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Informal Employment and Poor Mental Health in a Sample of 180,260 Workers from 13 Iberoamerican Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137883. [PMID: 35805540 PMCID: PMC9265366 DOI: 10.3390/ijerph19137883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023]
Abstract
The aim of this study is to estimate the association between employment conditions and mental health status in the working population of Iberoamerica. In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 13 countries. A sample of 180,260 workers was analyzed. Informality was assessed by social security, health affiliation, or contract holding. Mental health was assessed using several instruments. We used Poisson regression models to estimate the contribution of informality to poor mental health by sex and country, adjusted by sociodemographic and work-related characteristics. Then, we performed a meta-analysis pooling of aggregate data using a random-effects inverse-variance model. Workers in informal employments showed a higher adjusted prevalence ratio (aPR) of poor mental health than those in formal employment in Peru (aPR men 1.5 [95% confidence intervals 1.16; 1.93]), Spain (aPR men 2.2 [1.01; 4.78]) and Mexico (aPR men 1.24 [1.04; 1.47]; women 1.39 [1.18; 1.64]). Overall estimates showed that workers in informal employment have a higher prevalence of poor mental health than formal workers, with it being 1.19 times higher (aPR 1.19 [1.02; 1.39]) among men, and 1.11 times higher prevalence among women (aPR 1.11 [1.00; 1.23]). Addressing informal employment could contribute to improving workers’ mental health.
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Improving the detection and treatment of depression in Australians with multiple sclerosis: A qualitative analysis. Mult Scler Relat Disord 2021; 56:103290. [PMID: 34614457 DOI: 10.1016/j.msard.2021.103290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/26/2021] [Accepted: 09/26/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Depression is common in people with multiple sclerosis (MS), yet often goes undetected, untreated or undertreated. OBJECTIVE This qualitative research explored current practices, barriers and facilitators for detection and treatment of depression in Australians with MS. METHODS Participants were 26 people with MS recruited through social media. Participants completed the Centre for Epidemiological Studies Depression-Revised (CESD-R) scale and in-depth telephone or video interviews. Interviews were analysed using framework analysis. RESULTS Scores measured on the CESD-R proposed 73% of participants were experiencing severe depression symptoms. Participants reported that depression is not regularly and formally assessed through MS healthcare services and they are offered limited information about depression in MS. Barriers to mental health support included recognition of depression, resistance to treatment and limitations of collaborative support between general practitioners and MS healthcare services. Participants expressed a need for open conversations and information about depression during neurology consultations. CONCLUSION Based on our findings, improved detection and treatment of depression in people with MS requires: 1) better provision of information about depression for people with MS through healthcare services and community organisations; 2) regular screening and assessment; 3) better healthcare services collaboration to improve management.
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Escobar-Viera CG, Cernuzzi LC, Miller RS, Rodríguez-Marín HJ, Vieta E, González Toñánez M, Marsch LA, Hidalgo-Mazzei D. Feasibility of mHealth interventions for depressive symptoms in Latin America: a systematic review. Int Rev Psychiatry 2021; 33:300-311. [PMID: 34102945 PMCID: PMC8318676 DOI: 10.1080/09540261.2021.1887822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Depression is a prevalent disorder and leading cause of disability in Latin America, where the mental health treatment gap is still above 50%. We sought to synthesise and assess the quality of the evidence on the feasibility of mHealth-based interventions for depression in Latin America. We conducted a literature search of studies published in 2007 and after using four electronic databases. We included peer-reviewed articles, in English, Spanish or Portuguese, that evaluated interventions for depressive symptoms. Two authors independently extracted data using forms developed a priori. We assessed appropriateness of reporting utilising the CONSORT checklist for feasibility trials. Eight manuscripts were included for full data extraction. Appropriate reporting varied greatly. Most (n = 6, 75%) of studies were conducted in primary care settings and sought to deliver psychoeducation or behaviour change interventions for depressive symptoms. We found great heterogeneity in the assessment of feasibility. Two studies used comparator conditions. mHealth research for depression in Latin America is scarce. Included studies showed some feasibility despite methodological inconsistencies. Given the dire need for evidence-based mental health interventions in this region, governments and stakeholders must continue promoting and funding research tailored to cultural and population characteristics with subsequent pragmatic clinical trials.
