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Shah K, Kumari R, Jain M. Unveiling stress markers: A systematic review investigating psychological stress biomarkers. Dev Psychobiol 2024; 66:e22490. [PMID: 38680082 DOI: 10.1002/dev.22490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024]
Abstract
Psychological stress is a ubiquitous facet of modern life, impacting individuals across diverse contexts and demographics. Understanding its physiological manifestations through biomarkers has gained substantial attention within the scientific community. A comprehensive search was conducted across multiple databases for peer-reviewed articles published within the past decade. Preliminary findings reveal many biomarkers associated with psychological stress across different biological systems, including the hypothalamic-pituitary-adrenal axis, immune system, cardiovascular system, and central nervous system. This systematic review explores psychological, physiological, and biochemical biomarkers associated with stress. Analyzing recent literature, it synthesizes findings across these three categories, elucidating their respective roles in stress response mechanisms. Psychological markers involve subjective assessments like self-reported stress levels, perceived stress scales, or psychometric evaluations measuring anxiety, depression, or coping mechanisms. Physiological markers include heart rate variability, blood pressure, and immune system responses such as cytokine levels or inflammatory markers. Biochemical markers involve hormones or chemicals linked to stress. It includes cortisol, catecholamines, copeptin, salivary amylase, IL-6, and C-reactive protein.
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Affiliation(s)
- Khushi Shah
- Cell and Developmental Biology Lab, Research and Development Cell, Parul University, Vadodara, Gujarat, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
| | - Ruchi Kumari
- Cell and Developmental Biology Lab, Research and Development Cell, Parul University, Vadodara, Gujarat, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
| | - Mukul Jain
- Cell and Developmental Biology Lab, Research and Development Cell, Parul University, Vadodara, Gujarat, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
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Choi NG, Marti CN, Choi BY. Mental Health Treatment Use, Perceived Treatment Need, and Reasons for Non-Use Among U.S. Adults with Serious Suicidal Thoughts During the COVID-19 Pandemic. Community Ment Health J 2024; 60:972-984. [PMID: 38372825 DOI: 10.1007/s10597-024-01249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
Analyzing the 2021 National Survey on Drug Use and Health data with generalized linear models, we examined: (1) COVID pandemic-related and other correlates of mental health treatment use and unmet perceived treatment need among U.S. adults who experienced serious suicidal thoughts (N = 3,177); and (2) correlates of self-reported reasons for not receiving treatment. We found that 61% used any mental health treatment, and 48% of users and 37% of nonusers reported perceived treatment need. Significant correlates of treatment use were demographic factors, insurance, major depressive disorder, and illicit drug use disorder. Significant correlates of perceived treatment need were age 18-34, some college education, and major depressive episode. Perceived negative effect of the COVID pandemic on mental health was a significant factor for both treatment use and perceived need. The most frequent reasons for not getting treatment were the cost of treatment or lack of insurance and stigma-related concerns.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Philadelphia, USA
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Kohl F, Angerer P, Weber J. Determinants of the intention to seek psychotherapeutic consultation at work - a cross-sectional study in Germany. BMC Public Health 2023; 23:1945. [PMID: 37805517 PMCID: PMC10559521 DOI: 10.1186/s12889-023-16852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Psychotherapeutic consultation at work (PT-A) provides employees with mental illnesses or subclinical symptoms a short-term and low-threshold access to psychotherapeutic care. However, practical experience shows that the utilisation rate seems low compared to expected demand. Therefore, this study aimed to identify determinants of utilisation by exploring associations between sociodemographic characteristics, psychological well-being, stigma-related barriers and psychosocial safety climate and the intention to seek PT-A. METHODS Within a cross-sectional study, 658 participants were recruited via various social media channels in Germany. Participants answered an online questionnaire on potential determinants of (1) intention to seek PT-A in general and of intention to seek PT-A to specifically discuss (2) occupational burden and (3) private burden. Multiple ordinal regression analyses were conducted for the whole study sample and for the subgroups of participants screened positive and negative for current depression. RESULTS Lower stigma-related barriers were associated with higher general intention to seek PT-A among all study groups. Lower psychological well-being was associated with higher general intention to seek PT-A and with higher intention to seek PT-A to discuss occupational and private burden, but only so in the subgroup of employees who were screened negative for current depression. Treatment experience was associated with higher intention to seek PT-A for occupational burden among participants screened negative but not among participants screened positive for current depression. No associations were found between age, gender, education or psychosocial safety climate and any variable of intention to seek PT-A. CONCLUSION Those results give an overview on potential determinants for the intention to seek PT-A, but future research with longitudinal designs is needed to confirm that those factors also determine actual utilisation of PT-A. Based on the results, practical implications might include antistigma campaigns and promotion of PT-A adapted to the aims of the consultation.
