1
|
Woolley MG, Klimczak KS, Davis CH, Levin ME. Predictors of adherence to a publicly available self-guided digital mental health intervention. Cogn Behav Ther 2024; 53:577-591. [PMID: 38619511 DOI: 10.1080/16506073.2024.2341807] [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: 08/29/2023] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
Low adherence to self-guided digital mental health interventions (DMHIs) have raised concerns about their real-world effectiveness. Naturalistic data from self-guided DMHIs are often not available, hindering our ability to assess adherence among real-world users. This study aimed to analyze 3 years of user data from the public launch of an empirically supported 12-session self-guided DMHI, to assess overall program adherence rates and explore predictors of adherence. Data from 984 registered users were analyzed. Results showed that only 14.8% of users completed all 12 modules and 68.6% completed less than half of the modules. Users who were younger, had milder depression, had never seen a mental health provider, and who rejected signing-up for weekly program emails completed significantly more modules. Results add to concerns about the generalizability of controlled research on DMHIs due to lower adherence outside of research trials. This study highlights the potential of user data in identifying key factors that may be related to adherence. By examining adherence patterns among different sub-sets of users, we can pinpoint and focus on individuals who may adhere and benefit more from self-guided programs. Findings could also have implications for guiding intervention personalization for individuals who struggle to complete DMHIs.
Collapse
Affiliation(s)
| | | | - Carter H Davis
- Department of Psychology, Utah State University, Logan, USA
| | | |
Collapse
|
2
|
Kumari B, Goyal N, El Morr C. Predictive Models for Canadian Healthcare Workers Mental Health During COVID-19. J Prim Care Community Health 2024; 15:21501319241241468. [PMID: 38511839 PMCID: PMC10958798 DOI: 10.1177/21501319241241468] [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: 01/11/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE COVID-19 impact on the population's mental health has been reported worldwide. Predicting healthcare workers' mental health and life stress is needed to proactively plan for future emergencies. DESIGN Statistics Canada has surveyed Canadian healthcare workers and those working in healthcare settings to gauge their perceived mental health and perceived life stress. SETTING A cross-sectional survey of healthcare workers in Canada. SUBJECTS A sample of 18,139 healthcare workers respondents. ANALYSIS Eight algorithms, including Logistic Regression, Random Forest (RF), Naive Bayes (NB), K Nearest Neighbours (KNN), Adaptive boost (AdaBoost), Multi-layer perceptron (MLP), XGBoost, and LightBoost. AUC scores, accuracy and precision were measured for all models. RESULTS XGBoost provided the highest performing model AUC score (AUC = 82.07%) for predicting perceived mental health, and Random Forest performed the best for predicting perceived life stress (AUC = 77.74%). Perceived health, age group of participants, and perceived mental health compared to before the pandemic were found to be the most important 3 features to predict perceived mental health and perceived stress. Perceived mental health compared to before the pandemic was the most important predictor for perceived life stress. CONCLUSION Our models are highly predictive of healthcare workers' perceived mental health and life stress. Implementing scalable, non-expensive virtual mental health solutions to address mental health challenges in the workplace could mitigate the impact of workplace conditions on healthcare workers' mental health.
Collapse
Affiliation(s)
- Bhawna Kumari
- Indian Institute of Technology, Kharagpur, WB, India
| | - Nidhi Goyal
- Indian Institute of Technology, Kharagpur, WB, India
| | | |
Collapse
|
3
|
Escovar EL, Bocanegra ES, Craske MG, Bystritsky A, Roy-Byrne P, Sherbourne CD, Stein MB, Chavira DA. Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders. J Nerv Ment Dis 2023; 211:427-439. [PMID: 37252881 PMCID: PMC10234492 DOI: 10.1097/nmd.0000000000001533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
ABSTRACT Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1-10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.
Collapse
Affiliation(s)
| | | | | | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Peter Roy-Byrne
- Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations, University of Washington at Harborview Medical Center, Seattle, Washington
| | | | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Pubic Health, University of California, San Diego, La Jolla, California
| | | |
Collapse
|
4
|
Khatib HE, Alyafei A, Shaikh M. Understanding experiences of mental health help-seeking in Arab populations around the world: a systematic review and narrative synthesis. BMC Psychiatry 2023; 23:324. [PMID: 37161342 PMCID: PMC10170733 DOI: 10.1186/s12888-023-04827-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in mental health service utilisation and access is well established. Mental illness is common among Arab populations globally, but most individuals display negative attitudes towards mental health and do not seek professional help. The aim of this systematic review was to determine 1) help-seeking behaviours 2) help-seeking attitudes and 3) help-seeking barriers and facilitators, related to mental health services among Arab adults. METHOD A pre-defined search strategy and eligibility criteria allowed for database searching using terms related to: mental health, Arabs, help-seeking, as well as experiences and behaviours. Seventy-four articles were included and analysed through narrative synthesis. Results were reported using the PRISMA guidelines. The review protocol was registered prospectively on PROSPERO (CRD42022319889). RESULTS Arabs across the world have negative attitudes towards formal help-seeking and are reluctant to seek help, despite the presence of psychological distress. There is little information on factors that influence help-seeking behaviours and rates of service use. Preference for informal help sources such as family and friends were expressed and considered more acceptable. Low mental health literacy, stigma, gender, age, education, religion, acculturation, and immigrant status were the most common factors influencing help-seeking attitudes. Barriers to help-seeking included stigma, privacy and confidentiality, trust, mental health literacy, language, logistics, and culture related barriers. Increasing societal and family awareness, external support and encouragement, shared culture between the client and therapist, quality of doctor patient relationship, and feelings of connectedness with the host country among refugees were mentioned facilitators. Mixed findings for the role of religion, and family and community, in relation to facilitating or hindering help-seeking were reported. CONCLUSIONS There is an increased likelihood and preference to seek informal sources of psychological support among Arabs. Contextual and cultural factors impeding help-seeking for Arabs are common across the world. Future research should address actual utilisation rates of services to better understand factors that influence help-seeking behaviours and facilitators to help-seeking. Increasing mental health literacy and developing anti stigma campaigns is necessary. Developing culturally informed interventions should inform future efforts to promote help-seeking among this population.
Collapse
Affiliation(s)
- Hania El Khatib
- Division of Psychiatry, University College London, London, UK
| | - Aisha Alyafei
- Division of Psychiatry, University College London, London, UK
| | - Madiha Shaikh
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
- North East London NHS Foundation Trust, London, UK.
| |
Collapse
|
5
|
Kureshi N, Clarke DB, Feng C. Association between traumatic brain injury and mental health care utilization: evidence from the Canadian Community Health Survey. Inj Epidemiol 2023; 10:16. [PMID: 36915175 PMCID: PMC10012583 DOI: 10.1186/s40621-023-00424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Mental health disorders are a common sequelae of traumatic brain injury (TBI) and are associated with worse health outcomes including increased mental health care utilization. The objective of this study was to determine the association between TBI and use of mental health services in a population-based sample. METHODS Using data from a national Canadian survey, this study evaluated the association between TBI and mental health care utilization, while adjusting for confounding variables. A log-Poisson regression model was used to estimate unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS The study sample included 158,287 TBI patients and 25,339,913 non-injured individuals. Compared with those were not injured, TBI patients reported higher proportions of chronic mental health conditions (27% vs. 12%, p < 0.001) and heavy drinking (33% vs. 24%, p = 0.005). The adjusted prevalence of mental health care utilization was 60% higher in patients with TBI than those who were not injured (PR = 1.60, 95%; CI 1.05-2.43). CONCLUSIONS This study suggests that chronic mental health conditions and heavy drinking are more common in individuals with TBI. The prevalence of mental health care utilization is 60% higher in TBI patients compared with those who are not injured after adjusting for sociodemographic factors, mental health conditions, and heavy drinking. Future longitudinal research is required to examine the temporality and direction of the association between TBI and the use of mental health services.
Collapse
Affiliation(s)
- Nelofar Kureshi
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - David B. Clarke
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - Cindy Feng
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS Canada
| |
Collapse
|
6
|
Rudolphi JM, Berg RL. Mental health of agricultural adolescents and adults: Preliminary results of a five-year study. Front Public Health 2023; 11:1056487. [PMID: 36935670 PMCID: PMC10018023 DOI: 10.3389/fpubh.2023.1056487] [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: 09/28/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Background Work-related stressors common to agriculture have been associated with adverse mental health outcomes among adult farmers and ranchers. However, the mental health status of agricultural youth is unknown, despite farm and ranch youth being exposed to the same occupational hazards as their adult counterparts. The objective of this study was to estimate the prevalence of symptoms of depression and anxiety among farm adults and their adolescent child and examine the correlation between symptoms of mental health conditions and financial indicators described in the Family Stress Model (FSM). Methods Farm families were recruited to participate in online surveys by mail, email, and social media. One adolescent and at least one adult from each family were invited to complete on online survey. Where available, validated instruments were used to collect mental health, stress, family dynamics, and household financial variables. Descriptive statistics were used to describe sample demographics and prevalence of symptoms of depression and anxiety. Pearson correlations describe associations between variables within the Family Stress Model. Results Farm families (N = 122) completed the online survey. The mean age of farm parents was 41.4 years (SD = 4.4) and the mean age of farm adolescents was 15.4 (1.2). A majority of farm parents and farm adolescents were male, 58.2% and 70.5%, respectively. The sample was primarily white, non-Hispanic. In this sample of farm parents and adolescents alike, 60% met the criteria for at least mild depression, based on the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-A (PHQ-A). Similarly, among adolescents, 45.1% met the criteria for Generalized Anxiety Disorder (GAD), as did 54.9% of adults. As a measure of economic hardship, per capita income by itself showed relatively low correlations, even with other economic measures (r = 0.11 with negative financial events, r = 0.20 with financial needs, r = 0.17 with financial situation, and r = 0.27 with debt). Parent depressed mood was in turn highly associated with adolescent depression (r = 0.83), social anxiety (r = 0.54), and generalized anxiety (r = 0.69). Conclusions The results show a strong association between parent and adolescent mental health and parental depressed mood and debt. There is not a clear association between economic stress and mental health in this sample, but further work is needed to be done at a population level. Preliminary results are promising for application of the full Family Stress Model as we continue to accrue farm families into the study cohort.
