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Gibbons RD, Olfson M, Saulsberry L, Edlund MJ, Zangeneh S, Bareis N, Chwastiak L, Gibbons JB, Kessler RC. Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders. JAMA Psychiatry 2024:2821371. [PMID: 39046728 DOI: 10.1001/jamapsychiatry.2024.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Importance Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study. Objective To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older. Design, Setting, and Participants A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews. Main Outcomes and Measures Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level. Results The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80). Conclusions and Relevance In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.
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Affiliation(s)
- Robert D Gibbons
- Department of Medicine, Division of Biological Sciences, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, Division of Biological Sciences, University of Chicago, Chicago, Illinois
- Center for Health Statistics, University of Chicago, Chicago, Illinois
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, New York
| | - Loren Saulsberry
- Department of Public Health Sciences, Division of Biological Sciences, University of Chicago, Chicago, Illinois
| | | | - Sahar Zangeneh
- RTI International
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Natalie Bareis
- Department of Psychiatry, Columbia University, New York, New York
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jason B Gibbons
- Department of Health Systems, Management and Policy, University of Colorado, Aurora
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Zhao C, Huang Y, Cheng Y, Zhang R, Wang Y, Tong S, He J, Guo J, Xia F, Li Y, Yao X. Association between heatwaves and risk and economic burden of injury related hospitalizations in China. ENVIRONMENTAL RESEARCH 2024; 259:119509. [PMID: 38945512 DOI: 10.1016/j.envres.2024.119509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Public health is greatly affected by heatwaves, especially as a result of climate change. It is unclear whether heatwaves affect injury hospitalization, especially as developing countries facing the impact of climate change. OBJECTIVES To assess the impact of heatwaves on injury-related hospitalization and the economic burden. METHODS The daily hospitalizations and meteorological data from 2014 to 2019 were collected from 23 study sites in 11 meteorological geographic zones in China. We conducted a two-stage time series analysis based on a time-stratified case-crossover design, combined with DLNM to assess the association between heatwaves and daily injury hospitalization, and to further assess the regional and national economic losses resulting from hospitalization by calculating excess hospitalization costs (direct economic losses) and labor losses (indirect economic losses). To determine the vulnerable groups and areas, we also carried out stratified analyses by age, sex, and region. RESULTS We found that 6.542% (95%CI: 3.939%, 9.008 %) of injury hospitalization were attributable to heatwaves during warm season (May to September) from 2014 to 2019. Approximately 361,447 injury hospitalizations were attributed to heatwaves each year in China, leading to an excess economic loss of 5.173 (95%CI: 3.104, 7.196) billion CNY, of which 3.114 (95%CI: 1.454, 4.720) billion CNY for males and 4.785 (95%CI: 3.203, 6.321) billion CNY for people aged 15-64 years. The attributable fraction (AF) of injury hospitalizations due to heatwaves was the highest in the plateau mountain climate zone, followed by the subtropical monsoon climate zone and the temperate monsoon climate zone. CONCLUSIONS Heatwaves significantly increase the disease and economic burden of injury hospitalizations, and vary across populations and regions. Our findings implicate the necessity for targeted measures, including raising public awareness, improving healthcare infrastructure, and developing climate resilience policies, to reduce the threat of heatwaves to vulnerable populations and the associated disease and economic burden.
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Affiliation(s)
- Cheng Zhao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China.
| | - Yushu Huang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China; Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Yibin Cheng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Rui Zhang
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Yu Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Shilu Tong
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, 230032, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jiang He
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Jia Guo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Fan Xia
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Yonghong Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China.
| | - Xiaoyuan Yao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China.
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Ellison V, Berlin KS, Longoria J, Potter B, Raches D, Hankins JS, Takemoto C, Heitzer AM. Empirically derived profiles of neurocognitive functioning in youth and young adults with sickle cell disease. J Pediatr Psychol 2024:jsae029. [PMID: 38623054 DOI: 10.1093/jpepsy/jsae029] [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: 10/10/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE Sickle cell disease (SCD) is an inherited blood disorder associated with neurocognitive deficits. In contrast to variable-centered approaches, no known research has utilized person-centered strategies to identify multidimensional patterns of neurocognitive functioning of an individual with SCD. The purpose of the present study was to create empirically derived profiles and identify predictors of neurocognitive functioning subgroups among youth and young adults with SCD. METHODS Individuals with SCD (N = 393, mean age 14.05 years, age range 8-24, 50.4% female/49.6% male) completed neurocognitive assessments. Latent profile analysis derived subgroups/classes of neurocognitive functioning and determined relations with demographic and medical variables. RESULTS Three latent classes emerged: average functioning (n = 102, 27%), low average functioning (n = 225, 60%), and exceptionally low functioning (n = 46, 12%). Older age was associated with membership in the low average and exceptionally low functioning groups (relative to the average group). Being prescribed hydroxyurea was associated with membership in the average functioning group (relative to the low average group) and absence of hydroxyurea use was associated with membership in the exceptionally low group (relative to the low average group). Lower social vulnerability was associated with membership in the average functioning group compared to the low average and exceptionally low groups. CONCLUSIONS Clinicians can help reduce disparities in cognitive development for individuals with SCD by promoting early treatment with hydroxyurea and implementing methods to reduce social vulnerabilities that can interfere with access to evidence-based care.
