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Huang CJ, Lin CH, Liu TL, Lin PC, Chu CC, Wang JJ, Wei CW, Weng SF. Healthcare Utilization and Its Correlates in Comorbid Type 2 Diabetes Mellitus and Generalized Anxiety Disorder. Psychiatr Q 2024; 95:233-252. [PMID: 38639873 DOI: 10.1007/s11126-024-10072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
This study investigated the healthcare utilization and medical expenditure of type 2 diabetes mellitus (T2DM) patients with generalized anxiety disorder (GAD) and identified the associated factors. The healthcare utilization and expenditure of T2DM patients with (case group) and without (control group) GAD between 2002 and 2013 were examined using the population-based Taiwan National Health Insurance Research Database. Healthcare utilization included outpatient visits and hospitalization; health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, nonpsychiatric healthcare utilization and medical expenditure were distinguished from total healthcare utilization and medical expenditure. The average healthcare utilization, including outpatient visits and hospitalization, was significantly higher for the case group than for the control group (total and nonpsychiatric). The results regarding differences in average outpatient expenditure (total and nonpsychiatric), inpatient expenditure (total and nonpsychiatric), and total expenditure (total and nonpsychiatric) between the case and control groups are inconsistent. Sex, age, income, comorbidities/complications, and the diabetes mellitus complication severity index were significantly associated with outpatient visits, medical expenditure, and hospitalization in the case group (total and nonpsychiatric). Greater knowledge of factors affecting healthcare utilization and expenditure in comorbid individuals may help healthcare providers intervene to improve patient management and possibly reduce the healthcare burden in the future.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pai-Cheng Lin
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chun-Wang Wei
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Center for Medical Informatics and Statistics, Office of R&D, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Saha A, Mandal B, Muhammad T, Ali W. Decomposing the rural-urban differences in depression among multimorbid older patients in India: evidence from a cross-sectional study. BMC Psychiatry 2024; 24:60. [PMID: 38254089 PMCID: PMC10804604 DOI: 10.1186/s12888-023-05480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND In India, the prevalence of depression among older adults dealing with multiple health conditions varies between rural and urban areas due to disparities in healthcare access and cultural factors. The distinct patterns observed underscore the necessity for tailored research and interventions to address mental health inequalities among multimorbid older patients in diverse geographic contexts. METHODS This study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total of 7,608 adults aged ≥ 60 years who were diagnosed with two or more chronic conditions (such as hypertension, diabetes, cancer, chronic lung disease, chronic heart diseases, stroke, bone/joint disease, any neurological or psychiatric diseases, and high cholesterol) were included in this study. Descriptive statistics, bivariate analysis, logistic regression estimates, and Fairlie decomposition method were used to accomplish the study's objectives. RESULTS The prevalence of depression among older adults with multimorbidity was 9.48% higher in rural areas (38.33%) than in urban areas (28.85%).. Older adults with multimorbidity belonging to the scheduled caste group were 40% more likely to experience depression. Moreover, those with multimorbidity and any form of disability in activities of daily living (ADL) were 93% more likely to experience depression than those without disability, whereas those with multimorbidity and perceived good general health were 65% less likely to suffer from depression than those with poor self-perceived health. Additionally, decomposition analysis revealed that education (35.99%), caste status (10.30%), IADL disability (19.30%), and perceived discrimination (24.25%) were the primary factors contributing to the differences in depression prevalence among older adults with multimorbidity between rural and urban areas. CONCLUSIONS We found significant rural-urban differences in depression among older Indians with multimorbidity. The findings underscore the need for targeted interventions that address the unique challenges faced by older patients in rural areas, including lack of social capital, discrimination, and limited resources that enable access to healthcare services. Policymakers and healthcare professionals must collaboratively design and implement effective strategies to improve the mental health and overall well-being of rural older adults, particularly those with multiple comorbidities.
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Affiliation(s)
- Amiya Saha
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Bittu Mandal
- School of Humanities and Social Sciences, Indian Institute of Technology, Indore, 453552, India
| | - T Muhammad
- Center for Healthy Aging, The Pennsylvania State University, University park, 16802, USA
| | - Waad Ali
- Department of Geography, Sultan Qaboos University, Muscat, 123, Oman
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Huang CJ, Liu TL, Huang YT, Hsieh HM, Chang CC, Chu CC, Wei CW, Weng SF. Healthcare burden and factors of type 2 diabetes mellitus with Schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:519-529. [PMID: 33860331 DOI: 10.1007/s00406-021-01258-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/30/2021] [Indexed: 02/08/2023]
Abstract
This study investigated healthcare utilization and expenditure for patients with type 2 diabetes mellitus and schizophrenia and associated factors. Healthcare utilization (outpatient visits and hospitalization) and expenditure (outpatient, inpatient, and total medical expenditure) between 2002 and 2013 of patients with T2DM with schizophrenia (case group) and without (control group) were examined using the Taiwan National Health Insurance Research Database. (1) The average total numbers of outpatient visits and hospital admissions of the case group were 35.14 outpatient visits and 1.09 hospital admissions significantly higher than those of the control group in the whole study period (based on every 3-year period). Nonpsychiatric outpatient visits and nonpsychiatric hospital admissions were significantly more numerous for the case group. (2) The total outpatient expenditure, total inpatient expenditure, and total medical expenditure of the case group were NT$65,000, NT$170,000, and NT$235,000 significantly higher than those of the control group, respectively. Nonpsychiatric outpatient expenditure was significantly lower for the case group, but the inpatient and total nonpsychiatric medical expenditure were similar between groups. (3) Patients who were elder of low income, with complications, and high diabetes mellitus complication severity index had higher total numbers of outpatient visits and hospitalizations and medical expenditure. (4) Women had a higher number of outpatient visits but a lower number of hospitalization and medical expenditure. Lower non-psychiatric outpatient expenditure despite more visits indicated non-psychiatrist may not understand schizophrenia patients and cannot communicate well with them, leading to neglect of medical evaluation and treatment that should be carried out.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, 807, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Huang
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, 807, Taiwan
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, 442, Section. 2, Shulin Street, South District, Tainan, 702, Taiwan.,Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, 901, Chung Hwa Rd, Yung Kang District, Tainan, 710, Taiwan
| | - Chun-Wang Wei
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Center for Medical Informatics and Statistics, Office of R&D, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Peltzman T, Gottlieb DJ, Levis M, Shiner B. The role of race in rural-urban suicide disparities. J Rural Health 2021; 38:346-354. [PMID: 34128267 DOI: 10.1111/jrh.12603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the role that race-ethnicity plays in modifying the observed rural-urban disparity in suicide among Veteran Health Administration (VHA) users. METHODS We performed a retrospective cohort study of 10,737,864 VHA users between 2003 and 2017, using cross-linked VHA medical records and National Death Index mortality data to assess longitudinal race-stratified rural-urban differences in age- and sex-adjusted annual suicide rates. We used Poisson regression and generated incident rate ratios (IRRs) to formally assess the impact of race on the rural-urban suicide disparity. Given evidence of effect modification, we performed additional race-stratified Poisson regression models. FINDINGS Rurality is significantly associated with a higher risk of suicide in models which do not control for race (IRR = 1.14, 95% CI: 1.10-1.17). However, when race is added to the model, rural residence is no longer significant (0.98, CI: 0.95-1.01). Stratified models demonstrate that rural residence is significantly associated with a higher suicide risk among Hispanic VHA users (1.41, CI: 1.11-1.79), but it is not substantially associated with suicide among White (0.97, CI: 0.94-1.00) and Black (1.03, CI: 0.86-1.23) VHA users. White VHA users have considerably higher suicide rates than Black and Hispanic VHA users, though the suicide rate among Hispanic VHA users, particularly those in rural settings, increased markedly over the period of observation. CONCLUSIONS Race significantly modifies the relationship between rural residence and suicide risk. Studies seeking to assess suicide disparity between rural and urban VHA user populations must include adjustment or stratification by race.
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Affiliation(s)
| | - Daniel J Gottlieb
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Maxwell Levis
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Brian Shiner
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA.,Veterans Rural Health Resource Center, White River Junction, Vermont, USA
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Vigil-Hayes M, Collier AF, Hagemann S, Castillo G, Mikkelson K, Dingman J, Muñoz A, Luther J, McLaughlin A. Integrating Cultural Relevance into a Behavioral mHealth Intervention for Native American Youth. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2021; 5:165. [PMID: 34676359 PMCID: PMC8528378 DOI: 10.1145/3449239] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Native American communities are disproportionately affected by a number of behavioral health disparities, including higher rates of depression, substance abuse, and suicide. As mobile health (mHealth) interventions gain traction as methods for addressing these disparities, they continue to lack relevance to Native American youth. In an effort to explore the design of relevant behavioral mHealth intervention for Native American communities, we have developed ARORA (Amplifying Resilience Over Restricted Internet Access), a prototype behavioral mHealth intervention that has been co-designed with Native American youth, a community advisory board, and a clinical psychologist. In this paper, we qualitatively analyze our co-design and focus group sessions using a grounded theory approach and identify the key themes that Native American community members have identified as being critical components of relevant mHealth designs. Notably, we find that the Native American youth who participated in our focus groups desired a greater level of didactic interaction with cultural and behavioral health elements. We conclude with a discussion of the significant challenges we faced in our efforts to co-design software with Native American stakeholders and provide recommendations that might guide other HCI researchers and designers through challenges that arise during the process of cross-cultural design.
