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Geographic Region, Racial/Ethnic Disparities, and Late-Life Depression: Results From a Large US Cohort of Older Adults. Am J Geriatr Psychiatry 2022; 30:703-716. [PMID: 34969584 PMCID: PMC9106835 DOI: 10.1016/j.jagp.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine associations between geographic region and late-life depression (LLD) severity, item-level symptom burden, and treatment; to evaluate whether racial/ethnic disparities in LLD, previously observed in the overall sample, vary by region. METHODS We included 25,502 VITAL (Vitamin D and Omega-3 Trial) participants and administered the Patient Health Questionnaire-8 for depressive symptoms; participants also reported medication and/or counseling care for depression. Multivariable regression analyses were performed. RESULTS Despite overall lower LLD severity and item-level symptom burden in the Midwest versus Northeast, higher LLD severity and item-level burden were observed among minorities, especially Black and Hispanic adults, compared to non-Hispanic whites in this region. Racial/ethnic disparities in item-level symptoms (e.g., anhedonia, sadness, psychomotor changes) varied by region. There were no significant differences in depression care by region; furthermore, regional variation was not observed in racial disparities in care: e.g., among those with clinician/physician-diagnosed depression, Blacks versus non-Hispanic whites had greater than 50% lower odds of treatment in all regions. CONCLUSION LLD varied by geographic region. Furthermore, magnitudes of racial/ethnic disparities in LLD severity and item-level symptom burden, but not depression care, differed by region.
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Leary E, Zachary I, Kyeong NY. Regional Differences in Serious Psychological Distress and Overall Physical and Mental Health. Community Ment Health J 2022; 58:770-778. [PMID: 34455555 PMCID: PMC8403461 DOI: 10.1007/s10597-021-00882-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022]
Abstract
To determine regional differences in the prevalence of overall physical health, overall mental health, and serious psychological distress (SPD). Data from the 2004 to 2016 Medical Expenditure Panel Survey were used for weighted analysis across region. Relationship modifiers considered were sociodemographic factors, health factors, and measures of health expenditures. A higher burden ratio of health care expenditures is negatively associated with health outcomes, across all US regions and insurance. Compared to 2004 values, SPD, overall physical health, and mental health are significantly improved after 2014. This research supports the whole health paradigm, indicating that overall mental and physical health are closely related. The burden of health care costs is an important consideration and related to overall health outcomes, regardless of insurance status or region. These considerations are likely increasingly important to consider with recent global events.
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Affiliation(s)
- Emily Leary
- School of Medicine, University of Missouri-Columbia, Columbia, MO, USA.
| | - Iris Zachary
- School of Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Na Young Kyeong
- School of Medicine, University of Missouri-Columbia, Columbia, MO, USA
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3
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Schmutte T, Olfson M, Xie M, Marcus SC. Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm. Am J Geriatr Psychiatry 2022; 30:478-491. [PMID: 34563430 PMCID: PMC10563141 DOI: 10.1016/j.jagp.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental healthcare is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental healthcare in suicidal older adults. METHODS Retrospective cohort analysis using 2015 Medicare data for adults aged ≥65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n = 27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental healthcare. RESULTS Overall, 30.3% of patients received follow-up mental healthcare within 7 days of discharge. However, follow-up rates were higher for patients with any mental healthcare within 30 days prehospitalization (43.7%) compared to patients with no recent mental healthcare (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental healthcare in the 30 days prehospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-white patients were less likely to receive follow-up care. CONCLUSION Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut.
| | - Mark Olfson
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University, New York, New York
| | - Ming Xie
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven C Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania
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4
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Pendergrast C, Rhubart D. Socio-Spatial Disparities in County-Level Availability of Aging and Disability Services Organizations. JOURNAL OF RURAL SOCIAL SCIENCES 2022; 37:3. [PMID: 38650675 PMCID: PMC11034910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Aging and disability services are essential for supporting older adults in living independently in their homes and communities as they age. Applying theoretical perspectives of community gerontology and spatial inequality, we use county-level data (N=3142) from the National Neighborhood Data Archive (NaNDA) and the American Community Survey to explore if and how availability of aging and disability services organizations varies across the rural-urban continuum and across compositional characteristics of counties. Results show that rural counties are significantly more likely to be aging and disability services deserts. Stratified models show that poverty rates and relative shares of non-Hispanic Blacks are positively associated with greater odds of aging and disability services deserts across rural and urban counties, but divergent findings appear for county-level shares of Hispanics. These findings are discussed as well as implications for research, policy, and practice on equitable access to aging and disability services.
