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Greenwald A, Kelly A, Thomas L. Trauma-informed care in the emergency department: concepts and recommendations for integrating practices into emergency medicine. MEDICAL EDUCATION ONLINE 2023; 28:2178366. [PMID: 36799730 PMCID: PMC9946309 DOI: 10.1080/10872981.2023.2178366] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/08/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
The experience of psychological trauma is common and has become even more prevalent during the COVID-19 pandemic for both health care workers and the general population [1-3]. Traumatic experiences can have varied and lasting physical and mental health effects on patients, beyond what we are privy to in the acute environment of the emergency department. The effects of these prior traumatic experiences can be exacerbated by interaction with the healthcare system, and yet emergency medicine physicians have no standardized methods for working with patients in a trauma-informed way. The systematic implementation of trauma-informed care (TIC) practice requires the cooperation of multiple domains within the health care system, including focus on the physical environment, direct care, and administrative practices. Here we provide recommendations specific to emergency medicine for the development and implementation of TIC in the regular patient-clinician interaction, situated within the context of the TIC framework as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) [4].
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Affiliation(s)
- Audria Greenwald
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Amber Kelly
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Listy Thomas
- Department of Social Work, Quinnipiac University School for Health Sciences, North Haven, CT, USA
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2
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Leary E, Zachary I, Kyeong NY. Regional Differences in Serious Psychological Distress and Overall Physical and Mental Health. Community Ment Health J 2022; 58:770-778. [PMID: 34455555 PMCID: PMC8403461 DOI: 10.1007/s10597-021-00882-x] [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: 03/03/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022]
Abstract
To determine regional differences in the prevalence of overall physical health, overall mental health, and serious psychological distress (SPD). Data from the 2004 to 2016 Medical Expenditure Panel Survey were used for weighted analysis across region. Relationship modifiers considered were sociodemographic factors, health factors, and measures of health expenditures. A higher burden ratio of health care expenditures is negatively associated with health outcomes, across all US regions and insurance. Compared to 2004 values, SPD, overall physical health, and mental health are significantly improved after 2014. This research supports the whole health paradigm, indicating that overall mental and physical health are closely related. The burden of health care costs is an important consideration and related to overall health outcomes, regardless of insurance status or region. These considerations are likely increasingly important to consider with recent global events.
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Affiliation(s)
- Emily Leary
- School of Medicine, University of Missouri-Columbia, Columbia, MO, USA.
| | - Iris Zachary
- School of Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Na Young Kyeong
- School of Medicine, University of Missouri-Columbia, Columbia, MO, USA
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Ainslie M, Brunette MF, Capozzoli M. Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis. JMIR Ment Health 2022; 9:e33092. [PMID: 35311673 PMCID: PMC8981005 DOI: 10.2196/33092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. OBJECTIVE We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. METHODS We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. RESULTS A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. CONCLUSIONS The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness.
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Affiliation(s)
- Marcy Ainslie
- Department of Nursing, University of New Hampshire, Durham, NH, United States
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Michelle Capozzoli
- Department of Mathematics & Statistics, University of New Hampshire, Durham, NH, United States
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Germack HD, Combellick J, Cooper M, Koller K, McMichael B. Antidepressants Are the Most Commonly Discontinued Psychotherapeutic Medications in Pregnancy. Womens Health Issues 2021; 32:241-250. [PMID: 34840082 DOI: 10.1016/j.whi.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychiatric illnesses are common during the perinatal period. The use of antipsychotic medication during pregnancy has increased over the past two decades. In many instances, clinicians agree that untreated psychiatric illness during the perinatal period is more dangerous than the risks imposed by continuing psychotherapeutic medication. We describe patterns of psychotherapeutic medication continuation and discontinuation during pregnancy in a large U.S. cohort. METHODS We assessed the relationship between the demographic and clinical characteristics of women who continued or discontinued psychotherapeutic medications-antidepressants, anxiolytics/sedatives, anticonvulsants, antipsychotics, mood stabilizers, and stimulants-during pregnancy. This study used data from 2008 to 2015 from the Medical Expenditure Panel Survey. We used t tests and Medical Expenditure Panel Survey Household Component longitudinal sampling weights in the analysis of this data. RESULTS There were few significant differences noted in clinical and demographic characteristics between women who continued and discontinued medications during pregnancy. Those who continued were less likely to be employed (46.95% of continuers were employed vs. 80.55% of discontinuers; p = .0053). Women taking antipsychotics were more likely to continue medications during pregnancy (64.60% continually used antipsychotics vs. 35.40% discontinued antipsychotics; p = .008), whereas women taking antidepressants were more likely to discontinue their use (19.62% continually used antidepressants vs. 80.38% discontinued antidepressants; p = .032). For each medication category, women resumed medication after pregnancy. CONCLUSIONS Antidepressants are the most commonly discontinued psychotherapeutic medication during pregnancy. We recommend further research examining factors that may influence this observed difference.
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Affiliation(s)
- Hayley D Germack
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
| | | | - Mandy Cooper
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Krista Koller
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Yoshioka T, Okubo R, Tabuchi T, Odani S, Shinozaki T, Tsugawa Y. Factors associated with serious psychological distress during the COVID-19 pandemic in Japan: a nationwide cross-sectional internet-based study. BMJ Open 2021; 11:e051115. [PMID: 34226236 PMCID: PMC8260284 DOI: 10.1136/bmjopen-2021-051115] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan. DESIGN Nationwide cross-sectional study using survey data. SETTING Internet survey using sampling weights for national estimates conducted between 25 August and 30 September 2020 in Japan. EXPOSURES Demographics (age, gender), socioeconomic status (income level, employment type, educational attainment, marital status, family composition and caregiving burden); the experience of domestic violence (DV), the state of emergency and fear of and stigma related to COVID-19. MAIN OUTCOME MEASURES Prevalence of SPD, defined as Kessler 6 Scale score ≥13. RESULTS Among 25 482 respondents, 10.0% met the criteria of SPD. Overall, women (adjusted OR (aOR) 1.59; 95% CI 1.17 to 2.16; p=0.003), ages 15-29 (aOR 2.35 compared with ages 45-59 years; 95% CI 1.64 to 3.38; p<0.001), low-income level (aOR 1.70 compared with intermediate income; 95% CI 1.16 to 2.49; p=0.007), providing caregiving to family members (aOR 5.48; 95% CI 3.51 to 8.56; p<0.001), experiencing DV (aOR 5.72; 95% CI 3.81 to 8.59; p<0.001) and fear of COVID-19 (aOR 1.96; 95% CI 1.55 to 2.48; p<0.001) were associated with SPD. Among women aged 15-29 years, who have a higher risk of suicide during the COVID-19 pandemic in Japan, caregiving, DV, fear of COVID-19 and COVID-19-related stigma were associated with SPD. CONCLUSIONS Economic situation, caregiving burden, DV and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women, similar factors, except economic situation, were associated with SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population's mental health.
