Physical-psychiatric comorbidity: Implications for health measurement and the Hispanic Epidemiological Paradox

The Effectiveness of Interventions on Improving the Mental Health Literacy of Health Care Professionals in General Hospitals: A Systematic Review of Randomized Controlled Trials

BACKGROUND

Suboptimal mental health literacy levels among general hospital health care professionals negatively impact the care coordination of patients with physical-mental comorbidity.

AIMS

This review is to examine the evidence on the effectiveness of interventions to improve the mental health literacy of general hospital health care professionals.

METHODS

A systematic search of literature was conducted in 13 electronic databases with manual searching of reference lists from 1980 to 2021. Studies were screened by pre-set eligibility criteria, that is, participants who were general hospital health care professionals taking care of adult patients, the interventions aimed at improving any components of participants' mental health literacy, comparisons were alternative active intervention or no intervention, and the primary outcomes were any aspects of mental health literacy.

RESULTS

Eight randomized controlled trials (N = 1,732 participants) were included in this review. Evidence indicated that mental health literacy interventions with educational components can improve components of the health care professionals' mental health literacy, in terms of mental health knowledge and mental illness-related attitudes/stigma. In addition, few studies evaluated all components of participants' mental health literacy.

CONCLUSIONS

Based on the available evidence, educational interventions had a positive effect on components of general hospital health care professionals' mental health literacy. Health care organizations should provide educational programs to enhance general hospital health care professionals' mental health literacy. Further studies are needed to explore interventions that target all components of general hospital staff's mental health literacy and to evaluate its impact on the psychiatric consultation-liaison service utilization in general hospitals, as well as patient outcomes.

Obesity in Latinx and White U.S. military veterans: Mental health, psychosocial burden, non-suicidal self-injury and suicidal behavior

Obesity disproportionately affects Latinx communities and is linked to an increased risk of mental health problems. Military veterans are more likely to develop mental health problems, but the role of Latinx ethnicity in moderating the association between obesity and these problems is unclear. To address this gap, this study examined psychiatric and psychosocial correlates of obesity in a nationally representative sample of Latinx and White U.S. military veterans. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed 3524 Latinx and White veterans. Analyses revealed that Latinx ethnicity moderated associations between obesity and several measures. Specifically, among veterans with obesity, Latinx veterans had higher rates of major depression, generalized anxiety, post-traumatic stress disorders, drug use disorders, non-suicidal self-injury, and higher levels of childhood trauma, loneliness, and hostility relative to White veterans. These findings underscore the importance of culturally sensitive prevention and treatment efforts to help mitigate symptoms of internalizing disorders, drug use disorder, loneliness, and hostility, and to cultivate psychosocial resources such as resilience and coping self-efficacy among Latinx veterans with obesity.

Cultural adaptations and cultural factors in EBI implementation with Latinx communities

Introduction

Cultural factors are constructs that capture important life experiences of Latinx/Hispanic individuals, families, and communities. Despite their importance for Latinx communities, Latinx cultural factors have yet to be fully incorporated into the literature of many social, behavioral science, and health service fields, including implementation science. This significant gap in the literature has limited in-depth assessments and a more complete understanding of the cultural life experiences of diverse Latinx community residents. This gap has also stifled the cultural adaptation, dissemination, and implementation of evidence based interventions (EBIs). Addressing this gap can inform the design, dissemination, adoption, implementation, and sustainability of EBIs developed to serve Latinx and other ethnocultural groups.

Methods

Based on a prior Framework Synthesis systematic review of Latinx stress-coping research for the years 2000-2020, our research team conducted a thematic analysis to identify salient Latinx cultural factors in this research field. This thematic analysis examined the Discussion sections of 60 quality empirical journal articles previously included into this prior Framework Synthesis literature review. In Part 1, our team conducted an exploratory analysis of potential Latinx cultural factors mentioned in these Discussion sections. In Part 2 we conducted a confirmatory analysis using NVivo 12 for a rigorous confirmatory thematic analysis.

Results

This procedure identified 13 salient Latinx cultural factors mentioned frequently in quality empirical research within the field of Latinx stress-coping research during the years 2000-2020.

Discussion

We defined and examined how these salient Latinx cultural factors can be incorporated into intervention implementation strategies and can be expanded to facilitate EBI implementation within diverse Latinx community settings.