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Carney J. Culture and mood disorders: the effect of abstraction in image, narrative and film on depression and anxiety. MEDICAL HUMANITIES 2020; 46:430-443. [PMID: 31672734 PMCID: PMC7786153 DOI: 10.1136/medhum-2018-011459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
Can cultural representations be used to therapeutic effect in the treatment of mood disorders like depression and anxiety? This article develops a theoretical framework that outlines how this might be achieved by way of mid-level cultural metrics that allow otherwise heterogeneous forms of representation to be grouped together. Its prediction is that abstract representations-as measured by Shannon entropy-will impact positively on anxiety, where concrete representations will positively impact on depression. The background to the prediction comes from construal level theory, a branch of social psychology that deals with the effects of abstraction on psychological distance; the types of cultural representations analysed include image, narrative and film. With a view to evaluating the hypothesis, the article surveys the empirical literature in art therapy, creative bibliotherapy and cinema therapy.
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Affiliation(s)
- James Carney
- Arts & Humanities/Centre for Culture and Evolution, Brunel University London, Uxbridge UB8 3PH, UK
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6
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Starks SM, Hankerson SH, Collins PY. Shifting the Policy Paradigm to Achieve Equity. Psychiatr Clin North Am 2020; 43:439-450. [PMID: 32773073 DOI: 10.1016/j.psc.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article offers a brief history of mental health policies that have shaped current inequities in health care financing and service delivery. Mental health has a unique position within the health care system given the pervasive nature of stigma associated with illness; race and ethnicity often amplify this burden. The acknowledgment of disparities in mental health and the development of policies that address the needs of minority groups are relatively recent phenomena. Highlighted are legislative actions that have influenced reforms of the health care landscape. This text outlines opportunities to advance a targeted, community-based approach to mental health policy development.
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Affiliation(s)
- Steven M Starks
- Department of Clinical Sciences, University of Houston College of Medicine, Health 2 Building, 4849 Calhoun Road, Room 6014, Houston, TX 77201-6064, USA.
| | - Sidney H Hankerson
- Columbia University, Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington Schools of Medicine and Public Health, 1959 Northeast Pacific Street, Box 356560, Seattle, WA 98195-6560, USA; Department of Global Health, University of Washington Schools of Medicine and Public Health, 1959 Northeast Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
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Kim K, Lehning AJ, Sacco P. The Role of County Characteristics in Mental Health Service Use by Older African Americans. Psychiatr Serv 2020; 71:465-471. [PMID: 31960776 DOI: 10.1176/appi.ps.201900351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Older African Americans may underutilize mental health services, although they experience mental health problems at rates comparable with those of whites. Untreated mental disorders contribute to increased risk of morbidity and mortality and decreased quality of life, and therefore, understanding the factors that influence racial disparities in service use is critical. This study examined whether county characteristics were associated with mental health service use by older African Americans after the analyses adjusted for individual characteristics. METHODS This study combined individual-level data from the 2008-2012 Medical Expenditure Panel Survey with county-level data for 2008-2012 from the 2013-2014 Area Health Resources Files and county-level data from the 2008-2012 Chronic Conditions Report of the Chronic Conditions Data Warehouse for 1,567 community-dwelling African Americans ages 60 and older. Multilevel logistic regressions were used to examine the role of county characteristics on mental health services use with adjustment for individual-level risk factors. RESULTS At the county level, individuals living in a county with a higher proportion of African Americans were less likely to use mental health services. At the individual level, higher income and mental health status were associated with mental health service utilization. CONCLUSIONS Among older African Americans, the racial composition of one's county of residence played a role in mental health service use, indicating the need for future research focusing on the relationship between an area's racial composition and mental health service use. Programs may be able to ameliorate racial disparities in mental health care by targeting areas with a higher percentage of African Americans.