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Affiliation(s)
- Fiona Kohl
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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Liu Y, O’Grady MA. A cross-sectional study of the relationship between depression status, health care coverage, and sexual orientation. DISCOVER MENTAL HEALTH 2023; 3:13. [PMID: 37861944 PMCID: PMC10501004 DOI: 10.1007/s44192-023-00039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/22/2023] [Indexed: 10/21/2023]
Abstract
Health care coverage is an important factor in receipt of behavioral healthcare. This study uses data from the New York City Community Health Survey to examine how sexual minority status impacts the relationship between depression status and having health care coverage. Approximately 10% of the sample (n = 9571; 47% 45+ years old; 35% White Non-Hispanic; 7% sexual minority) reported probable depression and low health care coverage. Compared to heterosexual participants, a greater proportion of sexual minority participants had low health care coverage (17% vs. 9%) and probable depression (19% vs. 9%). Logistic regression examining the association between probable depression status and health care coverage showed that those with probable depression have odds of low health care coverage that are were 3.08 times those who did not have probable depression; this relationship was not modified by sexual orientation. Continued research to understand the interplay of health care coverage, mental health, and sexual orientation is needed.
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Affiliation(s)
- Yang Liu
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, USA
| | - Megan A. O’Grady
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, USA
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Huang W, Li G, Wang D, Qu H, Tian M, Wang Y. Postpartum depression literacy in Chinese perinatal women: a cross-sectional study. Front Psychiatry 2023; 14:1117332. [PMID: 37389174 PMCID: PMC10306307 DOI: 10.3389/fpsyt.2023.1117332] [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: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 07/01/2023] Open
Abstract
Background Postpartum depression literacy is a specific mental health literacy that can help perinatal women identify, manage, and prevent postpartum depression. However, the current status and associated factors of postpartum depression literacy among Chinese perinatal women are still unclear. This study investigated postpartum depression literacy and its associated factors among this group. Methods A cross-sectional survey was conducted involving 386 cases of perinatal women using the convenience sampling method. Participants completed four questionnaires to evaluate their general characteristics, postpartum depression literacy, perceived social support, and general self-efficacy. The SPSS 24.0 software was used for descriptive statistical analysis, univariate analysis, and multivariate analysis. Results The total PoDLiS score was (3.56 ± 0.32). The factors that composed the final multiple regression equation included planned pregnancy condition (β = -0.137, p = 0.003), education (β = 0.127, p < 0.001), history of depression (β = -0.271, p < 0.001), social support (β = 0.0012, p < 0.001), self-efficacy (β = 0.030, p < 0.001), and complications (β = -0.0191, p = 0.0019). They accounted for 32.8% of the total postpartum depression literacy variation (R2 = 0.328, F = 24.518, p < 0.001). Conclusion The findings of this study improved our understanding of perinatal women's postpartum depression literacy and its associated factors. Women with low postpartum depression literacy urgently need to be identified. Comprehensive nursing intervention measures should be taken from six dimensions of mental health literacy, social support, and self-efficacy to improve the postpartum depression literacy of perinatal women.
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Affiliation(s)
- Weijian Huang
- Eastern Operating Room, Yantai Yuhuangding Hospital, Yantai, China
| | - Guiqin Li
- Obstetrics Department, Yantai Yuhuangding Hospital, Yantai, China
| | - Dongmei Wang
- Obstetrics Department, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Hua Qu
- Obstetrics Department, Yantai Yuhuangding Hospital, Yantai, China
| | - Maozhou Tian
- Department of Cardiac Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Yanmei Wang
- Hemodialysis Department, Yantai Yuhuangding Hospital, Yantai, China
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Goodwin J, Cummins J, O'Malley M. "I thought it would just be, like, older men in white coats": A qualitative exploration of first encounters with mental health services. Int J Ment Health Nurs 2023. [PMID: 37114682 DOI: 10.1111/inm.13157] [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: 01/23/2023] [Revised: 03/28/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Individuals whose mental health is becoming a concern may not receive the care they require. Although efforts have been made to reduce barriers to accessing services, including stigma reduction campaigns and healthcare practitioner training, there remains a lack of understanding of individual perspectives regarding help-seeking behaviour. The aim of this study was to explore people's first experiences accessing mental health services. A qualitative descriptive approach was adopted. Interviews were conducted with eight service users. Data were analysed using reflexive thematic analysis. The COREQ checklist guided this study (Tong et al., 2007, International Journal for Quality in Health Care, 19, 349). Three themes were identified: learning to navigate an unfamiliar system, making sense of mental health services, and promoting a positive image for those in need of care. Uncertainty about mental health services and stigmatizing images could be mitigated by developing positive media-based interventions. Systemic barriers need to be addressed and services need to be better resourced to ensure the benefits of early intervention are available to those experiencing mental health challenges. To encourage people to access services earlier, services need to be promoted in a positive way.