The differential relationship of common health comorbidities with acculturative experiences in United States Latinxs

•A novel conceptualization of acculturation and related experiences is related to comorbidity.•Different patterns emerge in the relationship between acculturative experiences and health.•Toxic stress and social support may play differential roles in the risk for health comorbidities.

An epidemiological study of externally determined and self-identified mental and physical disability across the spectrum of bipolar disorders

BACKGROUND

Studies exploring disability in bipolar disorder (BD) have primarily assessed clinical samples of full-threshold BD-I and BD-II alongside so-called objective criteria such as unemployment or receipt of government disability payments. This study extends research on disability by examining externally determined and self-identified disability in a community sample and by including subthreshold BD (BDS).

METHODS

Data were extracted from the USA Collaborative Psychiatric Epidemiology Surveys about individuals who met recognized criteria for BD-I, BD-II and BDS who had completed self-ratings of physical and mental disability, comorbidities, and health risk factors (e.g., obesity). Rates of disability were estimated, and logistic regression analyses were used to determine demographic and clinical variables associated with externally determined and self-identified of disability.

RESULTS

Of 408 individuals who met eligibility criteria (BD-I = 100; BD-II=104; BDS=204), 35% met criteria for externally determined disability, about 40% self-reported mental disability and about 23% self-reported physical disability. The odds were three-fold (Odds Ratio (OR): 3.05; 95% Confidence Intervals (CI): 1.69, 5.53) that someone with self-identified physical disability would meet criteria for externally determined disability, but associations with mental disability were non-significant (OR: 1.06; 95% CI: 0.63, 1.80). Regression analyses demonstrated that mental disability was associated with being a current or past smoker and physical disability was associated with BD-I.

LIMITATIONS

the adequacy of the assessments of disability and definition of BDS can be questioned.

CONCLUSIONS

Future clinical and community studies need to consider both externally determined and self-identified disability across the entire Bd spectrum.

The Relationship between Physical-Mental Comorbidity and Subjective Well-Being among Older Adults

OBJECTIVES

The present study examined the relationship between types and severity of physical-mental comorbidity and subjective well-being (SWB) among older adults.

METHODS

The sample was drawn from the National Health and Aging Trends Study (NHATS) collected in 2011. A total of 6,945 older adults aged 65 to 105 were categorized into four groups using 16 common physical health conditions and two mental health problems: no chronic health condition (n = 562, referent), physical health condition (n = 4,946), mental health problem (n = 56), and physical-mental comorbidity (n = 1,380). Outcome variable was self-reported SWB measured with 11 items. Analyses of covariance (ANCOVAs) were used to assess the relationship between types and severity of physical-mental comorbidity and SWB.

RESULTS

After adjusting for covariates, older adults with a mental health problem or physical-mental comorbidity reported lower SWB compared to the no chronic health condition group. Physical-mental comorbidity was associated with lower SWB compared to the physical health condition group. Higher severity level of physical-mental comorbidity was associated with decreased SWB.

DISCUSSION

Findings suggest that mental health problem and physical-mental comorbidity negatively associated with SWB among older adults.

CLINICAL IMPLICATIONS

Integrative interventions should be developed to target mental health issues and comorbid physical-mental health conditions in the older populations.

Gendered tri-racial stratification and health disparities

Despite extensive evidence confirming racial and gender health disparities, little research considers how race theory might aid in understanding these patterns. Using the Collaborative Psychiatric Epidemiology Surveys (CPES), this study fills this void by integrating two research areas-sociology of race and medical sociology-to assess the utility of Bonilla-Silva's tri-racial stratification perspective in predicting health patterns. More specifically, I address the following questions: is the tri-racial stratification thesis aligned with the health profiles of racial groups in the U.S.? Does the applicability of this perspective differ for women and men? Last, do the health patterns suggested by tri-racial stratification persist after adjusting for social factors (socioeconomic status and social support) often invoked to explain health disparities? Results indicate that the racial patterning of life-threatening conditions lend partial support for tri-racial stratification for women and men. Self-rated health findings yield counterintuitive patterns. Furthermore, social factors do not explain the majority of ethnic differences in health. Research and theoretical implications of these findings are discussed.