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Shaligram D, Arshad SH, Rogers K, Caraballo AA, Tumuluru RV. Creating an Equitable System of Care for Minoritized Youth and Addressing Systemic and Structural Barriers. Child Adolesc Psychiatr Clin N Am 2024; 33:307-317. [PMID: 38823805 DOI: 10.1016/j.chc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
We provide an overview of the systems of care and the barriers faced by minoritized youth. We discuss ways to address barriers by forging alliances, improving communication with cultural humility, and a nonjudgmental approach. We underscore the importance of a holistic evaluation of minoritized children while leveraging their resilience to create a comprehensive and multipronged plan of action.
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Affiliation(s)
- Deepika Shaligram
- Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston MA 02115, USA
| | - Sarah H Arshad
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, The Hub for Clinical Collaboration, Floor 12, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA; UC Irvine School of Medicine
| | - Kenneth Rogers
- WellSpan Behavioral Health, UT Southwestern Medical School, 283 South Butler Road, Mt. Gretna, PA 17064, USA
| | | | - Rameshwari V Tumuluru
- Department of Psychiatry, University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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2
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Boodoo R, Saunders EFH, Thompson KS, Salzer M, Tan TL, Passley-Clarke J, Fooks AR, Torrey WC, Kunkel EJ. Recovery at 30: Perspectives from Psychiatry Clinicians and Senior Faculty. Community Ment Health J 2024:10.1007/s10597-024-01308-0. [PMID: 38896214 DOI: 10.1007/s10597-024-01308-0] [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: 09/02/2023] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
According to William Anthony's "Recovery from mental illness: the guiding vision of the mental health service system in the 1990s," mental health recovery means "changing one's attitudes, values, feelings, goals, and skills in order to live a satisfying life within the limitations caused by illness." This seminal work served as an overarching goal, a call to action, and a roadmap for the enhancement of psychiatric recovery. Unfortunately, from many viewpoints, the goals encouraged by Anthony have not been achieved. Through semi-structured interviews with psychiatry clinicians and senior faculty members, this article aims to elucidate the current status of psychiatric recovery, how the movement progressed to this point, and where we could go from here. The development of the recovery movement will be discussed, along with its assumptions and explicit goals. The interviews focus on the extent to which these goals have been achieved, barriers to progress, whether goals should be revised, and how to achieve these goals.
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Affiliation(s)
- Ramnarine Boodoo
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
| | | | - Mark Salzer
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Tjiauw-Ling Tan
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Janet Passley-Clarke
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Amanda R Fooks
- Pennsylvania Psychiatric Institute, Penn State Health, Harrisburg, PA, USA
| | - William C Torrey
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Elisabeth J Kunkel
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
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3
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Yang Y(S, Law M, Vaghri Z. New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey. PLoS One 2024; 19:e0301008. [PMID: 38848408 PMCID: PMC11161078 DOI: 10.1371/journal.pone.0301008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/09/2024] [Indexed: 06/09/2024] Open
Abstract
In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.
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Affiliation(s)
- Yuzhi (Stanford) Yang
- Department of Psychology, Faculty of Science, Applied Science, and Engineering, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira Law
- Department of Psychology, Faculty of Science, St. Mary’s University, Halifax, Nova Scotia, Canada
| | - Ziba Vaghri
- Global Child Program, Integrated Health Initiative, Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
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Diego VP, Manusov EG, Almeida M, Laston S, Ortiz D, Blangero J, Williams-Blangero S. Statistical Genetic Approaches to Investigate Genotype-by-Environment Interaction: Review and Novel Extension of Models. Genes (Basel) 2024; 15:547. [PMID: 38790175 PMCID: PMC11121143 DOI: 10.3390/genes15050547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
Statistical genetic models of genotype-by-environment (G×E) interaction can be divided into two general classes, one on G×E interaction in response to dichotomous environments (e.g., sex, disease-affection status, or presence/absence of an exposure) and the other in response to continuous environments (e.g., physical activity, nutritional measurements, or continuous socioeconomic measures). Here we develop a novel model to jointly account for dichotomous and continuous environments. We develop the model in terms of a joint genotype-by-sex (for the dichotomous environment) and genotype-by-social determinants of health (SDoH; for the continuous environment). Using this model, we show how a depression variable, as measured by the Beck Depression Inventory-II survey instrument, is not only underlain by genetic effects (as has been reported elsewhere) but is also significantly determined by joint G×Sex and G×SDoH interaction effects. This model has numerous applications leading to potentially transformative research on the genetic and environmental determinants underlying complex diseases.
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Affiliation(s)
- Vincent P. Diego
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA; (E.G.M.); (M.A.); (S.L.); (J.B.); (S.W.-B.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Eron G. Manusov
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA; (E.G.M.); (M.A.); (S.L.); (J.B.); (S.W.-B.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Marcio Almeida
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA; (E.G.M.); (M.A.); (S.L.); (J.B.); (S.W.-B.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Sandra Laston
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA; (E.G.M.); (M.A.); (S.L.); (J.B.); (S.W.-B.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - David Ortiz
- Department of Family Medicine, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA;
| | - John Blangero
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA; (E.G.M.); (M.A.); (S.L.); (J.B.); (S.W.-B.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Sarah Williams-Blangero
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA; (E.G.M.); (M.A.); (S.L.); (J.B.); (S.W.-B.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
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Flores MW, Mullin B, Sharp A, Kumar A, Moyer M, Cook BL. Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009-2014. J Racial Ethn Health Disparities 2024; 11:755-763. [PMID: 37326794 DOI: 10.1007/s40615-023-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/17/2023]
Abstract
In the USA, low-income racial/ethnic minority groups experience higher smoking rates and greater smoking-related disease burden than their White counterparts. Despite the adverse effects, racial/ethnic minorities are less likely to access tobacco dependence treatment (TDT). Medicaid is one of the largest payers of TDT in the USA and covers predominantly low-income populations. The extent of TDT use among beneficiaries from distinct racial/ethnic groups is unknown. The objective is to estimate racial/ethnic differences in TDT use among Medicaid fee-for-service beneficiaries. Using a retrospective study design and 50 state (including the District of Columbia) Medicaid claims (2009-2014), we employed multivariable logistic regression models and predictive margin methods to estimate TDT use rates among adults (18-64) enrolled (≥ 11 months) in Medicaid fee-for-service programs (January 2009-December 2014) by race/ethnicity. The population included White (n = 6,536,004), Black (n = 3,352,983), Latinx (n = 2,264,647), Asian (n = 451,448), and Native American/Alaskan Native (n = 206,472) beneficiaries. Dichotomous outcomes reflected service use in the past year. Any TDT use was operationalized as any smoking cessation medication fill, any smoking cessation counseling visit, or any smoking cessation outpatient visit. In secondary analyses, we disaggregated TDT use into three separate outcomes. Results suggested that Black (10.6%; 95% CI = 9.9-11.4%), Latinx (9.5%; 95% CI = 8.9-10.2%), Asian (3.7%; 95% CI = 3.4-4.1%), and Native American/Alaskan Native (13.7%; 95% CI = 12.7-14.7%) beneficiaries had lower TDT use rates compared to White beneficiaries (20.6%). Similar racial/ethnic treatment disparities were identified across all outcomes. By identifying significant racial/ethnic disparities in TDT use between 2009 and 2014, this study provides a benchmark against which to measure recent interventions in state Medicaid programs improving equity in smoking cessation interventions.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Center for Mindfulness & Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Anika Kumar
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Heller School of Social Policy, Brandies University, Waltham, MA, USA
| | - Margo Moyer
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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6
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Elhabashy M, Chiangong J, Villalobos K, Montiel Ishino FA, Adzrago D, Williams F. Prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups during the COVID-19 pandemic. Sci Rep 2024; 14:6727. [PMID: 38509221 PMCID: PMC10954677 DOI: 10.1038/s41598-024-57064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
Hispanic/Latino populations experienced disproportionate exposure to depression risk factors during the COVID-19 pandemic. While aggregated data confirm the risks of depressive symptoms among Hispanic/Latino individuals, little research uses disaggregated data to investigate these risks based on ethnic subgroups. Using the "Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases" survey, which was distributed nationally between May 13, 2021, and January 9, 2022 (N = 5413), we estimated the prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups during the pandemic. We performed descriptive analysis on a 116-item survey, which collected disaggregated data from Hispanic/Latino individuals aged ≥ 18 years (n = 1181). About one-third of the participants reported depressive symptoms (31.3%), with those who self-identified as other Hispanic/Latino/Spanish origin (40.2%) reporting the highest depressive symptom prevalence. Among participants who reported depression treatment before the pandemic, the highest reports of treatment were among Puerto Rican (81.8%) participants. More than one-third of participants receiving prior depression treatment (38.7%) reported treatment interference by the pandemic, mostly among Central American individuals (50.0%). This study highlights the need for integrating more disaggregated data into public health approaches which seek to target population subgroups and reduce racial/ethnic mental health disparities.
