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Blebu B, Jackson A, Reina A, Dossett EC, Saleeby E. Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness. Health Aff (Millwood) 2024; 43:532-539. [PMID: 38560805 DOI: 10.1377/hlthaff.2023.01456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
To characterize co-occurring social determinants of health for clients experiencing perinatal anxiety and depression (perinatal mood and anxiety disorders) or serious mental illness (SMI) in a diverse population receiving prenatal care in a safety-net health system, we conducted a latent class analysis, using data from a social determinants screener in pregnancy for the health system's clients during 2017-20. The sample included clients with positive screens for depression or anxiety or SMI diagnoses. Prenatal clients with a positive screen for perinatal mood and anxiety disorders or SMI comprised 13-30 percent of classes, characterized by more than two co-occurring social determinants (for example, co-occurring socioeconomic and interpersonal factors). The study findings highlight the salience of social determinants among prenatal patients experiencing perinatal mood and anxiety disorder and SMI and suggest the necessity of consistent screening for both social determinants and perinatal mental health. Policies to address social determinants within and beyond health care settings are critical.
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Affiliation(s)
- Bridgette Blebu
- Bridgette Blebu , Harbor-UCLA Medical Center, Torrance, California
| | - Ashaki Jackson
- Ashaki Jackson, Los Angeles County Department of Health Services, Torrance, California
| | - Astrid Reina
- Astrid Reina, University of California Los Angeles, Los Angeles, California
| | - Emily C Dossett
- Emily C. Dossett, University of Southern California, Los Angeles, California
| | - Erin Saleeby
- Erin Saleeby, Los Angeles County Department of Health Services
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Oh H, Winn JG, Li Verdugo J, Bañada R, Zachry CE, Chan G, Okine L, Park J, Formigoni M, Leaune E. Mental health outcomes of multiracial individuals: A systematic review between the years 2016 and 2022. J Affect Disord 2024; 347:375-386. [PMID: 38008291 DOI: 10.1016/j.jad.2023.11.040] [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: 10/21/2022] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Emerging evidence suggests that multiracial individuals are at high risk for mental health problems. Systematic and ongoing synthesis of literature is necessary to understand mental health among multiracial individuals. METHODS We conducted a systematic review of scholarly articles published during the years 2016-2022. Studies must have focused explicitly on mental health outcomes of biracial/multiracial individuals using quantitative methods. A total of 22 articles met criteria for this review. RESULTS Studies were mainly from the United States, with one study from the United Kingdom and one from the Netherlands. Sample sizes ranged from 57 to 393,681. Findings revealed a complicated picture between multiracial identity and mental health, which may be a function of how multiracial identity is defined and empirically examined. Among studies comparing multiracial individuals with monoracial groups, multiracial individuals tended to have worse mental health, with notable exceptions depending on the multiracial subgroup, the mental health outcome, and the reference group. Among studies that only examined multiracial individuals, discrimination and ethno-racial identity emerged as complex explanatory factors that can shape mental health, though each of these constructs can be explored more deeply across social milieu. LIMITATIONS The review focused on studies explicitly examining multiracial mental health, published during a limited time frame. CONCLUSION Multiracial individuals tended to have worse mental health outcomes compared to their monoracial counterparts, with variations depending on the outcomes, populations/subgroups, contexts, and reference groups. Racial discrimination and ethno-racial identity may shape mental health trajectories of multiracial people, calling for more research to inform targeted interventions.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, USA.
| | | | | | - Ronna Bañada
- Suzanne Dworak Peck School of Social Work, University of Southern California, USA.
| | - Corinne E Zachry
- Suzanne Dworak Peck School of Social Work, University of Southern California, USA.
| | - Gloria Chan
- Suzanne Dworak Peck School of Social Work, University of Southern California, USA.
| | - Lucinda Okine
- Suzanne Dworak Peck School of Social Work, University of Southern California, USA.
| | - Juyoung Park
- Suzanne Dworak Peck School of Social Work, University of Southern California, USA.
| | - Marco Formigoni
- Suzanne Dworak Peck School of Social Work, University of Southern California, USA.