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Affiliation(s)
- Vinkrya Ellison
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
- The Department of Psychology, The University of Memphis, Memphis, TN, United States
- The Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Kristoffer S Berlin
- The Department of Psychology, The University of Memphis, Memphis, TN, United States
- The Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Jennifer Longoria
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Brian Potter
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Darcy Raches
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Clifford Takemoto
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Andrew M Heitzer
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
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Stilita G, Charlson F. Keeping Sane in a Changing Climate: Assessing Psychologists' Preparedness, Exposure to Climate-Health Impacts, Willingness to Act on Climate Change, and Barriers to Effective Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:218. [PMID: 38397707 PMCID: PMC10888424 DOI: 10.3390/ijerph21020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Evidence of the impact of climate change on mental health is growing rapidly, and healthcare professionals are being called to be active participants in protecting the population's health. Yet, little is known about psychologists' understanding of climate-health impacts and their role in mitigation actions. We surveyed Australian psychologists (N = 59) to examine preparedness in identifying and managing the impact of climate change on mental health, exposure to climate-health impacts, willingness to act, and barriers to acting on climate change. Data was analysed through descriptive and associative methods. We found that participants are not prepared to identify and manage mental health presentations related to climate change, and they are not engaged in climate change mitigation. We identified that a lack of knowledge of climate-health impacts and tackling and mitigation strategies, in addition to ethical concerns, were the main barriers to engagement with communication and advocacy. With the impacts of climate change on mental health expected to soar, there is a clear and urgent need to prepare the psychological workforce to address this public health issue by establishing professional education programs and reframing climate change as a health crisis.
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Affiliation(s)
- Gabriela Stilita
- School of Public Health, Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia;
- Queensland Centre for Mental Health Research, Queensland Health, Wacol, QLD 4076, Australia
- Psychology Department, The Prince Charles Hospital–Queensland Health, Chermside, QLD 4032, Australia
| | - Fiona Charlson
- School of Public Health, Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia;
- Queensland Centre for Mental Health Research, Queensland Health, Wacol, QLD 4076, Australia
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Meadows J, Mansour A, Gatto MR, Li A, Howard A, Bentley R. Mental illness and increased vulnerability to negative health effects from extreme heat events: a systematic review. Psychiatry Res 2024; 332:115678. [PMID: 38150812 DOI: 10.1016/j.psychres.2023.115678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
RATIONALE Across countries, extreme heat events are projected to increase in frequency and intensity because of climate change. Exposure to extreme heat events can have a substantial negative impact on human health, and extant research suggests that individuals with mental illness are particularly vulnerable. To date, there has been no review of evidence regarding this vulnerability to inform response strategies and future research. OBJECTIVE A systematic review was undertaken to investigate mental illness as an effect modifier of the relationship between heat exposure and morbidity or mortality. METHODS Six databases (Medline, Embase, Global Health, PsychInfo, CINAHL and Scopus) were searched for studies published between the years 2000 to 2022. Twenty-two observational studies that met the inclusion criteria were investigated through narrative synthesis. The RoBANS tool, ROBIS and GRADE were used to assess the certainty of evidence including the risk of bias. RESULTS Individuals with mental illness experience worse morbidity and mortality outcomes compared to their counterparts without mental illness in all studies investigating high temperature over a single day. This did not hold for studies examining heatwaves, which reported mixed findings. CONCLUSIONS AND IMPLICATIONS People with diagnosed mental illness should be targeted for policy and service attention during high temperature days. Further research should investigate specific mental illness and adjust for a wider range of confounding factors.
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Affiliation(s)
- Julia Meadows
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Adelle Mansour
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Maria Rosa Gatto
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Ang Li
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Amber Howard
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca Bentley
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia.
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