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Affiliation(s)
- Kyeongmo Kim
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
| | - Amanda J Lehning
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
| | - Paul Sacco
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
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8
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Taylor RJ, Chatters LM. Psychiatric Disorders Among Older Black Americans: Within- and Between-Group Differences. Innov Aging 2020; 4:igaa007. [PMID: 32313842 PMCID: PMC7156931 DOI: 10.1093/geroni/igaa007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Indexed: 11/29/2022] Open
Abstract
Psychiatric disorders impose significant personal, social, and financial costs for individuals, families, and the nation. Despite a large amount of research and several journals focused on psychiatric conditions, there is a paucity of research on psychiatric disorders among Black Americans (i.e., African Americans and Black Caribbeans), particularly older Black Americans. The present literature review examines research on psychiatric disorders among older Black Americans and provides a broad overview of research findings that are based on nationally representative studies. Collectively, this research finds: (1) older African Americans have lower rates of psychiatric disorders than younger African Americans; (2) family support is not protective of psychiatric disorders, whereas negative interaction with family members is a risk factor; (3) everyday discrimination is a risk factor for psychiatric disorders; (4) both older African Americans and African American across the adult age range have lower prevalence rates of psychiatric disorders than non-Latino whites; (5) Black Caribbean men have particularly high rates of depression, posttraumatic stress disorder, and suicide attempts; and (6) a significant proportion of African American older adults with mental health disorders do not receive professional help. This literature review also discusses the “Race Paradox” in mental health, the Environmental Affordances Model, and the importance of investigating ethnicity differences among Black Americans. Future research directions address issues that are directly relevant to the Black American population and include the following: (1) understanding the impact of mass incarceration on the psychiatric disorders of prisoners’ family members, (2) assessing the impact of immigration from African countries for ethnic diversity within the Black American population, (3) examining the impact of racial identity and racial socialization as potential protective factors for psychiatric morbidities, and (4) assessing racial diversity in life-course events and their impact on mental health.
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Affiliation(s)
- Robert Joseph Taylor
- School of Social Work, University of Michigan, Ann Arbor.,Institute for Social Research, University of Michigan, Ann Arbor
| | - Linda M Chatters
- School of Social Work, University of Michigan, Ann Arbor.,Institute for Social Research, University of Michigan, Ann Arbor.,Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor
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Kim K. County Context and Mental Health Service Utilization by Older Hispanics. THE GERONTOLOGIST 2020; 59:456-464. [PMID: 29672691 DOI: 10.1093/geront/gny033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/25/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although older Hispanics experience high rates of depression, they tend to underuse mental health services. The study examined the association between county characteristics and mental health service use among older Hispanics, controlling for individual characteristics. RESEARCH DESIGN AND METHODS The study used the 2008-2012 Medical Expenditure Panel Study and linked county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse, using the Federal Information Processing Standard county code. The sample includes 1,143 community-dwelling Hispanics ages 60 years or older (Level 1) and 156 counties (Level 2) where the sample resides. The single dichotomous measure of mental health service utilization was based on whether or not the respondent met one or more of three conditions: (1) the respondent received care from a mental health professional, (2) received a service including mental health counseling or psychotherapy, or (3) received a service that was related to the International Classification of Diseases. Multilevel logistic regression analysis was used to examine the role of county context. RESULTS The proportion of older adults and the existence of community mental health centers at the county-level were associated with mental health services use among this population. At the individual-level, education and mental health status were also associated with using mental health services. DISCUSSION AND IMPLICATIONS The county context plays an important role in understanding mental health services use among older Hispanics, indicating the need for intervention strategies at the county level.