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Affiliation(s)
- John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Cummins
- Student Health and Wellbeing, University College Cork, Cork, Ireland
| | - Maria O'Malley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Understanding the Association Between Mental Health Knowledge and Mental Health Service Utilization Among Black Adults. Community Ment Health J 2023; 59:57-67. [PMID: 35794413 PMCID: PMC10371774 DOI: 10.1007/s10597-022-00988-w] [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: 10/11/2021] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
Mental health knowledge limitations may contribute to the treatment gap among Black adults. We conducted an online cross-sectional study of Black adults in the United States (n = 262, aged 18-65 years) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). Gamma regression using generalized linear models was used to estimate the associations between mental health knowledge and willingness to seek help from mental health professionals. After adjusting for age, education and ethnicity, participants with higher specific knowledge about mental health (such as recognition of schizophrenia as a mental illness) were 26% more likely to report willingness to seek help from a mental health professional for personal and emotional problems (RR = 1.26, CI 1.12-1.41, p < 0.001). Knowledge building interventions (such as psychoeducation) that seek to increase specific knowledge (rather than general knowledge) may correlate more strongly with utilization of mental health services among Black adults.
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Vohra-Gupta S, Petruzzi L, Jones C, Cubbin C. An Intersectional Approach to Understanding Barriers to Healthcare for Women. J Community Health 2023; 48:89-98. [PMID: 36273069 PMCID: PMC9589537 DOI: 10.1007/s10900-022-01147-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/27/2022]
Abstract
Access to health care depends on multiple sociodemographic factors such as race/ethnicity, marital status, education, income, and insurance status. However, a paucity of research has examined access to healthcare disparities as they uniquely affect women, specifically women of color. National data were analyzed from the Medical Expenditure Panel Survey (MEPS) utilizing an 11-year sample (2005-2015) of women ages 18-74 (N = 128,355). More recent data were not included due to changes in how sampling was conducted after 2015. Predictor variables included race/ethnicity cross-classified with marital status, education, income, or insurance status, controlling for age. A dichotomous outcome variable called "any barriers to healthcare" was created based on usual source of care, delayed medical care, delayed dental care and delayed prescription care. Multivariate logistic regression models were used to identify associations with barriers to care. The foundation of this methodology is intersectionality and how it impacts access to care for women across social identities. Hispanic women (OR 1.08, 95% CI 1.02-1.14) had higher odds of having a barrier to care compared to White women. However, Black women (OR 0.92, 95% CI 0.87-0.97) had lower odds of having a barrier to care compared to White women. Race/ethnicity also significantly moderated the relationship between socioeconomic variables (marital status, income, education and insurance status) and having a barrier to care. To achieve a healthy community, addressing these racial/ethnic and socioeconomic inequalities helps to support the people who live and work within these communities.
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Affiliation(s)
- Shetal Vohra-Gupta
- The Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Liana Petruzzi
- The Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Casey Jones
- Youth & Opportunity United, 1911 Church Street, Evanston, IL 60201 USA
| | - Catherine Cubbin
- The Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
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Badu E, O'Brien AP, Mitchell R, Osei A. Factors associated with the quality of mental health services and consumers' functionality using tertiary-based services. Perspect Psychiatr Care 2022; 58:592-607. [PMID: 33942311 DOI: 10.1111/ppc.12820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/25/2021] [Accepted: 04/09/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Assess factors associated with the quality of mental health services. DESIGN AND METHODS Cross-sectional design, quantitative data, and 510 consumers from three psychiatric facilities. RESULTS The average age of consumers was 34 years and 51.57% males. Consumers reported mixed satisfaction with the quality of mental health services (mean = 3.2; SD = 0.56) but were dissatisfied with the range of interventions (mean = 1.57; SD = 0.77). Predisposing (age, education, and primary occupation), enabling (insurance status), and need factors (mental health status) were significantly associated with quality indicators (range of interventions, efficacy, and overall satisfaction). These factors were significantly associated with consumers' functionality (cognition, mobility, self-care, getting along, life activities, and participation). PRACTICE IMPLICATIONS Policymakers and clinicians are encouraged to incorporate the predisposing, enabling, and need factors into mental health planning, monitoring, and advocacy to improve service outcomes.