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Affiliation(s)
| | | | | | | | | | | | | | - Jade Luther
- Northern Arizona University, Flagstaff, AZ, USA
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Abstract
Among US geographic regions classified as rural, death rates are significantly higher for children and teens as compared with their urban peers; the disparity is even greater for Alaskan Native/American Indian and non-Hispanic black youth. Violence-related injuries and death contribute significantly to this finding. This article describes the epidemiology of violence-related injuries, with a limited discussion on child abuse and neglect and an in-depth analysis of self-inflicted injuries including unintentional firearm injuries and adolescent suicide. Potential interventions are also addressed, including strategies for injury prevention, such as firearm safe storage practices.
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Affiliation(s)
- James M Dodington
- Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511, USA.
| | - Kathleen M O'Neill
- Investigative Medicine Program, Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511, USA
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Andrilla CHA, Garberson LA, Patterson DG, Quigley TF, Larson EH. Comparing the Health Workforce Provider Mix and the Distance Travelled for Mental Health Services by Rural and Urban Medicare Beneficiaries. J Rural Health 2020; 37:692-699. [PMID: 32808705 DOI: 10.1111/jrh.12504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the mix of health professionals who care for rural and urban seniors suffering from mood and/or anxiety disorders, the quantity of services they receive, and to understand where beneficiaries receive care for mood and/or anxiety disorders and the distance and time they travel for care. METHODS We used 2014 Medicare administrative claims data to examine access to health care for fee-for-service Medicare beneficiaries aged ≥ 65 years who received outpatient services for mood and anxiety disorders. We classified providers into 9 categories: (1) family physicians/general practice, (2) internists, (3) nurse practitioners (NPs) and physician assistants (PAs), (4) psychiatrists, (5) psychologists, (6) clinical social workers, (7) emergency medicine physicians, (8) other physicians, and (9) other providers. We calculated the 1-way driving distance and travel time between the beneficiary residence and provider location. We classified beneficiaries into 1 of 4 geographic categories based on their residence ZIP Code. FINDINGS Urban beneficiaries had an average of 2.7 visits for mood and anxiety disorders, while rural beneficiaries had 2.4. Generalist physicians and NPs/PAs provided 50.8% of all visits. Urban beneficiaries saw more behavioral health specialists (34.3%) than rural beneficiaries (16.1%). NPs and PAs provided more than twice as much of the care for rural beneficiaries (14.8%) as for urban beneficiaries (6.4%). Rural beneficiaries travelled about twice as far as urban beneficiaries. CONCLUSIONS Rural and urban Medicare beneficiaries received care for mood/anxiety disorders from different mixes of health care providers, and ensuring access for rural populations will require innovative solutions.
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Affiliation(s)
- C Holly A Andrilla
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Lisa A Garberson
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Davis G Patterson
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Tim F Quigley
- MEDEX Northwest, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Eric H Larson
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
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Hilty DM, Gentry MT, McKean AJ, Cowan KE, Lim RF, Lu FG. Telehealth for rural diverse populations: telebehavioral and cultural competencies, clinical outcomes and administrative approaches. Mhealth 2020; 6:20. [PMID: 32270012 PMCID: PMC7136658 DOI: 10.21037/mhealth.2019.10.04] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
Rural health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care and leverage scarce resources. This scoping review from January 2000 - July 2019 was conducted to see if the literature had data for two related the research questions, "What are the components of culturally competent, telepsychiatric clinical care, and what approaches have clinicians and systems taken to implement and evaluate it?" The review focused on key words in four concept areas: (I) competencies; (II) telehealth in the form of telepsychiatry, telebehavioral or telemental health; (III) culture; and (IV) health. It was done in accordance with the six-stage scoping review process in PubMed/Medline and other databases. The screeners reviewed the full-text articles for final inclusion based on inclusion (mesh of the key words) and exclusion (e.g., need for only, skills abstractly discussed) criteria. From a total of 1,118 papers, the authors found 44 eligible for full text review and found 7 papers directly relevant to the concepts. Few studies specifically discuss skills and competencies of both telehealth and cultural factors. Many organizations are attending to cultural competencies and approaches to care, but there are no specific competencies that integrate telepsychiatry or telebehavioral health with culture. Existing telepsychiatric (i.e., video, social media, mobile health) and one set telebehavioral health competencies included cultural component, including use of interpreters and language matters. Administrative adjustments are suggested to promote culturally competent care by telehealth via clinical, educational, quality improvement, program/system evaluation, and other (e.g., finance and reimbursement) interventions. More structured research is needed on development, implementation and evaluation of combined competencies in rural settings.
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Affiliation(s)
- Donald M. Hilty
- Northern California Veterans Administration Health Care System, Mather, CA 95655, USA
- Department of Psychiatry & Behavioral Sciences, UC Davis, Mather, CA 95655, USA
| | - Melanie T. Gentry
- Geriatric Psychiatry Fellowship, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Alastair J. McKean
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Kirsten E. Cowan
- Essentia Health and Child Psychiatrist Affiliated with Mayo Clinic Department of Psychiatry and Psychology, Hinckley, MN 55037, USA
| | - Russell F. Lim
- Emeritus Clinical Professor of Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Francis G. Lu
- Clinical Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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Dagnew B, Dagne H, Andualem Z. Depression and Its Determinant Factors Among University of Gondar Medical and Health Science Students, Northwest Ethiopia: Institution-Based Cross-Sectional Study. Neuropsychiatr Dis Treat 2020; 16:839-845. [PMID: 32280225 PMCID: PMC7125332 DOI: 10.2147/ndt.s248409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depression is a common mental disorder characterized by loss of interest or pleasure. Prevalence of depression is varied in different groups and countries. No adequate study has been undertaken in Ethiopia. This study aimed to determine the prevalence of depression and determinant factors among University of Gondar Medical and Health Sciences students, Northwest Ethiopia, 2019. METHODS An institution-based cross-sectional study was carried out using simple random sampling technique to select study participants and the study was conducted from June to July 2019. We used self-administered second edition of Beck's Depression Inventory (BDI-II) to collect data on depressive symptoms. The sample size was determined using a single population proportion formula. We entered the data using Epi Info 7 and then exported into Stata 14 for analysis. A binary logistic regression was used to identify determinant factors of depression. In the final model, a variable with a p<0.05 was considered as a significant factor for depression by an adjustment of odds ratio with 95% of uncertainty interval (UI). RESULTS Three hundred and eighty-three students completed the questionnaire with 97.7% response rate. The mean age of participants was 20.8 (±1.83, 18-34) years. The prevalence of depression was 34.73% (95% UI: 29.94-39.52%). The odds of having depression was higher among students who came from rural family (AOR=1.67, 95% UI: 1.02-2.72), who experienced tooth grinding (AOR=2.79, 95% UI: 1.36-5.74), who had night sleep disturbances (AOR=1.95, 95% UI: 1.17-3.25), who reported daytime sleepiness (AOR=1.93, 95% UI: 1.16-3.20), who had reported stress (AOR=4.20, 95% UI: 1.90-9.26), and those studying Health sciences (AOR=2.65, 95% UI: 1.34-5.26). CONCLUSIONS The prevalence of depression among university students was high which could lead to loss of personal control, disturbed learning capacity, and social interaction. Preventive strategies such as life skills training should be given for prevention and management of depression particularly targeting students coming from a rural family, those with stress, and having poor sleep quality.
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Affiliation(s)
- Baye Dagnew
- Department of Human Physiology, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Ethiopia
| | - Zewudu Andualem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Ethiopia
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Rojas SM, Carter SP, McGinn MM, Reger MA. A Review of Telemental Health as a Modality to Deliver Suicide-Specific Interventions for Rural Populations. Telemed J E Health 2019; 26:700-709. [PMID: 31502929 DOI: 10.1089/tmj.2019.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchronous clinical video telehealth (CVT) technologies as one approach to improving access to suicide-specific interventions. Results: Studies were reviewed if (1) the modality of interest was telemental health by CVT and (2) management, assessment, or intervention of suicidal thoughts or behaviors was discussed. A total of 22 studies were included. Conclusions: Findings from the limited existing studies are synthesized, and recommendations are provided for future research, clinical, and educational advancements.