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Affiliation(s)
- Kyeongmo Kim
- Virginia Commonwealth University School of Social Work, Richmond
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10
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Bryant AN, Kim G. Regional and racial/ethnic variations in alcohol consumption among older adults. Aging Ment Health 2019; 23:1503-1509. [PMID: 30600687 PMCID: PMC6606409 DOI: 10.1080/13607863.2018.1506746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/23/2018] [Indexed: 10/27/2022]
Abstract
Objectives: This paper sought to examine the role of region and race/ethnicity in alcohol consumption among older adults. Methods: Data were obtained from the 2010 Behavioral Risk Factor Surveillance System (BRFSS). Participants aged 60 and older were included (n = 185, 190). Analyses of covariance (ANCOVAs) were conducted to examine the effects of region and race/ethnicity on alcohol consumption among older adults. Results: Results indicate that region and race/ethnicity are significantly related to the alcohol consumption of older adults. More specifically, results suggest that White older adults consume significantly more alcohol than other racial/ethnic groups among older adults. Regarding regional effects, results suggest that older adults in the West consume significantly more alcohol than older adults in the Midwest and South. Additionally, results suggest regional variation in alcohol consumption patterns by race/ethnicity. Conclusion: Findings provide additional insight into how and where alcohol is being used among older adults in the United States. Further, findings highlight the importance of taking race/ethnicity and geography into consideration when investigating the health behaviors of older adults.
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Affiliation(s)
- Ami N Bryant
- Department of Psychology, The University of Alabama, 253-345-1670,
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University
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11
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Charron E, Francis EC, Heavner-Sullivan SF, Truong KD. Disparities in Access to Mental Health Services Among Patients Hospitalized for Deliberate Drug Overdose. Psychiatr Serv 2019; 70:758-764. [PMID: 31084295 DOI: 10.1176/appi.ps.201800496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined patient and hospitalization characteristics associated with receiving a mental health assessment and disposition to an inpatient psychiatric facility among patients hospitalized for deliberate drug overdose. METHODS This retrospective analysis of 2012-2013 South Carolina all-payer data included adults ages 18-64 with at least one inpatient admission for a primary diagnosis of deliberate illicit or pharmaceutical drug overdose (N=2,686). Outcomes were receipt of a mental health assessment and disposition to an inpatient psychiatric facility. Multivariable logistic regression models were used to estimate the effects of patient and hospitalization characteristics on study outcomes. RESULTS Non-Hispanic blacks and people of other races-ethnicities were less likely than non-Hispanic whites to receive a mental health assessment (non-Hispanic blacks, adjusted odds ratio [AOR]=0.52, 95% CI=0.34-0.81; other races-ethnicities, AOR=0.24, 95% CI=0.12-0.49). Non-Hispanic blacks were also less likely than non-Hispanic whites to be discharged to an inpatient psychiatric facility than to home (AOR=0.60, 95% CI=0.47-0.77). Compared with persons without insurance, those with insurance, except those with Medicaid, were more likely to be discharged to an inpatient psychiatric facility than to home (Medicare, AOR=3.06, 95% CI=2.36-3.96; private, AOR=2.78, 95% CI=2.23-3.47; other, AOR=7.58, 95% CI=4.21-13.6). CONCLUSIONS Non-Hispanic white race-ethnicity and having insurance were predictive of receipt of a mental health assessment and disposition to an inpatient psychiatric facility among patients hospitalized for deliberate drug overdose. Study findings can inform clinical strategies and interventions aimed at reducing mental health care disparities among populations who are vulnerable to overdose or suicide.