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Affiliation(s)
- Eric Badu
- School of Nursing and Midwifery, Faculty Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Anthony P O'Brien
- Faculty of Health, Southern Cross University, New South Wales, Australia
| | - Rebecca Mitchell
- Health & Wellbeing Research Unit (HoWRU), Macquarie Business School, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Akwasi Osei
- Ghana Mental Health Authority, Ghana Health Services, Accra, Ghana
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Zou S, Qi X, Marshall K, Bhura M, Takesue R, Tang K. Understanding the context of healthcare utilisation for children under-five with diarrhoea in the DRC: based on Andersen behavioural model. BMC Health Serv Res 2022; 22:144. [PMID: 35120503 PMCID: PMC8815172 DOI: 10.1186/s12913-022-07530-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrhoea is one of the leading causes of death among children under 5 years old in the Democratic Republic of the Congo (DRC). Despite positive effects on prognosis, there is limited literature about the healthcare-seeking behaviours of children with diarrhoea, especially in the DRC. This study used the Andersen Behavioural Model, a theoretical framework, which was commonly adopted to study healthcare utilisation, to investigate and predict factors associated with the use of healthcare to treat diarrhoea in the DRC. METHODS Data collected from 2626 under-five children with diarrhoea in the last 2 weeks from the Multiple Indicators Cluster Survey conducted by the National Institute of Statistics in 2017-2018, in collaboration with the United Nations Children's Fund were used in this study. Both direct and indirect relationships among four latent variables: predisposing traits, enabling resources access, health needs, and health services use were measured using the structural equation modelling to test the Andersen behavioural model. The confirmatory Factor Analysis model was also modified based on the DRC context to explore this further. RESULTS The modified model had the goodness of fit index (GFI) of 0.972, comparative fit index (CFI) of 0.953 and RMSEA of 0.043 (95% CI: 0. 040, 0.047). Health needs (especially diarrhoea) had the largest positive direct effect on healthcare utilisation (standardized regression coefficient [β] = 0.135, P < 0.001), followed by "enabling resources" (β = 0.051, P = 0.015). Health needs also emerged as a mediator for the positive effect of predisposing on utilisation (indirect effect, β = 0.014; P = 0.009). CONCLUSION Access to improved water and improved sanitation, as well as socioeconomic factors like household wealth, were significantly associated with health-seeking behaviours for diarrhoea treatment in the DRC. Besides, caregivers who own higher levels of educational attainments were more inclined to have positive health services uses during the treatments. Efforts are needed to enhance the oral rehydration therapy coupled with educating caregivers on its appropriate use.
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Affiliation(s)
- Siyu Zou
- Vanke School of Public Health, Tsinghua University, Beijing, 100191, China.,School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xinran Qi
- School of Nursing, Capital Medical University, Beijing, China
| | - Keiko Marshall
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Maria Bhura
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rie Takesue
- Health Section Programme Division, UNICEF Headquarters, New York, USA
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, 100191, China.
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Health care utilization in very advanced ages: A study on predisposing, enabling and need factors. Arch Gerontol Geriatr 2021; 98:104561. [PMID: 34706319 DOI: 10.1016/j.archger.2021.104561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022]
Abstract
This study aims to examine the effects of predisposing, enabling, and need factors on healthcare utilization in advanced age. Data from a sample of 270 Portuguese community-dwelling persons aged ≥80 years was used. Face-to-face interviews were conducted and included the application of a research protocol addressing a set of sociodemographic and health-related variables that expressed the Andersen Behavioral model (i.e., predisposing, enabling, and need factors). Predictors of visits to general practitioners (GP) and specialist physicians, as well as emergency department (ED) use and hospitalizations were investigated. Multivariate linear and logistic regression analyzes were used to model the effects of predictor factors specified in the Andersen Behavioral model. Our findings underscore that younger age and having multimorbidity were significantly associated with having GP visits. Specialist physician visits were associated with younger age and a higher number of daily medications. ED use was associated with being male, having formal social support and a higher number of daily medications. Hospitalizations were associated with being younger, being male and having multimorbidity. Our findings revealed that need and predisposing factors determined the most healthcare use.
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Trusty WT, Swift JK, Rasmussen EB. A Behavioral Economic Model of Help-Seeking for Depression. Perspect Behav Sci 2021; 44:541-560. [DOI: 10.1007/s40614-021-00308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/28/2022] Open
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Dwivedi R, Pradhan J, Athe R. Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India. Int J Health Plann Manage 2021; 36:1887-1915. [PMID: 34196030 DOI: 10.1002/hpm.3272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022] Open
Abstract
Healthcare expenditure significantly varies among various segments of the population. The appropriate measures of catastrophic health expenditure (CHE) will help to unravel the real burden of spending among households. Present study provides a link between the theoretical insights from Grossman's model and various methodological approaches for the estimation of CHE by using data from the three rounds of nationally representative Consumer Expenditure Surveys, India. Statistical analysis has been carried out by using multivariate logistic regression to identify the major determinants of CHE. Findings indicate that the occurrence of CHE has increased during 1993-2012. Rural residents and households with varying age composition such as with higher numbers of children and elderly were at higher risk. Economic status is significantly associated with CHE and increased demand for healthcare. The measurements differ as per the methodological approaches of CHE and definition of household's capacity to pay. Approach-based variations in the results can be of key importance in determining trends and magnitude in CHE. Despite these variations in measurements, study finds a limited incidence of CHE among the disadvantaged segment of the population though a greater share was devoted to health expenditure in recent years. Better risk pooling mechanism is required to address the healthcare needs of the disadvantaged segment such as elderly, children, poor and rural population in India.