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Affiliation(s)
- Sasha M Rojas
- VA Puget Sound Health Care System, Seattle, Washington.,University of Arkansas, Fayetteville, Arkansas, USA
| | - Sarah P Carter
- VA Puget Sound Health Care System, Seattle, Washington.,Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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11
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Coughlin LN, Wilson SM, Erwin MC, Beckham JC, Calhoun PS. Cigarette smoking rates among veterans: Association with rurality and psychiatric disorders. Addict Behav 2019; 90:119-123. [PMID: 30388505 DOI: 10.1016/j.addbeh.2018.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/28/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022]
Abstract
AIMS Compared to the general U.S. population, military veterans and those living in rural areas disproportionately smoke cigarettes at higher rates, leading to increased health consequences. In the current study, prevalence and severity of cigarette smoking in Iraq and Afghanistan era veterans was assessed across rural and urban areas and comorbid mental health disorders. METHOD Iraq/Afghanistan era veterans who participated in the Post-Deployment Mental Health study from 2005 to 2017 (N = 3229) were cross-sectionally assessed for the probability of being a current cigarette smoker based on locality status and psychiatric comorbidity. Multivariate logistic and linear regressions, adjusted for demographic characteristics, were used to model the odds of being a current smoker and the severity of nicotine dependence, respectively. RESULTS Veterans residing in rural regions, veterans with psychiatric comorbidities, and the interaction of locality and psychiatric disorders were significantly associated with smoking rates. Those veterans living in extremely rural areas and, independently, those living with psychiatric comorbidities were also more severely dependent on nicotine compared to urban veterans and veterans without psychiatric conditions. CONCLUSIONS Rural veterans and veterans with psychiatric comorbidities are at increased risk of smoking and are more severely dependent on nicotine than urban veterans. These findings underscore the need to reduce barriers for treatment both for smoking cessation and mental healthcare for veterans residing in the most rural areas.
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Affiliation(s)
- Lara N Coughlin
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA, United States; Durham VA Health Care System, Durham, NC, United States
| | - Sarah M Wilson
- Durham VA Health Care System, Durham, NC, United States; Center for Health Services Research in Primary Care, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | | | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, United States; Center for Health Services Research in Primary Care, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC, United States
| | - Patrick S Calhoun
- Durham VA Health Care System, Durham, NC, United States; Center for Health Services Research in Primary Care, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC, United States.
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12
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Huang CJ, Lin CH, Hsieh HM, Chang CC, Chu CC, Sun DP, Weng SF. A longitudinal study of healthcare utilisation and expenditure in people with type 2 diabetes mellitus with and without major depressive disorder. Gen Hosp Psychiatry 2019; 57:50-58. [PMID: 30908962 DOI: 10.1016/j.genhosppsych.2018.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 09/12/2018] [Accepted: 09/16/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated the healthcare service utilisation and expenditure of patients with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) and identified associated factors. METHODS Healthcare service utilisation and expenditure of patients with T2DM with and without MDD during 2002-2013 were examined using Taiwan's population-based National Health Insurance claims database. Healthcare service utilisation included outpatient visits and inpatient admissions, and health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, non-psychiatric health service utilisation and expenditure were distinguished from total health service utilisation and medical expenditure. RESULTS Average healthcare service utilisation was significantly higher in those with comorbid MDD (both total and non-psychiatric utilisation). The higher overall costs of the patients with comorbid MDD largely driven by psychiatric costs and non-psychiatric costs between the groups were not significantly different. Gender, age, income, comorbidities and complications, and diabetes complications severity index were significant factors in outpatient visits, medical expenditure, and hospitalisation in those with comorbid MDD. CONCLUSIONS Type 2 diabetes patients with comorbid MDD were found to have higher costs, and that they appeared to be driven by more visits in the first 6 years and by psychiatric-related costs rather than general medical costs.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung 807, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung 807, Taiwan; Department of Adult Psychiatry, Kai-Suan Psychiatric Hospital, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung 807, Taiwan
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, 442, Section 2, Shulin Street, South District, Tainan City 702, Taiwan; Department of Health Psychology, Chang Jung Christian University, 1, Changda Rd., Gueiren District, Tainan City 711, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, 901, Chung Hwa Rd, Yung Kang District, Tainan 710, Taiwan
| | - Ding-Ping Sun
- Department of Surgery, Chi-Mei Medical Center, 901, Chung Hwa Rd, Yung Kang District, Tainan 710, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Slovak K, Pope N, Giger J, Kheibari A. An Evaluation of the Counseling on Access to Lethal Means (CALM) Training with an Area Agency on Aging. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:48-66. [PMID: 30247989 DOI: 10.1080/01634372.2018.1522410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/07/2018] [Indexed: 06/08/2023]
Abstract
Firearms are a significant risk factor in suicide and older adults are disproportionately impacted in suicide by this means. This study investigated the impact of Counseling on Access to Lethal Means (CALM) training with geriatric case managers at an Area Agency on Aging. A concurrent mixed methods approach was used to explore 1) geriatric case managers' attitudes, beliefs, and behavioral intentions about counseling on access to lethal means following CALM training, and 2) perceived barriers to assessing for suicidality and counseling clients on access to firearms. The CALM evaluation data was collected immediately posttest at CALM training, at three-month follow up. Results indicated that 38% of respondents reported they had, since CALM training, discussed reducing access to lethal means with clients and/or families. At three-month follow up, data showed that most beliefs, attitudes, and behavioral intentions about counseling clients and families on this topic increased. Focus group findings indicated that training had a positive effect on participants' attitudes, beliefs, and behavioral intentions about counseling on access to lethal means.The findings of the present study offer additional evidence and implication for trainings of this type.
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Affiliation(s)
- Karen Slovak
- a Social Work , aMalone University , Canton , USA
- b College of Social Work , bUnviversity of Kentucky , Lexington , USA
| | - Natalie Pope
- a Social Work , aMalone University , Canton , USA
- b College of Social Work , bUnviversity of Kentucky , Lexington , USA
| | - Jarod Giger
- a Social Work , aMalone University , Canton , USA
- b College of Social Work , bUnviversity of Kentucky , Lexington , USA
| | - Athena Kheibari
- a Social Work , aMalone University , Canton , USA
- b College of Social Work , bUnviversity of Kentucky , Lexington , USA
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Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry 2018; 30:292-309. [PMID: 30821540 DOI: 10.1080/09540261.2019.1571483] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.
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Affiliation(s)
- Donald M Hilty
- a Mental Health Service , Northern California Veterans Administration Health Care System , Mather , CA , USA.,b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Nadiya Sunderji
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Shannon Suo
- b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Steven Chan
- d Physician, Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System , Affiliate, University of California , San Francisco , CA , USA
| | - Robert M McCarron
- e Department of Psychiatry , University of California Irvine , Irvine , CA , USA
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Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry 2018; 18:262. [PMID: 30134869 PMCID: PMC6104009 DOI: 10.1186/s12888-018-1837-1] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). METHODS We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model. RESULTS Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors. CONCLUSION In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. TRIAL REGISTRATION PROSPERO registration number: 42016046551 .
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Affiliation(s)
- Tessa Roberts
- Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Georgina Miguel Esponda
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Dzmitry Krupchanka
- grid.447902.cDepartment of Social Psychiatry, National Institute of Mental Health, Prague, Czech Republic ,0000 0001 2322 4988grid.8591.5Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Rahul Shidhaye
- 0000 0004 1761 0198grid.415361.4Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Sujit Rathod
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Telehealth for Rural Diverse Populations: Cultural and Telebehavioral Competencies and Practical Approaches for Clinical Services. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41347-018-0054-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Hilty DM, Rabinowitz T, McCarron RM, Katzelnick DJ, Chang T, Bauer AM, Fortney J. An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care. PSYCHOSOMATICS 2017; 59:227-250. [PMID: 29544663 DOI: 10.1016/j.psym.2017.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance. METHOD This conceptual review article explores TP as applied to newer models of care (e.g., collaborative, stepped, and integrated care). RESULTS The field of psychosomatic medicine (PSM) has developed clinical care models, educates interdisciplinary team members, and provides leadership to clinical teams. PSM is uniquely positioned to steer TP and implement other telebehavioral health care options (e.g., e-mail/telephone, psych/mental health apps) in the future in primary care. Together, PSM and TP provide versatility to health systems by enabling more patient points-of-entry, matching patient needs with provider skills, and helping providers work at the top of their licenses. TP and other technologies make collaborative, stepped, and integrated care less costly and more accessible. CONCLUSION Effective health care delivery matches the intensity of the services to the needs of a patient population or clinic, standardizes interventions, and evaluates both process and clinical outcomes. More research is indicated on the application of TP and other technologies to these service delivery models.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California, Veterans Administration Health Care System, Mather, CA; Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC).