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Affiliation(s)
- Maryam Elhabashy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 11545 Rockville Pike, Bethesda, MD, USA
| | - Jolyna Chiangong
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 11545 Rockville Pike, Bethesda, MD, USA
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 11545 Rockville Pike, Bethesda, MD, USA
| | - Francisco A Montiel Ishino
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 11545 Rockville Pike, Bethesda, MD, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 11545 Rockville Pike, Bethesda, MD, USA.
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Ali S, Wright E, Charlson F. Using a systems thinking approach to explore the complex relationships between schizophrenia and premature mortality. Int J Soc Psychiatry 2024; 70:70-79. [PMID: 37644696 PMCID: PMC10860352 DOI: 10.1177/00207640231194477] [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] [Indexed: 08/31/2023]
Abstract
BACKGROUND People with schizophrenia have a higher risk of mortality compared to the general population, which has not improved over time. The majority of premature deaths are due to comorbid physical diseases, driven by interrelated factors operating at the individual level, through health systems and influenced by social determinants of health. A holistic understanding of this problem and the causal pathways linking these factors together is lacking. AIMS This study aims to understand why the mortality gap between people with schizophrenia and the general population is not improving by developing a causal loop diagram (CLD), a systems thinking approach which enables empirical research and theoretical knowledge to be combined into a visual representation of causal relationships and feedback loops. METHOD The CLD was constructed using published literature, including both quantitative and qualitative studies, to identify key variables and relationships, and refined through consultation with experts in the topic area. RESULTS A total of 21 variables and 68 connections were included in the CLD, with 23 distinct feedback loops identified. Stigma and social support had the most connections, while unemployment was involved in the greatest number of feedback loops. Most feedback mechanisms served to reinforce behavioural risk factors, inadequate healthcare and social disadvantage. CONCLUSIONS The CLD has created a holistic and dynamic understanding of the causal pathways driving the mortality gap between people with schizophrenia and the general population, providing insights into why it has persisted over time. One of the key findings was the critical role of social determinants in shaping health outcomes, highlighting the need for person-centred models of care and multisectoral government action.
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Affiliation(s)
- Suhailah Ali
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Eryn Wright
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Fiona Charlson
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
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Bergmans RS, Chambers-Peeple K, Yu C, Xiao LZ, Wegryn-Jones R, Martin A, Dell'Imperio S, Aboul-Hassan D, Williams DA, Clauw DJ, DeJonckheere M. 'I'm still here, I'm alive and breathing': The experience of Black Americans with long COVID. J Clin Nurs 2024; 33:162-177. [PMID: 37140186 PMCID: PMC10624641 DOI: 10.1111/jocn.16733] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 12/05/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
AIMS AND OBJECTIVES In this study, we aimed to characterize the impact of long COVID on quality of life and approaches to symptom management among Black American adults. BACKGROUND As a novel condition, qualitative evidence concerning long COVID symptoms and their impact on quality of life can inform the refinement of diagnostic criteria and care plans. However, the underrepresentation of Black Americans in long COVID research is a barrier to achieving equitable care for all long COVID patients. DESIGN We employed an interpretive description study design. METHODS We recruited a convenience sample of 15 Black American adults with long COVID. We analysed the anonymized transcripts from race-concordant, semi-structured interviews using an inductive, thematic analysis approach. We followed the SRQR reporting guidelines. RESULTS We identified four themes: (1) The impact of long COVID symptoms on personal identity and pre-existing conditions; (2) Self-management strategies for long COVID symptoms; (3) Social determinants of health and symptom management; and (4) Effects on interpersonal relationships. CONCLUSION Findings demonstrate the comprehensive ramifications of long COVID on the lives of Black American adults. Results also articulate how pre-existing conditions, social risk factors, distrust due to systemic racism, and the nature of interpersonal relationships can complicate symptom management. RELEVANCE TO CLINICAL PRACTICE Care approaches that support access to and implementation of integrative therapies may be best suited to meet the needs of long COVID patients. Clinicians should also prioritize eliminating patient exposure to discrimination, implicit bias, and microaggressions. This is of particular concern for long COVID patients who have symptoms that are difficult to objectively quantify, such as pain and fatigue. NO PATIENT OR PUBLIC CONTRIBUTION While patient perspectives and experiences were the focus of this study, patients were not involved with the design or conduct of the study, data analysis or interpretation, or writing the manuscript.
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Affiliation(s)
- Rachel S Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Christine Yu
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lillian Z Xiao
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Riley Wegryn-Jones
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Allie Martin
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Deena Aboul-Hassan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Toulany A, Kurdyak P, Stukel TA, Strauss R, Fu L, Guan J, Fiksenbaum L, Cohen E, Guttmann A, Vigod S, Chiu M, Moore Hepburn C, Moran K, Gardner W, Cappelli M, Sundar P, Saunders N. Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:904-915. [PMID: 36855797 PMCID: PMC9982398 DOI: 10.1177/07067437231156254] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. METHODS This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status. RESULTS Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata. CONCLUSION During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.
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Affiliation(s)
- Alene Toulany
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Paul Kurdyak
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Therese A. Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Lisa Fiksenbaum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Simone Vigod
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital and Women's College Research Institute, Toronto, Canada
| | - Maria Chiu
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Mario Cappelli
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Purnima Sundar
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Natasha Saunders
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
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Compton MT. Food and Nutrition Insecurity: A Social Determinant Hungry for Attention by Mental Health Professionals. Psychiatr Serv 2023; 74:1303-1306. [PMID: 37221887 DOI: 10.1176/appi.ps.20220511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Food and nutrition security-healthy food being available and households being able to access and use it-is necessary for mental and overall health but is a neglected social determinant of mental health. Mental health professionals should address food and nutrition insecurity by weighing in on federal and state legislation and policies related to food and nutrition; promoting food banks and pantries, "food is medicine" initiatives, and programs offering better opportunities to afford and access whole foods and fresh produce; and addressing food and nutrition insecurity at the individual level in the clinical setting through screening, assessment, treatment, and follow-up.