Collapse
Affiliation(s)
- Josie M. Rudolphi
- Department of Agricultural and Biological Engineering, University of Illinois, Urbana, IL, United States
- *Correspondence: Josie M. Rudolphi
| | - Richard L. Berg
- Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield Clinic, Marshfield, WI, United States
| |
Collapse
|
7
|
Virgilsen LF, Falborg AZ, Vedsted P, Prior A, Pedersen AF, Jensen H. Unplanned cancer presentation in patients with psychiatric disorders: A nationwide register-based cohort study in Denmark. Cancer Epidemiol 2022; 81:102293. [PMID: 36370657 DOI: 10.1016/j.canep.2022.102293] [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: 09/09/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022]
Abstract
Unplanned presentation in the cancer pathway is more common in patients with psychiatric disorders than in patients without. More knowledge about the risk factors for unplanned presentation could help target interventions to ensure earlier diagnosis of cancer in patients with psychiatric disorders. This study aims to estimate the association between patient characteristics (social characteristics and coexisting physical morbidity) and cancer diagnosis following unplanned presentation among cancer patients with psychiatric disorders. We conducted a population-based register study including patients diagnosed with cancer in 2014-2018 and also registered with at least one psychiatric disorder in the included Danish registers (n = 26,005). We used logistic regression to assess patient characteristics associated with an unplanned presentation. Almost one in four symptomatic patients (23.6 %) with pre-existing psychiatric disorders presented unplanned in the cancer trajectory. Unplanned presentation was most common for severe psychiatric disorders, e.g. organic disorders and schizophrenia. Old age, male sex, living alone, low education, physical comorbidity, and non-attendance in primary care were associated with increased odds of unplanned presentation. In conclusion, several characteristics of patients with pre-existing psychiatric disorders were associated with unplanned presentation in the cancer trajectory; for some groups more than 40 % had an unplanned presentation. This information could be used to design targeted interventions for patients with pre-existing psychiatric disorders to ensure earlier diagnosis of cancer in this population.
Collapse
Affiliation(s)
| | | | - Peter Vedsted
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, 8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus C, Denmark.
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, 8000 Aarhus C, Denmark.
| | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, 8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus C, Denmark.
| | - Henry Jensen
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, 8000 Aarhus C, Denmark.
| |
Collapse
|
8
|
Clarke C, Oh J, Khan H, LoParo D, Lamis DA. Referral patterns and demographic factors predict treatment dropout in suicidal youth. Suicide Life Threat Behav 2021; 51:616-623. [PMID: 33870542 DOI: 10.1111/sltb.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Due to increasing suicide rates, treatment engagement among suicidal youth is paramount. Identification of factors that predict treatment dropout could aid in bolstering treatment engagement. In this study, we examine whether demographic factors, specific treatment referrals, and interactions among referrals predict treatment dropout in youth deemed at risk for suicide. METHODS Youth (N = 3606) were screened for suicide using the Early Identification, Referral, and Follow-up (EIRF) system across three community behavioral health centers. If considered at-risk, all were provided mental health referrals and some were provided family support, crisis hotline, and/or school support referrals. Analyses were performed to analyze dropout patterns based on the binary logistic regression framework. RESULTS Being older (OR = 1.06, p < 0.001) and being male (OR = 1.28, p < 0.001) were related to greater odds of dropping out from referrals, while being referred to family support (OR = 0.13, p < 0.001), and being referred to a crisis hotline (OR = 0.58, p < 0.001) were associated with smaller odds of dropping out. Interactions were also analyzed. CONCLUSION Monitoring utilization and referral patterns is essential to appropriately meet the needs of youth at-risk for suicide. Specifically, referring youth for family support and to use a crisis hotline may be particularly helpful in retaining treatment engagement.
Collapse
Affiliation(s)
- Christina Clarke
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - JungSu Oh
- Department of Psychology, Eastern Illinois University, Charleston, IL, USA
| | - Humama Khan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Devon LoParo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
9
|
Tewari A, Kallakuri S, Devarapalli S, Peiris D, Patel A, Maulik PK. SMART Mental Health Project: process evaluation to understand the barriers and facilitators for implementation of multifaceted intervention in rural India. Int J Ment Health Syst 2021; 15:15. [PMID: 33557902 PMCID: PMC7871593 DOI: 10.1186/s13033-021-00438-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Globally, mental health problems are a growing public health concern. Resources and services for mental disorders are disproportionately low compared to disease burden. In order to bridge treatment gaps, The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project was implemented across 12 villages in West Godavari district of the southern Indian state of Andhra Pradesh. This paper reports findings from a process evaluation of feasibility and acceptability of the intervention that focused on a mental health services delivery model to screen, diagnose and manage common mental disorders (CMDs). METHODS A mixed methods evaluation was undertaken using quantitative service usage analytics, and qualitative data from in-depth interviews and focus group discussions were conducted with stakeholders including primary care physicians, community health workers, field staff and community members. Barriers to and facilitators of intervention implementation were identified. Andersen's Behavioral Model for Health Services Use was the conceptual framework used to guide the process evaluation and interpretation of data. RESULTS In all, 41 Accredited Social Health Activists (ASHAs) and 6 primary health centre (PHC) doctors were trained in mental health symptoms and its management. ASHAs followed up 98.7% of screen positive cases, and 81.2% of these were clinically diagnosed and treated by the PHC doctors. The key facilitators of implementation were adequate training and supervision of field staff, ASHAs and doctors, use of electronic decision support, incorporation of a door-to-door campaign and use of culturally tailored dramas/videos to raise awareness about CMDs, and organising health camps at the village level facilitating delivery of intervention activities. Barriers to implementation included travel distance to receive care, limited knowledge about mental health, high level of stigma related to mental health issues, and poor mobile network signals and connectivity in the villages. Lack of familiarity with and access to mobile phones, especially among women, to accessing health related messages as part of the intervention. CONCLUSIONS The evaluation not only provides a context to the interventions delivered, but also allowed an understanding of possible factors that need to be addressed to make the programme scalable and of benefit to policy makers.
Collapse
Affiliation(s)
- Abha Tewari
- George Institute for Global Health, New Delhi, India
| | | | | | - David Peiris
- George Institute for Global Health, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Anushka Patel
- George Institute for Global Health, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India. .,University of New South Wales, Sydney, Australia.
| |
Collapse
|
10
|
Chiu M, Amartey A, Wang X, Vigod S, Kurdyak P. Trends in objectively measured and perceived mental health and use of mental health services: a population-based study in Ontario, 2002-2014. CMAJ 2020; 192:E329-E337. [PMID: 32392484 DOI: 10.1503/cmaj.190603] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mental illness is widely perceived to be more of a public health concern now than in the past; however, it is unclear whether this perception is due to an increase in the prevalence of mental illness, an increase in help-seeking behaviours or both. We examined temporal trends in use of mental health services as well as objectively measured and perceived mental health. METHODS We conducted a repeat cross-sectional study of Ontario residents who participated in Statistics Canada's Canadian Community Health Survey (2002-2014). We assessed temporal trends in objectively measured past-year major depressive episode (based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, and International Classification of Diseases, 10th Revision) and past-month psychological distress (Kessler Psychological Distress Scale-6 score ≥ 8) and perceived, self-rated mental health. We also examined use of mental health services, including service use among those with a need for mental health care. RESULTS A total of 260 090 survey participants were included. The age- and sex-standardized prevalence of a major depressive episode (4.8%, 95% confidence interval [CI] 4.2%-5.3% in 2002 v. 4.9%, 95% CI 4.2%-5.7% in 2012; p = 0.9) and psychological distress (7.0%, 95% CI 6.3%-7.6% in 2002 v. 6.5%, 95% CI 5.7%-7.5% in 2012; p = 0.4) did not change significantly over time. However, self-rated fair or poor mental health status increased from 4.9% in 2003-2005 to 6.5% in 2011-2014 (p trend < 0.001), as did the use of mental health services (7.2% to 12.8%, p trend < 0.001). The percentage of individuals who had subjective or objectively measured mental health problems and did not access mental health services decreased significantly over time. INTERPRETATION Given the stable prevalence of objectively measured psychiatric symptoms, the increase in use of mental health services appears to be, at least partly, explained by an increase in perceived poor mental health and help-seeking behaviours.