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine, Burlington, Vermont; Division of Consultation Psychiatry and Psychosomatic Medicine, University of Vermont College of Medicine, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
| | - Robert M McCarron
- Psychiatry & Behavioral Sciences and Department of Internal Medicine, University of California, Irvine Health System, Irvine, CA
| | - David J Katzelnick
- Department of Psychiatry and Division of Integrated Behavioral Health, Mayo Clinic, Rochester, MN
| | - Trina Chang
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amy M Bauer
- Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA; Behavioral Health Integration Program (BHIP) and Washington State's Mental Health Integration Program (MHIP), Seattle, WA
| | - John Fortney
- Division of Population Health, Seattle, WA; Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA
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Huang CJ, Hsieh HM, Chiu HC, Wang PW, Lee MH, Li CY, Lin CH. Health Care Utilization and Expenditures of Patients with Diabetes Comorbid with Depression Disorder: A National Population-Based Cohort Study. Psychiatry Investig 2017; 14:770-778. [PMID: 29209380 PMCID: PMC5714718 DOI: 10.4306/pi.2017.14.6.770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/14/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study investigated to compare health care utilization and expenditures between diabetic patients with and without depression in Taiwan. METHODS Health care utilization and expenditure among diabetic patients with and without depression disorder during 2000 and 2004 were examined using Taiwan's population-based National Health Insurance claims database. Health care utilization included outpatient visits and the use of inpatient services, and health expenditures were outpatient, inpatient, and total medical expenditures. Moreover, general estimation equation models were used for analyzing the factors associated with outpatient visits and expenditures. Multiple logistic regression analysis was applied for identifying the factors associated with hospitalization. RESULTS The average annual outpatient visits and annual total medical expenditures in the study period were 44.23-52.20; NT$87,496-133,077 and 30.75-32.92; NT$64,411-80,955 for diabetic patients with and without depression. After adjustment for covariates, our results revealed that gender and complication were associated with out-patient visits. Moreover, the time factor was associated with the total medical expenditure, and residential urbanization and complication factors were associated with hospitalization. CONCLUSION Health care utilization and expenditures for diabetic patients with depression were significantly higher than those without depression. Sex, complications, time, and urbanization are the factors associated with health care utilization and expenditures.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsuan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yi Li
- Division of Secretary, Kaohsiung Medical University Hospital, Kaohsiung Medical, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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Nestadt PS, Triplett P, Fowler DR, Mojtabai R. Urban-Rural Differences in Suicide in the State of Maryland: The Role of Firearms. Am J Public Health 2017; 107:1548-1553. [PMID: 28817331 DOI: 10.2105/ajph.2017.303865] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess whether the use of firearms explains rural-urban differences in suicide rates. METHODS We performed a retrospective analysis on all 6196 well-characterized adult suicides in Maryland from 2003 through 2015. We computed rate ratios by using census data and then stratified by sex, with adjustment for age and race. RESULTS Suicide rates were higher in rural compared with urban counties. However, the higher rural suicide rates were limited to firearm suicides (incident rate ratio [IRR] = 1.66; 95% confidence interval [CI] = 1.20, 2.31). Nonfirearm suicide rates were not significantly higher in rural settings. Furthermore, 89% of firearm suicides occurred in men and the higher rural firearm suicide rate was limited to men (IRR = 1.36; 95% CI = 1.09, 1.69). Women were significantly less likely to complete suicide in rural areas (IRR = 0.63; 95% CI = 0.43, 0.94), regardless of method. CONCLUSIONS Male firearm use drives the increased rate of suicide in rural areas. The opposite associations between urbanicity and suicide in men and women may be driven by the male preference for firearms as a method for committing suicide.
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Affiliation(s)
- Paul S Nestadt
- Paul S. Nestadt and Ramin Mojtabai are with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Patrick Triplett is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore. David R. Fowler is with the Office of the Chief Medical Examiner, Baltimore
| | - Patrick Triplett
- Paul S. Nestadt and Ramin Mojtabai are with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Patrick Triplett is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore. David R. Fowler is with the Office of the Chief Medical Examiner, Baltimore
| | - David R Fowler
- Paul S. Nestadt and Ramin Mojtabai are with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Patrick Triplett is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore. David R. Fowler is with the Office of the Chief Medical Examiner, Baltimore
| | - Ramin Mojtabai
- Paul S. Nestadt and Ramin Mojtabai are with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Patrick Triplett is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore. David R. Fowler is with the Office of the Chief Medical Examiner, Baltimore
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Keith Branham D, Borders TF, Stewart KE, Curran GM, Booth BM. Acceptability of HIV Testing Sites Among Rural and Urban African Americans Who Use Cocaine. AIDS Behav 2017; 21:576-586. [PMID: 27557985 PMCID: PMC5290213 DOI: 10.1007/s10461-016-1527-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate that rural AA who use cocaine have lower odds of viewing local health departments (OR = 0.09, 95 % CI = 0.03-0.21), physician offices (OR = 0.19, 95 % CI = 0.09-0.42), and drug use treatment centers (OR = 0.49; 95 % CI = 0.30-0.80) as acceptable relative to their urban counterparts. The findings have implications for further targeting HIV testing toward AAs who use of cocaine, particularly those residing in the rural South.
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Affiliation(s)
- D Keith Branham
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, 40536, USA.
| | - Tyrone F Borders
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, 40536, USA
| | - Katharine E Stewart
- Department of Psychology and Provost's Office, North Carolina State University, Raleigh, NC, USA
| | - Geoffrey M Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Ranney ML, Locci N, Adams EJ, Betz M, Burmeister DB, Corbin T, Dalawari P, Jacoby JL, Linden J, Purtle J, North C, Houry DE. Gender-specific research on mental illness in the emergency department: current knowledge and future directions. Acad Emerg Med 2014; 21:1395-402. [PMID: 25413369 PMCID: PMC4271843 DOI: 10.1111/acem.12524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/14/2014] [Accepted: 07/29/2014] [Indexed: 12/31/2022]
Abstract
Mental illness is a growing, and largely unaddressed, problem for the population and for emergency department (ED) patients in particular. Extensive literature outlines sex and gender differences in mental illness' epidemiology and risk and protective factors. Few studies, however, examined sex and gender differences in screening, diagnosis, and management of mental illness in the ED setting. Our consensus group used the nominal group technique to outline major gaps in knowledge and research priorities for these areas, including the influence of violence and other risk factors on the course of mental illness for ED patients. Our consensus group urges the pursuit of this research in general and conscious use of a gender lens when conducting, analyzing, and authoring future ED-based investigations of mental illness.
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Affiliation(s)
- Megan L Ranney
- Injury Prevention Center, Department of Emergency Medicine, Brown University, Providence, RI; Alpert Medical School, Brown University, Providence, RI
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Feng L, Li P, Lu C, Tang W, Mahapatra T, Wang Y, Wang X, Ma Y, Ben Y, Cao X, Mahapatra S, Ling M, Gou A, Wang Y, Xiao J, Hou M, Wang X, Lin B, Chen R, Wang F, Hu Z. Burden and correlates of geriatric depression in the Uyghur elderly population, observation from Xinjiang, China. PLoS One 2014; 9:e114139. [PMID: 25437860 PMCID: PMC4250089 DOI: 10.1371/journal.pone.0114139] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 11/03/2014] [Indexed: 11/19/2022] Open
Abstract
Background With the gradual aging of the population, geriatric depression has become a major public health issue in China owing to its overall upward trend and associated negative socio-economic impact. Dearth of information regarding the burden and correlates of geriatric depression among Uyghur minority population in Xinjiang Autonomous Region, called for a comprehensive survey involving representative sample for designing efficient targeted intervention to control this disabling disease. Methods A cross-sectional study was conducted among 1329 consenting Uyghur elderly in 2011 in six randomly selected communities/villages in Xinjiang. Information about socio-demographics, behavior, negative life-events, satisfaction regarding income/quality of life and other chronic diseases were collected while assessment of geriatric depression was done using Geriatric Mental State Schedule (GMS). Results Among these participants, majority were currently married, had attended elementary school or less, had an average annual family income of less than 3000 Yuan/person, had strong religious beliefs while 10.61% (2.77% in urban and 23.60% in rural area) had geriatric depression (5.91% among male and 14.58% among females). 61.83% were suffering from other chronic diseases, 96.16% could take care of themselves and 39.28% had experienced negative events during last two years. Religious belief (AOR = 3.92, 95% CI 1.18–13.03), satisfaction regarding quality of life (AOR = 0.53, 95% CI 0.37–0.84) and income (AOR = 0.75, 95% CI 0.35–1.60), suffering from more chronic diseases (AOR = 1.70, 95% CI 1.42–2.04), experiencing three or more negative events (AOR = 1.72, 95% CI 0.92–3.22) and lack of ability to take self-care (AOR = 2.20, 95% CI 1.09–4.48) were all associated with having geriatric depression with or without adjustment for gender, education and occupation. Conclusion High prevalence of geriatric depression among Uyghur elderly in Xinjiang seemed to call for urgent interventions, specifically targeting rural residents, who experienced more negative life-events, were suffering from chronic diseases and were dissatisfied with their income and quality of life.