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Affiliation(s)
- Michael T Compton
- New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York City
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Flores MW, Sharp A, Carson NJ, Cook BL. Estimates of Major Depressive Disorder and Treatment Among Adolescents by Race and Ethnicity. JAMA Pediatr 2023; 177:1215-1223. [PMID: 37812424 PMCID: PMC10562990 DOI: 10.1001/jamapediatrics.2023.3996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/08/2023] [Indexed: 10/10/2023]
Abstract
Importance The COVID-19 pandemic has contributed to poorer mental health and a greater need for treatment. Nationally representative estimates of major depressive disorder (MDD) and mental health treatment among US adolescents during the pandemic are needed. Objective To estimate MDD prevalence among adolescents, evaluate mental health treatment use among adolescents with MDD, and assess differences by race and ethnicity. Design, Setting, and Participants This cross-sectional analysis of the nationally representative 2021 National Survey on Drug Use and Health included noninstitutionalized US adolescents between the ages of 12 and 17 years (n = 10 743). Analytic weights were applied to all rates and model estimates to be nationally representative and account for sample design and survey nonresponse. Data were collected from January 14 to December 20, 2021, and analyzed from February 11 to April 3, 2023. Exposures Self-reported race and ethnicity. Main Outcomes and Measures Dichotomous outcomes of MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), MDD-specific mental health treatment, any type of mental health treatment, telehealth visits, and delays in mental health treatment. Results The sample included 10 743 adolescents (51.1% male). Self-reported race and ethnicity included 5.1% Asian, 14.1% Black, 23.3% Latinx, 51.2% White, and 6.3% more than 1 race. Ages were evenly distributed: 34.0% aged 12 to 13 years; 33.3% aged 14 to 15 years; and 32.7% aged 16 to 17 years. Adolescents of more than 1 race or ethnicity had the highest MDD rate (26.5%). Compared with White adolescents, the lowest rates of any MDD treatment overall were found among Latinx adolescents (29.2% [95% CI, 22.2%-36.2%]) and those of more than 1 race or ethnicity (21.1% [95% CI, 11.6%-30.7%]). Similar results were found for treatment by any clinician (Latinx, 25.6% [95% CI, 18.8%-32.4%]; >1 race or ethnicity, 19.1% [95% CI, 9.7%-28.6%]), treatment by a mental health specialist (Latinx, 22.9% [95% CI, 16.9%-28.9%]; >1 race or ethnicity, 16.7% [95% CI, 7.1%-26.3%]), treatment by a nonspecialist clinician (Latinx, 7.3% [95% CI, 3.3%-11.3%]; >1 race or ethnicity, 4.8% [95% CI, 1.9%-7.7%]), and use of any psychotropic medication prescription (Latinx, 11.6% [95% CI, 7.3%-15.9%]; >1 race or ethnicity, 8.3% [95% CI, 2.8%-13.7]). Compared with White adolescents, Black adolescents had lower rates of MDD treatment by any clinician (31.7% [95% CI, 23.7%-39.8%]) and by nonspecialist clinicians (8.4% [95% CI, 3.8%-13.2%]) and experienced lower prescription rates for any psychotropic medication (12.6 [95% CI, 4.6%-20.6%]). Asian (16.0% [95% CI, 5.0%-27.2%]) and Latinx (17.8% [95% CI, 12.6%-23.0%]) adolescents had lower rates of virtual mental health treatment compared with White adolescents. Black (19.1% [95% CI, 14.1%-24.2%]) and Latinx (17.9% [95% CI, 15.0%-21.1%]) adolescents had lower rates of appointments transition to telehealth, while Black adolescents (14.1% [95% CI, 10.7%-17.4%]) experienced delays getting their prescriptions. Conclusions and Relevance During the first full calendar year of the pandemic, approximately 1 in 5 adolescents had MDD, and less than half of adolescents who needed treatment had any mental health treatment. Adolescents in racial and ethnic minority groups, particularly Latinx, experienced the lowest treatment rates. Federal policy should target adolescents as a whole, and minority populations in particular, to ensure equitable treatment access. Efforts should consider the social, racial, ethnic, and cultural determinants of health.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Nicholas J. Carson
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Benjamin L. Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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12
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Plummer N, Guardado R, Ngassa Y, Montalvo C, Kotoujian PJ, Siddiqi K, Senst T, Simon K, Acevedo A, Wurcel AG. Racial Differences in Self-Report of Mental Illness and Mental Illness Treatment in the Community: An Analysis of Jail Intake Data. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:966-975. [PMID: 37733128 PMCID: PMC10543583 DOI: 10.1007/s10488-023-01297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/22/2023]
Abstract
Jails and prisons in the United States house people with elevated rates of mental health and substance use disorders. The goal of this cross-sectional study was to evaluate the frequency of racial/ethnic differences in the self-report of mental illness and psychiatric medication use at jail entry. Our sample included individuals who had been incarcerated between 2016 and 2020 at the Middlesex Jail & House of Correction, located in Billerica, MA. We used data from the "Offender Management System," the administrative database used by the jail containing data on people who are incarcerated, and COREMR, the electronic medical record (EMR) used in the Middlesex Jail & House of Correction. We evaluated two primary outcomes (1) self-reported mental illness history and (2) self-reported use of psychiatric medication, with the primary indicator of interest as race/ethnicity. At intake, over half (57%) of the sample self-reported history of mental illness and 20% reported the use of psychiatric medications. Among people who self-reported a history of mental illness, Hispanic (AOR: 0.73, 95% CI: 0.60-0.90), Black (AOR: 0.52, 95% CI: 0.43-0.64), Asian/Pacific Islander (Non-Hispanic) people (AOR: 0.31, 95% CI: 0.13-0.74), and people from other racial/ethnic groups (AOR: 0.33, 95% CI: 0.11-0.93) all had decreased odds of reporting psychiatric medications. Mental illness was reported in about one-half of people who entered jail, but only 20% reported receiving medications in the community prior to incarceration. Our findings build on the existing literature on jail-based mental illness and show racial disparities in self-report of psychiatric medications in people who self-reported mental illness. The timing, frequency, and equity of mental health services in both the community and the jail setting deserves further research, investment, and improvement.
