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Calais-Ferreira L, Armstrong G, Hahn E, Newton-Howes G, Foulds J, Hopper JL, Spinath FM, Kurdyak P, Young JT. Mental disorders and discrimination: A prospective cohort study of young twin pairs in Germany. SSM Popul Health 2024; 25:101622. [PMID: 38380053 PMCID: PMC10877176 DOI: 10.1016/j.ssmph.2024.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
Background Mental disorders and perceived discrimination share common risk factors. The association between having a mental disorder and experiencing discrimination is well-known, but the extent to which familial factors, such as genetic and shared environmental factors, might confound this association, including sex differences in familial confounding, remains unexplored. Aims We investigated potential unmeasured familial confounding in the association between mental disorders and perceived discrimination using a matched twin study design. Method We examined data from 2044 same-sex twin pairs (n = 4088) aged 16-25 years from the German population-based study 'TwinLife'. We applied random-effects logistic regression to within-individual and within-and-between pair models of the association between mental disorder and perceived discrimination, and used likelihood ratio tests (LRTs) to compare these models. Multivariable models were adjusted for body mass index, educational attainment, and life satisfaction. Results There were 322 (8.1%) participants with a diagnosed mental disorder, and 15% (n = 604) of the cohort reported having experienced discrimination in the previous 12 months. Mental disorder and discrimination were associated in the adjusted within-individual model (adjusted odds ratio = 2.19, 95% confidence interval: 1.42-3.39, P<0.001). However, the within-and-between pair model showed that this association was explained by the within-pair mean (aOR = 4.24, 95% CI: 2.17-8.29, P<0.001) and not the within-pair difference (aOR = 1.26, 95% CI: 0.70-2.28, P = 0.4) of mental disorder. Therefore, this association was mostly explained by familial confounding, which is also supported by the LRTs for the unadjusted and adjusted models (P<0.001 and P = 0.03, respectively). This familial confounding was more prominent for males than females. Conclusions Our findings show that the association between mental disorder and discrimination is at least partially explained by unmeasured familial factors. Designing family-based healthcare models and incorporating family members in interventions targeted at ameliorating mental ill-health and experiences of discrimination among adolescents may improve efficacy.
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Affiliation(s)
- Lucas Calais-Ferreira
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, Victoria, Australia
- Justice Health Group, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elisabeth Hahn
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Frank M. Spinath
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jesse T. Young
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
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Cleary M, West S, Kornhaber R, Hungerford C. Autism, Discrimination and Masking: Disrupting a Recipe for Trauma. Issues Ment Health Nurs 2023; 44:799-808. [PMID: 37616302 DOI: 10.1080/01612840.2023.2239916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Outcomes of discrimination for autistic people include masking, social isolation and exclusion, trauma, and mental health problems. This discursive paper discusses the discrimination experienced by autistic people in health, education, employment, and media settings; and considers how to reduce the impact of discrimination. Addressing the impact of discrimination requires an improved understanding of the lived experience of the autistic person, the embedding of inclusive practices in communities, developing the person's life skills and supports, and enabling the person to work through their psychological trauma. Further research can aid in minimizing and preventing discrimination against people with autism.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Rachel Kornhaber
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Sydney, NSW, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
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Jegede O, Na PJ, Rhee TG, Stefanovics EA, Rosenheck RA. Psychiatric and Substance Use Disorders and Related Service Use in the Diverse Black Sub-Populations in the United States. J Racial Ethn Health Disparities 2022; 9:2237-2247. [PMID: 34590245 DOI: 10.1007/s40615-021-01163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Existing literature on the epidemiology of psychiatric and substance use disorders and service use among African Americans in the USA has not fully addressed the heterogeneity of Black populations. This study compares the proportions and diverse characteristics of these sub-populations, their mental and substance use diagnoses, and related service use. METHODS The data for this study was obtained from the restricted version of the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III). Participants who identified as Black/African Americans were categorized into four groups: African-born, Caribbean-born, US-born with at least one immigrant parent, and US-born with both parents born in the USA. Effect sizes were used to evaluate bivariate between-group differences and multinomial logistic regression analysis was used to identify factors that independently differentiated each of the first three groups from the reference group termed US-born. RESULTS This exploratory analysis strengthened the notion of the immigrant paradox as African- and Caribbean-born Black individuals scored significantly higher on all measures of quality of life and had fewer mental health and substance use diagnoses, but this advantage was not observed in the children of immigrants born in the USA. There were few significant differences in service use across the groups after adjusting for clinical characteristics. CONCLUSION The differences observed in the diverse Black populations of the USA, across measures of mental and physical health, and substance use, deserve attention in future research, policy, and program development.