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Affiliation(s)
- Elizabeth Charron
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | - Ellen C Francis
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | | | - Khoa D Truong
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
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12
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Martino SC, Mathews M, Agniel D, Orr N, Wilson‐Frederick S, Ng JH, Ormson AE, Elliott MN. National racial/ethnic and geographic disparities in experiences with health care among adult Medicaid beneficiaries. Health Serv Res 2019; 54 Suppl 1:287-296. [PMID: 30628052 PMCID: PMC6341217 DOI: 10.1111/1475-6773.13106] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To investigate whether health care experiences of adult Medicaid beneficiaries differ by race/ethnicity and rural/urban status. DATA SOURCES A total of 270 243 respondents to the 2014-2015 Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems Survey. STUDY DESIGN Linear regression was used to estimate case mix adjusted differences in patient experience between racial/ethnic minority and non-Hispanic white Medicaid beneficiaries, and between beneficiaries residing in small urban areas, small towns, and rural areas vs large urban areas. Dependent measures included getting needed care, getting care quickly, doctor communication, and customer service. PRINCIPAL FINDINGS Compared with white beneficiaries, American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (API) beneficiaries reported worse experiences, while black beneficiaries reported better experiences. Deficits for AIAN beneficiaries were 6-8 points on a 0-100 scale; deficits for API beneficiaries were 13-22 points (P's < 0.001); advantages for black beneficiaries were 3-5 points (P's < 0.001). Hispanic white differences were mixed. Beneficiaries in small urban areas, small towns, and isolated rural areas reported significantly better experiences (2-3 points) than beneficiaries in large urban areas (P's < 0.05), particularly regarding access to care. Racial/ethnic differences typically did not vary by geography. CONCLUSIONS Improving experiences for racial/ethnic minorities and individuals living in large urban areas should be high priorities for policy makers exploring approaches to improve the value and delivery of care to Medicaid beneficiaries.
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Affiliation(s)
| | | | | | - Nate Orr
- RAND CorporationSanta MonicaCalifornia
| | | | - Judy H. Ng
- National Committee for Quality AssuranceWashingtonDistrict of Columbia
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Cook BL, Kim G, Morgan KL, Chen CN, Nillni A, Alegría M. Measuring Geographic "Hot Spots" of Racial/Ethnic Disparities: An Application to Mental Health Care. J Health Care Poor Underserved 2018; 27:663-84. [PMID: 27180702 DOI: 10.1353/hpu.2016.0091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This article identifies geographic "hot spots" of racial/ethnic disparities in mental health care access. Using data from the 2001-2003 Collaborative Psychiatric Epidemiology Surveys(CPES), we identified metropolitan statistical areas(MSAs) with the largest mental health care access disparities ("hot spots") as well as areas without disparities ("cold spots"). Racial/ethnic disparities were identified after adjustment for clinical need. Richmond, Virginia and Columbus, Georgia were found to be hot spots for Black-White disparities, regardless of method used. Fresno, California and Dallas, Texas were ranked as having the highest Latino-White disparities and Riverside, California and Houston, Texas consistently ranked high in Asian-White mental health care disparities across different methods. We recommend that institutions and government agencies in these "hot spot" areas work together to address key mechanisms underlying these disparities. We discuss the potential and limitations of these methods as tools for understanding health care disparities in other contexts.
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Kim G, Parmelee P, Bryant AN, Crowther MR, Park S, Parton JM, Chae DH. Geographic Region Matters in the Relation Between Perceived Racial Discrimination and Psychiatric Disorders Among Black Older Adults. THE GERONTOLOGIST 2017; 57:1142-1147. [PMID: 27927726 PMCID: PMC5881795 DOI: 10.1093/geront/gnw129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/24/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study This study examined whether the relation between perceived racial discrimination and psychiatric disorders varied by large geographic region among Black older adults in the United States. Design and Methods Black adults aged 55 or older who had experienced racial/ethnic-specific discrimination were drawn from the National Survey of American Life (NSAL). Logistic regression analysis was used to examine main and interaction effects. Results Results show that there was a significant main effect of perceived racial discrimination, indicating that greater perceived discrimination was significantly associated with increased odds of having any past-year psychiatric disorder. The interaction of region by perceived racial discrimination was significant: The effect of perceived racial discrimination on any past-year psychiatric disorder was stronger among Blacks in the West than those in the South. Implications Findings suggest that whereas, in general, perceived racial discrimination is a risk factor for poor mental health among older Blacks, this association may differ by geographic region. Additional research examining reasons for this variation is needed.