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Affiliation(s)
- Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima-shi, Fukushima, Japan
| | - Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira-shi, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka-shi, Osaka, Japan
| | - Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka-shi, Osaka, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Understanding how psychosocial factors relate to seeking medical care among older adults using a new model of care seeking. Soc Sci Med 2021; 281:114113. [PMID: 34144482 DOI: 10.1016/j.socscimed.2021.114113] [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] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 01/07/2023]
Abstract
RATIONALE Research has identified psychosocial factors related to the use of health services among the older population; however, the specific roles by which these factors drive behavior have not been identified and empirically tested. OBJECTIVE This study tested whether previously identified psychosocial factors decrease or increase the motivational potential to seek care, the motivational sensitivity to perceived access, or the motivational sensitivity to perceived need. METHODS The 2014 U.S. Health and Retirement Study was used. Analysis was based on 2589 older noninstitutionalized respondents (age greater than 64). The dependent variable was the number of healthcare provider visits in the preceding two years. Psychosocial factors included were life satisfaction, social network indicators, optimism, pessimism, positive social support, hopelessness, loneliness, self-efficacy, health efficacy, positive affect, negative affect, and purpose in life. Covariates included age and sex. Maximum likelihood estimation of an interpretable structural model was used. RESULTS Results of the study provide evidence that psychosocial variables are related to health care seeking through both motivational potential and sensitivity parameters. Some psychosocial variables are related to multiple roles. For example, pessimism is related to a lower motivational potential and is more sensitive to access at higher levels of access, whereas hopelessness is related to a higher motivational potential and more sensitive to need and access at lower levels of each. CONCLUSIONS Findings imply psychosocial characteristics are related to health care seeking and utilization of older adults via different roles that can countervail each other, and therefore the influence of interventions can be complex. To address this, complex interventions may be required.
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Adams M, Sionean C, Broz D, Lewis R, Wejnert C. Serious Mental Illness Among Young People Who Inject Drugs: An Assessment of Injection Risks and Healthcare Use. J Infect Dis 2021; 222:S401-S409. [PMID: 32877554 DOI: 10.1093/infdis/jiaa238] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data on behavioral correlates of mental illness among young people who inject drugs (PWID) are limited. We examine injection risks and healthcare use among young PWID with probable serious mental illness (PSMI). METHODS People who inject drugs were recruited and interviewed in 20 US cities for 2015 National HIV Behavioral Surveillance. Probable serious mental illness was assessed using the Kessler-6 screening scale. Bivariate analyses using log-linked Poisson regression with generalized estimating equations adjusted for design covariates were conducted to examine associations between PSMI and behaviors among PWID ages 18-29 years. RESULTS Of 1769 young PWID, 45% had PSMI. Compared to those without PSMI, PWID with PSMI were more likely to report injecting more than once a day, receptive syringe sharing, sharing of other injection equipment, and unmet needs for medical care and substance use disorder (SUD) treatment. Those with PSMI were less likely to use syringe services programs than those without PSMI. CONCLUSIONS Approximately half of young PWID had PSMI. People who inject drugs with PSMI engaged in high-risk injection behaviors and encountered barriers to healthcare. Human immunodeficiency virus prevention programs such as Syringe Services Programs (SSPs) could benefit from screening for mental illness among young PWID and strong linkage to healthcare, including mental health and SUD treatment.
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Affiliation(s)
- Monica Adams
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Catlainn Sionean
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Dita Broz
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Rashunda Lewis
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Cyprian Wejnert
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
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Yoshioka T, Okubo R, Tabuchi T, Odani S, Shinozaki T, Tsugawa Y. Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33688666 PMCID: PMC7941641 DOI: 10.1101/2021.02.27.21252458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance: The coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on mental health of the population, leading to higher suicide rates, in many countries. However, little is known about risk factors associated with worsened mental health during the COVID-19 pandemic. Objective: To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan. Design, Setting, and Participants: A cross-sectional study using a large-scale internet survey conducted between August 25 and September 30, 2020, in Japan. Exposures: Demographics (age, gender, marital status, family composition, and caregiving burden), socio-economic status (income level, employment type, educational attainment), the experience of domestic violence (DV), the state of emergency, fear of COVID-19, and stigma related to COVID-19. Main Outcomes and Measures: Prevalence of SPD, defined as Kessler 6 scale score ≥13. Results: Among 25,482 individuals included in this study, 2,556 (10%) met the criteria of SPD. Overall, women (adjusted odds ratio [aOR] 1.59; 95%CI, 1.17–2.16; P=0.003), ages 15–29 (aOR compared with ages 45–59, 2.35; 95%CI, 1.64–3.38; P<0.001), low income (aOR compared with intermediate income, 1.70; 95%CI, 1.16–2.49; P=0.007), providing caregiving to family members (aOR, 5.48; 95%CI, 3.51–8.56; P<0.001), experiencing DV (aOR, 5.72; 95%CI, 3.81–8.59; P<0.001), and fear of COVID-19 (aOR, 1.96; 95%CI, 1.55–2.48; P<0.001) were associated with a higher rate of SPD. Among women aged 15–29 years, who experienced the highest rate of SPD, caregiving, DV, fear of COVID-19, and COVID-19-related stigma were associated with a higher rate of SPD; whereas economic situation (income level and employment type) and social isolation (marital status) were not associated with the prevalence of SPD. Conclusions and Relevance: Economic situation, caregiving burden, DV, and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women—who have a higher risk of suicide during the COVID-19 pandemic in Japan—similar factors, except economic situation, were associated with a higher rate of SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population’s mental health.