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Affiliation(s)
- Lei Feng
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Ping Li
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Chen Lu
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, Guangdong, 510095, China
| | - Tanmay Mahapatra
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90066, United States of America
| | - Yu Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Xihua Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Ying Ma
- Anhui medical university, Hefei, Anhui, 230032, China
| | - Yanli Ben
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Xiaolin Cao
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Sanchita Mahapatra
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90066, United States of America
| | - Min Ling
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Anshuan Gou
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Yanmei Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Jiangqin Xiao
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Ming Hou
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Xiuli Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Bo Lin
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Ruoling Chen
- Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, WV1 1DT, United Kingdom
| | - Faxing Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
- * E-mail: (FW); (ZH)
| | - Zhi Hu
- Anhui medical university, Hefei, Anhui, 230032, China
- * E-mail: (FW); (ZH)
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Clarke G, Jo Yarborough B. Evaluating the promise of health IT to enhance/expand the reach of mental health services. Gen Hosp Psychiatry 2013; 35:339-44. [PMID: 23701698 PMCID: PMC3716575 DOI: 10.1016/j.genhosppsych.2013.03.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE A growing number of health information technologies (HIT) are being developed and tested to address mental health conditions. HIT includes Internet and smartphone programs or apps, text messaging protocols and telepsychiatry. We reviewed the promise and evidence that HIT can expand access to mental health care and reduce disparities in use of services across groups in need. CONCLUSIONS Limited reach of mental health services is a pervasive problem in the United States, and solving it will require innovations that enable us to extend our clinical reach into underserved populations without significantly expanding our workforce. In theory, HIT can extend access to mental health care in several ways: by enhancing the reach to priority populations, addressing system capacity issues, supporting training, improving clinical decision making, lowering the "consumer's threshold" for treatment, delivering preventive mental health services, speeding innovation and adoption and reducing cost barriers to treatment. At present, evidence is limited, and research is needed, focusing on consumer engagement strategies, the benefits and harms of HIT for the therapeutic relationship and the comparative effectiveness of various HIT alternatives.
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Affiliation(s)
- Greg Clarke
- Kaiser Permanente Center for Health Research, Portland, OR, USA.
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Boenisch S, Kocalevent RD, Matschinger H, Mergl R, Wimmer-Brunauer C, Tauscher M, Kramer D, Hegerl U, Bramesfeld A. Who receives depression-specific treatment? A secondary data-based analysis of outpatient care received by over 780,000 statutory health-insured individuals diagnosed with depression. Soc Psychiatry Psychiatr Epidemiol 2012; 47:475-86. [PMID: 21350809 DOI: 10.1007/s00127-011-0355-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 02/09/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE This study examined the effects of individual and regional characteristics on receiving depression-specific treatment in the statutory health-insured population of Bavaria (83% of the population). METHODS Data of the Association of Statutory Health Insurance Physicians in Bavaria were analysed for prevalence, diagnosis of and treatment for depression in outpatient care by considering individual and regional characteristics. RESULTS Prevalence of diagnosed depression was 9.2% for the statutory health-insured population aged 18-100 years. More than half of all individuals diagnosed with depression (F32.x/F33.x) and more than one-third of persons diagnosed with severe depression (F32.2/.3 and F33.2/.3) did not receive depression-specific treatment. Rates of a depression-specific treatment were higher for females, the middle aged, individuals with more severe depression diagnoses, those with psychiatric comorbidity and those without physical comorbidity and for individuals living in more rural areas. CONCLUSIONS The pathways to depression-specific treatment for persons diagnosed with moderate and severe depression need to be improved. Training for physicians, stepped care approaches, psycho-education for patients and anti-stigma campaigns are possible measures to reach this goal. The knowledge on individual characteristics that influence receiving a depression-specific treatment is important to target the groups at increased risk for under-treatment.
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Affiliation(s)
- Stefanie Boenisch
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
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Miller M, Azrael D, Barber C. Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide. Annu Rev Public Health 2012; 33:393-408. [PMID: 22224886 DOI: 10.1146/annurev-publhealth-031811-124636] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Suicide mortality varies widely across age, sex, race, and geography, far more than does mortality from the leading causes of natural death. Unlike the tight correlation between cancer mortality and the incidence of cancer, suicide mortality is only modestly correlated with the incidence of suicidal acts and other established risk factors for suicidal behavior, such as major psychiatric disorders. An implication of this modest correlation is that the proportion of all suicidal acts that prove fatal (the case fatality ratio) must account for a substantial portion of the (nonrandom) variation observed in suicide mortality. In the United States, the case fatality ratio is strongly related to the availability of household firearms. Findings from ecologic and individual-level studies conducted over the past two decades illustrate the importance of accounting for the availability of highly lethal suicide methods in efforts to understand (and ultimately reduce) disparities in suicide mortality across populations.
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Affiliation(s)
- Matthew Miller
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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26
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Lin CH, Lee YY, Liu CC, Chen HF, Ko MC, Li CY. Urbanization and prevalence of depression in diabetes. Public Health 2011; 126:104-11. [PMID: 22178148 DOI: 10.1016/j.puhe.2011.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 06/13/2011] [Accepted: 10/27/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To depict recent secular trend (2001-2005) in prevalence of depression among diabetic population in Taiwan, and to explore the influences of urbanization on the prevalence of depression. STUDY DESIGN A descriptive correlation study design relating urbanization and prevalence of depression. METHODS Annual prevalence of depression was calculated as the ratio of number of individuals with depression (ICD-9-CM: 296, 309, or 311) to the size of diabetic population (ICD-9-CM: 250), which were ascertained from ambulatory care claim data of Taiwan's National Health Insurance between 2001 and 2005. Multivariate Poisson regression analysis was used to assess the secular trend in the prevalence of comorbid depression, and to appraise the influence of urbanization on prevalence of depression in diabetic patients. RESULTS The prevalence of depression among diabetic population increased annually from 22.6/10(3) in 2001 to 27.0/10(3) in 2005 with a significantly and linearly rising trend (β = 0.0461, p < 0.0001). Diabetic population living in urban areas showed the largest increase in prevalence (6.3/10(3)), followed by those from rural areas (5.6/10(3)). Compared to the diabetic patients residing in rural areas, those living in urban areas (RR = 1.28, 95% CI = 1.25-1.31) and those from satellite towns (RR = 1.22, 95% CI = 1.19-1.25) both had significantly increased adjusted RR. CONCLUSIONS There is a significant increasing trend in prevalence of depression among diabetic population in recent years in Taiwan. Diabetic patients from urban areas not only had the greatest prevalence of depression but also showed the largest increase in prevalence during the study period, which highlights a need for managing depression in urban diabetes.
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Affiliation(s)
- C H Lin
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan
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Deliberate self-harm in rural and urban regions: A comparative study of prevalence and patient characteristics. Soc Sci Med 2011; 73:274-81. [DOI: 10.1016/j.socscimed.2011.05.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 04/19/2011] [Accepted: 05/09/2011] [Indexed: 11/18/2022]
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Novello DJ, Stain HJ, Lyle D, Kelly BJ. Psychological distress of rural parents: Family influence and the role of isolation. Aust J Rural Health 2011; 19:27-31. [PMID: 21265922 DOI: 10.1111/j.1440-1584.2010.01173.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Research regarding psychological distress has often underestimated the importance of contextual social factors. This research aims to investigate patterns of psychological distress within the family system (parent dyads) across rural and remote communities and the influence of remoteness on such distress. DESIGN Self-report survey data from the Australian Rural Mental Health Study was used to examine the distress levels of cohabitating parental figures in rural and remote Australia. SETTING The survey was conducted across rural and remote communities within New South Wales. PARTICIPANTS The sample consisted of 129 adult couples (mean age = 42.66 years, SD = 8.11), 43 from Inner Regional areas, 48 from Outer Regional areas, 24 from Remote areas and 14 from Very Remote areas. MAIN OUTCOME MEASURE Distress levels (Kessler-10). RESULTS A significant association was detected between the levels of psychological distress among parents within a household. The strength of this relationship increased with increasing remoteness of residence. CONCLUSIONS Identifying the influence of spousal factors on mental health in rural and remote areas allows health services in such regions to be aware of the needs of rural couples and families. These results support the need to consider partner/spouse mental health in clinical assessment and support the importance of household factors especially in remote communities.