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Affiliation(s)
- Oluwole Jegede
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Peter J Na
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs, Education, and Clinical Center, New England Mental Illness Research, 950 Campbell Avenue, West Haven, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs, Education, and Clinical Center, New England Mental Illness Research, 950 Campbell Avenue, West Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs, Education, and Clinical Center, New England Mental Illness Research, 950 Campbell Avenue, West Haven, CT, USA
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Mejia-Lancheros C, Lachaud J, Woodhall-Melnik J, O'Campo P, Hwang SW, Stergiopoulos V. Longitudinal interrelationships of mental health discrimination and stigma with housing and well-being outcomes in adults with mental illness and recent experience of homelessness. Soc Sci Med 2021; 268:113463. [DOI: 10.1016/j.socscimed.2020.113463] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/03/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
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Mejia-Lancheros C, Lachaud J, O’Campo P, Wiens K, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V. Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PLoS One 2020; 15:e0229385. [PMID: 32106225 PMCID: PMC7046214 DOI: 10.1371/journal.pone.0229385] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/04/2020] [Indexed: 12/27/2022] Open
Abstract
Stigma and discrimination toward individuals experiencing homelessness and mental disorders remain pervasive across societies. However, there are few longitudinal studies of stigma and discrimination among homeless adults with mental illness. This study aimed to identify the two-year group trajectories of stigma and discrimination and examine the predictive role of mental health characteristics among 414 homeless adults with mental illness participating in the extended follow-up phase of the Toronto At Home/Chez Soi (AH/CS) randomized trial site. Mental health-related perceived stigma and discrimination were measured at baseline, one, and two years using validated scales. Group-based-trajectory modelling was used to identify stigma and discrimination group trajectory memberships and the effect of the Housing First treatment (rent supplements and mental health support services) vs treatment as usual on these trajectories. The associations between mental health-related characteristics and trajectory group memberships were also assessed using multinomial logistic regression. Over two-years, three group trajectories of stigma and discrimination were identified. For discrimination, participants followed a low, moderate, or increasingly high discrimination group trajectory, while for stigma, participants followed a low, moderate or high stigma group trajectory. The Housing First treatment had no significant effect on discrimination or stigma trajectories groups. For the discrimination trajectories, major depressive episode, mood disorder with psychotic features, alcohol abuse, suicidality, severity of mental health symptoms, and substance use severity in the previous year were predictors of moderate and increasingly high discrimination trajectories. History of discrimination within healthcare setting was also positively associated with following a moderate or high discrimination trajectory. For the stigma trajectories, substance dependence, high mental health symptoms severity, substance use severity, and discrimination experiences within healthcare settings were the main predictors for the moderate trajectory group; while substance dependence, suicidality, mental health symptom severity, substance use severity and discrimination experiences within health care setting were also positive predictors for the high stigma trajectory group. Ethno-racial status modified the association between having a major depression episode, alcohol dependence, and the likelihood of being a member of the high stigma trajectory group. This study showed that adults experiencing mental illness and homelessness followed distinct stigma and discrimination group trajectories based on their mental health-problems. There is an urgent need to increase focus on strategies and policies to reduce stigma and discrimination in this population.