Collapse
Affiliation(s)
- Maria Chiu
- Mental Health and Addictions Research Program (Chiu, Amartey, Wang, Vigod, Kurdyak), ICES; Institute of Health Policy, Management and Evaluation (Chiu, Vigod, Kurdyak), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital and Research Institute (Vigod); Department of Psychiatry, Faculty of Medicine (Vigod, Kurdyak), University of Toronto; Social and Epidemiological Research Department (Kurdyak), Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont.
| | - Abigail Amartey
- Mental Health and Addictions Research Program (Chiu, Amartey, Wang, Vigod, Kurdyak), ICES; Institute of Health Policy, Management and Evaluation (Chiu, Vigod, Kurdyak), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital and Research Institute (Vigod); Department of Psychiatry, Faculty of Medicine (Vigod, Kurdyak), University of Toronto; Social and Epidemiological Research Department (Kurdyak), Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont
| | - Xuesong Wang
- Mental Health and Addictions Research Program (Chiu, Amartey, Wang, Vigod, Kurdyak), ICES; Institute of Health Policy, Management and Evaluation (Chiu, Vigod, Kurdyak), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital and Research Institute (Vigod); Department of Psychiatry, Faculty of Medicine (Vigod, Kurdyak), University of Toronto; Social and Epidemiological Research Department (Kurdyak), Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont
| | - Simone Vigod
- Mental Health and Addictions Research Program (Chiu, Amartey, Wang, Vigod, Kurdyak), ICES; Institute of Health Policy, Management and Evaluation (Chiu, Vigod, Kurdyak), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital and Research Institute (Vigod); Department of Psychiatry, Faculty of Medicine (Vigod, Kurdyak), University of Toronto; Social and Epidemiological Research Department (Kurdyak), Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont
| | - Paul Kurdyak
- Mental Health and Addictions Research Program (Chiu, Amartey, Wang, Vigod, Kurdyak), ICES; Institute of Health Policy, Management and Evaluation (Chiu, Vigod, Kurdyak), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital and Research Institute (Vigod); Department of Psychiatry, Faculty of Medicine (Vigod, Kurdyak), University of Toronto; Social and Epidemiological Research Department (Kurdyak), Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont
| |
Collapse
|
11
|
Dixon De Silva LE, Ponting C, Ramos G, Guevara MVC, Chavira DA. Urban Latinx parents' attitudes towards mental health: Mental health literacy and service use. CHILDREN AND YOUTH SERVICES REVIEW 2020; 109:104719. [PMID: 37842164 PMCID: PMC10575228 DOI: 10.1016/j.childyouth.2019.104719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Latinx youth report elevated internalizing symptomatology as compared to their non-Latinx White counterparts and are less likely to access mental health care for these problems. This qualitative study examined the knowledge, beliefs and perceptions that Latinx parents (86% foreign-born; 66.7% monolingual Spanish speakers) living in urban communities have about mental health and service use for anxiety and depression in children. We used thematic analysis to analyze interview data from 15 Latinx parents who expressed concerns about their child's (age 6-13) worry or sadness. Analyses revealed that Latinx parents often have difficulty identifying mental health problems, report stigma about mental health problems and help-seeking and want more information about how they can help their children. Although Latinx parents report significant mental health and treatment-seeking stigma, the majority were open to seeking mental health services for their children or were already receiving services. Findings suggest that stigma although prevalent, may not deter service utilization for some Latinx families. Implications for community health and future research are discussed.
Collapse
Affiliation(s)
| | - Carolyn Ponting
- Department of Psychology, University of California Los Angeles
| | - Giovanni Ramos
- Department of Psychology, University of California Los Angeles
| | | | | |
Collapse
|
12
|
Aneshensel CS, van Draanen J, Riess H, Villatoro AP. Newcomers and Old Timers: An Erroneous Assumption in Mental Health Services Research. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:453-473. [PMID: 31912763 DOI: 10.1177/0022146519887475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Based on the premise that treatment changes people in ways that are consequential for subsequent treatment-seeking, we question the validity of an unrecognized and apparently inadvertent assumption in mental health services research conducted within a psychiatric epidemiology paradigm. This homogeneity assumption statistically constrains the effects of potential determinants of recent treatment to be identical for former patients and previously untreated persons by omitting treatment history or modeling only main effects. We test this assumption with data from the 2001-2003 Collaborative Psychiatric Epidemiology Surveys; the weighted pooled sample is representative of noninstitutionalized U.S. adults (18+; analytic n = 19,227). Contrary to the homogeneity assumption, some associations with recent treatment are conditional on past treatment, including psychiatric disorder and race-ethnicity-measures of need and treatment disparities, respectively. We conclude that the widespread application of the homogeneity assumption probably masks differences in the determinants of recent use between previously untreated persons and former patients.
Collapse
|
13
|
Assari S, Dejman M. Gender, Depressive Symptoms, Chronic Medical Conditions, and Time to First Psychiatric Diagnosis among American Older Adults. Int J Prev Med 2019; 10:182. [PMID: 32133100 PMCID: PMC6826688 DOI: 10.4103/ijpvm.ijpvm_333_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/11/2018] [Indexed: 11/26/2022] Open
Abstract
Background: To test whether gender moderates the effects of baseline depressive symptoms and chronic medical conditions (CMCs) on risk of receiving subsequent psychiatric diagnosis among older adults. Methods: Data came from ten waves of the Health and Retirement Study, a nationally representative longitudinal study. We followed 9794 individuals older than 52 years without any diagnosed psychiatric disorder at baseline for up to 18 years. Baseline depressive symptoms and CMC were the predictors, time to receiving an emotional diagnosis was the outcome, baseline demographics and socioeconomics were controls, and gender was the moderator. We used Cox proportional hazards models for data analysis. Results: In the pooled sample, female gender increased the effect of baseline depressive symptoms (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.26–2.00) and reduced the effect of baseline CMC (HR, 0.78; 95% CI, 0.63–0.97) on time to receiving a psychiatric diagnosis. Among men, baseline depressive symptoms (HR, 2.36; 95% CI, 1.87–2.97) increased and baseline CMC (HR, 0.81; 95% CI, 0.69–0.95) decreased time to receiving a psychiatric diagnosis. Among women, depressive symptoms (HR, 1.49; 95% CI, 1.21–1.83) but not CMC (HR, 1.06; 95% CI, 0.91–1.23) were associated with time to receiving a psychiatric diagnosis over time. Conclusions: Men and women differ in how depressive symptoms and CMC influence their risk of receiving a psychiatric diagnosis over time. Depressive symptoms are more salient promotor for men than women while CMC is only a barrier for men.
Collapse
Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Masoumeh Dejman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
14
|
Zamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50:132-143. [PMID: 31157418 DOI: 10.1111/apt.15325] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common and potential disabling functional gastrointestinal disorder. Studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Existing systematic reviews have addressed only the levels of anxiety or depression in patients with IBS. AIM To investigate systematically the prevalence of anxiety or depression in IBS patients METHODS: A literature search was conducted using the related keywords from the bibliographic databases of Embase, PubMed, Scopus, Web of Science and POPLINE published until 1 January 2019 with no language restriction. Studies reporting the prevalence of anxiety/depressive symptoms/disorders in adult (≥15 years) IBS patients were evaluated. The pooled prevalence, odds ratio (OR) and 95% CI were calculated using stata software. RESULTS A total of 14 926 articles were initially screened, and finally 73 papers were included. The prevalence rates of anxiety symptoms and disorders in IBS patients were 39.1% (95% CI: 32.4-45.8) and 23% (95% CI: 17.2-28.8) respectively. The ORs for anxiety symptoms and disorders in IBS patients compared with healthy subjects were 3.11 (95% CI: 2.43-3.98) and 2.52 (95% CI: 1.99-3.20) respectively. The prevalence estimates of depressive symptoms and disorders in IBS patients were 28.8% (95% CI: 23.6-34) and 23.3% (95% CI: 17.2-29.4) respectively. The ORs for depressive symptoms and disorders in IBS patients compared to healthy subjects were 3.04 (95% CI: 2.37-3.91) and 2.72 (95% CI: 2.45-3.02) respectively. CONCLUSION Patients with IBS have a three-fold increased odds of either anxiety or depression, compared to healthy subjects.
Collapse
Affiliation(s)
- Mohammad Zamani
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran.,Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Vahid Zamani
- Vice-Chancellery for Health, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
15
|
Simo B, Bamvita JM, Caron J, Fleury MJ. Predictors of mental health service use among individuals with high psychological distress and mental disorders. Psychiatry Res 2018; 270:1122-1130. [PMID: 30360914 DOI: 10.1016/j.psychres.2018.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/24/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023]
Abstract
This study identified predictors of mental health service use over 12 months among 746 individuals with mental disorders and high psychological distress from a catchment area in southwest Montreal, Quebec (Canada). Data collected in 2011 and 2014 were analyzed using Andersen's Behavioral Model of Health Services Use. A hierarchical logistic regression identified predictors of mental health service use. In all, 29% of participants reported using mental health services in the previous 12 months. Three key enabling variables predicted mental health service use: having a family doctor, previous experience with mental health services, and employment. Self-perception of mental health, stressful events, and unmet needs marginally (Needs factors: non-clinical variables) were also associated with the outcome variable. Mental health service utilization depends primarily on organization of the health system, and patient perceptions of its condition (non-clinical needs). Mental health policy should focus on increasing the availability of services and professionals, especially family doctors. Other measures for encouraging service use and overall population wellbeing include raising public awareness around the signs and symptoms of mental illness as a way to promote more rapid response to patient needs, and protecting workplace mental health by reducing stress and stigma toward individuals affected by mental distress.
Collapse
Affiliation(s)
- Béatrice Simo
- École de santé publique, Université de Montréal, 7101 av. du Parc, Montreal, QC H3X1X9, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada
| | - Jean Caron
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada.
| |
Collapse
|
16
|
Hamilton JE, Heads AM, Meyer TD, Desai PV, Okusaga OO, Cho RY. Ethnic differences in the diagnosis of schizophrenia and mood disorders during admission to an academic safety-net psychiatric hospital. Psychiatry Res 2018; 267:160-167. [PMID: 29908484 DOI: 10.1016/j.psychres.2018.05.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/24/2018] [Accepted: 05/18/2018] [Indexed: 01/26/2023]
Abstract
U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (n = 5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication.