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Affiliation(s)
- Rinshu Dwivedi
- Department of Science and Humanities, Indian Institute of Information Technology, Trichy, Tamil Nadu, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha, India
| | - Ramesh Athe
- Department of Humanities and Sciences, Indian Institute of Information Technology, Dharwad, Karnataka, India
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Meng D, Xu G, Davidson PM. Perceived unmet needs for community-based long-term care services among urban older adults: A cross sectional study. Geriatr Nurs 2021; 42:740-747. [PMID: 33872858 DOI: 10.1016/j.gerinurse.2021.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to explore the perceived unmet needs for community-based long-term care services among older urban adults in China. We analyzed the cross-sectional data of 5,201 urban community respondents ≥65 years of age from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The chi-squared automatic interaction detection technique was used to examine the variables associated with older adults' unmet needs for four common types of community-based services: personal care, grocery shopping, home visits, and psychological consulting. We found that the majority of the older adults perceived that they needed the four services, but only 9%-27.4% of the respondents reported that their perceived needs were met. There was a high prevalence of unmet community-based service needs (51.3%-55.5%) among urban older adults in China. Factors associated with unmet needs included depression status, ADL (activities of daily living) limitations, self-rated health, number of surviving children, educational attainment, and marital status. The results suggest that policy makers should develop services targeting specific segments of the older population, increasing the adequacy of services provided.
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Affiliation(s)
- Dijuan Meng
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
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Baek S, Choi EH, Lee J. Unmet Healthcare Needs of Children in Vulnerable Families in South Korea: Finding from the Community Child Center Child Panel Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218241. [PMID: 33171882 PMCID: PMC7664643 DOI: 10.3390/ijerph17218241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
Presented in this paper is a study that examined the status of unmet healthcare needs of children in vulnerable families and identified factors affecting such unmet needs. The Community Child Center (CCC) Child Panel Survey data in Korea were used. A multiple stepwise logistic regression analysis was performed to examine factors influencing unmet healthcare needs of children. Influencing factors comprised predisposing, enabling, and need factors based on the Andersen Behavioral Model of Health Services Utilization. A total of 340 sixth-graders from vulnerable families participated, and 96 (28.2%) children had unmet healthcare needs. Factors included absence of an after-school caregiver (OR = 1.95, 95% CI [1.16, 3.27]), perceived physical symptoms (OR = 1.33, 95% CI [1.02, 1.73]), parental indifference (OR = 1.33, 95% CI [1.002, 1.77]), duration of daily stay at CCCs (OR = 1.32, 95% CI [1.01, 1.71]), and satisfaction with CCC teachers (OR = 0.65, 95% CI [0.49, 0.85]). The relationship with parents and CCC teachers had the strongest influence on unmet healthcare needs of children. In order to reduce the unmet healthcare needs of children in vulnerable families, existing support structures should be expanded to offer financial and administrative support for children’s parents and CCC teachers.
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Affiliation(s)
- Suyon Baek
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju-si 32588, Korea;
| | - Eun-Hi Choi
- College of Nursing, Eulji University, Daejeon 34824, Korea
- Correspondence:
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI 02881, USA;
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Youn HM, Kang SH, Jang SI, Park EC. Association between social participation and mental health consultation in individuals with suicidal ideation: a cross-sectional study. BMC Psychiatry 2020; 20:305. [PMID: 32546143 PMCID: PMC7296757 DOI: 10.1186/s12888-020-02724-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 06/09/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Suicidal ideation is a significant public health concern worldwide. Although suicides might be preventable through the provision of adequate treatment, mental health consultation is still mostly underutilized. This study thus aimed to examine the association between social participation and utilization of mental health consultations in individuals with suicidal ideation. METHODS Data were collected from the nationwide Community Health Survey (conducted by the Korea Centers for Disease Control and Prevention, 2017). A total of 17,067 individuals (men: 32.9%, women: 67.1%) who reported experiencing suicidal ideation were included in the analysis. The mean age of the study population was 60.1 (±17.8) years old. This study examined social participation; the number of social activities participated in among leisure, volunteer, social, and religion related activities. Multivariate logistic regression was then used to assess the significance of these associations. RESULTS Among those experienced suicidal ideation, 1860 (10.9%) reported receiving mental health consultation services (men: 8.8%, women: 11.9%). Overall, an increased social participation was significantly associated with increased odds of using forms of mental health consultation (OR = 1.65, 95% CI: 1.31-2.09). CONCLUSIONS In this study, significant evidence of the links between social participation and utilization of mental health consultation was discovered among at risk individuals with suicidal ideation. Suicide prevention policies and programs designed to enhance social participation could potentially encourage people at suicide risk to seek the help they need. Further research focusing on social approaches can produce useful information to plan and implement comprehensive and effective strategies.