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Affiliation(s)
- Denika J Novello
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia.
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Reeb BT, Conger KJ. Mental health service utilization in a community sample of rural adolescents: the role of father-offspring relations. J Pediatr Psychol 2011; 36:661-8. [PMID: 21586425 DOI: 10.1093/jpepsy/jsr016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Children and adolescents living in rural communities may be at particular risk for psychiatric problems, yet factors associated with mental health service use in these populations are not clear. This study examined the role of father warmth in offspring psychological treatment utilization in community sample of rural families (n = 298). METHODS Observer ratings of paternal warmth were examined as a predictor of adolescent treatment seeking and as a moderator of the longitudinal association between adolescent depressive symptoms and treatment seeking. RESULTS Paternal warmth was a marginally significant predictor of adolescent mental health service use. The association between adolescent depressive symptoms and treatment seeking varied as a function of paternal behavior; adolescents were more likely to seek needed help in the context of a warm, supportive father. CONCLUSIONS These findings suggest that fathers can play an important role in the intrafamilial processes through which rural adolescents recognize and seek help for their psychological problems.
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Affiliation(s)
- Ben T Reeb
- Department of Human Development, University of California at Davis, USA.
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Rost K, Hsieh YP, Xu S, Harman J. Gender differences in hospitalization after emergency room visits for depressive symptoms. J Womens Health (Larchmt) 2011; 20:719-24. [PMID: 21417934 DOI: 10.1089/jwh.2010.2396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressed women have greater than three times the odds of hospitalization as clinically comparable men. The objective of this study is to understand if these gender differences emerge in admissions decisions after depressed individuals' arrival at the emergency room (ER). METHODS We used multivariate logistic regression to examine gender differences in hospitalization after 6266 ER visits for depressive symptoms in the nationally representative 1998-2007 National Hospital Ambulatory Care Medical Survey. RESULTS ER visits by depressed women have only 0.82 the odds of hospitalization (95% confidence interval [CI] 0.70-0.96, p=0.02) in models adjusted for sociodemographic, clinical, and system covariates. Sensitivity analyses demonstrate gender differences in visits by patients with no injury but not in visits by patients with self-inflicted injury. CONCLUSIONS These findings suggest that admission decisions after ER visits are not responsible for the increased risk of hospitalization previously reported in depressed women, as ER visits by women with depressive symptoms actually have lower odds of hospitalization than visits by men. We encourage further research to explore the causes and consequences of this practice pattern to move toward rational delivery systems committed to providing comparable treatment to clinically comparable individuals regardless of gender.
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Affiliation(s)
- Kathryn Rost
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA.
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31
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Examining Perceptions About Mental Health Care and Help-Seeking Among Rural African American Families of Adolescents. J Youth Adolesc 2011; 40:1118-31. [DOI: 10.1007/s10964-010-9627-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 12/30/2010] [Indexed: 11/27/2022]
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Pfeiffer PN, Glass J, Austin K, Valenstein M, McCarthy JF, Zivin K. Impact of distance and facility of initial diagnosis on depression treatment. Health Serv Res 2011; 46:768-86. [PMID: 21210800 DOI: 10.1111/j.1475-6773.2010.01228.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To assess whether distance to services or diagnosis at a hospital-based medical center compared with a community clinic influences the receipt of psychotherapy versus pharmacotherapy for depression. DATA SOURCE Veterans Affairs (VA) administrative data for 132,329 depressed veterans between October 2003 and September 2004. STUDY DESIGN Multivariable logistic and multinomial regression models were used to examine the relationship between distance to the nearest mental health facility and the facility of initial depression diagnosis on receipt of any and adequate psychotherapy and/or pharmacotherapy, adjusted for patient characteristics. PRINCIPAL FINDINGS Compared with those living within 30 miles of the nearest mental health treatment facility, depressed patients living between 30 and 60 miles away had a decreased likelihood of receiving psychotherapy (OR=0.71; 95 percent CI: 0.66, 0.76) and a greater likelihood of receiving antidepressant treatment (OR=1.27; 95 percent CI: 1.22, 1.33). Initial diagnosis at a small community clinic compared with a VA medical center was not associated with a difference in receipt of any psychotherapy (OR=0.95; 95 percent CI: 0.83, 1.09), but it was associated with decreased likelihood of receiving eight or more psychotherapy visits (OR=0.46; 95 percent CI: 0.35, 0.61) or any antidepressant treatment (OR=0.69; 95 percent CI: 0.63, 0.75). CONCLUSIONS The VA and similar health systems should make efforts to insure adequate psychotherapy is provided to patients who initiate treatment at small community clinics and provide psychotherapy alternatives that may be less sensitive to travel barriers for patients living remote distances from mental health treatment. Extending services to small community clinics that support antidepressant treatment should also be considered.
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Affiliation(s)
- Paul N Pfeiffer
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
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Shrira I, Christenfeld N. Disentangling the person and the place as explanations for regional differences in suicide. Suicide Life Threat Behav 2010; 40:287-97. [PMID: 20560750 DOI: 10.1521/suli.2010.40.3.287] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Identifying whether suicides in a region are due to characteristics of the residents living there or to some enduring feature of the region is difficult when using cross-sectional studies. To distinguish these factors, we compared the suicides of a region's residents with people who were temporarily visiting the region. Using U.S. death records from 1973-2004, we focused on states with the highest and lowest suicide rates over this period. The high suicide region consisted of Arizona, Colorado, Montana, New Mexico, Nevada, Oregon, and Wyoming; the low suicide region consisted of Connecticut, Illinois, Massachusetts, New Jersey, and New York. For each region, we considered three groups of decedents: residents who died inside the region, residents who died outside the region, and visitors to the region. Proportionate mortality ratios were calculated for all suicides and separately for firearm suicides. In the high suicide region, visitors to and residents away from the region both had elevated suicide levels, to about the same extent as residents dying inside the region. Therefore, short-term exposure to the region and being a resident of the region each predicted suicide. In the low suicide region, the suicides of residents at home were reduced, but their suicides rose dramatically once they left the area. There was no decrease in suicides among visitors to the region. Firearm use was related to the suicide levels of each region. Overall, the results suggest that both the available means to commit suicide and the contextual features of the regions contributed to their extreme suicides. We discuss how an examination of visitors can help researchers generate novel inferences about the causes of suicide.
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Affiliation(s)
- Ilan Shrira
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA.
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Kemppainen JK, Taylor J, Jackson LA, Kim-Godwin YS, Kirby E. Incidence, sources, and self-management of depression in persons attending a rural health clinic in southeastern North Carolina. J Community Health Nurs 2009; 26:1-13. [PMID: 19177268 DOI: 10.1080/07370010802605697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to determine the incidence, sources, and self-management strategies of depression in a sample of 48 persons visiting a primary care clinic in rural Southeastern North Carolina. Forty percent of the participants met the criteria of clinical depression on the Center for Epidemiological Studies Depression Scale (CES-D). Highest rates of depression found in single, African American men who were employed with adequate health insurance were attributed primarily to work related stressors in dealing with overwhelming social problems of other rural residents, as well as economic stressors. Critical incident interviews identified depression self-management strategies and sources of social support.
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Rural-urban differences in injury hospitalizations in the U.S., 2004. Am J Prev Med 2009; 36:49-55. [PMID: 19095165 DOI: 10.1016/j.amepre.2008.10.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 09/17/2008] [Accepted: 10/03/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite prior research demonstrating higher injury-mortality rates among rural populations, few studies have examined the differences in nonfatal injury risk between rural and urban populations. The objective of this study was to compare injury-hospitalization rates between rural and urban populations using population-based national estimates derived from patient-encounter data. METHODS A cross-sectional analysis of the 2004 Nationwide Inpatient Sample was conducted in 2007. Rural-urban classifications were determined based on residence. SUDAAN software and U.S. Census population estimates were used to calculate nationally representative injury-hospitalization rates. Injury rates between rural and urban categories were compared with rate ratios and 95% CIs. RESULTS An estimated 1.9 million (95% CI=1,800,250-1,997,801) injury-related hospitalizations were identified. Overall, injury-hospitalization rates generally increased with increasing rurality; rates were 27% higher in large rural counties (95% CI=10%, 44%) and 35% higher in small rural counties (95% CI=16%, 55%). While hospitalization rates for assaults were highest in large urban counties, the rates for unintentional injuries from motor vehicle traffic, falls, and poisonings were higher in rural populations. Rates for self-inflicted injuries from poisonings, cuttings, and firearms were higher in rural counties. The total estimated hospital charges for injuries were more than $50 billion. On a per-capita basis, hospital charges were highest for rural populations. CONCLUSIONS These findings highlight the substantial burden imposed by injury on the U.S. population and the significantly increased risk for those residing in rural locations. Prevention and intervention efforts in rural areas should be expanded and should focus on risk factors unique to these populations.
