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Fontanella CA, Xia X, Campo JV, Steelesmith DL, Bridge JA, Ruch DA. Characteristics Associated With Mental Health Treatment Prior to Suicide Among Youth in the United States. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)01317-0. [PMID: 39128560 DOI: 10.1016/j.jaac.2024.07.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/27/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE To examine individual and contextual characteristics associated with receipt of mental health treatment prior to youth suicide. METHOD Data from the US National Violent Death Reporting System, Area Health Resource File, and Social Vulnerability Index were used to examine characteristics associated with receipt of mental health treatment within 2 months before death among youth suicide decedents aged 5 to 17 years from 2013 to 2020 (N = 6,229). The association between individual (demographic, precipitating circumstances, and clinical characteristics) and contextual-level variables (county health resources, Social Vulnerability Index) and mental health service use was modeled using logistic regression. RESULTS Mental health treatment was received by 31.6% of youth suicide decedents (n = 1,967) in the 2 months before suicide. Male individuals and youth from all racial and ethnic minority groups were less likely to receive mental health treatment in the 2 months prior to suicide, as were youth residing in non-metropolitan counties and living in counties characterized by high compared to low levels of social vulnerability. A history of family problems, a recent crisis, criminal/legal problems, and suicidal thoughts and attempts were associated with increased odds of receiving mental health services. CONCLUSION Youth suicide decedents who were male, members of a racial or ethnic minority group, and residing in counties that are non-metropolitan and/or socially disadvantaged were less likely to have received mental health services in the months prior to death. Suicide prevention efforts that focus on improving access to care are essential for these vulnerable populations at risk for suicide.
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Affiliation(s)
- Cynthia A Fontanella
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Ohio State University College of Medicine, Columbus, Ohio.
| | - Xueting Xia
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - John V Campo
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Jeffrey A Bridge
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Ohio State University College of Medicine, Columbus, Ohio
| | - Donna A Ruch
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Ohio State University College of Medicine, Columbus, Ohio
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Xu KY, Schiff DM, Jones HE, Martin CE, Kelly JC, Bierut LJ, Carter EB, Grucza RA. Racial and Ethnic Inequities in Buprenorphine and Methadone Utilization Among Reproductive-Age Women with Opioid Use Disorder: an Analysis of Multi-state Medicaid Claims in the USA. J Gen Intern Med 2023; 38:3499-3508. [PMID: 37436568 PMCID: PMC10713957 DOI: 10.1007/s11606-023-08306-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Associations between race/ethnicity and medications to treat OUD (MOUD), buprenorphine and methadone, in reproductive-age women have not been thoroughly studied in multi-state samples. OBJECTIVE To evaluate racial/ethnic variation in buprenorphine and methadone receipt and retention in a multi-state U.S. sample of Medicaid-enrolled, reproductive-age women with opioid use disorder (OUD) at the beginning of OUD treatment. DESIGN Retrospective cohort study. SUBJECTS Reproductive-age (18-45 years) women with OUD, in the Merative™ MarketScan® Multi-State Medicaid Database (2011-2016). MAIN MEASURES Differences by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, "other" race/ethnicity) in the likelihood of receiving buprenorphine and methadone during the start of OUD treatment (yes/no) were estimated using multivariable logistic regression. Differences in time to medication discontinuation (days) by race/ethnicity were evaluated using multivariable Cox regression. RESULTS Of 66,550 reproductive-age Medicaid enrollees with OUD (84.1% non-Hispanic White, 5.9% non-Hispanic Black, 1.0% Hispanic, 5.3% "other"), 15,313 (23.0%) received buprenorphine and 6290 (9.5%) methadone. Non-Hispanic Black enrollees were less likely to receive buprenorphine (adjusted odds ratio, aOR = 0.76 [0.68-0.84]) and more likely to be referred to methadone clinics (aOR = 1.78 [1.60-2.00]) compared to non-Hispanic White participants. Across both buprenorphine and methadone in unadjusted analyses, the median discontinuation time for non-Hispanic Black enrollees was 123 days compared to 132 days and 141 days for non-Hispanic White and Hispanic enrollees respectively (χ2 = 10.6; P = .01). In adjusted analyses, non-Hispanic Black enrollees experienced greater discontinuation for buprenorphine and methadone (adjusted hazard ratio, aHR = 1.16 [1.08-1.24] and aHR = 1.16 [1.07-1.30] respectively) compared to non-Hispanic White peers. We did not observe differences in buprenorphine or methadone receipt or retention for Hispanic enrollees compared to the non-Hispanic White enrollees. CONCLUSIONS Our data illustrate inequities between non-Hispanic Black and non-Hispanic White Medicaid enrollees with regard to buprenorphine and methadone utilization in the USA, consistent with literature on the racialized origins of methadone and buprenorphine treatment.