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Affiliation(s)
- Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRCLE), Fukushima Medical University, Fukushima, Japan
| | - Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Germack HD, Drake C, Donohue JM, Golberstein E, Busch SH. National Trends in Outpatient Mental Health Service Use Among Adults Between 2008 and 2015. Psychiatr Serv 2020; 71:1127-1135. [PMID: 32907475 PMCID: PMC7877566 DOI: 10.1176/appi.ps.201900576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to characterize recent trends in mental health visits of adult outpatients to primary care physicians (PCPs), specialty mental health providers (SMHPs), and other providers (non-primary care physicians, specialists other than SMHPs, nurse practitioners, and physician assistants). Trends determined by degree of patients' psychological distress and in the types of treatments received within different settings were also examined. METHODS Data were from the household component of the nationally representative Medical Expenditure Panel Survey for the 2008-2011 and 2012-2015 periods for adults ages ≥18 years (N=13,111) who had a mental health outpatient visit. Bivariate logistic regression was used to compare means between the two periods. RESULTS The percentage of adults having mental health outpatient visits increased between the two periods, largely driven by an increase in visits with providers other than SMHPs and PCPs, which rose from 11.9% (N=667) to 15.5% (N=1,048). Outpatient mental health visits with PCPs decreased from 29.0% (N=1,802) to 26.8% (N=1,945). The proportion of respondents with mental health outpatient visits increased both among those with high psychological distress and among those with low or no psychological distress (from 30.7% [N=1,332] to 36.2% [N=1,491] and from 6.0% [N=4,516] to 6.9% [N=5,772], respectively). The percentage of respondents receiving only psychotropic medication decreased over the two periods. CONCLUSIONS Mental health outpatient visits for adults increased between 2008 and 2015, and visits with SMHPs remained relatively stable during that time. A greater understanding of recent trends in types of outpatient mental health services may help identify targets for future mental health workforce studies.
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Affiliation(s)
- Hayley D Germack
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh (Germack); Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake, Donohue); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch)
| | - Coleman Drake
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh (Germack); Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake, Donohue); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch)
| | - Julie M Donohue
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh (Germack); Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake, Donohue); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch)
| | - Ezra Golberstein
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh (Germack); Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake, Donohue); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch)
| | - Susan H Busch
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh (Germack); Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake, Donohue); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch)
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Nguyen Thi Hong U. Anxiety And Depression Among Cancer Patients. J Clin Med 2020. [DOI: 10.38103/jcmhch.2020.64.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Depression and anxiety are common problems of cancer patients. They affect importantly the patients’ health, the decision to be treated, and the outcome of the treatment.
Objectives: This study aimed to assess the prevalence of depression and anxiety among cancer patients being treated at Hue University Hospital in 2019 and to reveal its correlation factors.
Materials and methods: A cross-sectional study was conducted on 104 cancer patients hospitalized for the treatment. Using the CES-DR and GAD-7 scales to assess depression and anxiety disorders. Chisquare Tests and multivariate logistic regression were performed.
Results: The rate of depression (CES-DR) and anxiety (GAD-7) was 77.9% and 63.5%, respectively. Multivariate regression analysis showed the correlation of anxiety among cancer patients to stage III, stage IV of cancer, and the presence of difficulty in paying healthcare costs. Whilst, depression had significant associations with gender (female), late stages of cancer (III, IV), and type of cancer (lung cancer, breast cancer, stomach cancer).
Conclusions: The prevalence of anxiety and depression was found relatively important in our study among cancer patients. Thus, it is necessary to propose solutions to improve the mental health of cancer patients to increase treatment efficiency.
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11
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Chiu M, Saxena FE, Kurdyak P, Wilton AS, Vigod SN. Health Service Use among Individuals with Depression and Psychological Distress: A Population-Based Cohort Study in Ontario, Canada: Utilisation des services de santé par les personnes souffrant de dépression et de détresse psychologique : une étude de cohorte dans la population de l'Ontario, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:641-651. [PMID: 32458758 PMCID: PMC7485038 DOI: 10.1177/0706743720927826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Relatively little is known about how health-care utilization differs among individuals with psychological distress compared to those with major depressive disorder (MDD). METHODS Ontario participants of the Canadian Community Health Survey Cycle 1.2 (2002) were linked to health administrative data to follow their health-care utilization patterns for up to 15 years. Based on their survey responses, we classified individuals hierarchically into Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria MDD, psychological distress (Kessler-6: 8 to 24), or an unexposed group with neither condition. We compared the rates of outpatient and acute care mental and nonmental health-related visits across the 3 groups over time using Poisson regression. RESULTS Among the 430 individuals with MDD, 668 with psychological distress, and 9,089 in the unexposed group, individuals with MDD and psychological distress had higher rates of health-care utilization than the unexposed overall and across time. The rates of psychiatrist visits for the MDD group were significantly higher than the other groups initially but declined over the follow-up. Conversely, the rates of psychiatrist visits among the psychological distress group increased over time and converged with that of the MDD group by the end of follow-up (rate ratioMDD vs. psychological distress at 1 year: 4.20 [1.97 to 11.40]; at 15 years: 1.53 [0.54 to 4.08]). Acute care visits were similar between the MDD and psychological distress groups at all time points. CONCLUSIONS Individuals with psychological distress required mental health care rivalling that of individuals with MDD over time, suggesting that even a cross-sectional assessment of significant psychological distress is a serious clinical concern.
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Affiliation(s)
- Maria Chiu
- 50010ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Paul Kurdyak
- 50010ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Simone N Vigod
- 50010ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
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Social determinants and emergency department utilization: Findings from the Veterans Health Administration. Am J Emerg Med 2020; 38:1904-1909. [DOI: 10.1016/j.ajem.2020.05.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022] Open
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Rana RH, Alam K, Gow J. Selection of private or public hospital care: examining the care-seeking behaviour of patients with private health insurance. BMC Health Serv Res 2020; 20:380. [PMID: 32375869 PMCID: PMC7201676 DOI: 10.1186/s12913-020-05253-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 04/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to examine the healthcare-seeking (hospital, primary and preventive care) and healthcare utilisation behaviour of patients with private health insurance (PHI) in Australia. It also aimed to examine the socioeconomic, demographic and lifestyle factors that influence the choice of hospital care in Australia. Method A logistic regression model with repeated measure t-test and Pearson’s Chi-square test were used to identify the factors that affect the choice of care. Data from waves 9 (2009) and 13 (2013) of the nationally-representative Household, Income and Labour Dynamics in Australia (HILDA) survey were used in the analysis. Results Patients with PHI had a higher number of hospital nights’ stay despite having a lower number of hospital admissions than those without private cover. Significant disparities were identified in preventive and specialist care use between patients with cover and without cover. No significant variations were observed in healthcare utilisation for PHI patients before and after dropping PHI. One in four patients chose to use public hospitals despite holding PHI cover. Moreover, those insured and from lower socioeconomic backgrounds and those who were younger and without long-term health conditions showed a higher probability of selecting public rather than private care. Conclusions It is evident that PHI cover encourages people to use private care. However, a considerable number of PHI patients are using public care, even though eligible for private care may indicate consumer information asymmetry.