Collapse
Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; UTHealth Harris County Psychiatric Center, Houston, TX, USA.
| | - Angela M Heads
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pratikkumar V Desai
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Olaoluwa O Okusaga
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
| | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
| |
Collapse
|
17
|
Kocsis-Bogár K, Mészáros V, Perczel-Forintos D. Gender differences in the relationship of childhood trauma and the course of illness in schizophrenia. Compr Psychiatry 2018; 82:84-88. [PMID: 29452966 DOI: 10.1016/j.comppsych.2018.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Different types of childhood trauma have been repeatedly shown to contribute to psychotic symptoms. Gender differences in schizophrenia are well known. Some studies argue that trauma history means a significantly higher risk of psychosis for women than men. However, there is evidence of early adverse life events to be associated with higher stress-sensitivity in men. Little is known about the connection of specific type of trauma and specific psychotic symptoms as well as the course of illness with explicit regard to gender differences. METHODS 102 men and women with schizophrenia spectrum disorder were tested using Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Scale for Assessing Positive Symptoms, Early Trauma Inventory-SR. RESULTS Although, women had a later age at onset without regarding trauma history (d = 0.74), this difference became non-significant when introducing trauma variables. Patients reporting physical abuse had a significantly earlier age at onset, regardless of their sex (V = 0.13, F = 3.11, p = 0.03. Physical abuse predicted an earlier age at onset only in women (R2 = 0.23). History of general trauma predicted more frequent hospitalizations only in men (R2 = 0.55). CONCLUSIONS Although women generally tend to have a more favorable course of illness including a later age at onset men, women with CPA seem to lose this "advantage". It is necessary to investigate the contribution of gender interacting with adverse life events in contribution to the phenomenology and etiology of schizophrenia.
Collapse
Affiliation(s)
- Krisztina Kocsis-Bogár
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary; Department of Applied Psychology: Health, Development, Enhancement and Intervention, University of Vienna, Austria.
| | - Veronika Mészáros
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
| | | |
Collapse
|
18
|
Barriers to and Correlates of Retention in Behavioral Health Treatment Among Latinos in 2 Different Host Countries: The United States and Spain. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:e20-e27. [PMID: 26910867 DOI: 10.1097/phh.0000000000000391] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Latino immigrants constitute a large portion of the Spanish and US immigrant populations, yet a dearth of research exists regarding barriers to retention in behavioral health care. OBJECTIVES To identify and compare perceived barriers related to behavioral health care among first- and second-generation Latinos in Boston, Madrid, and Barcelona, and evaluate whether the frequency of behavioral health care use in the last year was related to these barriers. DESIGN, SETTING, AND PARTICIPANTS Data were obtained from the International Latino Research Partnership project. First- or second-generation self-identified Latino immigrants aged 18 years and more who resided more than 1 year in the host country were recruited from community agencies and primary care, mental health, substance abuse, and HIV clinics. MAIN OUTCOME MEASURES Eleven barriers were assessed and compared across sites. The relationship between barriers and behavioral services visits within the last year was evaluated, adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors. RESULTS Wanting to handle the problem on one's own, thinking that treatment would not work, and being unsure of where to go or who to see were the most frequently reported barriers for Latino immigrants. Previous treatment failure, difficulties in transportation or scheduling, and linguistic barriers were more likely to be reported in Boston; trying to deal with mental health problems on one's own was more commonly reported in Barcelona and Madrid. Two barriers associated with the number of visits were concerns about the cost of services and uncertainty about where to go or who to see. CONCLUSIONS After adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors, barriers still differed significantly across sites. Efforts to improve behavioral health services must be tailored to immigrants' context, with attention to changing attitudes of self-reliance and outreach to improve access to and retention in care.
Collapse
|
19
|
Rosales R, Calvo R. "Si Dios Quiere": Fatalismo and use of mental health services among Latinos with a history of depression. SOCIAL WORK IN HEALTH CARE 2017; 56:748-764. [PMID: 28696860 DOI: 10.1080/00981389.2017.1339760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Latinos are less likely to seek professional mental health care than other groups in the United States. While fatalismo has long been hypothesized to be responsible for this behavior, there is little evidence on this assumption. Using an adapted version of the Behavioral Model of Health Service Use (BMHSU), and a nationally representative sample, this study examined the association between fatalismo and mental health service use among Latinos with a history of depression. Participants (n = 703) were drawn from the 2007 Pew Hispanic Healthcare survey. Results showed that fatalismo was significantly associated with the use of psychiatric care, even after controlling for traditional deterrents of health care access and utilization. The findings underscore the importance of fatalismo in predicting Latinos' use of psychiatric care. Implications for practice are discussed.
Collapse
Affiliation(s)
- Robert Rosales
- a Boston College School of Social Work , Chestnut Hill , Massachusetts , USA
| | - Rocío Calvo
- a Boston College School of Social Work , Chestnut Hill , Massachusetts , USA
| |
Collapse
|
20
|
Ghose B, Abdoul Razak MY. Memory and Learning Complaints in Relation to Depression among Elderly People with Multimorbidity. Geriatrics (Basel) 2017; 2:geriatrics2020015. [PMID: 31011025 PMCID: PMC6371096 DOI: 10.3390/geriatrics2020015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 11/16/2022] Open
Abstract
Although current models of care are generally well-suited to providing treatment for individual medical conditions, the emergence of multimorbidity is becoming a serious concern for practitioners and policy researchers, particularly in developing countries. The challenges of tackling multimorbidity are further compounded when the multimorbidity co-occurs with psychiatric conditions such as cognitive and depressive disorders. Understanding the relationships between multimorbidity and psychiatric illnesses is therefore of considerable clinical importance. In the present study, we cross-sectionally examined whether multimorbidity has an association with perceived cognition-including memory, learning complaints, and depression-among elderly population in South Africa. Study subjects were 422 men and women aged 50 years and older. The prevalence of arthritis, asthma, cancer, diabetes, heart disease, chronic lung disease, hypertension, and stroke was respectively 31.5, 7.3, 1.7, 10.2, 1.2, 1.7, 52.1, and 31.5%, and that of multimorbidity was 30.8%. In the multivariate analysis, women with multimorbidity were 4.33 times (OR = 4.33, 95%CI = 2.96⁻14.633) more likely to report memory complaints. The odds of diagnosed depression were 1.4 times (OR = 1.4, 95%CI = 1.045⁻5.676), and the odds of self-reported depression were 1.7 times (OR = 1.7, 95%CI = 1.41⁻2.192) higher among women who had multimorbidity compared with those who had no morbid conditions. However, the association was not significant among men. Overall, the findings suggest that the occurrence of multimorbidity warrants special attention, especially regarding its compounding effects on psychological health. The findings need to be replicated through longitudinal studies that consider a broader range of chronic conditions.
Collapse
Affiliation(s)
- Bishwajit Ghose
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Mahaman Yacoubou Abdoul Razak
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| |
Collapse
|
21
|
Abstract
OBJECTIVE To document racial/ethnic and gender differences in health service use and access after the Affordable Care Act went into effect. DATA SOURCE Secondary data from the 2006-2014 National Health Interview Survey. STUDY DESIGN Linear probability models were used to estimate changes in health service use and access (i.e., unmet medical need) in two separate analyses using data from 2006 to 2014 and 2012 to 2014. DATA EXTRACTION Adult respondents aged 18 years and older (N = 257,560). PRINCIPAL FINDINGS Results from the 2006-2014 and 2012-2014 analyses show differential patterns in health service use and access by race/ethnicity and gender. Non-Hispanic whites had the greatest gains in health service use and access across both analyses. While there was significant progress among Hispanic respondents from 2012 to 2014, no significant changes were found pre-post-health care reform, suggesting access may have worsened before improving for this group. Asian men had the largest increase in office visits between 2006 and 2014, and although not statistically significant, the increase continued 2012-2014. Black women and men fared the worst with respect to changes in health care access. CONCLUSIONS Ongoing research is needed to track patterns of health service use and access, especially among vulnerable racial/ethnic and gender groups, to determine whether existing efforts under health care reform reduce long-standing disparities.
Collapse
|
22
|
Harris MG, Baxter AJ, Reavley N, Diminic S, Pirkis J, Whiteford HA. Gender-related patterns and determinants of recent help-seeking for past-year affective, anxiety and substance use disorders: findings from a national epidemiological survey. Epidemiol Psychiatr Sci 2016; 25:548-561. [PMID: 26428069 PMCID: PMC7137666 DOI: 10.1017/s2045796015000876] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 09/05/2015] [Indexed: 11/06/2022] Open
Abstract
AIMS To examine: (1) gender-specific determinants of help-seeking for mental health, including health professional consultation and the use of non-clinical support services and self-management strategies (SS/SM) and; (2) gender differences among individuals with unmet perceived need for care. METHOD Analyses focused on 689 males and 1075 females aged 16-85 years who met ICD-10 criteria for a past-year affective, anxiety or substance use disorder in an Australian community-representative survey. Two classifications of help-seeking for mental health in the previous year were created: (1) no health professional consultation or SS/SM, or health professional consultation, or SS/SM only, and; (2) no general practitioner (GP) or mental health professional consultation, or GP only consultation, or mental health professional consultation. Between- and within-gender help-seeking patterns were explored using multinomial logistic regression models. Characteristics of males and females with unmet perceived need for care were compared using chi-square tests. RESULTS Males with mental or substance use disorders had relatively lower odds than females of any health professional consultation (adjusted odds ratio [AOR] = 0.46), use of SS/SM only (AOR = 0.59), and GP only consultation (AOR = 0.29). Notably, males with severe disorders had substantially lower odds than females of any health professional consultation (AOR = 0.29) and GP only consultation (AOR = 0.14). Most correlates of help-seeking were need-related. Many applied to both genders (e.g., severity, disability, psychiatric comorbidity), although some were male-specific (e.g., past-year reaction to a traumatic event) or female-specific (e.g., past-year affective disorder). Certain enabling and predisposing factors increased the probability of health professional consultation for both genders (age 30+ years) or for males (unmarried, single parenthood, reliance on government pension). Males with unmet perceived need for care were more likely to have experienced a substance use disorder and to want medicine or tablets or social intervention, whereas their females peers were more likely to have experienced an anxiety disorder and to want counselling or talking therapy. For both genders, attitudinal/knowledge barriers to receiving the types of help wanted (e.g., not knowing where to get help) were more commonly reported than structural barriers (e.g., cost). CONCLUSIONS Findings suggest a need to address barriers to help-seeking in males with severe disorders, and promote GP consultation. Exploring gender-specific attitudinal/knowledge barriers to receiving help, and the types of help wanted, may assist in designing interventions to increase consultation. Mental health promotion/education efforts could incorporate information about the content and benefits of evidence-based treatments and encourage males to participate in other potentially beneficial actions (e.g., physical activity).