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Affiliation(s)
- Hin Moi Youn
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Soo Hyun Kang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Jiang L, Ye L, Dai M, Zhou J, Li Q. Use Andersen's behavior model to explain non-urgent visits in emergency department: A single center study in southwest China. Int Emerg Nurs 2020; 52:100845. [PMID: 32205107 DOI: 10.1016/j.ienj.2020.100845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/26/2019] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Non-urgent ED visit was an important contributor of emergency overcrowding. Previous studies showed that patients make non-urgent ED visits for many reasons and their ED use patterns may be influenced by many factors. However, seldom studies were theory-based research aimed to offer a systemic insight regarding this question. METHODS This was a cross-sectional study conducted in the ED of a tertiary hospital in China guided by Andersen's behavior model of health service use. Patients triaged as non-urgent were surveyed using a self-administrated questionnaire to investigate the reasons for ED presentation and associated factors influenced their ED use patterns. RESULTS Perceived severity of illness and urgent treatment need (374, 68.6%), accessible problems to alternative services (144, 26.4%) and referral by medical staffs (134, 24.6%) were most commonly reported reasons for ED presentation. Alternative service attempt before ED presentation was determined by two predisposing factors: education level (OR = 0.638, P < 0.05) and use of nearest medical institution (OR = 1.588, P < 0.05). Prior non-urgent ED use was explained by both predisposing and need factors. They were: nationality (OR = 3.057, P < 0.01), type of health problems (OR = 1.641, P < 0.01) and self-rated health status (OR = 0.769, P < 0.01). CONCLUSION Patients' perceived need of emergency care played an extremely important role in driving ED use although several factors were identified. Future studies aim to decrease non-urgent ED use in China may firstly gain success from patient education programs.
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Affiliation(s)
- Lingjun Jiang
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China; West China School of Nursing, West China Hospital, Sichuan University, China
| | - Lei Ye
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China.
| | - Min Dai
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
| | - Jing Zhou
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
| | - Qin Li
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
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Badu E, Mitchell R, O'Brien AP. Pathways to mental health treatment in Ghana: Challenging biomedical methods from herbal- and faith-healing perspectives. Int J Soc Psychiatry 2019; 65:527-538. [PMID: 31277557 DOI: 10.1177/0020764019862305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The clinical pathways for treating mental illness have received global attention. Several empirical studies have been undertaken on treatment pathways in Ghana. No study, however, has systematically reviewed the literature related to the pathways of mental health treatment in Ghana. AIM This article aims to identify the pathways used to treat mental illnesses; examine the evidence about the possibility of collaboration between biomedical, faith and traditional healing pathways; and draw attention to the barriers hindering such collaboration. METHODS A search of the published literature was conducted using Medline, Embase, PsycINFO, CINAHL (EBSCO), Web of Science and Scopus databases. The search was limited to the articles that were published in English and released between 2000 and June 2018. The review synthesises both qualitative and quantitative data. RESULTS The findings showed that mental illnesses in Ghana are treated using a mixture of biomedical and faith-based and traditional healing services. Faith and traditional healing pathways are typically used as a preliminary source of cultural assessment before seeking biomedical treatment. There is an increasing desire for collaboration between biomedical, faith and traditional healing pathways. However, several individual factors (attitude or stigma, the perceived efficacy of treatment and differences in the treatment process) and health system factors (a lack of policy and regulation, a limited number of biomedical service providers, limited financial support and geographical isolation of services) jointly contribute to barriers precluding establishing such collaboration. CONCLUSION This review recommends that policies, regulations, educational support and financial incentives should be developed to facilitate collaboration between biomedical, faith and traditional healing service provision.
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Affiliation(s)
- Eric Badu
- 1 School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Mitchell
- 2 Faculty of Business and Economics, Macquarie University, Sydney, NSW, Australia
| | - Anthony Paul O'Brien
- 3 Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
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Nartey AK, Badu E, Agyei-Baffour P, Gyamfi N, Opoku MP, O'Brien AP, Mitchell R. The predictors of treatment pathways to mental health services among consumers in Ghana. Perspect Psychiatr Care 2019; 55:300-310. [PMID: 30648278 DOI: 10.1111/ppc.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/29/2018] [Accepted: 12/24/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore factors influencing treatment pathways to mental health services among consumers in Ghana. DESIGN AND METHODS Cross-sectional design using quantitative method. FINDINGS Treatment pathways for mental illness were general hospitals/clinics, psychiatric hospitals, and faith-based practices. The predisposing (age, household size, primary occupation, ethnicity, marital status, religion, and geographic location, as well as attitudes and beliefs), enabling (affordability), and need factors (severity of mental illness) were significant predictors of treatment pathways. PRACTICE IMPLICATIONS Current advocacy and awareness for mental health services in Ghana should consider the predisposing, enabling, and need factors of consumers. Policy initiatives on mental health services should ensure adequate financing mechanisms and further establish collaboration between biomedical and faith-based services.
