depression in primary care: A randomized controlled trial. Int J Med Inform 2020; 141:104145. [PMID: 32480319 DOI: 10.1016/j.ijmedinf.2020.104145] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/19/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of this study was to examine the effect of mobile phone applications (App) based cognitive behavioral therapy (CBT) on postpartum depression. METHOD A non-blinded parallel-group randomized controlled trial was conducted. The study population consisted of women attended to three health care centers in Kerman, Iran. Participants were recruited between September and November 2018, and randomized 1:1 to either the intervention group (mobile application access) or control group (no mobile application access). All participants completed the Edinburgh Postnatal Depression Scale (EPDS) at the baseline and 2 months after baseline. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression. RESULTS A total of 75 women with an average age of 27 years participated in this study. Before the intervention, there was no statistically significant difference between the EPDS score between the two groups (p > 0.001). However, in the intervention group, the average EPDS score after intervention was 8.18 and in the control group was 15.05, which was statistically significant (p < 0.001). CONCLUSION These findings provide proof that providing a CBT program using a mobile application can lead to clinically important improvements in outcomes for mothers who suffer from postpartum depression.
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Affiliation(s)
- Nazanin Jannati
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrzad Mazhari
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Moghaddameh Mirzaee
- Epidemiology and Biostatistics, Kerman University of Medical Sciences, Kerman, Iran
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Szlyk H, Deng J, Xu C, Krauss MJ, Cavazos-Rehg P. Leveraging social media to explore the barriers to treatment among individuals with depressive symptoms. Depress Anxiety 2020; 37:458-465. [PMID: 31943530 PMCID: PMC7239721 DOI: 10.1002/da.22990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 11/06/2019] [Accepted: 12/06/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Individuals with depression may not seek treatment for their symptoms due to several types of barriers to treatment. In support of the growing research on mental health care access and the role of social media, this study aimed to increase knowledge of these barriers among social media users. METHODS Participants were recruited from several social media platforms, including Instagram, Facebook, Twitter, Reddit, Tumblr, and online depression forums. Eligible participants had endorsed having posted about feeling sad or depressed on social media, or followed social media groups that post about depression-related topics. Participants completed an online survey about their depression symptoms, interest in treatment, and potential barriers to accessing treatment. RESULTS Of the participants reaching criteria for depression, those with major depression were more likely to seek out treatment, to report an unmet need for treatment, and have a higher risk of suicide. For participants with major depression, barriers to treatment were more likely to be attitudinal, while participants with mild depression experienced more structural barriers. CONCLUSIONS This study demonstrates several barriers to treatment that occur for individuals struggling with depression, and that online platforms are effective mediums to recruit individuals with depression symptoms who seek mental health support.
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Affiliation(s)
- Hannah Szlyk
- George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - John Deng
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110,George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Christine Xu
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110,George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Melissa J. Krauss
- George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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Bleyel C, Hoffmann M, Wensing M, Hartmann M, Friederich HC, Haun MW. Patients' Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers. J Med Internet Res 2020; 22:e17330. [PMID: 32310139 PMCID: PMC7199141 DOI: 10.2196/17330] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. Objective From the patients’ perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. Methods Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. Results Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85%; lower threshold for seeking specialist mental health care: 6/13, 46%; shorter travel distances: 3/13, 23%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38%). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. Conclusions Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one
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Affiliation(s)
- Caroline Bleyel
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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50
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Brandl EJ, Dietrich N, Mell N, Winkler JG, Gutwinski S, Bretz HJ, Schouler-Ocak M. Attitudes towards psychopharmacology and psychotherapy in psychiatric patients with and without migration background. BMC Psychiatry 2020; 20:176. [PMID: 32303265 PMCID: PMC7164188 DOI: 10.1186/s12888-020-02585-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sociodemographic factors, attitude towards treatment and acculturation may be important factors influencing the decision of immigrants to seek and maintain psychiatric treatment. A better understanding of these factors may significantly improve treatment adherence and outcome in these patients. Therefore, we investigated factors associated the attitude towards psychotherapy and medication in a sample of psychiatric outpatients with and without migration background. METHODS N = 381 patients in a psychiatric outpatient unit offering specialized treatment for migrants were included in this study. Attitude towards psychotherapy was assessed using the Questionnaire on Attitudes Toward Psychotherapeutic Treatment, attitude towards medication with the Drug Attitude Inventory-10. Acculturation, symptom load and sociodemographic variables were assessed in a general questionnaire. Statistical analyses included analyses of covariance and hierarchical regression. RESULTS Patients of Turkish and Eastern European origin reported a significantly more positive attitude towards medication than patients without migration background. When controlling for sociodemographic and clinical variables, we did not observe any significant differences in attitude towards psychotherapy. Acculturation neither influenced the attitude towards psychotherapy nor towards medication. CONCLUSION Our study indicates that sociodemographic and clinical factors may be more relevant for patients´ attitudes towards treatment than acculturation. Considering these factors in psychiatric treatment of patients with migration background may improve treatment outcome and adherence.
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Affiliation(s)
- Eva J. Brandl
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Nora Dietrich
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Nicoleta Mell
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Johanna G. Winkler
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Stefan Gutwinski
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - H. Joachim Bretz
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Meryam Schouler-Ocak
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
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