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Affiliation(s)
- Narcissa Plummer
- Department of Population Health, Northeastern University, Boston, MA USA
| | - Rubeen Guardado
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA USA
| | - Yvane Ngassa
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA USA
| | - Cristina Montalvo
- Department of Psychiatry, Tufts Medical Center, Boston, MA USA
- Tufts University School of Medicine, Boston, MA USA
| | | | | | | | - Kevin Simon
- Harvard Medical School, Boston, MA USA
- Children’s Hospital, Boston, MA USA
| | - Andrea Acevedo
- Department of Community Health, Tufts University, Medford, MA USA
| | - Alysse G. Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA USA
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13
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Sturm ET, Thomas ML, Sares AG, Dave S, Baron D, Compton MT, Palmer BW, Jester DJ, Jeste DV. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments. Schizophr Bull 2023; 49:851-866. [PMID: 37022911 PMCID: PMC10318889 DOI: 10.1093/schbul/sbad024] [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] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND AIMS Social determinants of health (SDoHs) impact the development and course of schizophrenia-spectrum psychotic disorders (SSPDs). Yet, we found no published scholarly reviews of psychometric properties and pragmatic utility of SDoH assessments among people with SSPDs. We aim to review those aspects of SDoH assessments. STUDY DESIGN PsychInfo, PubMed, and Google Scholar databases were examined to obtain data on reliability, validity, administration process, strengths, and limitations of the measures for SDoHs identified in a paired scoping review. STUDY RESULTS SDoHs were assessed using different approaches including self-reports, interviews, rating scales, and review of public databases. Of the major SDoHs, early-life adversities, social disconnection, racism, social fragmentation, and food insecurity had measures with satisfactory psychometric properties. Internal consistency reliabilities-evaluated in the general population for 13 measures of early-life adversities, social disconnection, racism, social fragmentation, and food insecurity-ranged from poor to excellent (0.68-0.96). The number of items varied from 1 to more than 100 and administration time ranged from less than 5 minutes to over an hour. Measures of urbanicity, low socioeconomic status, immigration status, homelessness/housing instability, and incarceration were based on public records or targeted sampling. CONCLUSIONS Although the reported assessments of SDoHs show promise, there is a need to develop and test brief but validated screening measures suitable for clinical application. Novel assessment tools, including objective assessments at individual and community levels utilizing new technology, and sophisticated psychometric evaluations for reliability, validity, and sensitivity to change with effective interventions are recommended, and suggestions for training curricula are offered.
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Affiliation(s)
- Emily T Sturm
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Anastasia G Sares
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | | | - David Baron
- Western University of Health Sciences, CA, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center, San Diego, CA, USA
| | - Dylan J Jester
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA, USA (Retired)
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14
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Jester DJ, Thomas ML, Sturm ET, Harvey PD, Keshavan M, Davis BJ, Saxena S, Tampi R, Leutwyler H, Compton MT, Palmer BW, Jeste DV. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: I. Clinical Outcomes. Schizophr Bull 2023; 49:837-850. [PMID: 37022779 PMCID: PMC10318890 DOI: 10.1093/schbul/sbad023] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Social determinants of health (SDoHs) are receiving growing attention and are particularly relevant to persons with schizophrenia-spectrum psychotic disorders (SSPDs), considering their heightened risk of comorbidities, cognitive and functional decline, and early mortality. Yet, we did not find any comprehensive review of multiple SDoHs in SSPD. STUDY DESIGN We conducted a scoping review of meta-analyses and systematic reviews of nine major SDoHs in SSPD. STUDY RESULTS Childhood abuse, parental psychopathology, parental communication problems, bullying, and urban settings with lower socioeconomic status were major risk factors for the greater incidence of SSPD and/or worse health. Social network size was inversely associated with overall psychopathology and negative symptoms. Experiences of racial/ethnic discrimination correlated with the prevalence of psychotic symptoms and experiences. Compared to native populations, the risk of psychosis was higher in immigrants, refugees, and asylees. Social fragmentation was associated with an increased prevalence of schizophrenia. Homeless populations had a 30-fold higher prevalence of schizophrenia than the general population. Seriously mentally ill people were 2.7 times more likely to report food insecurity than controls. The prevalence of non-affective psychosis in prisoners was 2.0%-6.5%, compared to 0.3% in the general population. Certain potentially positive factors like family and community resilience remain poorly studied. CONCLUSIONS SDoHs are associated with higher rates of and worse outcomes in SSPD. Well-designed longitudinal studies are needed to understand SDoHs' contribution to health in persons with SSPD, to develop interventions, and to implement changes in clinical care and public health policies that would reduce adverse health impacts of SDoHs. Positive SDoHs deserve greater attention.
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Affiliation(s)
- Dylan J Jester
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Emily T Sturm
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, and Research Service, Bruce W. Carter Miami VA Medical Center, Miami, FL, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess medical Center and Harvard Medical School, Boston, MA, USA
| | - Beshaun J Davis
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shekhar Saxena
- Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rajesh Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA
| | - Heather Leutwyler
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA, USA
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15
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Tedesco S, Gonzalez R, Owusu-Antwi P, Robinson RE, Janusz C. A Case of Undiagnosed Schizophrenia With Catatonia in a Hispanic Adolescent: The Significance of Social Determinants in the Diagnosis and the Efficacy of Risperidone and Lorazepam in Treatment. Cureus 2023; 15:e42598. [PMID: 37641761 PMCID: PMC10460505 DOI: 10.7759/cureus.42598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Catatonia is a potentially life-threatening motor dysregulation syndrome associated with various psychiatric, medical, or developmental conditions. It is not uncommon but rarely described in the pediatric population. The timely identification of catatonia is essential as the treatment approach differs from the differential diagnoses and possible underlying conditions. The social determinants of health are factors that may negatively impact psychological well-being, increase the risk and prevalence of mental disorders, and deteriorate the prognosis for those who already have them. The comprehension of social determinants of health is essential because it provides a deeper understanding of the complexity of societal structures and how they influence the lives of children and families. This case demonstrates how social determinants of health may contribute to misdiagnosis, delayed diagnosis, and an increase in the incidence of mental health disorders. We present a case report on a Hispanic adolescent with first-episode catatonia in the presence of disorganized, psychotic thoughts. The patient was successfully treated with the lorazepam challenge in conjunction with Risperidone M-Tab treatment in three days. The origin of catatonia was rooted in undiagnosed schizophrenia that had worsened over a year originating from a first-episode break that questions an untreated substance-induced psychosis: the substance is unknown, as her parents had not brought her to the emergency department at that time. The demographics of this patient have also placed her at risk for a lack of access and sociocultural aspects in the delay of treatment. Through this case report, we aim to highlight some critical points in diagnosing and managing nonmalignant catatonia in a demographically underserved minority adolescent female. This report emphasizes the need for more data about the etiology and treatment of catatonia, especially in the pediatric population.
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Affiliation(s)
- Sarah Tedesco
- Department of Psychiatry, Richmond University Medical Center, Staten Island, USA
| | - Raquel Gonzalez
- Department of Clinical Medicine, American University of Antigua, St. John's, ATG
| | - Philipa Owusu-Antwi
- Department of Psychiatry, Richmond University Medical Center, Staten Island, USA
| | - Raymond E Robinson
- Department of Clinical Medicine, American University of Antigua, St. John's, ATG
| | - Christopher Janusz
- Department of Psychiatry, Richmond University Medical Center, Staten Island, USA
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16
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Cadenas GA, Cerezo A, Carlos Chavez FL, Capielo Rosario C, Torres L, Suro B, Fuentes M, Sanchez D. The citizenship shield: Mediated and moderated links between immigration status, discrimination, food insecurity, and negative health outcomes for latinx immigrants during the COVID-19 pandemic. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2355-2371. [PMID: 35243656 PMCID: PMC9088249 DOI: 10.1002/jcop.22831] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/10/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
A framework termed "the citizenship shield" is introduced to conceptualize how legal protections buffer against negative health outcomes among Latinx immigrants in the United States. In this study, we tested the citizenship shield framework in the context of the disproportionate impact of the COVID-19 pandemic on Latinx immigrants. We investigated the connection between immigration status, discrimination, food insecurity, and negative health outcomes. Analyses involved testing mediation and moderation models among a community-based sample of 536 Latinx immigrants holding five statuses (i.e., U.S. citizenship, permanent residency, Deferred Action for Childhood Arrivals, undocumented, and temporary status). Results suggested that food insecurity mediated the link between discrimination and negative impacts from the pandemic for Latinx immigrants across all statuses. Follow up analyses suggested that two of the three paths were moderated by immigration status. This research provides novel, important data to inform health interventions and federal policy targeted for the most vulnerable immigrants in the United States.