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Affiliation(s)
- Rezwanul Hasan Rana
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.
| | - Khorshed Alam
- School of Commerce, Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Rana RH, Alam K, Gow J, Ralph N. Predictors of health care use in Australian cancer patients. Cancer Manag Res 2019; 11:6941-6957. [PMID: 31440086 PMCID: PMC6664209 DOI: 10.2147/cmar.s193615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/07/2019] [Indexed: 12/24/2022] Open
Abstract
Objective The purpose of this study is to measure health care utilization in Australian cancer patients based on their demographic, geographic and socioeconomic backgrounds. Method A total of 13,609 participants (aged 15 and over) from 7,230 households were interviewed as part of Wave 13 of the national Household, Income and Labour Dynamics in Australia (HILDA) survey. Five hundred and seventeen participants indicated a current cancer diagnosis with 90% of those receiving active treatment at the time of interview. Independent sample t-tests, Pearson Chi-sq tests, Kruskal‒Wallis H test, binary logistic regression and a zero-inflated Poisson regression were used to examine inequality in health care use. Results Demographic and sociocultural factors such as advancing age, gender, low income, low education status, rurality, no private health insurance, increased psychological distress and less access to specialist care are associated with lower health care utilization among cancer patients. However, models of care such as general practitioner-led cancer care is preferable in younger individuals with cancer, while accessing specialist care is associated with lower rates of hospitalization and higher levels of psychological distress increases hospital length of stay. Conclusions The findings of lower health care utilization by those cancer patients with characteristics of disadvantage have implications for policy development and intervention design. Broadly, policies targeting structural social inequities are likely to increase health care utilization among the most affected/disadvantaged populations. Further investigation is needed to identify potential links between health care utilization and cancer outcomes as a step toward targeted interventions for improving outcomes in the adversely affected groups.
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Affiliation(s)
- Rezwanul Hasan Rana
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,Centre for Health, Informatics and Economic Research, University of Southern Queensland, Queensland, Australia
| | - Khorshed Alam
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,Centre for Health, Informatics and Economic Research, University of Southern Queensland, Queensland, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,School of Accounting, Economics and Finance, University of Kwazulu-Natal, Durban, South Africa
| | - Nicholas Ralph
- Health Systems & Psycho-Oncology, Cancer Council Queensland, Queensland, Australia.,School of Nursing, University of Southern Queensland, Queensland, Australia.,St Vincent's Private Hospital , Queensland, Australia
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15
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Olfson M, Wang S, Wall M, Marcus SC, Blanco C. Trends in Serious Psychological Distress and Outpatient Mental Health Care of US Adults. JAMA Psychiatry 2019; 76:152-161. [PMID: 30484838 PMCID: PMC6439744 DOI: 10.1001/jamapsychiatry.2018.3550] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Reports of a recent increase in US outpatient mental health care raise questions about whether it has been driven by rising rates of psychological distress and whether mental health treatment has become either more or less focused on people with higher levels of distress. OBJECTIVE To characterize national trends in serious psychological distress and trends in outpatient mental health service use by adults with and without serious psychological distress. DESIGN, SETTING, AND PARTICIPANTS The 2004-2005, 2009-2010, and 2014-2015 Medical Expenditure Panel Surveys (MEPS) were nationally representative surveys taken in US households. The analysis was limited to participants 18 years or older. Dates of this analysis were February 2018 to April 2018. MAIN OUTCOMES AND MEASURES Annual national trends in the percentages of adults with serious psychological distress (Kessler 6 scale score ≥13), outpatient mental health service use (outpatient visit with a mental disorder diagnosis, psychotherapy visit, or psychotropic medication), and type of psychotropic medication use (antidepressants, anxiolytics/sedatives, antipsychotics, mood stabilizers, and stimulants). Age- and sex-adjusted odds ratios of the associations of survey period with the odds of serious psychological distress, outpatient mental health service use, and outpatient mental health service use were stratified by level of psychological distress. RESULTS The analysis involved 139 862 adult participants from the 2004-2005, 2009-2010, and 2014-2015 MEPS, including 51.67% women, 48.33% men, 67.11% white adults, and 32.89% nonwhite adults, with an overall mean (SE) age of 46.41 (0.14) years. Serious psychological distress declined overall from 4.82% (2004-2005) to 3.71% (2014-2015), including significant declines among young (3.94% to 3.07%), middle-aged (5.52% to 4.36%), and older adults (5.24% to 3.79%); men (3.94% to 3.09%) and women (5.64% to 4.29%); and major racial/ethnic groups (white, 4.52% to 3.82%; African American, 5.12% to 3.64%; Hispanic, 6.03% to 3.55%; and other, 5.22% to 3.26%). Overall, the percentage of adults receiving any outpatient mental health service increased from 19.08% (2004-2005) to 23.00% (2014-2015) (adjusted odds ratio, 1.25; 95% CI, 1.17-1.34). Although the proportionate increase in outpatient mental health service use for adults with serious psychological distress (54.17% to 68.40%) was larger than that for adults with less serious or no psychological distress (17.26% to 21.08%), the absolute increase in outpatient mental health service use was almost completely the result of growth in outpatient mental health service use by individuals with less serious or no psychological distress. CONCLUSIONS AND RELEVANCE The recent increase in outpatient mental health service use occurred during a period of decline in serious psychological distress. Adults with less serious psychological distress accounted for most of the absolute increase in outpatient mental health service use, while adults with serious psychological distress experienced a greater relative increase in outpatient mental health service use.
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Affiliation(s)
- Mark Olfson
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Shuai Wang
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Melanie Wall
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Steven C. Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia
| | - Carlos Blanco
- National Institute on Drug Abuse, Bethesda, Maryland
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Baicker K, Allen HL, Wright BJ, Taubman SL, Finkelstein AN. The Effect of Medicaid on Management of Depression: Evidence From the Oregon Health Insurance Experiment. Milbank Q 2018; 96:29-56. [PMID: 29504203 DOI: 10.1111/1468-0009.12311] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points: We take advantage of Oregon's Medicaid lottery to gauge the causal effects of Medicaid coverage on mental health care, how effectively it addresses unmet needs, and how those effects differ for those with and without a history of depression. Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50% and untreated depression by more than 60%. It increased use of medications and reduced the share of respondents reporting unmet mental health care needs by almost 40%. There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable populations. CONTEXT Expanding Medicaid to previously uninsured adults has been shown to increase detection and reduce the prevalence of depression, but the ways that Medicaid affects mental health care, how effectively it addresses unmet needs, and how those effects differ for those with and without a history of depression remain unclear. METHODS We take advantage of Oregon's Medicaid lottery to gauge the causal effects of Medicaid coverage using a randomized-controlled design, drawing on both primary and administrative data sources. FINDINGS Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50% and untreated depression by more than 60%. It increased use of medications frequently prescribed to treat depression and related mental health conditions and reduced the share of respondents reporting unmet mental health care needs by almost 40%. The share of respondents screening positive for depression dropped by 9.2 percentage points overall, and by 13.1 for those with preexisting depression diagnoses, with greatest relief in symptoms seen primarily in feeling down or hopeless, feeling tired, and trouble sleeping-consistent with the increase observed not just in medications targeting depression but also in those targeting sleep. CONCLUSIONS Medicaid coverage had significant effects on the diagnosis, treatment, and outcomes of a population with substantial unmet mental health needs. Coverage increased access to care, reduced the prevalence of untreated and undiagnosed depression, and substantially improved the symptoms of depression. There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable populations.