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Affiliation(s)
- Anna Korley Nartey
- Techiman Municipal Health Directorate/Ghana Health Services, Techiman, Ghana
| | - Eric Badu
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia
| | - Peter Agyei-Baffour
- Department of Health Policy, Management and Economics/School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Naomi Gyamfi
- Department of Health Promotion and Disability Studies, Centre for Disability and Rehabilitation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Rebecca Mitchell
- Faculty of Business and Economics, Macquarie University, Sydney, Australia
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20
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Loranger C, Bamvita JM, Fleury MJ. Typology of patients with mental health disorders and perceived continuity of care. J Ment Health 2019; 29:296-305. [PMID: 30862205 DOI: 10.1080/09638237.2019.1581329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: While multiple socio-demographic, clinical and service use variables have been associated with continuity of care (CoC) in patients diagnosed with mental health disorders (MHDs), little is known about how these variables may inform clinical practice and service planning.Aim: This article identified profiles of patients with MHDs to better understand their perceptions of CoC.Method: The sample for this cross-sectional study comprised 327 patients recruited by staff or self-referred from four local health networks in Quebec (Canada). Data were collected using standardized instruments, and patient medical records. A three-factor conceptual framework based on Andersen's Behavioral Model was used, integrating predisposing, needs and enabling factors.Results: Cluster analyses identified five patient profiles. Profiles that included relatively more patients with common MHDs reported less continuity than those with patients primarily affected by severe MHDs.Conclusions: Service planning and delivery should be better adapted to patient profiles in order to improve CoC, and increased access to services prioritized.
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Affiliation(s)
- Claudie Loranger
- Research Centre, Centre intégré de santé et services sociaux de l'Outaouais, Gatineau, Québec.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montréal, Québec.,Department of Psychiatry, McGill University, Montréal, Québec
| | - Jean-Marie Bamvita
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montréal, Québec.,Department of Psychiatry, McGill University, Montréal, Québec
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montréal, Québec.,Department of Psychiatry, McGill University, Montréal, Québec
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Badu E, O’Brien AP, Mitchell R. An integrative review of potential enablers and barriers to accessing mental health services in Ghana. Health Res Policy Syst 2018; 16:110. [PMID: 30445980 PMCID: PMC6240297 DOI: 10.1186/s12961-018-0382-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/14/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The importance of accessible mental health treatment is a global concern, particularly when one in five people will experience a mental health problem in their lifespan. This is no less important in Ghana; however, no studies have yet attempted to appraise and synthesise the potential enablers and barriers to accessing services in Ghana. The aim of this integrative review is therefore to identify and synthesise existing evidence on the barriers and enablers to accessing mental health services in Ghana. METHODS A search of the published literature was conducted using Medline, EMBASE, PsycINFO, CINAHL (EBSCO), Web of Science, and Scopus electronic databases. The search was limited to papers published in English and within 2000-2018. Using pre-defined inclusion and exclusion criteria, two reviewers independently screened the titles and abstracts of the retrieved papers. A data extraction form and a Critical Appraisal Checklist were used to extract and appraise data, respectively. The integrative review incorporates both qualitative and quantitative data into a single synthesis. RESULTS Out of 42 papers that met the inclusion criteria, 50% used qualitative methods, 33.3% used mixed methods and 16.7% used quantitative methods alone. The potential barriers in accessing mental health services were attitudinal, knowledge about services, treatment cost, transportation and geographical proximity, as well as perceived efficacy of medication. Similarly, the health systems factors contributing to barriers were low priority, limited funding sources, irregular medicine supply, limited services for marginalised groups and poor state of psychiatric facilities, together with poor management of mental health cadres. The potential enablers for service users involved increased decentralisation and integration, task-shifting and existing support services. CONCLUSION The existing evidence on mental health in Ghana is skewed towards weaknesses in the systems and stigma, with rationally little, or no, evidence or emphasis on the effectiveness, or quality of mental health services. These attributes largely neglect the provision of psychiatric services for marginalised mental health service user groups, including children, adolescents, people with disabilities and the elderly.