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Affiliation(s)
| | - Alison Cerezo
- Gevirtz Graduate School of EducationUniversity of California Santa BarbaraSanta BarbaraCaliforniaUSA
| | | | | | - Lucas Torres
- Department of PsychologyMarquette UniversityMilwaukeeWisconsinUSA
| | - Beatriz Suro
- College of EducationLehigh UniversityBethlehemPennsylvaniaUSA
| | | | - Delida Sanchez
- Department of PsychologyUniversity of Maryland College ParkCollege ParkMarylandUSA
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17
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Fishbein D, Clepper-Faith M, Owen J. Leveraging North Carolina's Assets to Prevent Child Trauma. N C Med J 2023; 84:288-292. [PMID: 39312787 DOI: 10.18043/001c.87512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Adverse childhood experiences increase risk for a range of health problems. A statewide summit, "Leveraging North Carolina's Assets to Prevent Child Trauma," convened researchers, practitioners, educators, government officials, policymakers, and community stakeholders to identify common goals and determine next steps in a statewide plan to prevent and heal child trauma.
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Affiliation(s)
- Diana Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill
| | | | - Jenni Owen
- North Carolina Office of Strategic Partnerships
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18
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Ing CT, Clemens B, Ahn HJ, Kaholokula JK, Hovmand PS, Seto TB, Novotny R. Food Insecurity and Blood Pressure in a Multiethnic Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6242. [PMID: 37444090 PMCID: PMC10341426 DOI: 10.3390/ijerph20136242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (n = 124) were recruited from a U.S. Department of Agriculture-funded study called the Children's Healthy Living Center of Excellence. Biometrics (i.e., blood pressure, weight, and height) were measured. Demographics, physical activity, diet, psychosocial variables, food insecurity, and financial instability were assessed via self-report questionnaires. Hierarchical linear regression models were conducted. Model 1, which included sociodemographic variables and known biological risk factors, explained a small but significant amount of variance in systolic blood pressure. Model 2 added physical activity and daily intake of fruit, fiber, and whole grains, significantly improving the model. Model 3 added financial instability and food insecurity, further improving the model (R2 = 0.37, F = 2.67, p = 0.031). Food insecurity, female sex, and BMI were significantly and independently associated with increased systolic blood pressure. These results suggest a direct relationship between food insecurity and systolic blood pressure, which persisted after controlling for physical activity, consumption of fruits, fiber, and whole grains, and BMI. Efforts to reduce food insecurity, particularly among Native Hawaiians, may help reduce hypertension in this high-risk population.
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Affiliation(s)
- Claire Townsend Ing
- Department of Native Hawaiian Health, University of Hawaii at Mānoa, 677 Ala Moana Boulevard, Honolulu, HI 96813, USA
| | - Brettany Clemens
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Mānoa, 2528 McCarthy Mall, Honolulu, HI 96822, USA
| | - Hyeong Jun Ahn
- Department of Complementary & Integrative Medicine, University of Hawaii at Mānoa, 651 Ilalo Street, Honolulu, HI 96813, USA
| | | | - Peter S. Hovmand
- Center for Community Health Integration, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Todd B. Seto
- Cardiovascular Diseases, Queen’s Medical Center, 550 S Beretania Street, Honolulu, HI 96813, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences, University of Hawaii at Mānoa, 1955 East-West Road, Honolulu, HI 96822, USA
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19
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Leigh JP, Moss SJ, Sriskandarajah C, McArthur E, Ahmed SB, Birnie K, Halperin D, Halperin S, Harley M, Hu J, Ng Kamstra J, Leppan L, Nickel A, Racine N, Russell K, Smith S, Solis M, Stelfox M, Tutelman PR, Stelfox HT, Fiest KM. A muti-informant national survey on the impact of COVID-19 on mental health symptoms of parent-child dyads in Canada. Sci Rep 2023; 13:7972. [PMID: 37198202 PMCID: PMC10189235 DOI: 10.1038/s41598-023-34544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
The COVID-19 pandemic negatively impacted the mental health of children, youth, and their families which must be addressed and prevented in future public health crises. Our objective was to measure how self-reported mental health symptoms of children/youth and their parents evolved during COVID-19 and to identify associated factors for children/youth and their parents including sources accessed for information on mental health. We conducted a nationally representative, multi-informant cross-sectional survey administered online to collect data from April to May 2022 across 10 Canadian provinces among dyads of children (11-14 years) or youth (15-18 years) and a parent (> 18 years). Self-report questions on mental health were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6+ Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. McNemar's test and the test of homogeneity of stratum effects were used to assess differences between children-parent and youth-parent dyads, and interaction by stratification factors, respectively. Among 933 dyads (N = 1866), 349 (37.4%) parents were aged 35-44 years and 485 (52.0%) parents were women; 227 (47.0%) children and 204 (45.3%) youth were girls; 174 (18.6%) dyads had resided in Canada < 10 years. Anxiety and irritability were reported most frequently among child (44, 9.1%; 37, 7.7%) and parent (82, 17.0%; 67, 13.9%) dyads, as well as among youth (44, 9.8%; 35, 7.8%) and parent (68, 15.1%; 49, 10.9%) dyads; children and youth were significantly less likely to report worsened anxiety (p < 0.001, p = 0.006, respectively) or inattention (p < 0.001, p = 0.028, respectively) compared to parents. Dyads who reported financial or housing instability or identified as living with a disability more frequently reported worsened mental health. Children (96, 57.1%), youth (113, 62.5%), and their parents (253, 62.5%; 239, 62.6%, respectively) most frequently accessed the internet for mental health information. This cross-national survey contextualizes pandemic-related changes to self-reported mental health symptoms of children, youth, and families.