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Chiu M, Lebenbaum M, Cheng J, de Oliveira C, Kurdyak P. The direct healthcare costs associated with psychological distress and major depression: A population-based cohort study in Ontario, Canada. PLoS One 2017; 12:e0184268. [PMID: 28873469 PMCID: PMC5584795 DOI: 10.1371/journal.pone.0184268] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/21/2017] [Indexed: 11/17/2022] Open
Abstract
The objective of our study was to estimate direct healthcare costs incurred by a population-based sample of people with psychological distress or depression. We used the 2002 Canadian Community Health Survey on Mental Health and Well Being and categorized individuals as having psychological distress using the Kessler-6, major depressive disorder (MDD) using DSM-IV criteria and a comparison group of participants without MDD or psychological distress. Costs in 2013 USD were estimated by linking individuals to health administrative databases and following them until March 31, 2013. Our sample consisted of 9,965 individuals, of whom 651 and 409 had psychological distress and MDD, respectively. Although the age-and-sex adjusted per-capita costs were similarly high among the psychologically distressed ($3,364, 95% CI: $2,791, $3,937) and those with MDD ($3,210, 95% CI: $2,413, $4,008) compared to the comparison group ($2,629, 95% CI: $2,312, $2,945), the population-wide excess costs for psychological distress ($441 million) were more than twice that for MDD ($210 million) as there was a greater number of people with psychological distress than depression. We found substantial healthcare costs associated with psychological distress and depression, suggesting that psychological distress and MDD have a high cost burden and there may be public health intervention opportunities to relieve distress. Further research examining how individuals with these conditions use the healthcare system may provide insight into the allocation of limited healthcare resources while maintaining high quality care.
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Affiliation(s)
- Maria Chiu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Lebenbaum
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Joyce Cheng
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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18
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Shin JK, Poltavskiy E, Kim TN, Hasan A, Bang H. Help-seeking behaviors for serious psychological distress among individuals with diabetes mellitus: The California Health Interview Survey, 2011-2012. Prim Care Diabetes 2017; 11:63-70. [PMID: 27492797 PMCID: PMC5201434 DOI: 10.1016/j.pcd.2016.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/28/2016] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
Abstract
AIM To investigate patterns of and factors associated with help-seeking behaviors among individuals with diabetes mellitus (DM) and/or serious psychological distress (SPD). METHODS The analysis was conducted with the California Health Interview Survey (CHIS) 2011-2012 of 40,803 adults. Logistic regression was used to examine the associations between the multiple facilitating/preventing factors and outcome, guided by the Andersen's Health Care Utilization Model. RESULTS The prevalence of DM and SPD were 10.9% and 3.4%, respectively, among participants in the survey. The participants with DM were more likely to experience SPD than those without DM (OR 1.46, 95% CI=1.11-1.91, p=0.006). Participants with combined DM and SPD, the most underserved, were less likely to perceive the need for mental health services and less likely to seek help, compared to those with only SPD. Need factors (SPD status and perceived need) were significantly associated with help-seeking behaviors for mental health, along with predisposing factors (age, gender, obesity, race, and employment), and enabling factors (insurance, English proficiency). CONCLUSIONS Perceptions about need for seeking help seem to play an important role in receiving mental health services in addition to other predisposing or enabling factors. Identification of these factors may improve clinical outcomes related to DM and SPD.
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MESH Headings
- Adult
- California/epidemiology
- Chi-Square Distribution
- Comorbidity
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/psychology
- Female
- Health Care Surveys
- Health Services Accessibility
- Help-Seeking Behavior
- Humans
- Logistic Models
- Male
- Mental Health
- Mental Health Services
- Middle Aged
- Odds Ratio
- Patient Acceptance of Health Care
- Prevalence
- Risk Factors
- Severity of Illness Index
- Socioeconomic Factors
- Stress, Psychological/diagnosis
- Stress, Psychological/epidemiology
- Stress, Psychological/psychology
- Stress, Psychological/therapy
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Affiliation(s)
- Jinah K Shin
- Psychiatric Department at Elmhurst Hospital in New York 79-01, Broadway, Elmhurst, NY 11373, USA.
| | - Eduard Poltavskiy
- Graduate Group of Epidemiology, Department of Public Health Sciences, School of Medicine, University of California at Davis, Davis, CA, USA
| | - Tae Nyun Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Haeundae Paik Hospital, Inje University School of Medicine, Busan, South Korea
| | - Abdullah Hasan
- Psychiatric Department at Elmhurst Hospital in New York 79-01, Broadway, Elmhurst, NY 11373, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California at Davis, Davis, CA, USA
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Lynch CP, Strom Williams J, Voronca D, Walker RJ, Egede LE. Meaning of Illness and Cardiovascular Risk Factors in Patients With Type 2 Diabetes. DIABETES EDUCATOR 2016; 42:220-7. [PMID: 26879460 DOI: 10.1177/0145721716631430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationship between meaning of illness and cardiovascular disease risk factors in patients with type 2 diabetes. METHODS The sample population was recruited from primary care clinics in the southeastern United States. The meaning of illness was assessed by a validated questionnaire with 5 subscales. The primary outcomes were cardiovascular disease (CVD) risk factors, assessed by A1C, systolic and diastolic blood pressure (SBP and DBP, respectively), and low-density lipoprotein cholesterol (LDL-C). Multivariate linear regression models investigated associations between the clinical outcomes and the 5 MIQ factors, controlling for possible confounders. RESULTS The sample comprised 302 black and white participants of whom more than half were elderly (65+ years) and the vast majority were male (98%). Systolic blood pressure was positively associated with non-anticipated vulnerability. Diastolic blood pressure was negatively associated with degree of stress/change in commitments and positively associated with challenge/motivation/hope and non-anticipated vulnerability. Low-density lipoprotein cholesterol was significantly and negatively associated with degree of stress/change in commitments. CONCLUSIONS Meaning of illness had a significant effect on measured outcomes of CVD risk. The specific factor included in the overarching concept of meaning of illness differed in its influence, with more positive views of stress/commitments associated with lower blood pressure and LDL but more positive views of the challenge/hope/motivation and negative views of non-anticipated vulnerability associated with diabetes associated with higher systolic and diastolic blood pressure.