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Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, MA, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology and VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jeannie C Kelly
- Division of Maternal-Fetal Medicine and the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J Bierut
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J Siteman Cancer Center, Barnes Jewish Hospital, St. Louis, MO, USA
| | - Ebony B Carter
- Division of Maternal-Fetal Medicine and the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard A Grucza
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, St. Louis, MO, USA
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Aggarwal NK. Editorial: Combatting the Intergenerational Trauma of Structural Racism Through Practice, Policy, and Research. J Am Acad Child Adolesc Psychiatry 2023; 62:1092-1094. [PMID: 37341670 DOI: 10.1016/j.jaac.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 06/22/2023]
Abstract
Several recent studies have investigated the mental health consequences of structural racism. Structural racism has been defined as "macro-level societal conditions that limit opportunities, resources, and well-being of less privileged groups on the basis of race/ethnicity and/or other statuses, including but not limited to, gender identity, sexual orientation, disability status, social class or socioeconomic status (SES), religion, geographic residence, national origin, immigration status, limited English proficiency, physical characteristics, or health conditions."1 Researchers have hypothesized that the trauma of structural racism transmits across generations through pathways that are physiological (ie, compromised immune systems, activated hormonal stress responses), environmental (ie, limited access to housing, health care, employment, and income), social (ie, domestic violence, substance consumption, criminal justice involvement), and psychological (ie, family histories of depression, anxiety, and traumatic stress-disorders).2.
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Siddiqui S, Morris A, Ikeda DJ, Balsari S, Blanke L, Pearsall M, Rodriguez R, Saxena S, Miller BF, Patel V, Naslund JA. Scaling up community-delivered mental health support and care: A landscape analysis. Front Public Health 2022; 10:992222. [PMID: 36568763 PMCID: PMC9773996 DOI: 10.3389/fpubh.2022.992222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/27/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction The mental health crisis has caused widespread suffering and has been further exacerbated by the COVID-19 pandemic. Marginalized groups are especially affected, with many concerns rooted in social determinants of mental health. To stem this tide of suffering, consideration of approaches outside the traditional biomedical model will be necessary. Drawing from task-sharing models of mental health care that have been pioneered in low-resource settings, community-initiated care (CIC) represents a potentially promising collection of approaches. This landscape analysis seeks to identify examples of CIC that have been implemented outside of the research context, with the aim of identifying barriers and facilitators of scale up. Methods A narrative review approach was used for this landscape analysis in which the PubMed database was searched and further supplemented with Google Scholar. Promising programs were then discussed over multiple rounds of meetings with the research team, consisting of collaborators with varied experiences in mental health. Using the selection criteria and feedback derived from group meetings, a final list of programs was identified and summarized according to common characteristics and features. Results The initial PubMed search yielded 16 results, supplemented by review of the first 100 entries in Google Scholar. Through 5 follow-up meetings among team members, consensus was reached on a final list of 9 programs, which were grouped into three categories based on similar themes and topics: (1) approaches for the delivery of psychosocial interventions; (2) public health and integrative approaches to mental health; and (3) approaches for addressing youth mental health. Key facilitators to scale up included the importance of sustainable financing and human resources, addressing social determinants and stigma, engaging diverse stakeholders, leveraging existing health infrastructure, using sustainable training models, ensuring cultural relevance and appropriateness, and leveraging digital technologies. Discussion This landscape analysis, though not an exhaustive summary of the literature, describes promising examples of efforts to scale up CIC outside of the research context. Going forward, it will be necessary to mobilize stakeholders at the community, health system, and government levels to effectively promote CIC.
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Affiliation(s)
| | - Angelika Morris
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Satchit Balsari
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | | | | | - Shekhar Saxena
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Benjamin F. Miller
- Well Being Trust, Oakland, CA, United States,Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States,*Correspondence: John A. Naslund
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Bansal N, Karlsen S, Sashidharan SP, Cohen R, Chew-Graham CA, Malpass A. Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography. PLoS Med 2022; 19:e1004139. [PMID: 36512523 PMCID: PMC9746991 DOI: 10.1371/journal.pmed.1004139] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention. METHODS AND FINDINGS Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to "ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view)." We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as "medical" and "Eurocentric") and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections. CONCLUSIONS In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services.
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Affiliation(s)
- Narinder Bansal
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Saffron Karlsen
- Centre for the Study of Ethnicity and Citizenship, School of Sociology, Politics and International Studies, University of Bristol, Bristol, United Kingdom
| | - Sashi P. Sashidharan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rachel Cohen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Alice Malpass
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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