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Affiliation(s)
| | | | | | | | - Sofia B Ahmed
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Donna Halperin
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Scott Halperin
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Josh Ng Kamstra
- Department of Surgery, University of Hawaii John A Burns School of Medicine, Honolulu, HI, Canada
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Nicole Racine
- Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Stacie Smith
- Young Canadian Roundtable On Health, Toronto, ON, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Henry T Stelfox
- Department of Critical Care Medicine, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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20
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Compton MT, Ku BS. Prevalence of Food Insecurity and Living in a Food Desert among Individuals with Serious Mental Illnesses in Public Mental Health Clinics. Community Ment Health J 2023; 59:357-362. [PMID: 35963919 PMCID: PMC10209833 DOI: 10.1007/s10597-022-01013-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Very little is known about the prevalence of food insecurity-and living in a food desert-among persons with serious mental illnesses, such as schizophrenia and major mood disorders. This study evaluated those prevalences and assessed for associations with six other variables. Surveys were conducted with 300 patients with a psychotic or mood disorder receiving outpatient services at five community mental health agencies in Washington, D.C. The prevalences of low food security and very low food security were 68.9% and 46.8%, compared to national rates of 13.7% (13.2% in Washington, D.C.) and 5.4% (4.8% in Washington, D.C.). 50.0% of participants lived in food desert census tracts, which was associated with both severe and morbid obesity (p = .02 and p = .03, respectively). Additional research, evaluation of clinical implications, and potential policy approaches to these concerning social determinants of physical and mental health, in an already vulnerable patient population, are warranted.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 722 W. 168, Street, Room R249, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
| | - Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Bergmans RS, Loewenstein E, Aboul-Hassan D, Chowdhury T, Schaefer G, Wegryn-Jones R, Xiao LZ, Yu C, Moore MN, Kahlenberg JM. Social determinants of depression in systemic lupus erythematosus: A systematic scoping review. Lupus 2023; 32:23-41. [PMID: 36274579 PMCID: PMC9812916 DOI: 10.1177/09612033221135145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Social determinants of health (SDOH) influence inequities in systemic lupus erythematosus (SLE). While these inequities contribute to overall disease experience, there is little consensus guiding our understanding of the psychological implications of SDOH in SLE. Given the paucity of evidence in this area, the aim of this scoping review was to systematically assess the volume and features of available research literature on associations of SDOH with depression in SLE over the past 20 years, from 1 January 2000 to 16 November 2021. We developed a search strategy for PubMed and EMBASE that included keywords for depression and lupus. After screening 2188 articles, we identified 22 original articles that met our inclusion criteria. At least one SDOH was associated with depression in two of the six studies with unadjusted estimates and 13 of the 16 studies with adjusted estimates. Results provide consistent but sparse evidence that SDOH are associated with depression in SLE. Additionally, depression epidemiology in SLE may differ from the general population such that depression risk is more similar across genders and racial/ethnic groups. More work is needed to identify the SDOH that have the greatest impact on depression and mental health among SLE patients, as well as how and when to intervene.
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Affiliation(s)
- Rachel S. Bergmans
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Emma Loewenstein
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Deena Aboul-Hassan
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Tasfia Chowdhury
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Grace Schaefer
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Riley Wegryn-Jones
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Lillian Z. Xiao
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | - Christine Yu
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Meriah N. Moore
- University of Michigan, Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, Michigan
| | - J. Michelle Kahlenberg
- University of Michigan, Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, Michigan
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Nickitas DM, Emmons KR, Ackerman-Barger K. A policy pathway: Nursing's role in advancing diversity and health equity. Nurs Outlook 2022; 70:S38-S47. [PMID: 36446539 DOI: 10.1016/j.outlook.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this manuscript is to embolden nurses to engage in policy that promotes diversity, equity, inclusion, and belonging to advance health equity. BACKGROUND It uses the Future of Nursing Report 2020-2030 to acknowledge the impact of structural racism and the need for a more equitable, just, and fair society. DISCUSSION It also recognizes that nurses must harness their power and political will, to change and strengthen policies, so all nurses can practice to the full extent of their education and license. CONCLUSION A case study of the response to COVID-19 in one underserved community is included to illustrate policy in action.
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Zhai Y, Du X. Trends and prevalence of suicide 2017-2021 and its association with COVID-19: Interrupted time series analysis of a national sample of college students in the United States. Psychiatry Res 2022; 316:114796. [PMID: 35987067 PMCID: PMC9375853 DOI: 10.1016/j.psychres.2022.114796] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide is among the leading causes of death for college students. We aimed to assess the impact of the pandemic on trends in suicidal thoughts and behaviors among college students, and whether suicidal thoughts and behaviors were associated with COVID-19 infection and psychosocial factors. METHODS We analyzed 2017-2021 data from 4 waves of Healthy Minds Study including a random sample of college students (N = 354,473) from 286 U.S. institutions. We performed interrupted time series analysis to model the effect of the pandemic on trends in suicidal ideation (SI), plan (SP), and attempt (SA). At the peripandemic assessment, we utilized multivariable logistic regression to examine the association of SI, SP, and SA with COVID-19 infection and psychosocial factors. RESULTS We observed significant decreases in SI, SP, and SA among college students from 2017 to 2021. The pandemic was significantly associated with a 1.33 percentage points reduction in SI and a 0.85 percentage points reduction in SP but was not associated with a significant reduction in SA. Adjusted associations of SI, SP, and SA with risk factors showed the significant odds ratio (OR) for suspected COVID-19 infection (SI: 1.33, SP: 1.22, SA: 1.32), severe depression (SI: 6.39, SP: 6.63, SA: 5.63), severe anxiety (SI: 3.66, SP: 3.62, SA: 3.60), COVID-19-related financial stress (SI: 1.35, SP: 1.34, SA: 1.48), food insecurity (SI: 2.12, SP: 2.13, SA: 2.79), and academic impairment (SI: 2.07, SP: 2.05, SA: 2.14) but not for test-confirmed COVID-19. CONCLUSION Certain COVID-19 mitigation strategies might have protected college students from suicidal thoughts/behaviors.
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Affiliation(s)
- Yusen Zhai
- Department of Human Studies, The University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Xue Du
- Department of Food Science, The Pennsylvania State University, University Park, PA, United States
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Shim RS, Tierney M, Rosenzweig MH, Goldman HH. Improving Behavioral Health Services in the Time of COVID-19 and Racial Inequities. NAM Perspect 2021; 2021:202110c. [PMID: 34901776 DOI: 10.31478/202110c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Moore R, Zielinski MJ, Thompson RG, Willis DE, Purvis RS, McElfish PA. "This Pandemic Is Making Me More Anxious about My Welfare and the Welfare of Others:" COVID-19 Stressors and Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5680. [PMID: 34073187 PMCID: PMC8197875 DOI: 10.3390/ijerph18115680] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/19/2022]
Abstract
COVID-19 and subsequent social distancing guidelines have changed many aspects of people's daily lives including the way that they interact within their social environment. Pandemics are inherently social phenomena, and public health measures intended to curtail transmission of COVID-19 (e.g., quarantine and social distancing) have consequences for individuals with anxiety and depression. Using qualitative methods, respondents with previously diagnosed anxiety or depression identified ways in which COVID-19 affected their symptoms at multiple levels of the social ecological model (SEM). Key themes reported were organized following the SEM. Emergent themes at the individual level are isolation/loneliness, fear of contracting COVID-19, and uncertainty about the future. Themes at the interpersonal level are: fears of family contracting COVID-19, separation from family members, and domestic relationships. Themes at the level of community and societal stressors are: employment, community and societal systems, media, and the COVID-19 pandemic. Our findings demonstrate the ways that mental health, physical health/safety, and social environments are interrelated in the experience of COVID-19 for individuals diagnosed with anxiety or depression. These findings make a significant contribution to the literature as this is the first article to document mental health stressors related to the COVID-19 pandemic among individuals with diagnosed anxiety and depressive disorders.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Melissa J. Zielinski
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.J.Z.); (R.G.T.J.)