| | - Edouard Leaune
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
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Stern KE, Hicks S, Gavin AR, Littman AJ, Wander PL. Cross-sectional Associations of Multiracial Identity with Self-Reported Asthma and Poor Health Among American Indian and Alaska Native Adults. J Racial Ethn Health Disparities 2023; 10:2444-2452. [PMID: 36205849 DOI: 10.1007/s40615-022-01423-2] [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: 06/06/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 10/10/2022]
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) multiracial subgroups are underrecognized in health outcomes research. METHODS We performed a cross-sectional analysis of Behavioral Risk Factor Surveillance System surveys (2013-2019), including adults who self-identified as AI/AN only (single race AI/AN, n = 60,413) or as AI/AN and at least one other race (multiracial AI/AN, (n = 6056)). We used log binomial regression to estimate the survey-weighted prevalence ratios (PR) and 95% confidence intervals (CI) of lifetime asthma, current asthma, and poor self-reported health among multiracial AI/AN adults compared to single race AI/AN adults, adjusting for age, obesity, and smoking status. We then examined whether associations differed by sex and by Latinx identity. RESULTS Lifetime asthma, current asthma, and poor health were reported by 25%, 18%, and 30% of multiracial AI/AN adults and 18%, 12%, and 28% single race AI/AN adults. Multiracial AI/AN was associated with a higher prevalence of lifetime (PR 1.30, 95% CI 1.18-1.43) and current asthma (PR 1.36, 95% CI 1.21-1.54), but not poor health. Associations did not differ by sex. The association of multiracial identity with current asthma was stronger among AI/AN adults who identified as Latinx (PR 1.77, 95% CI 1.08-2.94) than non-Latinx AI/AN (PR 1.18, 95% CI 1.04-1.33), p-value for interaction 0.03. CONCLUSIONS Multiracial AI/AN adults experience a higher prevalence of lifetime and current asthma compared to single race AI/AN adults. The association between multiracial identity and current asthma is stronger among AI/AN Latinx individuals. The mechanisms for these findings remain under-explored and merit further study.
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Affiliation(s)
- Katherine E Stern
- University of Washington School of Public Health, Seattle, WA, USA.
- University of California San Francisco East Bay Surgery Program, Oakland, CA, USA.
| | - Sarah Hicks
- University of Washington School of Public Health, Seattle, WA, USA
| | - Amelia R Gavin
- University of Washington School of Social Work, Seattle, WA, USA
| | - Alyson J Littman
- University of Washington School of Public Health, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - Pandora L Wander
- University of Washington Department of Medicine, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
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Oh H, Du J, Smith L, Koyanagi A. Mental health differences between multiracial and monoracial college students in the United States: Emerging racial disparities. Int J Soc Psychiatry 2022; 69:744-751. [PMID: 36384304 DOI: 10.1177/00207640221135817] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiracial individuals appear to be at higher risk for mental health problems; however, more research is needed to confirm these racial disparities among young adult college populations. METHODS We analyzed data from the Health Minds Study (N = 99728 young adult college students aged 18-34), collected online across 140 college campuses from September 2020 to June 2021. We used multivariable logistic regression to examine associations between multiracial identity and several mental health outcomes, including mental and behavioral health (depression, anxiety, languishing, perceived need, loneliness), self-injurious behaviors (non-suicidal self-injury, suicidal ideation, suicide plan, suicide attempt), and history of lifetime psychiatric disorders, adjusting for age and gender. RESULTS Almost a tenth of the weighted sample were multiracial. Multiracial students had greater odds of all mental and behavioral health outcomes, self-injurious behaviors (though only marginally significant for suicide attempt), and most lifetime psychiatric disorders. CONCLUSION Multiracial young adult college students were more likely to have mental health problems than their monoracial counterparts, calling for targeted preventive interventions on college campuses to address these mental health disparities.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jinyu Du
- Southern Methodist University, University Park, TX, USA
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, ICREA, Barcelona, Spain
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Oh H, Susser E, Volpe VV, Lui F, Besecker M, Zhou S, Anglin DM. Psychotic experiences among Black college students in the United States: The role of socioeconomic factors and discrimination. Schizophr Res 2022; 248:198-205. [PMID: 36088750 PMCID: PMC10227771 DOI: 10.1016/j.schres.2022.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 07/27/2022] [Accepted: 09/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychosis is more prevalent among Black individuals compared with White individuals. However, it is unknown whether this disparity exists among college populations in the United States, and if so, what factors contribute to the disparity. METHODS We analyzed data from Black and White young adult students using the Health Minds Study (2020-2021), which is a survey administered at 140 colleges in the U.S. Using mediation analysis, we examined the extent to which the relation between race and psychotic experiences was mediated by socioeconomic factors (past and current financial distress, food insecurity, parental education) and discrimination. RESULTS Approximately 38 % of Black students and 30 % of White students reported lifetime psychotic experiences. Including all socioeconomic factors together in the same model accounted for just over half (50.2 %) the association between race and psychotic experiences. We then conducted additional analyses examining discrimination, all the socioeconomic factors plus discrimination accounted for 81.5 % of the association between race and psychotic experiences. When disentangling the mediators, food insecurity and discrimination accounted for the largest percentages of the association. The effects of past financial distress and parental education were modified by race. CONCLUSION Black college students were more likely to report lifetime psychotic experiences than their White counterparts. Moreover, socioeconomic factors and discrimination made significant contributions to this racial difference.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, 1149 Hill St Suite 1422, Los Angeles, CA 90015, United States of America.