Collapse
Affiliation(s)
- M. G. Harris
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Queensland 4076, Australia
| | - A. J. Baxter
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Queensland 4076, Australia
| | - N. Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - S. Diminic
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Queensland 4076, Australia
| | - J. Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - H. A. Whiteford
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Queensland 4076, Australia
| |
Collapse
|
23
|
Bolu A, Ozselek S, Akarsu S, Alper M, Balikci A. Is There a Role of Gender in Electroconvulsive Therapy Response? ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20150207075355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Abdullah Bolu
- Eskisehir Military Hospital, Research Center for Volatile Substances, Eskisehir - Turkey
| | | | | | - Mustafa Alper
- Gulhane Military Medical Academy, Department of Psychiatry, Ankara - Turkey
| | - Adem Balikci
- Gulhane Military Medical Academy, Department of Psychiatry, Ankara - Turkey
| |
Collapse
|
24
|
Hansen AH, Høye A. Gender differences in the use of psychiatric outpatient specialist services in Tromsø, Norway are dependent on age: a population-based cross-sectional survey. BMC Health Serv Res 2015; 15:477. [PMID: 26493268 PMCID: PMC4619275 DOI: 10.1186/s12913-015-1146-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/16/2015] [Indexed: 11/22/2022] Open
Abstract
Background Overall, men are less likely than women to seek health care services for mental health problems, but differences between genders in higher age groups are equivocal. The aim of the current study was to investigate the association between gender and the use of psychiatric outpatient specialist services in Norway, both in a general population and in a subpopulation with self-reported anxiety and/or depression. Methods Using questionnaires from 12,982 participants (30–87 years) in the cross-sectional sixth Tromsø Study (2007-8) we estimated proportions reporting anxiety/depression, and proportions using psychiatric outpatient specialist services in a year. By logistic regressions we studied the association between gender and the use of psychiatric outpatient specialist services. Analyses were adjusted for age, marital status, income, education, self-reported degree of anxiety/depression, and GP visits last year. Analyses were also performed for genders separately. Results Anxiety/depression was reported by 21.5 % of women and 12.3 % of men in the general population. Visits to psychiatric outpatient services during one year were reported by 4.6 % of women and 3.3 % of men. The general population’s probability of a visit was significantly lower among men compared to women in ages 30–49 years (odds ratio [OR] 0.58, confidence interval [CI] 0.39–0.84, p-value [p] = 0.004), whereas men used services slightly more than women in ages 50 years and over (OR 1.36, CI 1.00–1.83, p = 0.047). Among those with anxiety/depression 13.5 % of women and 10.5 % of men visited psychiatric outpatient services in a year. We found no statistically significant gender differences in the use of services in this subgroup. Other factors associated with services use in women with anxiety/depression were higher education, more severe anxiety/depression, and GP visits the last year, whereas in men only a more severe anxiety/depression was associated with psychiatric outpatient visits. Overall, the use of services decreased with higher age. Conclusions Most people with self-reported anxiety/depression did not visit specialist outpatient clinics. This applies in particular to men aged 30–49 years, older individuals, and individuals with lower education. Gender differences in the use of services in the general population were dependent on age, whereas in the subgroup with anxiety/depression gender differences were not confirmed.
Collapse
Affiliation(s)
- Anne Helen Hansen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, and Faculty of Health Sciences, Department of Community Medicine, UiT-The Arctic University of Norway, PO box 35, 9038, Tromsø, Norway.
| | - Anne Høye
- Department of Psychiatric Research, University Hospital of North Norway and Center of Clinical Documentation and Evaluation (CCDE/SKDE), University Hospital of North Norway, PO box 6, 9038, Tromsø, Norway.
| |
Collapse
|
25
|
Depression, Help-Seeking and Self-Recognition of Depression among Dominican, Ecuadorian and Colombian Immigrant Primary Care Patients in the Northeastern United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10450-74. [PMID: 26343691 PMCID: PMC4586621 DOI: 10.3390/ijerph120910450] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/07/2015] [Accepted: 08/19/2015] [Indexed: 12/31/2022]
Abstract
Latinos, the largest minority group in the United States, experience mental health disparities, which include decreased access to care, lower quality of care and diminished treatment engagement. The purpose of this cross-sectional study of 177 Latino immigrants in primary care is to identify demographic factors, attitudes and beliefs, such as stigma, perceived stress, and ethnic identity that are associated with depression, help-seeking and self-recognition of depression. Results indicated that 45 participants (25%) had depression by Patient Health Questionnaire (PHQ-9) criteria. Factors most likely to be associated with depression were: poverty; difficulty in functioning; greater somatic symptoms, perceived stress and stigma; number of chronic illnesses; and poor or fair self-rated mental health. Fifty-four people endorsed help-seeking. Factors associated with help-seeking were: female gender, difficulty in functioning, greater somatic symptoms, severity of depression, having someone else tell you that you have an emotional problem, and poor or fair self-rated mental health. Factors most likely to be associated with self-recognition were the same, but also included greater perceived stress. This manuscript contributes to the literature by examining attitudinal factors that may be associated with depression, help-seeking and self-recognition among subethnic groups of Latinos that are underrepresented in research studies.
Collapse
|
26
|
Ahmad F, Jhajj AK, Stewart DE, Burghardt M, Bierman AS. Single item measures of self-rated mental health: a scoping review. BMC Health Serv Res 2014; 14:398. [PMID: 25231576 PMCID: PMC4177165 DOI: 10.1186/1472-6963-14-398] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/09/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A single-item measure of self-rated mental health (SRMH) is being used increasingly in health research and population health surveys. The item asks respondents to rate their mental health on a five-point scale from excellent to poor. This scoping study presents the first known review of the SRMH literature. METHODS Electronic databases of Medline, CINAHL, PsycINFO, EMBASE and Cochrane Reviews were searched using keywords. The databases were also searched using the titles of surveys known to include the SRMH single item. The search was supplemented by manually searching the bibliographic sections of the included studies. Two independent reviewers coded articles for inclusion or exclusion based on whether articles included SRMH. Each study was coded by theme and data were extracted about study design, sample, variables, and results. RESULTS Fifty-seven studies included SRMH. SRMH correlated moderately with the following mental health scales: Kessler Psychological Distress Scale, Patient Health Questionnaire, mental health subscales of the Short-Form Health Status Survey, Behaviour and Symptom Identification Scale, and World Mental Health Clinical Diagnostic Interview Schedule. However, responses to this item may differ across racial and ethnic groups. Poor SRMH was associated with poor self-rated health, physical health problems, increased health service utilization and less likelihood of being satisfied with mental health services. Poor or fair SRMH was also associated with social determinants of health, such as low socioeconomic position, weak social connections and neighbourhood stressors. Synthesis of this literature provides important information about the relationships SRMH has with other variables. CONCLUSIONS SRMH is associated with multi-item measures of mental health, self-rated health, health problems, service utilization, and service satisfaction. Given these relationships and its use in epidemiologic surveys, SRMH should continue to be assessed as a population health measure. More studies need to examine relationships between SRMH and clinical mental illnesses. Longitudinal analyses should look at whether SRMH is predictive of future mental health problems.
Collapse
Affiliation(s)
- Farah Ahmad
- />School of Health Policy and Management, Faculty of Health, York University, 4700 Keele Street, HNES 414, Ontario, M3J 1P3 Canada
| | - Anuroop K Jhajj
- />OPTIMUS | SBR, 30 Adelaide St. E, Suite 600, Toronto, ON M5C 3G8 Canada
| | - Donna E Stewart
- />Women’s Health Program at University Health Network, University of Toronto, 200 Elizabeth St, Toronto, M5G 2C4 Canada
| | - Madeline Burghardt
- />School of Heath Policy and Management, Critical Disability Studies, Faculty of Health, York University, 4700 Keele Street, Ontario, M3J 1P3 Canada
| | - Arlene S Bierman
- />Lawrence S. Bloomberg Faculty of Nursing; Institute of Health Policy, Management and Evaluation; Dalla Lana School of Public Health and Department of Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1 W8 Canada
| |
Collapse
|
27
|
Villatoro AP, Aneshensel CS. Family Influences on the Use of Mental Health Services among African Americans. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2014; 55:161-180. [PMID: 24872466 PMCID: PMC4395552 DOI: 10.1177/0022146514533348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We examine how families influence mental health service (MHS) utilization among African Americans by drawing on the concept of family ambivalence, which encompasses both family support and stress, and by placing utilization within the context of family histories of psychiatric disorder and treatment. Data are from the 2001-2003 National Survey of American Life, a nationally representative sample of African American adults (n = 3,149), including a clinical need subsample (n = 605) of respondents with a disorder. Negative family interactions have indirect positive effects on use of any MHS through need for care, whereas family social support lacks any effect. Although poor self-rated mental health (SRMH) is associated with greater utilization of any and specialty MHS given family histories of no disorder or treated disorder, utilization is low given a family history of untreated disorder, irrespective of SRMH. Screening for family histories of psychiatric disorder in primary care is recommended.