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Affiliation(s)
- Cheryl P Lynch
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Lynch, Dr Walker, Dr Egede),Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede),Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Egede)
| | - Joni Strom Williams
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede),Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Egede)
| | - Delia Voronca
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede),Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Egede)
| | - Rebekah J Walker
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Lynch, Dr Walker, Dr Egede),Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede)
| | - Leonard E Egede
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Lynch, Dr Walker, Dr Egede),Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede),Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Egede)
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20
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Behr JG, Diaz R. Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study. PLoS One 2016; 11:e0147116. [PMID: 26784515 PMCID: PMC4718591 DOI: 10.1371/journal.pone.0147116] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 12/29/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model. DATA SOURCE Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department. STUDY DESIGN Representative randomized sample of 1,443 adult patients triaged ESI levels 4-5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios. PRINCIPAL FINDINGS 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance. CONCLUSIONS Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.
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Affiliation(s)
- Joshua G. Behr
- Virginia Modeling, Analysis and Simulation Center, Old Dominion University, Suffolk, Virginia, United States of America
- * E-mail:
| | - Rafael Diaz
- Zaragoza Logistics Center, Massachusetts Institute of Technology, Zaragoza, España
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21
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Marko D, Linder SH, Tullar JM, Reynolds TF, Estes LJ. Predictors of Serious Psychological Distress in an Urban Population. Community Ment Health J 2015; 51:708-14. [PMID: 25535042 PMCID: PMC4506482 DOI: 10.1007/s10597-014-9790-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 12/05/2014] [Indexed: 12/02/2022]
Abstract
While there are state and national estimates of serious psychological distress (SPD), these are not useful for targeting local mental health interventions or for addressing the needs of sub-populations at increased risk for SPD. This cross-sectional study uses data from the population-based 2010 Health of Houston Survey (n = 5,116) to examine (1) the prevalence of SPD and its determinants in Houston area and (2) predictors of the utilization of mental health services among people with SPD. The prevalence of SPD among the Houston area adult population was 7 %, more than twice the national average. Correlates of SPD included: being female, under 65, lacking emotional support, smoking, having poor health status and financial distress. The odds of utilizing health services by those with SPD were affected by financial distress, insurance, employment and perceived need for services, among other factors. Interventions should be tailored to mitigate risk factors for SPD and to improve access to mental health services in the SPD sub-population.
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Affiliation(s)
- Dritana Marko
- Institute for Health Policy, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA,
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22
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Slade EP, Goldman HH, Dixon LB, Gibbons B, Stuart EA. Assessing the Representativeness of Medical Expenditure Panel Survey Inpatient Utilization Data for Individuals With Psychiatric and Nonpsychiatric Conditions. Med Care Res Rev 2015; 72:736-55. [PMID: 26149973 DOI: 10.1177/1077558715592745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/28/2015] [Indexed: 11/17/2022]
Abstract
Sampling and reporting biases in the Medical Expenditure Panel Survey (MEPS) survey could render data on inpatient utilization that are not representative for individuals with severe psychiatric conditions. The authors assessed the representativeness of MEPS data on psychiatric inpatient utilization, by comparing MEPS estimates of total annual psychiatric and nonpsychiatric inpatient admissions and bed days, and mean length of stay, for nonelderly U.S. adults in calendar years 2005 to 2010 (N = 9,288) to estimates from the Nationwide Inpatient Sample (NIS), a nationally representative inpatient care database derived from hospitals' administrative records (N = 21,934,378). Compared with the NIS, the MEPS indicated 34% as many psychiatric admissions and 86% as many nonpsychiatric admissions, while mean psychiatric length of stay was greater in MEPS than in NIS. In MEPS data, underrepresentation of psychiatric inpatient utilization at community hospitals may result in measurement distortions for commonly used statistics on psychiatric inpatient utilization and costs.
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Affiliation(s)
- Eric P Slade
- U.S. Department of Veterans Affairs, Baltimore, MD, USA University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Lisa B Dixon
- Columbia University College of Physicians and Surgeons, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
| | - Brent Gibbons
- University of Maryland-Baltimore County, Baltimore, MD, USA
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23
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Han X, Lin CC, Li C, de Moor JS, Rodriguez JL, Kent EE, Forsythe LP. Association between serious psychological distress and health care use and expenditures by cancer history. Cancer 2015; 121:614-22. [PMID: 25345778 PMCID: PMC4492528 DOI: 10.1002/cncr.29102] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 08/15/2014] [Accepted: 09/02/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Serious psychological distress (SPD) is associated with adverse health outcomes such as poor quality of life and shorter survival in cancer survivors, but to the authors' knowledge, the relationship between SPD and health care use and medical expenditures is not clear. METHODS A total of 4326 cancer survivors and 57,109 noncancer participants were identified from the 2008 through 2010 Medical Expenditure Panel Survey, a nationwide population-based survey, and their psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (SPD defined by a score ≥13). The association between SPD and use and medical expenditures of various types of health care (office-based, outpatient, hospital inpatient, emergency department, dental, and prescriptions) was examined using a 2-part modeling approach that adjusted for demographic, personal, and comorbidity factors. The marginal effects of SPD on health care use and expenditures were calculated for cancer survivors and were compared with those of noncancer participants. RESULTS The weighted prevalence of SPD in cancer survivors was 8.2% compared with 4.8% in the noncancer participants. SPD was significantly associated with higher use of all care types except dental care in cancer survivors. Cancer survivors with SPD spent $4431 (95% confidence interval, $3419-$5443) more than survivors without SPD on medical services each year, whereas this extra expenditure associated with SPD for participants without cancer was $2685 (95% confidence interval, $2099-$3271). CONCLUSIONS In a national representative sample of cancer survivors, SPD was found to be associated with higher health care use and medical expenditures. Distress screening and psychosocial care in cancer survivors may help reduce the economic burden of cancer in the United States.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Chun Chieh Lin
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Chunyu Li
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet S. de Moor
- Health Services and Economics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Juan L. Rodriguez
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin E. Kent
- Outcomes Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laura P. Forsythe
- Research Integration and Evaluation Program, Patient-Centered Outcomes Research Institute, Washington, DC
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Xiang X, Hernandez R, Larrison CR. Provider Advice on Exercise and Diet Among Adults With Comorbid Serious Psychological Distress and Diabetes or Diabetes Risk Factors. DIABETES EDUCATOR 2015; 41:185-93. [DOI: 10.1177/0145721714567234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To examine the lifetime prevalence and correlates of provider advice to increase exercise and reduce dietary fat intake among adults with comorbid serious psychological distress (SPD) and diabetes or diabetes risk factors. Methods Study sample (n = 5942) was selected from the Medical Expenditure Panel Survey Household Component (MEPS-HC) series of 2007-2011. SPD was defined as a score of ≥13 on the Kessler Psychological Distress Scale (K6). Multivariate logistic regression was used to examine correlates of lifetime provider advice. Results Less than half of adults with SPD had been advised to increase exercise (49.4%) or reduce dietary fat intake (45.6%). The prevalence of receiving provider advice increased in a linear fashion as the number of diabetes risk factors increased and was the highest among those with diabetes. Provision of provider advice was strongly associated with clinical factors rather than individuals’ sociodemographic characteristics and current health behaviors. Conclusions Health care providers are missing opportunities to provide exercise and low-fat dietary advice to patients with SPD before they manifest clinical risk factors associated with diabetes. It is important that providers counsel them as early as possible about exercise and nutritional changes that reduce the risks associated with diabetes.