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Affiliation(s)
- César G. Escobar-Viera
- Center for Research on Behavioral Health, Media, and Technology, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luca C. Cernuzzi
- Facultad de Ciencias y Tecnología, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Rebekah S. Miller
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hugo J. Rodríguez-Marín
- Dirección de Salud Mental, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay;,Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Magalí González Toñánez
- Facultad de Ciencias y Tecnología, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Satre DD, Anderson AN, Leibowitz AS, Levine-Hall T, Slome S, Flamm J, Hare CB, McNeely J, Weisner CM, Horberg MA, Volberding P, Silverberg MJ. Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial. Contemp Clin Trials 2019; 84:105833. [PMID: 31446142 PMCID: PMC6760257 DOI: 10.1016/j.cct.2019.105833] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care. METHODS The Promoting Access to Care Engagement (PACE) trial currently in process examines the impact of self-administered electronic screening for SUD risk, depression and anxiety in three large Kaiser Permanente Northern California primary care clinics serving over 5000 PWH. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]; and the Adult Outcomes Questionnaire [AOQ], which includes the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-2]) delivered via three modalities (secure messaging, tablets in waiting rooms, and desktop computers in exam rooms). Results are integrated automatically into the electronic health record. Based on screening results and physician referrals, behavioral health specialists embedded in primary care initiate motivational interviewing- and cognitive behavioral therapy-based brief treatment and link patients to addiction and psychiatry clinics as needed. Analyses examine implementation (screening and treatment rates) and effectiveness (SUD, depression and anxiety symptoms; HIV viral control) outcomes using a stepped-wedge design, with a 12-month intervention phase implemented sequentially in the clinics, and a 24-month usual care period prior to implementation in each clinic functioning as sequential observational phases for comparison. We also evaluate screening and treatment costs and implementation barriers and facilitators. DISCUSSION The study examines innovative, technology-facilitated strategies for improving assessment and treatment in primary care. Results may help to inform substance use, mental health, and HIV services. TRIAL REGISTRATION NCT03217058.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Alexandra N Anderson
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Amy S Leibowitz
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Sally Slome
- Kasier Permanente Oakland Medical Center, 3801 Howe St, Oakland, CA 94611, United States of America
| | - Jason Flamm
- Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, Sacramento, CA 95825, United States of America
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, 2238 Geary Blvd, San Francisco, CA 94115, United States of America
| | - Jennifer McNeely
- New York University School of Medicine, 550 1st Ave., New York, NY 10016, United States of America
| | - Constance M Weisner
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson, Rockville, MD 20852, United States of America
| | - Paul Volberding
- AIDS Research Institute, University of California San Francisco, San Francisco, CA, 94158, United States of America
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
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Gutnick D, Siegel C, Laska E, Wanderling J, Wagner EC, Haugland G, Conlon MK. Making the cut: Depression screening in urban general hospital clinics for culturally diverse Latino populations. Gen Hosp Psychiatry 2017; 45:85-90. [PMID: 28274345 DOI: 10.1016/j.genhosppsych.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We examined whether the cut-point 10 for the Patient Health Questionnaire-9 (PHQ9) depression screen used in primary care populations is equally valid for Mexicans (M), Ecuadorians (E), Puerto Ricans (PR) and non-Hispanic whites (W) from inner-city hospital-based primary care clinics; and whether stressful life events elevate scores and the probability of major depressive disorder (MDD). METHODS Over 18-months, a sample of persons from hospital clinics with a positive initial PHQ2 and a subsequent PHQ9 were administered a stressful life event questionnaire and a Structured Clinical Interview to establish an MDD diagnosis, with oversampling of those between 8 and 12: (n=261: 75 E, 71 M, 51 PR, 64 W). For analysis, the sample was weighted using chart review (n=368) to represent a typical clinic population. Receiver Operating Characteristics analysis selected cut-points maximizing sensitivity (Sn) plus specificity (Sp). RESULTS The optimal cut-point for all groups was 13 with the corresponding Sn and Sp estimates for E=(Sn 73%, Sp 71%), M=(76%, 81%), PR=(81%, 63%) and W=(80%, 74%). Stressful life events impacted screen scores and MDD diagnosis. CONCLUSIONS Elevating the PHQ9 cut-point for inner-city Latinos as well as whites is suggested to avoid high false positive rates leading to improper treatment with clinical and economic consequences.