Collapse
|
28
|
Gagné S, Vasiliadis HM, Préville M. Gender differences in general and specialty outpatient mental health service use for depression. BMC Psychiatry 2014; 14:135. [PMID: 24884891 PMCID: PMC4028012 DOI: 10.1186/1471-244x-14-135] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/02/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND This study ascertained gender-specific determinants of outpatient mental health (MH) service use for depression to highlight any gender disparities in barriers to care and explain how depressed men and women in need of care might differ in their help-seeking behaviour. METHODS Data used in this study came from the Canadian Community Health Survey on Mental Health and Well Being, cycle 1.2 (CCHS 1.2) conducted by Statistics Canada in 2002 (N = 36,984). The sample was limited to respondents filling criteria for a probable major depression in the 12 months prior to the interview (n = 1743). Gender-specific multivariate logistic regression analyses were carried out. RESULTS The results showed that 54.3% of respondents meeting criteria for major depression had consulted for mental health reasons in the year prior to interview. When looking at type of outpatient mental health service use, males were more likely to consult a general practitioner and a mental health specialist in the past year as opposed to females. However, females were more likely to consult a general practitioner only as opposed to no service use than males. Gender specific differences in determinants associated with outpatient service use included for males, lower adjusted household income, and for females, a younger age, the presence of social support, self-reported availability barriers, the presence of self-reported suicidal thoughts or attempt and a poorer self- perceived mental health. CONCLUSIONS Continued efforts to promote access to mental health care are needed for men and women affected by depression, and this, to target specific vulnerable populations and increase utilization rates.
Collapse
Affiliation(s)
- Sarah Gagné
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbooke, Canada.
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbooke, Canada,Charles Lemoyne Research Centre, 150, place Charles-LeMoyne, Bureau 200, Longueuil, (Québec) J4K 0A8, Canada
| | - Michel Préville
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbooke, Canada,Charles Lemoyne Research Centre, 150, place Charles-LeMoyne, Bureau 200, Longueuil, (Québec) J4K 0A8, Canada
| |
Collapse
|
29
|
Correa-Fernández V, Carrión-Baralt JR, Alegría M, Albizu-García CE. Correlates associated with unipolar depressive disorders in a Latino population. Psychopathology 2012; 46:163-71. [PMID: 23006435 PMCID: PMC4225145 DOI: 10.1159/000339527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 04/29/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study reports the comparison and associations of demographic, clinical and psychosocial correlates with three unipolar depressive disorders: dysthymia (DYS), major depression (MD) and double depression (DD), and examines to which extent these variables predict the disorders. SAMPLING AND METHOD Previously collected data from 563 adults from a community in Puerto Rico were analyzed. One hundred and thirty individuals with DYS, 260 with MD and 173 with DD were compared by demographic variables, psychiatric and physical comorbidity, familial psychopathology, psychosocial stressors, functional impairment, self-reliance, problem recognition and formal use of mental health services. Multinomial regression was used to assess the association of the predictor variables with each of the three disorders. RESULTS Similarities outweighed the discrepancies between the disorders. The main differences observed were between MD and DD, while DYS shared common characteristics with both MD and DD. After other variables were controlled, anxiety, functional impairment and problem recognition most strongly predicted a DD diagnosis, while age predicted a DYS diagnosis. CONCLUSION MD, DYS and DD are not completely different disorders, but they do differ in key aspects that might be relevant for nosology, research and practice. A dimensional system that incorporates specific categories of disorders would better reflect the different manifestations of unipolar depressive disorders.
Collapse
Affiliation(s)
- Virmarie Correa-Fernández
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | | |
Collapse
|
30
|
Ai AL, Noël LT, Appel HB, Huang B, Hefley WE. Overall health and health care utilization among Latino American men in the United States. Am J Mens Health 2012; 7:6-17. [PMID: 22954558 DOI: 10.1177/1557988312452752] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although the Latino American male population is increasing, the subgroup Latino men's health remains underinvestigated. This study examined the overall pattern of Latino male health and health care utilization in major subgroups, using a nationally representative sample (N = 1,127) from the National Latino and Asian American Study. The authors evaluated rates of chronic, behavioral, and mental health service utilization in this first nationally representative survey. The results identified significant cross-subgroup differences in most physical and chronic conditions with Puerto Rican American men having high rates in 8 of 15 physical ailments, including life-altering conditions such as cardiovascular diseases. Despite differences in racial/ethnic, socioeconomic, and cultural factors, Cuban American men shared similar rates of heart diseases and cancer with Puerto Rican American men. In addition, Puerto Rican American men had higher rates of substance abuse than other Latinos. For health providers, the authors' findings encourage awareness of subgroup differences regarding overall health issues of Latino American men to provide culturally appropriate care.
Collapse
Affiliation(s)
- Amy L Ai
- Florida State University, Tallahassee Florida, FL 32306, USA.
| | | | | | | | | |
Collapse
|
31
|
Leão PBDOES, Martins LAN, Menezes PR, Bellodi PL. Well-being and help-seeking: an exploratory study among final-year medical students. Rev Assoc Med Bras (1992) 2012; 57:379-86. [PMID: 21876917 DOI: 10.1590/s0104-42302011000400009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/10/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Doubts, competitiveness and preparation for the residency examination increase stress and insecurity at the end of medical course. Well-being is very important at this point, but it is known that medical students are reluctant to seek help, particularly for emotional problems. This study investigated the relationship among well-being, perceived needs and help-seeking in final-year students. METHODS Well-being was assessed using Beck's Inventories of Anxiety (BAI) and Depression (BDI) and the WHOQOL-brief (quality of life). A questionnaire was used to assess perceived needs and medical school support resources. RESULTS The students reported good quality of life (68%) but presented anxiety (27%), depression (20%) and impaired social functioning. Fifty-one percent of the students acknowledged academic needs and 25% psychological needs. Only a portion of the students with anxiety and depression or bad quality of life used the institutional support. Female gender, perceived psychological needs and anxiety symptoms were associated to the use of the Mental Health Service. Satisfaction with mentoring relationships and positive changes were associated to Mentoring attendance. CONCLUSION There are different factors involved in help-seeking and identifying specificities in the use of institutional support resources can help to develop strategies to sensitize students about help-seeking during the medical course.
Collapse
|
32
|
Kouwenberg M, Rieffe C, Theunissen SCPM, Oosterveld P. Pathways underlying somatic complaints in children and adolescents who are deaf or hard of hearing. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2011; 17:319-332. [PMID: 22193292 DOI: 10.1093/deafed/enr050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Frequent somatic complaints are not only a problem in themselves but also related to other difficulties. So far, no conclusive findings have been reported about the prevalence of and factors underlying these complaints in children and adolescents who are deaf or hard of hearing (DHH). Such information would be valuable for prevention and intervention. Therefore, the aim of this study was to examine the prevalence of somatic complaints and their relation with emotional functioning in DHH youngsters, as compared with hearing youngsters. This was established by assessing how somatic complaints, mood states, and sense of coherence were experienced by 186 Dutch participants (mean age = 11;07 years). DHH and hearing groups were compared using multivariate analysis of variance and structural equation modeling. The results showed that somatic complaints were reported equally often for both groups, but that the pathways leading to these complaints were partly different. Only in DHH participants were feelings of fear associated with more somatic complaints. The results suggest that DHH children and adolescents would benefit from support in the regulation of fear and its causes. Other aspects affecting adjustment outcomes of DHH youngsters were education type and communication mode.
Collapse
Affiliation(s)
- Maartje Kouwenberg
- Department of Developmental Psychology, Leiden University, The Netherlands.
| | | | | | | |
Collapse
|
33
|
Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res 2011; 45:1027-35. [PMID: 21439576 PMCID: PMC3135672 DOI: 10.1016/j.jpsychires.2011.03.006] [Citation(s) in RCA: 1263] [Impact Index Per Article: 97.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/03/2011] [Indexed: 01/21/2023]
Abstract
Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N=20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men.
Collapse
|
34
|
Sousa Leao PBDOE, Nogueira Martins LA, Menezes PR, Bellodi PL. Well-being and help-seeking: an exploratory study among final-year medical students. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
35
|
A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00000877] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryAim– To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifing the costs of these packages.Methods– Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs.Results– Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users.Conclusion– It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.
Collapse
|
36
|
Gonzalez JM, Alegría M, Prihoda TJ, Copeland LA, Zeber JE. How the relationship of attitudes toward mental health treatment and service use differs by age, gender, ethnicity/race and education. Soc Psychiatry Psychiatr Epidemiol 2011; 46:45-57. [PMID: 19921079 PMCID: PMC3654385 DOI: 10.1007/s00127-009-0168-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 10/27/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Promoting help-seeking for mental health problems can result in improved treatment rates. For the most impact, social marketing interventions need to be tailored to targeted demographic subgroups. We investigated the influence of interactions between attitudes toward treatment and age, gender, ethnicity/race and education for both general medical and specialty care. METHOD Cross-sectional data from the 2001-2003 National Comorbidity Survey Replication (NCS-R) were analyzed using multivariate models adjusted for the sampling design and controlled for relevant clinical and sociodemographic factors. RESULTS Greater comfort talking to a professional was associated with greater past-year specialty care across all demographic groups, while strongest for non-Latino whites and not evident for those 50-64 years old. For all demographic groups, reported willingness to seek professional help was associated with general medical care. However, for specialty care the association was much stronger for men compared to women. For African Americans, but not non-Latino whites, the perceived efficacy of mental health treatment improved the likelihood of past-year specialty use. CONCLUSION Our analyses suggest both the importance of understanding demographic differences in relevant attitudes and potential directions for marketing campaigns.