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Affiliation(s)
- Xiaoling Xiang
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
| | - Rosalba Hernandez
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
| | - Christopher R. Larrison
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
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Serious Psychological Distress as a Barrier to Cancer Screening Among Women. Womens Health Issues 2015; 25:49-55. [DOI: 10.1016/j.whi.2014.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/16/2014] [Accepted: 09/02/2014] [Indexed: 11/24/2022]
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Stockbridge EL, Wilson FA, Pagán JA. Psychological distress and emergency department utilization in the United States: evidence from the Medical Expenditure Panel Survey. Acad Emerg Med 2014; 21:510-9. [PMID: 24842501 DOI: 10.1111/acem.12369] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/12/2013] [Accepted: 12/01/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Psychological distress not only has substantial health and social consequences, but is also associated with emergency department (ED) use. Previous studies have typically used cross-sectional data to focus on the relation between serious psychological distress and dichotomized ED utilization measures, without assessing the volume of ED use or examining nonserious levels of psychological distress. The objective of this study was to explore the association between ED utilization volume and the full spectrum of psychological distress. METHODS Data from Panel 14 of the Medical Expenditure Panel Survey (MEPS; 2009-2010, n = 9,743) provided a nationally representative sample of U.S. individuals. ED utilization volume and three specifications of the Kessler Psychological Distress Scale (K6) were analyzed: a dichotomous serious/no serious psychological distress measure, a five-category ordinal measure, and a scale measure with a range of 0 to 24. Negative binomial-logit hurdle regression models were used to analyze how the different specifications of the K6 psychological distress measure were related to ED use. RESULTS Adults with serious psychological distress in 2009 had 1.59 (95% confidence interval [CI] = 1.15 to 2.20) times greater adjusted odds of having one or more ED visits in 2010 than those without serious psychological distress. Nonserious psychological distress levels in 2009 were also associated with increased adjusted odds of having at least one ED visit in 2010. The K6 scores showed a dose-response relationship in terms of the adjusted odds of having one or more ED visits. The adjusted odds ratios (ORs) were 1.86 (95% CI = 1.37 to 2.54) for adults with K6 scores at or above 11, OR 1.76 (95% CI = 1.38 to 2.25) for adults with K6 scores between 6 and 10, OR 1.33 (95% CI = 1.05 to 1.68) for adults with K6 scores between 3 and 5, and OR 1.17 (95% CI = 0.92 to 1.48) for adults with K6 scores of 1 or 2. In addition, the adjusted odds of having one or more ED visits in 2010 significantly increased with increasing psychological distress in 2009 (OR = 1.04, 95% CI = 1.03 to 1.06). Each additional point added to the K6 scale results in an increase in the adjusted odds of an ED visit. CONCLUSIONS Even a low level of psychological distress, and not just serious psychological distress, may be an early indicator of future ED use. These results highlight the need to develop novel responses to better manage or avert ED use not only for adults with serious psychological distress but also for those who are experiencing even mild symptoms of psychological distress.
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Affiliation(s)
- Erica L. Stockbridge
- The School of Public Health; Department of Health Management and Policy; University of North Texas Health Science Center; Fort Worth TX
- The Analytic Services Department; Magellan Health Services Maryland Heights; MO
| | - Fernando A. Wilson
- College of Public Health Department of Health Services Research & Administration; University of Nebraska Medical Center; Omaha NE
| | - José A. Pagán
- The Center for Health Innovation; The New York Academy of Medicine; New York NY
- The Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia PA
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Ye J, Shim R, Rust G. Health care avoidance among people with serious psychological distress: analyses of 2007 Health Information National Trends Survey. J Health Care Poor Underserved 2014; 23:1620-9. [PMID: 23698676 DOI: 10.1353/hpu.2012.0189] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Using data of 2007 Health Information National Trends Survey, we investigated the association between individuals' psychological distress and their reported avoidance of medical care and assessed whether people with serious psychological distress (SPD) were more likely to report psychosocial barriers to care. After controlling for demographic and health characteristics, individuals with SPD were more likely than those without SPD to report having avoided visiting a doctor even when they suspected they should (OR=1.64, 95% CI=1.08-2.48). The distressed individuals were also more likely to agree that they avoided a doctor because of fear of having a serious illness (OR=1.99, 95% CI=1.15-3.44) or thinking about dying (OR=2.15, 95% CI=1.12-4.11). Further understanding of the mechanism under which an individuals' mental health status may influence their perceived need for health and their use of medical services would improve the interface between mental health and primary care services.
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Affiliation(s)
- Jiali Ye
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr., Atlanta, GA 30310, USA.