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Affiliation(s)
- Damara Gutnick
- Montefiore Hudson Valley Collaborative, 3 Executive Boulevard, Yonkers, NY 10701, United States.
| | - Carole Siegel
- Langone School of Medicine, New York University Department of Psychiatry, One Park Avenue, New York, NY 10016, United States.
| | - Eugene Laska
- Langone School of Medicine, New York University Department of Psychiatry, One Park Avenue, New York, NY 10016, United States.
| | - Joseph Wanderling
- Nathan Kline Institute for Psychiatric Research, 140, Old Orangeburg Rd., Orangeburg, NY 10962, United States.
| | - Ellen Cogen Wagner
- Adolescent Health Initiative, University of Michigan, 2025 Traverwood Drive, Ann Arbor, MI 48105, United States.
| | - Gary Haugland
- Nathan Kline Institute for Psychiatric Research, 140, Old Orangeburg Rd., Orangeburg, NY 10962, United States.
| | - Mary K Conlon
- Langone School of Medicine, New York University Department of Child and Adolescent Psychiatry, One Park Avenue, New York, NY 10016, United States.
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Wade R, Becker BD, Bevans KB, Ford DC, Forrest CB. Development and Evaluation of a Short Adverse Childhood Experiences Measure. Am J Prev Med 2017; 52:163-172. [PMID: 27865652 PMCID: PMC5596508 DOI: 10.1016/j.amepre.2016.09.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 08/16/2016] [Accepted: 09/30/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Clinicians require tools to rapidly identify individuals with significant childhood adversity as part of routine primary care. The goal of this study was to shorten the 11-item Behavioral Risk Factor Surveillance System Adverse Childhood Experiences (ACEs) measure and evaluate the feasibility and validity of this shortened measure as a screener to identify adults who have experienced significant childhood adversity. METHODS Statistical analysis was conducted in 2015. ACE item responses obtained from 2011-2012 Behavioral Risk Factor Surveillance System data were combined to form a sample of 71,413 adults aged ≥18 years. The 11-item Behavioral Risk Factor Surveillance System ACE measure was subsequently reduced to a two-item screener by maintaining the two dimensions of abuse and household stressors and selecting the most prevalent item within each dimension. RESULTS The screener included household alcohol and childhood emotional abuse items. Overall, 42% of respondents and at least 75% of the individuals with four or more ACEs endorsed one or both of these experiences. Using the 11-item ACE measure as the standard, a cut off of one or more ACEs yielded a sensitivity of 99%, but specificity was low (66%). Specificity improved to 94% when using a cut off of two ACEs, but sensitivity diminished (70%). There was no substantive difference between the 11-and two-item ACE measures in their strength of association with an array of health outcomes. CONCLUSIONS A two-item ACE screener appropriate for rapid identification of adults who have experienced significant childhood adversity was developed.
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Affiliation(s)
- Roy Wade
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Brandon D Becker
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katherine B Bevans
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Derek C Ford
- Division of Violence Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Quantifying the importance of disease burden on perceived general health and depressive symptoms in patients within the Mayo Clinic Biobank. Health Qual Life Outcomes 2015; 13:95. [PMID: 26138599 PMCID: PMC4490595 DOI: 10.1186/s12955-015-0285-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/11/2015] [Indexed: 12/21/2022] Open
Abstract
Background Deficits in health-related quality of life (HRQOL) may be associated with worse patient experiences, outcomes and even survival. While there exists evidence to identify risk factors associated with deficits in HRQOL among patients with individual medical conditions such as cancer, it is less well established in more general populations without attention to specific illnesses. This study used patients with a wide range of medical conditions to identify contributors with the greatest influence on HRQOL deficits. Methods Self-perceived general health and depressive symptoms were assessed using data from 21,736 Mayo Clinic Biobank (MCB) participants. Each domain was dichotomized into categories related to poor health: deficit (poor/fair for general health and ≥3 for PHQ-2 depressive symptoms) or non-deficit. Logistic regression models were used to test the association of commonly collected demographic characteristics and disease burden with each HRQOL domain, adjusting for age and gender. Gradient boosting machine (GBM) models were applied to quantify the relative influence of contributors on each HRQOL domain. Results The prevalence of participants with a deficit was 9.5 % for perception of general health and 4.6 % for depressive symptoms. For both groups, disease burden had the strongest influence for deficit in HRQOL (63 % for general health and 42 % for depressive symptoms). For depressive symptoms, age was equally influential. The prevalence of a deficit in general health increased slightly with age for males, but remained stable across age for females. Deficit in depressive symptoms was inversely associated with age. For both HRQOL domains, risk of a deficit was associated with higher disease burden, lower levels of education, no alcohol consumption, smoking, and obesity. Subjects with deficits were less likely to report that they were currently working for pay than those without a deficit; this association was stronger among males than females. Conclusions Comorbid health burden has the strongest influence on deficits in self-perceived general health, while demographic factors show relatively minimal impact. For depressive symptoms, both age and comorbid health burden were equally important, with decreasing deficits in depressive symptoms with increasing age. For interpreting patient-reported metrics and comparison, one must account for comorbid health burden.
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