Collapse
Affiliation(s)
- Jodi M. Gonzalez
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | | | - Thomas J. Prihoda
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Laurel A. Copeland
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. Veterans Affairs HSR&D (VERDICT), San Antonio, TX, USA
| | - John E. Zeber
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. Veterans Affairs HSR&D (VERDICT), San Antonio, TX, USA
| |
Collapse
|
37
|
Ishikawa RZ, Cardemil EV, Falmagne RJ. Help seeking and help receiving for emotional distress among Latino men and women. QUALITATIVE HEALTH RESEARCH 2010; 20:1558-72. [PMID: 20448272 DOI: 10.1177/1049732310369140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In this study, we examined help-seeking pathways and help-receiving experiences among Latinos, a population that has been shown to under-utilize mental health services. We used the qualitative approach of dual mode of analysis to explore the experiences of 13 Latino men and women who utilized formal as well as informal treatment and support resources. We explored three specific themes: (a) individual and family help-seeking perspectives intersecting with Latino cultural norms; (b) referral source and style, needs identification, and prior help-seeking experiences as key motivational factors for help seeking; and (c) client-therapist match and client-therapist relational style as integral to mental health treatment satisfaction. We discuss clinical implications for efforts to improve the cultural sensitivity and accessibility of mental health services.
Collapse
Affiliation(s)
- Rachel Zack Ishikawa
- Frances L. Hiatt School of Psychology, Clark University, 950 Main St., Worcester, MA 01610, USA.
| | | | | |
Collapse
|
38
|
Abstract
OBJECTIVES The purpose of this study was to examine factors associated with the mental health service use of Latino and Asian immigrant elders. Adapting Andersen's behavioral health model of health service utilization, predisposing, enabling, and mental health need factors were considered as potential predictors for use of mental health services. METHOD Data were drawn from a nationally representative dataset, the National Latino and Asian American Survey (NLAAS). Hierarchical logistic regression analyses of mental health service use were conducted for Latino (N = 290) and Asian (N = 211) immigrant elders. RESULTS For both groups of immigrant elders, poor self-rated mental health was associated with significantly greater mental health service use, even after controlling for all other variables. For Latinos, use of mental health services was significantly associated with both predisposing factors (being younger and female) and mental health need factors (having any mood disorders and poor self-rated mental health). Among Asians, only mental health need factors (having any mood disorders and poor self-rated mental health) significantly affected mental health service use. In addition, poor self-rated mental health mediated the association between mood disorders and mental health service use only in Latino immigrant elders. CONCLUSION Results highlight an important role of self-rated mental health as a potential barrier in the use of mental health services, and suggest intervention strategies to enhance service use.
Collapse
|
39
|
Gudmundsdottir G, Vilhjalmsson R. Group differences in outpatient help-seeking for psychological distress: results from a national prospective study of Icelanders. Scand J Public Health 2010; 38:160-7. [PMID: 20064916 DOI: 10.1177/1403494809357357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS This study focused on group differences in health care use for psychological distress. Specifically, the study examined if some subgroups and kinds of distress predicted use of particular providers. METHODS The study uses data from a repeated national postal health survey of a random sample of Icelanders aged 18-75. Response rate at the first wave was 69% (n = 1924), and 83% of the participants from the first wave also responded to the second. The dependent variables referred to use of outpatient visits to different types of professionals (doctor, psychiatrist, registered nurse, psychologist, social worker, clergy, and complementary and alternative medicine provider). RESULTS Gender, age, marital status, residence, education and income affected the selection of healthcare provider. Significant interactions indicated, among other things, that divorced people made the most visits to psychiatrists when depressed, that urban residents visited psychiatrists and psychologists more than others when experiencing anxiety, that the university-educated visited psychologists more when depressed, and that individuals with higher incomes visited psychiatrists, nurses and social workers less when experiencing anxiety or depression. CONCLUSIONS Results indicate considerable group variations in help-seeking. The group in question and the nature of symptoms affected the decision where to seek help. A substantial number of distressed individuals do not seek any professional help, and there are indications of inequity in the distribution of health services. Further studies are needed to better understand the complex social selection processes involved in seeking help for psychological problems.
Collapse
|
40
|
Durantini MR, Albarracín D. Material and social incentives to participation in behavioral interventions: a meta-analysis of gender disparities in enrollment and retention in experimental human immunodeficiency virus prevention interventions. Health Psychol 2009; 28:631-40. [PMID: 19751090 DOI: 10.1037/a0015200] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A meta-analysis was conducted to test theoretical hypotheses about the predictors of enrollment and completion of condom-use-promotion interventions among men and women. DESIGN A meta-analysis summarized research reports of the efficacy of experimental interventions on human immunodeficiency virus (HIV) prevention. MAIN OUTCOME MEASURES The outcome measure consisted of (a) a measure of participation, obtained by subtracting the actual number of participants from the number of the invited people, and (b) a measure of retention was obtained by subtracting the number of participants who completed the intervention from the number of commencers. RESULTS Experimental interventions providing instrumental and financial resources (e.g., payments) increased initiation and retention more among predominantly male samples, whereas experimental interventions using group formats increased initiation and retention more among predominantly female samples. These patterns remained while controlling for past condom use, other HIV-risk behaviors, and demographics associated with gender composition. CONCLUSION People seek out HIV-prevention interventions to fulfill gender-specific needs, and these differences must be taken into account in the design of HIV-prevention interventions.
Collapse
Affiliation(s)
- Marta R Durantini
- Department of Psychology, University of Florida, PO Box 112260, Gainesville, FL 32611, USA.
| | | |
Collapse
|
41
|
Matsui N, Sakane A, Omori Y, Kimoto S, Kadota N, Moriya M. Correlates of Community Health Service Utilization for Menopausal Symptoms among Urban Japanese Women. Public Health Nurs 2009; 26:229-39. [DOI: 10.1111/j.1525-1446.2009.00775.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
42
|
The influence of social anchorage on the gender difference in the use of mental health services. J Behav Health Serv Res 2009; 36:372-84. [PMID: 19252987 DOI: 10.1007/s11414-009-9168-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
Abstract
Overall, women are more likely than men to seek professional care when they face light or moderate mental health problems. This difference is usually attributed to culture-related factors, but neither women nor men form a homogeneous cultural group. The help-seeking behavior may reflect not only the cultural values and expectations associated with a specific gender but also those associated with specific social roles endorsed by women and men. In addition, the influence of these culture-related factors on the help-seeking behavior is constrained by barriers to care, which apply similarly to women and men. In consequence, the gender difference in the use of mental health services should vary across social roles and types of service. This hypothesis was tested on data from the cycle 1.2 of the Canadian Community Health Survey. Logistic regression analyses show that, although women are more likely than men to use mental health services, this gender difference is larger for general services than for psychiatric and psychological services whose access in Canada is constrained, respectively, by systemic and financial barriers to care. They also suggest that holding the role of worker tends to foster the use of psychological services in women, especially in married women, and to a lesser degree in men, whereas it tends to hinder the use of general and psychiatric services in men but to exert no or less influence in women. Thus, professional anchorage seems to be an important source of the societal norms that influence the decision of women and men to seek or not to seek medical care for mental health problems.
Collapse
|
43
|
Ojeda VD, Bergstresser SM. Gender, race-ethnicity, and psychosocial barriers to mental health care: an examination of perceptions and attitudes among adults reporting unmet need. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2008; 49:317-334. [PMID: 18771066 DOI: 10.1177/002214650804900306] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Though researchers have described psychosocial barriers to mental health care-seeking, limited research has examined ways in which gender and race-ethnicity are associated with individuals' perceptions and attitudes. This study investigates correlates of psychosocial barriers to mental health care in a population of adults reporting unmet need for mental health care, focusing on gender and race-ethnicity. Data are from the 2002 National Survey on Drug Use and Health. Multivariate analyses show that non-Latino white male status is positively associated with stigma avoidance and mistrust/fear of the mental health care system. Persons of lower income or educational status are less likely to report negative attitudes towards care. Findings imply a need to reconsider the roles of gender race-ethnicity, and socioeconomic status within investigations of psychosocial barriers to care. Future research should examine the relationships among social status, help-seeking behaviors, and attitudes toward mental health care.
Collapse
Affiliation(s)
- Victoria D Ojeda
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0622, USA.
| | | |
Collapse
|
44
|
Janney CA, Richardson CR, Holleman RG, Glasheen C, Strath SJ, Conroy MB, Kriska AM. Gender, mental health service use and objectively measured physical activity: Data from the National Health and Nutrition Examination Survey (NHANES 2003-2004). Ment Health Phys Act 2008; 1:9-16. [PMID: 19946571 PMCID: PMC2782873 DOI: 10.1016/j.mhpa.2008.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE: To examine the relationship between physical activity levels measured objectively by accelerometry and the use of mental health services (MHS) in a representative sample of males and females. METHOD: NHANES 2003-2004 is a cross-sectional study of the civilian, non-institutionalized US adult population. Participants reported whether or not they had seen a mental health professional during the past 12 months. Three measures of daily physical activity (light minutes, moderate-vigorous minutes, and total activity counts) and sedentary minutes were determined by accelerometry. The relationship between physical activity and use of MHS was modeled with and without adjustments for potential socioeconomic and health confounders. RESULTS: Of the 1846 males and 1963 females included in this analysis, 7 and 8% reported seeing mental health professionals during the past 12 months, respectively. Men who used MHS were significantly less active than men who did not use MHS (227,700 versus 276,900 total activity counts, respectively, p < 0.05). Men who did not use MHS engaged in 38 min (95% CI 16.3, 59.0) more of light or moderate-vigorous physical activity per day than men who used MHS. Physical activity levels of women, regardless of MHS use, were significantly lower than men who did not use MHS. Differences in total physical activity between women who did and did not use MHS were small (1.3, 95% CI - 14.0, 11.4). CONCLUSION: Men and women who used MHS were relatively sedentary. Additional research is warranted to determine if increasing physical activity levels results in improved mental health in individuals who use MHS.