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Affiliation(s)
- Eric Badu
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW Australia
| | - Anthony Paul O’Brien
- Faculty Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Newcastle, 2308 NSW Australia
| | - Rebecca Mitchell
- Health Services Research Centre, Faculty of Business and Economics, The University of Newcastle, Newcastle, NSW Australia
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Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry 2018; 18:262. [PMID: 30134869 PMCID: PMC6104009 DOI: 10.1186/s12888-018-1837-1] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). METHODS We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model. RESULTS Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors. CONCLUSION In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. TRIAL REGISTRATION PROSPERO registration number: 42016046551 .
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Affiliation(s)
- Tessa Roberts
- Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Georgina Miguel Esponda
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Dzmitry Krupchanka
- grid.447902.cDepartment of Social Psychiatry, National Institute of Mental Health, Prague, Czech Republic ,0000 0001 2322 4988grid.8591.5Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Rahul Shidhaye
- 0000 0004 1761 0198grid.415361.4Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Sujit Rathod
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Islam F, Khanlou N, Macpherson A, Tamim H. Mental Health Consultation Among Ontario's Immigrant Populations. Community Ment Health J 2018; 54:579-589. [PMID: 29147950 DOI: 10.1007/s10597-017-0210-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
To determine the prevalence rates and characteristics of past-year mental health consultation for Ontario's adult (18 + years old) immigrant populations. The Canadian Community Health Survey (CCHS) 2012 was used to calculate the prevalence rates of past-year mental health consultation by service provider type. Characteristics associated with mental health consultation were determined by carrying out multivariable logistic regression analysis on merged CCHS 2008-2012 data. Adult immigrant populations in Ontario (n = 3995) had lower estimated prevalence rates of past-year mental health consultation across all service provider types compared to Canadian-born populations (n = 14,644). Amongst those who reported past-year mental health consultation, 57.89% of Ontario immigrants contacted their primary care physician, which was significantly higher than the proportion who consulted their family doctor from Canadian-born populations (45.31%). The factors of gender, age, racial/ethnic background, education level, working status, food insecurity status, self-perceived health status, smoking status, alcohol drinking status, years since immigration, and age at time of immigration were significantly associated with past-year mental health consultation for immigrant populations. Ontario's adult immigrant populations most commonly consult their family doctor for mental health care. Potential exists for expanding the mental health care role of primary care physicians as well as efforts to increase accessibility of specialized mental health services. Integrated, coordinated care where primary care physicians, specialized mental health professionals, social workers, and community educators, etc. working together in a sort of "one-stop-shop" may be the most effective way to mitigate gaps in the mental health care system. In order to effectively tailor mental health policy, programming, and promotion to suit the needs of immigrant populations initiatives that focus on the connection between physical and mental health and migration variables such as length of stay in Canada, years since immigration, and other important migration variables (beyond the scope of the CCHS which require further study) need to be developed. Examination of the social determinants of mental health is critical to understand how we can best serve the mental health needs of Ontario's immigrant populations.
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Affiliation(s)
- Farah Islam
- School of Kinesiology and Health Science (KAHS), York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | | | - Alison Macpherson
- School of Kinesiology and Health Science (KAHS), York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Hala Tamim
- School of Kinesiology and Health Science (KAHS), York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
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Choi S. Experiencing Financial Hardship Associated With Medical Bills and Its Effects on Health Care Behavior: A 2-Year Panel Study. HEALTH EDUCATION & BEHAVIOR 2017; 45:616-624. [DOI: 10.1177/1090198117739671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using 2-year panel data, this study examined (1) whether experiencing financial hardship associated with out-of-pocket medical expenditures affected delaying/missing necessary health care in the following year; (2) whether such financial hardship mediated the effects of predisposing, enabling, and need characteristics on timely health care access (i.e., significant indirect effects); and (3)whether such mediating effects are different by chronic health status (i.e., moderated mediation) among U.S. adults. The 2011 National Health Interview Survey was linked to the 2012 Medical Expenditure Panel Survey. The sample includes 8,993 adults aged between 26 and 64 years. Among them, 1,089 reported having at least one chronic health condition that had caused activity limitations. Multiple-group path analysis was conducted using Mplus 7.2. Approximately 35% experienced financial difficulties paying medical bills, including 28% who were currently paying off medical debts. Almost 14% of the respondents reported delayed/missed necessary medical treatments. In addition to direct effects, predisposing, enabling, and need factors affected access to care indirectly via financial hardship, although significant moderated mediation was found by chronic health status. However, different from the Andersen’s behavioral model of health service utilization, the effect of financial hardship due to medical bills as a barrier to the timely use of necessary health services was not smaller among adults with chronic health conditions. Policy alternatives should be explored to provide affordable financing programs and adequate safety net health services to reduce the financial burden of health care for those who are financially vulnerable, especially those suffering from chronic health conditions.
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Affiliation(s)
- Sunha Choi
- The University of Tennessee, Knoxville, TN, USA
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