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, United States of America
| | - Vanessa V Volpe
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC 27695
| | - Florence Lui
- Memorial Sloan Kettering Cancer Center, United States of America
| | - Megan Besecker
- Suzanne Dworak Peck School of Social Work, University of Southern California, 1149 Hill St Suite 1422, Los Angeles, CA 90015, United States of America
| | - Sasha Zhou
- Department of Public Health, Wayne State University, United States of America
| | - Deidre M Anglin
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, North Academic Center, New York, NY 10031, United States of America; The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, United States of America
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Weller BE, Conrad JK, Wilburn VG, Ramamonjiarivelo Z, Gladden J. Adverse childhood experiences and mental health conditions among multiracial adolescents. ETHNICITY & HEALTH 2022; 27:1088-1102. [PMID: 33472407 DOI: 10.1080/13557858.2020.1869187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective of this study was to verify the factor structure of the household dysfunction type of ACE using data from the National Survey of Children's Health (NSCH), and then examine whether household dysfunction (measured as a latent construct) was associated with mental health conditions among multiracial adolescents. DESIGN We used cross-sectional data collected in 2016 from caregivers who completed the NSCH and analyzed data from a subpopulation of adolescents (12-17) who reported more than one race (n = 1,231). Mplus 8.4 was used to conduct confirmatory factor analysis and probit models from a structural equation modeling framework. RESULTS Results from this study indicated that the household dysfunction type of ACE, as a latent construct, had good model fit and was significantly associated with depression [standardized coefficient [B] = .50, 95% confidence interval [CI] .36, .65], anxiety [B = .61, 95% CI .48, .73], behavior problems [B = .58, 95% CI .44, .72], and ADHD [B = .54, 95% CI .38, .69] for multiracial adolescents. CONCLUSIONS Household dysfunction may result in adolescents being separated (physically or emotionally) from their caregivers, which may hinder adolescents' ability to establish or maintain one of the most important relationships needed to promote racial/ethnic identity development and mental health. Implications for advancements in theory and NSCH are presented.
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Affiliation(s)
- Bridget E Weller
- School of Social Work, Western Michigan University, College of Health and Human Services, Kalamazoo, MI, USA
| | - Joseph K Conrad
- School of Social Work, Western Michigan University, College of Health and Human Services, Kalamazoo, MI, USA
| | - Victoria G Wilburn
- Department of Occupational Therapy, Indiana University Purdue University Indianapolis, School of Health and Human Sciences, Indianapolis, IN, USA
| | - Zo Ramamonjiarivelo
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Jessica Gladden
- School of Social Work, Western Michigan University, College of Health and Human Services, Kalamazoo, MI, USA
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Yao ES, Bullen P, Meissel K, Tiatia J, Fleming T, Clark TC. Effects of Ethnic Classification on Substantive Findings in Adolescent Mental Health Outcomes. J Youth Adolesc 2022; 51:1581-1596. [PMID: 35438431 PMCID: PMC9232462 DOI: 10.1007/s10964-022-01612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
Although most adolescents are healthy, epidemiological studies show that a significant number experience mental health challenges, and that Indigenous and ethnic minority youth tend to have poorer mental health outcomes. However, ethnic classification in adolescence is complex due to increasing multi-ethnic identification, and little is known about how different classification methods affect research conclusions. This study used a nationally representative adolescent sample from Aotearoa New Zealand (N = 8275; ages 12–18; 55% female; 32% multi-ethnic) to investigate the effects that five ethnic classification methods have on substantive findings in three mental health outcomes: overall psychosocial difficulties, deliberate self-harm, and suicide attempts. The results showed that, depending on the classification method used, reported outcomes within the same nominal ethnic group varied by an effect size (d) of up to 0.12, and the reported magnitude of difference between nominal ethnic groups varied by an effect size (d) of up to 0.25. These effects are substantial given that they are solely due to a change in method. The impact that ethnic classification method has on substantive findings highlights the importance of criticality and transparency in research involving ethnicity data.
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Affiliation(s)
- Esther S Yao
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand.
| | - Pat Bullen
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
| | - Kane Meissel
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
| | - Jemaima Tiatia
- School of Māori Studies and Pacific Studies, The University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Terryann C Clark
- School of Nursing, The University of Auckland, Auckland, New Zealand
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