Collapse
Affiliation(s)
- Carol A. Janney
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute and Clinic, Bellefield Towers, Eighth Floor, 100 Bellefield Avenue, Pittsburgh, PA 15213-2600, USA
| | - Caroline R. Richardson
- Department of Family Medicine, University of Michigan Health Systems and Health Services Research & Development Center for Excellence, Ann Arbor Veterans’ Affair Medical Center, Ann Arbor, MI, USA
| | - Robert G. Holleman
- Department of Family Medicine, University of Michigan Health Systems and Health Services Research & Development Center for Excellence, Ann Arbor Veterans’ Affair Medical Center, Ann Arbor, MI, USA
| | - Cristie Glasheen
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott J. Strath
- Department of Human Movement Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Molly B. Conroy
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Andrea M. Kriska
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
45
|
Poulsen T, Elkjaer E, Vass M, Hendriksen C, Avlund K. Promoting physical activity in older adults by education of home visitors. Eur J Ageing 2007; 4:115-124. [PMID: 28794780 DOI: 10.1007/s10433-007-0057-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The objectives were to investigate in older adults (1) whether regular preventive home visits are associated with change or stability in physical activity and (2) whether education of home visitors influences stability and change in physical activity. The design was a prospective controlled randomised follow-up study with randomization at municipality level (17 intervention and 17 control municipalities) and outcomes measured at individual level. Visitors in the intervention-municipalities received regular education during 3 years. The effect of the intervention was measured by a questionnaire survey among 1,913 old persons living in the 34 municipalities at baseline and 4½-year follow-up. Changes in physical activity were measured through self-reported frequencies of vigorous physical activity. All logistic regression analyses were stratified by sex and age group (75 and 80 years old). There was no effect of receiving preventive home visits on change in physical activity among the men and among the 75-year-old women. Among the physically active 80-year-old women those who accepted and received more than four preventive home visits were more likely to go on being physically active compared to women who did not receive preventive home visits. Among the sedentary 80-year-old women those living in the intervention municipalities tended to increase their physical activity compared to the control women. These results were not seen in the old men. Preventive home visits as part of daily routine in primary care and education of home visitors and general practitioners may promote physical activity in older women.
Collapse
Affiliation(s)
- Tine Poulsen
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O.2099, 1014 Copenhagen K, Denmark
| | - Eva Elkjaer
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O.2099, 1014 Copenhagen K, Denmark
| | - Mikkel Vass
- Department of General Practice and Central Research Unit for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Carsten Hendriksen
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O.2099, 1014 Copenhagen K, Denmark
| | - Kirsten Avlund
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O.2099, 1014 Copenhagen K, Denmark
| |
Collapse
|
46
|
Fleishman JA, Zuvekas SH. Global Self-Rated Mental Health: Associations With Other Mental Health Measures and With Role Functioning. Med Care 2007; 45:602-9. [PMID: 17571008 DOI: 10.1097/mlr.0b013e31803bb4b0] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A large body of research shows that global self-rated health is related to important outcome variables. Increasingly, studies also obtain a single global self-rating of mental health, but understanding of what this item measures is limited. OBJECTIVE To clarify interpretation of self-reported mental health, we examine its associations with other validated measures of mental health and role functioning. RESEARCH DESIGN We conducted cross-sectional analyses of nationally representative data from the Medical Expenditure Panel Survey. MEASURES In-person household interviews obtained data on global self-reported mental health and any limitations in work, school, or housekeeping activities. Adult respondents (N = 11,109) completed the SF-12 health status survey, the K6 scale of nonspecific psychologic distress, and the Patient Health Questionnaire (PHQ-2) depression screener in a self-administered questionnaire. We used the SF-12 Mental Component Summary and the mental health subscale. Analyses examined associations among mental health measures and regressed activity limitations, and the SF-12 physical and emotional role functioning scales on mental health measures, controlling for demographics and selected chronic conditions. RESULTS The 4 multi-item mental health measures were strongly correlated with each other (r > 0.69), but correlated less strongly with the self-reported mental health item (r approximately 0.4). In an exploratory factor analysis, self-reported mental health loaded on both mental and physical health factors. In multivariate analyses, each mental health variable was significantly associated with activity limitations and with role functioning, but the association of self-reported mental health with emotional role functioning was relatively weak. CONCLUSIONS Although global self-rated mental health is related to symptoms of psychologic distress, it cannot be considered to be a substitute for them.
Collapse
Affiliation(s)
- John A Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA.
| | | |
Collapse
|
47
|
Abstract
Given the increasing evidence that older ethnic minorities underuse mental health services, the present study assessed determinants of attitudes toward mental health services with a sample of older Korean Americans (N=472). Adapting Andersen's behavioral health model, predisposing factors (age, sex, marital status, education, length of residence in the United States), mental health needs (anxiety, suicidal ideation, depressive symptoms), and enabling factors (personal experiences and beliefs) were considered as potential predictors. Shorter residence in the United States and higher levels of depressive symptoms were associated with more-negative attitudes toward mental health services. Culture-influenced personal beliefs (knowledge about mental illness and stigmatism) were found to play a substantial role in shaping individuals' attitudes toward mental health services. Findings call attention to the need to investigate how culture influences the response to mental health needs and to develop community education and outreach programs to close the gaps between mental health needs and service utilization in older ethnic minority populations.
Collapse
Affiliation(s)
- Yuri Jang
- Department of Aging and Mental Health, Florida Mental Health Institute, University of South Florida, Tampa, Florida 33612, USA.
| | | | | | | |
Collapse
|
48
|
Cardemil EV, Adams ST, Calista JL, Connell J, Encarnación J, Esparza NK, Frohock J, Hicks E, Kim S, Kokernak G, McGrenra M, Mestre R, Pérez M, Pinedo TM, Quagan R, Rivera C, Taucer P, Wang E. The Latino mental health project: a local mental health needs assessment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 34:331-41. [PMID: 17279338 PMCID: PMC2863097 DOI: 10.1007/s10488-007-0113-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 01/02/2007] [Indexed: 11/26/2022]
Abstract
In this article, we present the results of a local needs assessment of the mental health experiences, service needs, and barriers to treatment-seeking of the Latino population in Worcester, Massachusetts. Overall, participants reported relatively high rates of experiences with symptoms of mental health problems, they indicated using a range of both formal and alternative mental health services, and they noted a variety of instrumental, attitudinal, and culturally-specific barriers to seeking mental health services. Findings are discussed with regards to the role that community-driven research can play in advancing efforts to provide relevant services to underserved populations.
Collapse
Affiliation(s)
- Esteban V Cardemil
- Department of Psychology, Clark University, 950 Main St, Worcester, MA 01610, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Alegria M, Sribney W, Mulvaney-Day NE. Social cohesion, social support, and health among Latinos in the United States. Soc Sci Med 2007; 64:477-95. [PMID: 17049701 PMCID: PMC3518460 DOI: 10.1016/j.socscimed.2006.08.030] [Citation(s) in RCA: 273] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Indexed: 11/30/2022]
Abstract
The role of individual versus community level social connections in promoting health is an important factor to consider when addressing Latino health. This analysis examines the relationships between social support, social cohesion, and health in a sample of Latinos in the United States. Using data from the National Latino and Asian American Study, the analysis uses ordered logistic regression to explore the relationships of family support, friend support, family cultural conflict, and neighborhood social cohesion with self-rated physical and mental health, taking into account language proficiency and use, nativity, and sociodemographic variables. Family support, friend support, and neighborhood social cohesion were positively related to self-rated physical and mental health, and family cultural conflict was negatively related when controlled only for sex and age. After controlling for education, income, and other demographic measures, only family support was found to have a weak association with self-rated physical health; however, the relationship seemed to be mediated by language. In contrast, family support and family cultural conflict were strongly associated with self-rated mental health, after controlling for language, education, income, and other demographic measures. The study did not find neighborhood social cohesion to be significantly related to either self-rated physical or mental health, after accounting for the effects of the other social connection variables. Language of interview did not explain the highly significant effects of language proficiency and use. Social connections are important for health and mental health, but language and other sociodemographic factors seem to be related to how Latinos establish these social linkages. Further investigation into the role of language in the development and maintenance of social connections may help unravel the mechanisms by which they promote or decrease health.
Collapse
Affiliation(s)
- Margarita Alegria
- Cambridge Health Alliance, Harvard Medical School, Somerville, MA UNITED STATES
| | | | | |
Collapse
|
50
|
Cabassa LJ, Zayas LH, Hansen MC. Latino adults' access to mental health care: a review of epidemiological studies. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2006; 33:316-30. [PMID: 16598658 PMCID: PMC2551758 DOI: 10.1007/s10488-006-0040-8] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Since the early 1980s, epidemiological studies using state-of-the-art methodologies have documented the unmet mental health needs of Latinos adults in the U.S. and Puerto Rico. This paper reviews 16 articles based on seven epidemiological studies, examines studies methodologies, and summarizes findings about how Latino adults access mental health services. Studies consistently report that, compared to non-Latino Whites, Latinos underutilize mental health services, are less likely to receive guideline congruent care, and rely more often on primary care for services. Structural, economic, psychiatric, and cultural factors influence Latinos' service access. In spite of the valuable information these studies provide, methodological limitations (e.g., reliance on cross-sectional designs, scarcity of mixed Latino group samples) constrict knowledge about Latinos access to mental health services. Areas for future research and development needed to improve Latinos' access and quality of mental health care are discussed.
Collapse
Affiliation(s)
- Leopoldo J Cabassa
- School of Social Work, University of Southern California, Los Angeles, CA 90089-0411, USA.
| | | | | |
Collapse
|