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Affiliation(s)
- Giyeon Kim
- Alabama Research Institute on Aging and
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Patricia Parmelee
- Alabama Research Institute on Aging and
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Ami N Bryant
- Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
| | | | - Soohyun Park
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Jason M Parton
- Alabama Research Institute on Aging and
- Department of Information Systems, Statistics, and Management Science, The University of Alabama, Tuscaloosa
| | - David H Chae
- Department of Human Development and Family Studies, Auburn University, Alabama
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15
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Kim G, Dautovich N, Ford KL, Jimenez DE, Cook B, Allman RM, Parmelee P. Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 2017; 52:939-948. [PMID: 28589236 DOI: 10.1007/s00127-017-1401-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The main purpose of this paper is to examine geographic variation in unmet need for mental health care among racially/ethnically diverse adults with psychiatric disorders in the US. METHODS Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES; 2001-2003), adults with any past year psychiatric disorder diagnosis (n = 3211) from diverse racial/ethnic backgrounds were selected for analyses. Using weighted data, descriptive analyses and logistic regression analyses were conducted. RESULTS Two-thirds of the total sample had unmet mental health care need, which differed significantly by race/ethnicity (p < .001). Logistic regression analyses show regional variation of the effect of race/ethnicity in unmet need: after adjusting for covariates, Latinos in the South, Blacks and Latinos in the Midwest, and Latinos and Asians in the West had higher unmet need than non-Hispanic Whites, whereas no significant racial/ethnic effects were found in the Northeast. CONCLUSIONS Findings suggest that geographic region plays an important role in the sufficient use of mental health services among racial/ethnic minorities. Further research should elucidate reasons for geographic disparities in mental health care among racial/ethnic minority adults to reduce disparities.
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Affiliation(s)
- Giyeon Kim
- Department of Psychology, Chung-Ang University, Seoul, South Korea.
| | - Natalie Dautovich
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Katy-Lauren Ford
- Alabama Research Institute on Aging, Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Benjamin Cook
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA.,Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, MA, USA
| | - Richard M Allman
- Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC, USA
| | - Patricia Parmelee
- Alabama Research Institute on Aging, Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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Pabayo R, Fuller D, Lee EY, Horino M, Kawachi I. State-level income inequality and meeting physical activity guidelines; differential associations among US men and women. J Public Health (Oxf) 2017; 40:229-236. [DOI: 10.1093/pubmed/fdx082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel Fuller
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Eun Young Lee
- Faculty of Physical Education & Recreation, University of Alberta, Edmonton, AB, Canada
| | - Masako Horino
- State of Nevada, Health & Human Services, Nevada Division of Public Health and Behavioral Health, Carson City, NV, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Wielen LM, Gilchrist EC, Nowels MA, Petterson SM, Rust G, Miller BF. Not Near Enough: Racial and Ethnic Disparities in Access to Nearby Behavioral Health Care and Primary Care. J Health Care Poor Underserved 2017; 26:1032-47. [PMID: 26320931 DOI: 10.1353/hpu.2015.0083] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Racial, ethnic, and geographical health disparities have been widely documented in the United States. However, little attention has been directed towards disparities associated with integrated behavioral health and primary care services. METHODS Access to behavioral health professionals among primary care physicians was examined using multinomial logistic regression analyses with 2010 National Plan and Provider Enumeration System, American Medical Association Physician Masterfile, and American Community Survey data. RESULTS Primary care providers practicing in neighborhoods with higher percentages of African Americans and Hispanics were less likely to have geographically proximate behavioral health professionals. Primary care providers in rural areas were less likely to have geographically proximate behavioral health professionals. CONCLUSION Neighborhood-level factors are associated with access to nearby behavioral health and primary care. Additional behavioral health professionals are needed in racial/ethnic minority neighborhoods and rural areas to provide access to behavioral health services, and to progress toward more integrated primary care.