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Affiliation(s)
- Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - James Lachaud
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kathryn Wiens
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Locating oneself in the past to influence the present: Impacts of Neolithic landscapes on mental health well-being. Health Place 2019; 62:102273. [PMID: 32479354 DOI: 10.1016/j.healthplace.2019.102273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 11/20/2022]
Abstract
There are well-established links between mental health and the environment. Mental illness is a global issue, and international policies increasingly focus on promoting mental health well-being through community-based approaches, including non-clinical initiatives such as therapeutic landscapes and the use of heritage assets. However, the empirical evidence-base for the impact of such initiatives is limited. This innovative study, known as Human Henge, used a mixed-methods approach to investigate the impact of immersive experiences of prehistoric landscapes on the well-being of participants with mental health issues. Uniquely, the study followed participants for a year after their participation in the project to explore the long-term impact of their experiences on their mental well-being. Findings highlight that, overall, participants experienced improved mental health well-being from baseline to mid- and end-of programme (p = 0.01 & 0.003), as well as one-year post-programme (p = 0.03). Qualitative data indicated the reconnection of participants with local communities, and with other people, in ways that improved their mental health well-being. These data highlight the effectiveness of using heritage as a means of improving the well-being of people with mental health issues.
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Lowe K. Caring for people with mental health conditions in general clinical settings. Nurs Stand 2019; 34:70-75. [PMID: 31468894 DOI: 10.7748/ns.2019.e11263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 11/09/2022]
Abstract
Nurses often care for people with mental health conditions in general clinical settings. In these situations, they have a responsibility to ensure that the individual's physical, social and psychological needs are assessed and met. Nurses practising in general clinical settings should be familiar with the skills and knowledge required to meet the needs of people with mental health conditions. This article aims to provide nurses practising in general clinical settings with an understanding of such conditions and the associated effects on an individual's physical health. It also details the signs and symptoms of various mental health conditions, and outlines the communication skills that nurses can use when caring for people with these conditions in general clinical settings.
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Affiliation(s)
- Katy Lowe
- HIV Liaison Service, South London and Maudsley NHS Foundation Trust, London, England
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Fernández-Niño JA, Bojorquez I, Becerra-Arias C, Astudillo-Garcia CI. Religious affiliation and major depressive episode in older adults: a cross-sectional study in six low- and middle- income countries. BMC Public Health 2019; 19:460. [PMID: 31039777 PMCID: PMC6492427 DOI: 10.1186/s12889-019-6806-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
Background The relationship of religious affiliation and mental health is complex, and being part of a minority religious group could have negative effects on mental health. In this study, we assessed the association between religious affiliation and major depressive episode (MDE) in older adults (> = 60 years) from China, Ghana, India, Mexico, Russia and South Africa. Methods We conducted a secondary analysis of data from the Study on global Ageing and adult health (SAGE), with six nationally-representative community-based samples (n = 21,410). Religious affiliation was self-reported by participants, and we defined MDE based on ICD-10 classification. We estimated the association of MDE with religious affiliation versus no religious affiliation, and minority versus majority affiliation. Results We observed no association between having a religious affiliation (vs. no affiliation) and the odds of MDE in older adults. In most cases minorities had higher odds of MDE as compared with the majority religion, but the associations were only significant for Muslims in Ghana and for Muslims, Hindus and Other in South Africa. Conclusions While the results were significant only for two countries, we observed higher odds of MDE among minorities in most of them. Older adults who are members of religious minorities might be at risk for mental health problems, and there is a need for public health interventions aimed at them. Electronic supplementary material The online version of this article (10.1186/s12889-019-6806-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julian A Fernández-Niño
- Department of Public Health, Universidad del Norte, Colombia. Km. 5 Vía Puerto Colombia, Atlantico, Barranquilla, Colombia, ZP 081007
| | - Ietza Bojorquez
- Department of Population Studies, El Colegio de la Frontera Norte, Mexico, Km. 18.5 Carretera Escénica Tijuana-Ensenada, San Antonio del Mar, CP 22560, Tijuana, BC, Mexico.
| | - Carolina Becerra-Arias
- Research Group on Health, Rehabilitation and Work (SARET), Manuela Beltrán University -- Colombia.Sectional Bucaramanga, Calle 33 #27-12, Bucaramanga, Santander, Colombia, ZP 680002
| | - Claudia I Astudillo-Garcia
- Psychiatric Services, Secretaria de Salud, Marina Nacional 60, Tacuba, Miguel Hidalgo, ZP 11410, Ciudad de México, Mexico, Mexico
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