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Rhodes A, Bethell J, Jaakkimainen RL, Thurlow J, Spence J, Links PS, Streiner DL. The impact of rural residence on medically serious medicinal self-poisonings. Gen Hosp Psychiatry 2008; 30:552-60. [PMID: 19061682 DOI: 10.1016/j.genhosppsych.2008.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/28/2008] [Accepted: 06/30/2008] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Suicide rates are often high in rural areas. Despite the strong association between deliberate self-harm (DSH) and suicide, few have studied rural residence and DSH. Self-poisonings dominate DSH hospital presentations. We investigate a previously reported association between rural residence and medical severity (defined as a subsequent medical/surgical inpatient stay) among emergency department presentations for medicinal self-poisoning (SP) to determine whether differences in agents taken, mental health service use or hospital-level resources explain the relationship. METHOD A cohort of n=16,294 12-64-year olds presenting with SP to hospital emergency departments in Ontario, Canada, in 2001/2002 was linked to their service records over time. RESULTS The rural-medical severity association was best explained by differences in hospital resources; presenting to hospitals providing inpatient psychiatric services appeared to reduce medical/surgical inpatient stays in favor of psychiatric ones. Among those with a recent psychiatric admission, more intensive ambulatory psychiatric contact may be protective of a psychiatric inpatient stay subsequent to the SP presentation. Compared to nonrural residents, deliberate intent was identified less often in rural residents, particularly males. CONCLUSIONS The rural-medical severity association was best explained by disparities in the delivery systems serving rural and nonrural residents, important to rural suicide prevention efforts.
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Affiliation(s)
- Anne Rhodes
- Suicide Studies Unit, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8.
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Burman ME, Petrie J. Depression and anxiety outcomes at a free clinic in a rural state. ACTA ACUST UNITED AC 2008; 20:359-66. [PMID: 18638175 DOI: 10.1111/j.1745-7599.2008.00333.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the diagnostic and treatment patterns for depression and anxiety in clients receiving care at a free clinic. DATA SOURCES Charts for 43 clients who received antidepressant or anxiolytic medications were randomly selected and reviewed. CONCLUSIONS Clients presented to the clinic symptomatic; almost two thirds had been treated elsewhere. Most clients received pharmacological treatment and referral for counseling. Forty-four percent of the clients were still being treated at their last visit, but 33% were no longer being seen, and it could not be determined if they were receiving care at another clinic. IMPLICATIONS FOR PRACTICE If sustained relationships with clients with depression and anxiety can be developed, appropriate care can be provided.
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Affiliation(s)
- Mary E Burman
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyoming 82071, USA.
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Abstract
Cities are now the major sites of human habitation worldwide, a trend that will continue for the foreseeable future, not only in the developed world but in developing countries. Urban residence impacts health and health prospects both positively and negatively through a complex mix of exposures and mechanisms. In addition, cities concentrate population subsets of various demographic, economic, and social characteristics, some with particular health risks and vulnerabilities. Looking at health through the urban lens allows increased understanding of disparate risks and emphasizes the essentiality of collaborative efforts in protecting and enhancing the health of populations, especially those living in cities.
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Smith KB, Humphreys JS, Wilson MGA. Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research? Aust J Rural Health 2008; 16:56-66. [DOI: 10.1111/j.1440-1584.2008.00953.x] [Citation(s) in RCA: 330] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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40
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Borders TF, Booth BM. Research on rural residence and access to drug abuse services: where are we and where do we go? J Rural Health 2008; 23 Suppl:79-83. [PMID: 18237329 DOI: 10.1111/j.1748-0361.2007.00128.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Illicit drug use is common in rural areas, but very little research has investigated rural populations' access to drug abuse services. PURPOSE To describe the current state of the scientific literature on access to drug abuse services in rural areas and suggest directions for future research. METHODS We performed a literature review of published articles on rural drug abuse services and summarized the findings according to potential, realized, accommodating, and acceptable access. Relevant articles on rural access to medical, alcohol, and mental health care were selected to supplement the scarce literature specific to drug abuse. FINDINGS A limited body of work indicates that rural populations have lower availability and utilize needed drug abuse services less frequently than their urban counterparts. Even less is known about the accommodation and acceptability of drug abuse programs serving rural populations. CONCLUSIONS Research that investigates the existence and determinants of problems with access to drug abuse services is greatly needed to enable policy makers, drug treatment managers, and practitioners to better meet the needs of their rural clientele. As this field of inquiry advances, methodologies for constructing drug abuse service areas and measuring consumers' evaluations must be developed.
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Affiliation(s)
- Tyrone F Borders
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
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Roberts LW, Johnson ME, Brems C, Warner TD. Ethical disparities: challenges encountered by multidisciplinary providers in fulfilling ethical standards in the care of rural and minority people. J Rural Health 2008; 23 Suppl:89-97. [PMID: 18237331 DOI: 10.1111/j.1748-0361.2007.00130.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Health care disparities are well documented for people living in rural areas and for people who are members of ethnic minorities. PURPOSE Our goal was to determine whether providers report greater difficulty in providing care for rural than urban residents and for ethnic minorities than patients/clients in general in 4 practice areas of ethical relevance: attaining treatment adherence, assuring confidentiality, establishing therapeutic alliance, and engaging in informed consent processes. METHODS We received survey responses from 1,558 multidisciplinary medical and behavioral providers across rural and non-rural areas of New Mexico and Alaska in 2004 to assess a wide range of issues in providing health care. FINDINGS Providers reported some difficulties in fulfilling various ethical practices for all types of patients, but not more difficulty when caring for minority compared to nonminority patients/clients. However, they do report more frequent additional problems related to the practice issues of treatment adherence, therapeutic alliance, informed consent, and confidentiality with minority patients than others. Difficulties and more frequent additional problems are greater for providers in rural than in non-rural areas. Results generalize across both Alaska and New Mexico with few differences. CONCLUSIONS We obtained evidence for disparity in care for patients/ clients who were minority group members, and clear evidence of disparity for people residing in rural compared to non-rural areas of 2 states with large rural areas.
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Affiliation(s)
- Laura Weiss Roberts
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee 53226, USA.
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42
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Momose Y, Suenaga T, Une H. Job Satisfaction and Mental Distress among Japanese Farmers. J Rural Med 2008. [DOI: 10.2185/jrm.3.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pearce J, Barnett R, Jones I. Have urban/rural inequalities in suicide in New Zealand grown during the period 1980-2001? Soc Sci Med 2007; 65:1807-19. [PMID: 17618025 DOI: 10.1016/j.socscimed.2007.05.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Indexed: 11/23/2022]
Abstract
Previous studies have noted that in many countries there has been a disproportionate increase in suicide in rural areas, contributing to greater urban/rural inequalities in health. This paper evaluates whether this trend was also apparent in New Zealand during the 1980s and 1990s, a period of rapid social and economic change. Using suicide incidence data for the period 1980-2001, we investigate whether urban/rural status had an effect upon rates of suicide independently of socioeconomic deprivation. While both male and female suicide rates were significantly higher in urban than rural areas in 1980-1982, by the end of the 1990s, urban/rural differences in suicide rates were not significant. The narrowing of urban/rural differences was, to some extent, a result of the growth in suicide rates in more isolated rural communities and small rural service centres. Recent geographical variations in suicide in New Zealand are therefore to a large extent similar to trends observed elsewhere, but are less marked. Potential explanations are offered for the fluctuating urban/rural inequalities in suicide including compositional arguments, rural restructuring and economic decline, social isolation and health service utilisation.
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Affiliation(s)
- Jamie Pearce
- GeoHealth Laboratory, Department of Geography, Christchurch, New Zealand.
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Hilty DM, Nesbitt TS, Kuenneth CA, Cruz GM, Hales RE. Rural versus suburban primary care needs, utilization, and satisfaction with telepsychiatric consultation. J Rural Health 2007; 23:163-5. [PMID: 17397373 DOI: 10.1111/j.1748-0361.2007.00084.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT AND PURPOSE Rural and suburban populations remain underserved in terms of psychiatric services but have not been compared directly in terms of using telepsychiatry. METHODS Patient demographics, reasons for consultation, diagnosis, and alternatives to telepsychiatric consultation were collected for 200 consecutive, first-time telepsychiatric consultations at rural and suburban clinics. FINDINGS Rural patients were more likely than suburban patients to be younger than 18 years, using Medicaid, and needing treatment planning (lest they be referred out of the community). Rural patient and primary care physician satisfaction was higher than that of suburban counterparts. CONCLUSION Telepsychiatry programs may enhance access, satisfaction, and quality of rural care.