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Coughlan D, Yeh ST, O'Neill C, Frick KD. Evaluating direct medical expenditures estimation methods of adults using the medical expenditure panel survey: an example focusing on head and neck cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:90-7. [PMID: 24438722 DOI: 10.1016/j.jval.2013.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 10/08/2013] [Accepted: 10/17/2013] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To inform policymakers of the importance of evaluating various methods for estimating the direct medical expenditures for a low-incidence condition, head and neck cancer (HNC). METHODS Four methods of estimation have been identified: 1) summing all health care expenditures, 2) estimating disease-specific expenditures consistent with an attribution approach, 3) estimating disease-specific expenditures by matching, and 4) estimating disease-specific expenditures by using a regression-based approach. A literature review of studies (2005-2012) that used the Medical Expenditure Panel Survey (MEPS) was undertaken to establish the most popular expenditure estimation methods. These methods were then applied to a sample of 120 respondents with HNC, derived from pooled data (2003-2008). RESULTS The literature review shows that varying expenditure estimation methods have been used with MEPS but no study compared and contrasted all four methods. Our estimates are reflective of the national treated prevalence of HNC. The upper-bound estimate of annual direct medical expenditures of adult respondents with HNC between 2003 and 2008 was $3.18 billion (in 2008 dollars). Comparable estimates arising from methods focusing on disease-specific and incremental expenditures were all lower in magnitude. Attribution yielded annual expenditures of $1.41 billion, matching method of $1.56 billion, and regression method of $1.09 billion. CONCLUSIONS This research demonstrates that variation exists across and within expenditure estimation methods applied to MEPS data. Despite concerns regarding aspects of reliability and consistency, reporting a combination of the four methods offers a degree of transparency and validity to estimating the likely range of annual direct medical expenditures of a condition.
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Affiliation(s)
- Diarmuid Coughlan
- Economics of Cancer Research Group, Department of Economics, National University of Ireland, Galway, Ireland.
| | - Susan T Yeh
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ciaran O'Neill
- Economics of Cancer Research Group, Department of Economics, National University of Ireland, Galway, Ireland
| | - Kevin D Frick
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dallo FJ, Kindratt TB, Snell T. Serious psychological distress among non-Hispanic whites in the United States: the importance of nativity status and region of birth. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1923-30. [PMID: 23661150 DOI: 10.1007/s00127-013-0703-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 04/29/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE Serious psychological distress (SPD) is an understudied health topic. When studied, estimates for minority groups are compared to that of non-Hispanic whites. Non-Hispanic whites are heterogeneous, and comprise individuals from Europe, North Africa or the Middle East. The objectives of this study are to estimate and compare the sex- and age-adjusted prevalence of SPD first by nativity status and then by region of birth (Europe, Middle East and Russia) while controlling for potential confounders. METHODS The sample consisted of 196,483 participants, 18 years of age or older in the National Health Interview Survey (2000-2010). To measure SPD, Kessler's K6 Likert scale was used. Individuals with scores greater than or equal to 13 were considered to have SPD. RESULTS The age- and sex- adjusted prevalence of SPD was 3 % for foreign-born non-Hispanic whites. Of this, estimates were 6 % for those from the Middle East, 3 % for Europe and 2 % for Russia (p = 0.00). In the fully adjusted multivariable model, foreign-born non-Hispanic whites from the Middle East were more likely (OR = 1.76; 95 % CI = 1.01, 3.04) to report SPD when compared to US-born non-Hispanic whites. Within the foreign-born population, non-Hispanic whites from the Middle East were more than twice as likely to report SPD (OR = 2.43; 95 % CI = 1.15, 5.14) compared to foreign-born non-Hispanic whites from Europe after controlling for confounders. CONCLUSIONS This study's findings will help researchers understand which subgroups within non-Hispanic whites suffer most from SPD, which will facilitate tailored prevention intervention efforts.
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Affiliation(s)
- Florence J Dallo
- Wellness, Health Promotion and Injury Prevention, School of Health Sciences, Oakland University, Rochester, MI, 48309-4428, USA,
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Vilhjalmsson R, Gudmundsdottir G. Psychological distress and professional help-seeking: a prospective national study. Scand J Caring Sci 2013; 28:273-80. [PMID: 23692278 DOI: 10.1111/scs.12056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 05/06/2013] [Indexed: 11/27/2022]
Abstract
The study focuses on use of different healthcare providers in connection with elevated levels of psychological distress. The study used a prospective design based on two waves of a national health survey. Participants were Icelandic citizens, age 18-75, randomly drawn from the National Register (N = 1592). Distressed individuals chose a wide range of providers. The choice of provider was based in part on the type of distress experienced, although most individuals turned to the general medical sector. Psychophysiological symptoms were primarily related to visiting physicians (other than psychiatrists). Depression was related to visiting psychiatrists, and anxiety was related to visiting psychiatrists, psychologists and nurses. Anger/aggression was primarily related to visiting clergy. Between 10% and 16% of distressed individuals did not receive any help from the formal healthcare system within 1 year. Studies addressing professional help-seeking for psychological distress should closely consider the various factors facilitating and hampering use of health services for different forms of distress.
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Chi DL, Carpiano RM. Neighborhood social capital, neighborhood attachment, and dental care use for Los Angeles Family and Neighborhood Survey adults. Am J Public Health 2013; 103:e88-95. [PMID: 23409881 DOI: 10.2105/ajph.2012.301170] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the hypothesis that neighborhood-level social capital and individual-level neighborhood attachment are positively associated with adult dental care use. METHODS We analyzed data from the 2000-2001 Los Angeles Family and Neighborhood Survey that were linked to US Census Bureau data from 2000 (n = 1800 adults aged 18-64 years across 65 neighborhoods). We used 2-level hierarchical logistic regression models to estimate the odds of dental use associated with each of 4 forms of social capital and neighborhood attachment. RESULTS After adjusting for confounders, the odds of dental use were significantly associated with only 1 form of social capital: social support (adjusted odds ratio [AOR] = 0.85; 95% confidence interval [CI] = 0.72, 0.99). Individual-level neighborhood attachment was positively associated with dental care use (AOR = 1.05; 95% CI = 1.01, 1.10). CONCLUSIONS Contrary to our hypothesis, adults in neighborhoods with higher levels of social capital, particularly social support, were significantly less likely to use dental care. Future research should identify the oral health-related attitudes, beliefs, norms, and practices in neighborhoods and other behavioral and cultural factors that moderate and mediate the relationship between social capital and dental care use.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA 98195-7475, USA.
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Abstract
With the development of a measure of serious psychological distress (SPD) in 2002, more attention is being paid to the association of SPD with diabetes outcomes and processes of care. We review the literature on the relationship between SPD and diabetes processes of care and outcomes, as well as the literature on the relationship between specific mental health diagnoses and diabetes processes of care and outcomes during the 2010 to 2011 period. There is an extensive literature on the association of mental health diagnoses with diabetes outcomes, especially for depression. Because the Kessler scale measures a much broader range of mental health issues than any specific DSM-IV/Structured Clinical Interview for DSM Disorders diagnosis and is designed to assess SPD at the population level, additional research needs to be conducted both in clinical settings and using large administrative datasets to examine the association between SPD and diabetes outcomes and processes of care.
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