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72703, USA
| | - Ronald G. Thompson
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.J.Z.); (R.G.T.J.)
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
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McKune SL, Acosta D, Diaz N, Brittain K, Beaulieu DJ, Maurelli AT, Nelson EJ. Psychosocial health of school-aged children during the initial COVID-19 safer-at-home school mandates in Florida: a cross-sectional study. BMC Public Health 2021; 21:603. [PMID: 33781220 PMCID: PMC8006116 DOI: 10.1186/s12889-021-10540-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/03/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Given the emerging literature regarding the impacts of lockdown measures on mental health, this study aims to describe the psychosocial health of school-aged children and adolescents during the COVID-19 Safer-at-Home School mandates. METHODS A cross-sectional study was conducted in April 2020 (n = 280) among K-12 students at a research school in North Central Florida. Bivariate analysis and logistic and multinomial logistic regression models were used to examine socio-demographic and knowledge, attitude, and practice (KAP) predictors of indicators of anxiety-related, depressive, and obsessive-compulsive disorder(OCD)-related symptoms. Outcomes (anxiety, OCD, and depressive related symptoms) were measured by indices generated based on reported symptoms associated with each psychosocial outcome. RESULTS Loss of household income was associated with increased risk for all three index-based outcomes: depressive symptoms [aOR = 3.130, 95% CI = (1.41-6.97)], anxiety-related symptoms [aOR = 2.531, 95%CI = (1.154-5.551)], and OCD-related symptoms [aOR = 2.90, 95%CI = (1.32-6.36)]. Being female was associated with being at higher risk for depressive symptoms [aOR = 1.72, 95% CI = (1.02-2.93)], anxiety-related symptoms [aOR = 1.75, 95% CI = (1.04-2.97)], and OCD-related symptoms [aOR = 1.764, 95%CI = (1.027-3.028)]. Parental practices protective against COVID-19 were associated with children being at higher risk of depressive symptoms [aOR = 1.55, 95% CI = (1.04-2.31)]. Lower school level was associated with children being at higher risk of anxiety-related and OCD-related symptoms. CONCLUSIONS As the COVID-19 pandemic continues, schools should prioritize mental health interventions that target younger, female students, and children of families with income loss. Limiting the spread of COVID-19 through school closure may exacerbate negative psychosocial health outcomes in children, thus school administrators should move quickly to target those at greatest risk.
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Affiliation(s)
- Sarah L McKune
- Departments of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
| | - Daniel Acosta
- Departments of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Nick Diaz
- Departments of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Kaitlin Brittain
- Departments of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Diana Joyce- Beaulieu
- Department of Special Education, School Psychology, & Early Childhood Studies, College of Education, University of Florida, Gainesville, FL, USA
| | - Anthony T Maurelli
- Departments of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Eric J Nelson
- Departments of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
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Bermejo-Martins E, Luis EO, Sarrionandia A, Martínez M, Garcés MS, Oliveros EY, Cortés-Rivera C, Belintxon M, Fernández-Berrocal P. Different Responses to Stress, Health Practices, and Self-Care during COVID-19 Lockdown: A Stratified Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2253. [PMID: 33668717 PMCID: PMC7956515 DOI: 10.3390/ijerph18052253] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/09/2023]
Abstract
The aim of the present cross-sectional study was to analyze the differential impact of the first COVID-19 lockdown (3 April 2020) on stress, health practices, and self-care activities across different Hispanic countries, age range, and gender groups. One thousand and eighty-two participants from Spain, Chile, Colombia, and Ecuador took part in this study. Irrespective of the country, and controlling for income level, young people, especially females, suffered a greater level of stress, perceived the situation as more severe, showed less adherence to health guidelines, and reported lower levels of health consciousness, in comparison to their male peers and older groups. However, in the case of self-care, it seems that older and female groups are generally more involved in self-care activities and adopt more healthy daily routines. These results are mostly similar between Colombia, Ecuador, and Spain. However, Chile showed some different tendencies, as males reported higher levels of healthy daily routines and better adherence to health guidelines compared to females and people over the age of 60. Differences between countries, genders, and age ranges should be considered in order to improve health recommendations and adherence to guidelines. Moreover, developing community action and intersectoral strategies with a gender-based approach could help to reduce health inequalities and increase the success of people's adherence to health guidelines and self-care-promoting interventions. Future studies should be addressed to explore the possible causations of such differences in more cultural-distant samples and at later stages of the current outbreak.
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Affiliation(s)
- Elena Bermejo-Martins
- School of Nursing, University of Navarra, 31009 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31009 Pamplona, Spain
| | - Elkin O Luis
- Navarra Institute for Health Research, IdiSNA, 31009 Pamplona, Spain
- Psychological Processes in Education and Health Group, School of Education and Psychology, University of Navarra, 31009 Pamplona, Spain
- Cognitive and Affective Methods in Psychology CAMP, School of Education and Psychology, University of Navarra, 31009 Pamplona, Spain
| | - Ainize Sarrionandia
- Faculty of Psychology, University of the Basque Country, 20018 Donostia-San Sebastián, Spain
| | - Martín Martínez
- Navarra Institute for Health Research, IdiSNA, 31009 Pamplona, Spain
- Psychological Processes in Education and Health Group, School of Education and Psychology, University of Navarra, 31009 Pamplona, Spain
| | - María Sol Garcés
- Colegio de Ciencias Sociales y Humanidades, Universidad San Francisco de Quito USFQ, Instituto de Neurociencias, Quito 170901, Ecuador
| | - Edwin Y Oliveros
- Faculty of Psychology, University of San Buenaventura, Bogota 1008, Colombia
| | | | - Maider Belintxon
- School of Nursing, University of Navarra, 31009 Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, 31009 Pamplona, Spain
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Gadermann AC, Thomson KC, Richardson CG, Gagné M, McAuliffe C, Hirani S, Jenkins E. Examining the impacts of the COVID-19 pandemic on family mental health in Canada: findings from a national cross-sectional study. BMJ Open 2021; 11:e042871. [PMID: 33436472 PMCID: PMC7804831 DOI: 10.1136/bmjopen-2020-042871] [Citation(s) in RCA: 197] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/21/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES In the first wave of the COVID-19 pandemic, social isolation, school/child care closures and employment instability have created unprecedented conditions for families raising children at home. This study describes the mental health impacts of the COVID-19 pandemic on families with children in Canada. DESIGN, SETTING AND PARTICIPANTS This descriptive study used a nationally representative, cross-sectional survey of adults living in Canada (n=3000) to examine the mental health impacts of the COVID-19 pandemic. Outcomes among parents with children <18 years old living at home (n=618) were compared with the rest of the sample. Data were collected via an online survey between 14 May to 29 May 2020. OUTCOME MEASURES Participants reported on changes to their mental health since the onset of the pandemic and sources of stress, emotional responses, substance use patterns and suicidality/self-harm. Additionally, parents identified changes in their interactions with their children, impacts on their children's mental health and sources of support accessed. RESULTS 44.3% of parents with children <18 years living at home reported worse mental health as a result of the COVID-19 pandemic compared with 35.6% of respondents without children <18 living at home, χ2 (1, n=3000)=16.2, p<0.001. More parents compared with the rest of the sample reported increased alcohol consumption (27.7% vs 16.1%, χ2 (1, n=3000)=43.8, p<0.001), suicidal thoughts/feelings (8.3% vs 5.2%, χ2 (1, n=3000)=8.0, p=0.005) and stress about being safe from physical/emotional domestic violence (11.5% vs 7.9%, χ2 (1, n=3000)=8.1, p=0.005). 24.8% (95% CI 21.4 to 28.4) of parents reported their children's mental health had worsened since the pandemic. Parents also reported more frequent negative as well as positive interactions with their children due to the pandemic (eg, more conflicts, 22.2% (95% CI 19.0 to 25.7); increased feelings of closeness, 49.7% (95% CI 45.7 to 53.7)). CONCLUSIONS This study identifies that families with children <18 at home have experienced deteriorated mental health due to the pandemic. Population-level responses are required to adequately respond to families' diverse needs and mitigate the potential for widening health and social inequities for parents and children.