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18
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Kim G, Parton JM, Ford KL, Bryant AN, Shim RS, Parmelee P. Geographic and racial-ethnic differences in satisfaction with and perceived benefits of mental health services. Psychiatr Serv 2014; 65:1474-82. [PMID: 25123928 PMCID: PMC4329273 DOI: 10.1176/appi.ps.201300440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. METHODS Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. RESULTS In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. CONCLUSIONS The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.
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Affiliation(s)
- Giyeon Kim
- Dr. Kim and Dr. Parmelee are with the Center for Mental Health and Aging and Department of Psychology, University of Alabama, Tuscaloosa (e-mail: ). Dr. Parton is with the Department of Information Systems, Statistics, and Management Science and Ms. Ford and Ms. Bryant are with the Department of Psychology, also at the University of Alabama. Dr. Shim is with the Department of Psychiatry and Behavioral Sciences and National Center for Primary Care, Morehouse School of Medicine, Atlanta
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19
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Chen J, Mortensen K, Bloodworth R. Exploring contextual factors and patient activation: evidence from a nationally representative sample of patients with depression. HEALTH EDUCATION & BEHAVIOR 2014; 41:614-24. [PMID: 24786791 DOI: 10.1177/1090198114531781] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient activation has been considered as a "blockbuster drug of the century." Patients with mental disorders are less activated compared to patients with other chronic diseases. Low activation due to mental disorders can affect the efficiency of treatment of other comorbidities. Contextual factors are significantly associated with mental health care access and utilization. However, evidence of their association with patient activation is still lacking. Using data from the Health Tracking Household Survey 2007 and Area Health Resource File 2008, we examine the association between contextual factors and self-reported activation levels among patients with depression. We investigate two types of contextual factors--(a) site of usual source of care and (b) community characteristics, measured by mental health care resources availability, population demographics, and socioeconomic characteristics at the county level. Results show significant variation in activation levels by contextual factors. The availability of community mental health centers, lower proportion of foreign-born individuals, and higher income in the local community are associated with higher patient activation. Our results also show that depressed patients having a usual source of care at a physician's office have significantly higher patient activation levels than those with a usual source of care in the emergency department or hospital outpatient clinics. Results suggest that primary care setting is critical to having a sustained relationship between patients and physicians in order to enhance patient engagement in mental health care. Interventions in communities with low income and high immigrant populations are necessary.
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Affiliation(s)
- Jie Chen
- University of Maryland, College Park, MD, USA
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20
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Pabayo R, Kawachi I, Gilman SE. Income inequality among American states and the incidence of major depression. J Epidemiol Community Health 2013; 68:110-5. [PMID: 24064745 DOI: 10.1136/jech-2013-203093] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although cross-sectional and ecological studies have shown that higher area-level income inequality is related to increased risk for depression, few longitudinal studies have been conducted. This investigation examines the relationship between state-level income inequality and major depression among adults participating in a population-based, representative longitudinal study. METHODS We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=34 653). Respondents completed structured diagnostic interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modelling was used to determine if U.S. state-level income inequality (measured by the Gini coefficient) was a significant predictor of depression at baseline and at follow-up, while controlling for individual-level and state-level covariates. We also repeated the longitudinal analyses, excluding those who had a history of depression or at baseline, in order to test whether income inequality was related to incident depression. RESULTS State-level inequality was associated with increased incidence of depression among women but not men. In comparison to women residing in states belonging to the lowest quintile of income inequality, women were at increased risk for depression in the second (OR=1.18, 95% CI 0.86 to 1.62), third (OR=1.22, 95% CI 0.91 to 1.62), fourth (OR=1.37, 95% CI 1.03 to 1.82) and fifth (OR=1.50, 95% CI 1.14 to 1.96) quintiles at follow-up (p<0.05 for the linear trend). CONCLUSIONS Living in a state with higher income inequality increases the risk for the development of depression among women.
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Affiliation(s)
- Roman Pabayo
- Department of Social and Behavioral Sciences, Harvard School of Public Health, , Boston, Massachusetts, USA
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