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Affiliation(s)
- Donald M Hilty
- Department of Psychiatry and Behaviorial Science, University of California, Davis, Sacramento, CA 95817, USA.
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Simmons LA, Havens JR. Comorbid substance and mental disorders among rural Americans: results from the National Comorbidity Survey. J Affect Disord 2007; 99:265-71. [PMID: 16978706 DOI: 10.1016/j.jad.2006.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 08/04/2006] [Accepted: 08/14/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND The purpose of this study was to examine whether rural inhabitants were more likely than urban inhabitants to meet the criteria for comorbid mental health and substance abuse or dependence disorders. METHODS Data were from the National Comorbidity Survey, and included 5185 (532=rural; 4653=urban) persons age 14-54 years of age who were interviewed using the Composite International Diagnostic Interview (CIDI). Logistic regression that accounted for the complex survey data and weighting scheme was utilized. RESULTS Participants residing in rural areas were more likely to meet the DSM-III-R criteria for past month alcohol abuse or dependence if they also met the diagnostic criteria for past month major depressive disorder (MDD) or lifetime antisocial personality disorder (ASPD), adjusting for age, race, gender, education and income. Similarly, rural participants were more likely to meet the criteria for comorbid drug abuse or dependence in the past month if they met the diagnosis for either past month MDD, generalized anxiety disorder or lifetime ASPD, controlling for demographic characteristics. Rural residents with any current mental disorder also were less likely to seek treatment than their urban counterparts. LIMITATIONS Data were collected in 1991 and do not capture changes in prevalence of comorbidities. Also, the small number of rural residents sampled resulted in small cell sizes for some comorbidities. CONCLUSIONS Rural residents were significantly more likely to meet the criteria for substance disorders given they also met the criteria for a mental disorder, and those with any current mental disorder were less likely to seek treatment. Since the overall prevalence of these disorders does not differ between rural and urban inhabitants, findings suggest that rural persons may lack access to adequate treatment for their mental health disorders and subsequently may be self-medicating with alcohol and/or drugs.
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Affiliation(s)
- Leigh Ann Simmons
- Department of Family Studies, University of Kentucky, Lexington, KY, USA
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Reif S, Whetten K, Ostermann J, Raper JL. Characteristics of HIV-infected adults in the Deep South and their utilization of mental health services: A rural vs. urban comparison. AIDS Care 2007; 18 Suppl 1:S10-7. [PMID: 16938670 DOI: 10.1080/09540120600838738] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Insufficient utilization of mental health services has been described among HIV-infected individuals in urban areas; however, little is known about utilization of mental health services among rural-living HIV-infected individuals. This article examines use of mental health services by HIV-infected adults in the Southern U.S., where approximately two-thirds of rural HIV cases reside, and compares mental health services use between those in rural and urban areas. Data were obtained from surveys of HIV-infected individuals receiving care at tertiary Infectious Diseases clinics in the Southern U.S. (n = 474). Study findings indicated that participants living in areas with a higher proportion of rural-living individuals were less likely to report seeing a mental health provider (p < .001) in the last year even though there were no differences in level of psychological distress by degree of rurality. Participants living in more rural areas also reported significantly fewer mental health visits in the previous month (p = .025). Furthermore, rural living was significantly associated with being African-American, heterosexual, less educated, and having minor children in the home. Due to differences in characteristics and mental health services use by degree of rurality, efforts are needed to assess and address the specific mental health and other needs of HIV-infected individuals in rural areas.
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Affiliation(s)
- Susan Reif
- Health Inequalities Program, Duke University, Durham, NC 27708, USA
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Fortney J, Rushton G, Wood S, Zhang L, Xu S, Dong F, Rost K. Community-level risk factors for depression hospitalizations. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 34:343-52. [PMID: 17294123 DOI: 10.1007/s10488-007-0117-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 01/12/2007] [Indexed: 11/27/2022]
Abstract
This study measured geographic variation in depression hospitalizations and identified community-level risk factors. Depression hospitalizations were identified from the Statewide Inpatient Database. The dependent variable was specified as the indirectly standardized hospitalization rate. County-level data for 14 states were collected from federal agencies. The Bayesian spatial regression model included socio-demographic, economic, and health system characteristics as independent variables. There were 8.5 depression hospitalizations per 1,000 residents. 8.8% of counties had hospitalization rates 33% greater than the standardized rate. Significant risk factors included unemployment, poverty, physician supply, and hospital bed supply. Significant protective factors included rurality, economic dependence, and housing stress.
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Affiliation(s)
- John Fortney
- Health Services Research and Development, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.
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Shore JH, Hilty DM, Yellowlees P. Emergency management guidelines for telepsychiatry. Gen Hosp Psychiatry 2007; 29:199-206. [PMID: 17484936 PMCID: PMC1986661 DOI: 10.1016/j.genhosppsych.2007.01.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 01/24/2007] [Accepted: 01/24/2007] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Telepsychiatry, in the form of live interactive videoconferencing, is an emerging application for emergency psychiatric assessment and treatment and can improve the quality and quantity of mental health services, particularly for rural, remote and isolated populations. Despite the potential of emergency telepsychiatry, the literature has been fairly limited in this area. METHOD Drawing on the combined clinical and administrative experiences of its authors, this article reviews the common administrative, legal/ethical and clinical issues that arise in emergency telepsychiatry. RESULTS An initial set of guidelines for emergency telepsychiatry is presented to generate further discussion to assist those who are considering establishing general telepsychiatry and/or emergency telepsychiatry services. CONCLUSION The practices and techniques of emergency telepsychiatry are relatively new and require further examination, modification and refinement so that they may be fully utilized within comprehensive mental health service systems.
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Affiliation(s)
- Jay H Shore
- American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Nighthorse Campbell Native Health Building, Aurora, CO 80045-0508, USA.
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Shepherd L, Goldstein D, Whitford H, Thewes B, Brummell V, Hicks M. The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: results of a pilot study. J Pain Symptom Manage 2006; 32:453-61. [PMID: 17085271 DOI: 10.1016/j.jpainsymman.2006.05.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 04/01/2006] [Accepted: 05/11/2006] [Indexed: 01/18/2023]
Abstract
The unmet psychological needs of rural cancer patients are numerous. Telepsychology is a novel and feasible option that may provide cost-savings and help overcome inequalities in access to specialists. This is the first known study of psychological treatment for people with cancer delivered entirely via videoconferencing. We hypothesized that a telepsychology service would improve rural cancer patients' anxiety and depression levels and quality of life, and would be an acceptable, satisfactory, and practical mode of service delivery. Twenty-five cancer patients attended an average of three sessions with a clinical psychologist providing brief cognitive-behavioral therapy. Questionnaires were completed at pre-, post-, and 1-month follow-up. Patients benefited in terms of anxiety (P=0.01) and quality of life (P=0.04). The service was both practical and acceptable. These preliminary positive results provide a firm basis to conduct a randomized controlled trial of face-to-face interaction vs. videoconferencing.
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Affiliation(s)
- Louise Shepherd
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Evolution of telepsychiatry to rural sites: changes over time in types of referral and in primary care providers' knowledge, skills and satisfaction. Gen Hosp Psychiatry 2006; 28:367-73. [PMID: 16950370 DOI: 10.1016/j.genhosppsych.2006.05.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2005] [Revised: 05/29/2006] [Accepted: 05/30/2006] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Rural populations remain underserved in terms of psychiatric services. This study assesses changes over time in the utilization of telepsychiatric services by individual primary care providers (PCPs) and clinics in rural areas, specifically: (a) types of referrals for telepsychiatry service; (b) PCPs' knowledge and skills related to medication dosing; and (c) PCPs' satisfaction with telepsychiatry. METHODS Data with regard to patient demographics, diagnoses, reason for consultation, medication dosing and satisfaction were prospectively collected on the first 200 and the subsequent 200 telepsychiatric initial consultations. A number of educational interventions were implemented during the project. RESULTS Adult patients were primarily referred for mood and anxiety disorders, particularly for diagnosis and medication treatment planning. Over time, PCPs significantly improved medication dosing and asked for more treatment planning help. PCPs' satisfaction also improved over time. DISCUSSION Telepsychiatric consultation, in combination with specific educational interventions, appears to facilitate the enhancement of skills and knowledge of PCPs. "Developmental" steps in provider and clinic evolution, along with interventions specific to a given provider's and a given site's needs, ought to be further elucidated.
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