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Affiliation(s)
- Anne C Gadermann
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Kimberly C Thomson
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Chris G Richardson
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monique Gagné
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Corey McAuliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saima Hirani
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
PURPOSE OF REVIEW The ability to effectively prepare for and respond to the psychological fallout from large-scale disasters is a core competency of military mental health providers, as well as civilian emergency response teams. Disaster planning should be situation specific and data driven; vague, broad-spectrum planning can contribute to unprepared mental health teams and underserved patient populations. Herein, we review data on mental health sequelae from the twenty-first century pandemics, including SARS-CoV2 (COVID-19), and offer explanations for observed trends, insights regarding anticipated needs, and recommendations for preliminary planning on how to best allocate limited mental health resources. RECENT FINDINGS Anxiety and distress, often attributed to isolation, were the most prominent mental health complaints during previous pandemics and with COVID-19. Additionally, post-traumatic stress was surprisingly common and possibly more enduring than depression, insomnia, and alcohol misuse. Predictions regarding COVID-19's economic impact suggest that depression and suicide rates may increase over time. Available data suggest that the mental health sequelae of COVID-19 will mirror those of previous pandemics. Clinicians and mental health leaders should focus planning efforts on the negative effects of isolation, particularly anxiety and distress, as well as post-traumatic stress symptoms.
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Affiliation(s)
- Rachel H Han
- Walter Reed National Military Medical Center, Behavioral Health Consultation and Education, 8960 Brown Drive, Building 7 Room 5309, Bethesda, MD, 20889, USA.
| | | | - Wendi M Waits
- Walter Reed National Military Medical Center, Behavioral Health Consultation and Education, 8960 Brown Drive, Building 7 Room 5309, Bethesda, MD, 20889, USA
| | - Alexa K C Bell
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tashina L Miller
- Walter Reed National Military Medical Center, Behavioral Health Consultation and Education, 8960 Brown Drive, Building 7 Room 5309, Bethesda, MD, 20889, USA
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Abstract
Classification as primary, secondary, or tertiary prevention is based on when during the course of disease the intervention is provided. Another approach to classification-as universal, selective, or indicated preventive interventions-relates to who receives the intervention. The social determinants of health framework also provides a guide to prevention, which requires changing both public policies and social norms. It also addresses the weaknesses of the first two approaches, such as persistent health inequities regarding who has access to preventive services. The social determinants framework is a guide to providing timely and targeted preventive interventions in a way that ensures equal access.
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Affiliation(s)
- Michael T Compton
- New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Compton); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Shim). Dr. Compton and Dr. Shim are editors of this column
| | - Ruth S Shim
- New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Compton); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Shim). Dr. Compton and Dr. Shim are editors of this column
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Browne J, Ponce A. Assessing Food Insecurity in Individuals with Serious Mental Illness: A Pilot Training for Community Mental Health Providers. Community Ment Health J 2020; 56:1110-1114. [PMID: 32107661 DOI: 10.1007/s10597-020-00593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 02/21/2020] [Indexed: 11/24/2022]
Abstract
Food insecurity (FI), or limited or uncertain access to food, is a significant public health issue, especially for individuals with serious mental illness. As such, mental health providers should regularly assess FI and link individuals to resources. The purpose of this project was to create and pilot test a provider training on FI assessment at a community mental health center. Fifteen providers participated in the training and completed surveys at post-training and one-month follow-up. Results suggested success in delivering an acceptable training that conveyed the importance of FI and inspired confidence in assessment. Yet, it was not sufficient to modify providers' FI assessment behavior. A brief training can effectively teach providers about FI and promote confidence in assessment; however, it is not adequate to change behavior. Future work should examine the provider training in a larger sample and wider variety of CMHC providers and explore ways to integrate FI assessment into existing practices to address implementation barriers.
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Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina At Chapel Hill, 235 E. Cameron Ave, Davie Hall, CB #3270, Chapel Hill, NC, 27599, USA. .,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Allison Ponce
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Moreno FA. Diversity, Equity, and Inclusion in Psychiatry. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:1. [PMID: 32047390 PMCID: PMC7011219 DOI: 10.1176/appi.focus.18101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Francisco A Moreno
- Dr. Moreno is Associate Vice President for Diversity and Inclusion, University of Arizona Health Sciences, Tucson
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Ranjbar N, Erb M, Mohammad O, Moreno FA. Trauma-Informed Care and Cultural Humility in the Mental Health Care of People From Minoritized Communities. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:8-15. [PMID: 32047392 PMCID: PMC7011220 DOI: 10.1176/appi.focus.20190027] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The prevalence and impact of trauma constitute a public health crisis that is complicated by the cultural heterogeneity of contemporary society and a higher rate of trauma among individuals from minoritized communities. A trauma-informed care approach can facilitate improved treatment of those who have experienced trauma, and trauma-informed care is increasingly viewed as potentially beneficial for all patients. This article outlines general principles of trauma-informed care and ways to enact it. Because the situations in which trauma arises, the ways in which it is conceptualized, and how patients respond to it are influenced by both culture and individual factors, a cultural humility approach is also described and recommended. Psychiatrists can navigate the complex terrain of cultures and social backgrounds in the clinical encounter and can promote healing when treating patients who have experienced trauma by adopting a trauma-informed care approach and an attitude of cultural humility.
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Affiliation(s)
- Noshene Ranjbar
- Department of Psychiatry, University of Arizona, Tucson (Ranjbar, Moreno); The Center for Mind-Body Medicine, Washington, D.C. (Erb); Department of Psychiatry, University of Massachusetts-Baystate, Springfield (Mohammad)
| | - Matt Erb
- Department of Psychiatry, University of Arizona, Tucson (Ranjbar, Moreno); The Center for Mind-Body Medicine, Washington, D.C. (Erb); Department of Psychiatry, University of Massachusetts-Baystate, Springfield (Mohammad)
| | - Othman Mohammad
- Department of Psychiatry, University of Arizona, Tucson (Ranjbar, Moreno); The Center for Mind-Body Medicine, Washington, D.C. (Erb); Department of Psychiatry, University of Massachusetts-Baystate, Springfield (Mohammad)
| | - Francisco A Moreno
- Department of Psychiatry, University of Arizona, Tucson (Ranjbar, Moreno); The Center for Mind-Body Medicine, Washington, D.C. (Erb); Department of Psychiatry, University of Massachusetts-Baystate, Springfield (Mohammad)
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