1
|
Cook BL, Rastegar J, Patel N. Social Risk Factors and Racial and Ethnic Disparities in Health Care Resource Utilization Among Medicare Advantage Beneficiaries With Psychiatric Disorders. Med Care Res Rev 2024; 81:209-222. [PMID: 38235576 PMCID: PMC11168608 DOI: 10.1177/10775587231222583] [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] [Indexed: 01/19/2024]
Abstract
The intersection of social risk and race and ethnicity on mental health care utilization is understudied. This study examined disparities in health care treatment, adjusting for clinical need, among 25,780 Medicare Advantage beneficiaries with a diagnosis of a psychiatric disorder. We assessed contributions to disparities from racial and ethnic differences in the composition and returns of social risk variables. Black and Hispanic beneficiaries had lower rates of mental health outpatient visits than Whites. Assessing composition, Black and Hispanic beneficiaries experienced greater financial, food, and housing insecurity than White beneficiaries, factors associated with greater mental health treatment. Assessing returns, food insecurity was associated with an exacerbation of Hispanic-White disparities. Health care systems need to address the financial, food and housing insecurity of racial and ethnic minority groups with psychiatric disorder. Accounting for racial and ethnic differences in social risk adjustment-based payment reforms has significant implications for provider reimbursement and outcomes.
Collapse
Affiliation(s)
- Benjamin Lê Cook
- Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Nikesh Patel
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| |
Collapse
|
2
|
Stecher C, Cloonan S, Domino ME. The Economics of Treatment for Depression. Annu Rev Public Health 2024; 45:527-551. [PMID: 38100648 DOI: 10.1146/annurev-publhealth-061022-040533] [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: 12/17/2023]
Abstract
The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12-17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments' relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.
Collapse
Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
| | - Sara Cloonan
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Marisa Elena Domino
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
| |
Collapse
|
3
|
Woods-Giscombe CL, Yearwood EL, Wilson PR, Bravo L, Ngugi D, Minarik P, Brooks J, Rodney T, Starks S, Pasini M, Tatum ML, Martin VH. Honoring the past and charting the future: The International Society of Psychiatric Mental Health Nurses' commitment to advance diversity and equity in mental health care. Arch Psychiatr Nurs 2022; 41:354-358. [PMID: 36428072 DOI: 10.1016/j.apnu.2022.08.006] [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: 03/25/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/02/2022]
Abstract
For more than two decades, the International Society of Psychiatric Nurses has dedicated its efforts to improving mental health care services worldwide, focusing on leveraging the psychiatric nursing workforce and advocating to eradicate systemic health disparities. Part of this labor included creating a culturally centered initiative, the Position Statement on Diversity, Cultural Competence and Access to Mental Health Care to fortify the cultural awareness of ISPN members to improve health-care quality delivered to diverse individuals, families, and communities across the life span and to improve these populations' access to mental health care.
Collapse
Affiliation(s)
- Cheryl L Woods-Giscombe
- The University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, S. Columbia Street, Chapel Hill, NC 27599, United States of America
| | - Edilma L Yearwood
- Georgetown University School of Nursing & Health Studies, 3700 Reservoir Rd NW, Washington, DC 20007, United States of America
| | - Patty R Wilson
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States of America.
| | - Lilian Bravo
- The University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, S. Columbia Street, Chapel Hill, NC 27599, United States of America
| | - Dave Ngugi
- The University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, S. Columbia Street, Chapel Hill, NC 27599, United States of America
| | - Pamela Minarik
- Samuel Merritt University School of Nursing, 3100 Telegraph Ave, Oakland, CA 94609, United States of America
| | - Jada Brooks
- The University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, S. Columbia Street, Chapel Hill, NC 27599, United States of America
| | - Tamar Rodney
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States of America
| | - Shaquita Starks
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322, United States of America
| | - Mia Pasini
- Azusa Pacific University School of Nursing, 701 E. Foothill Blvd., Azusa, CA 91702, United States of America
| | - Mary Louise Tatum
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States of America
| | - Vicki Hines Martin
- University of Louisville School of Nursing, K-Wing 555 South Floyd Street Suite 3019, Louisville, KY 40202, United States of America
| |
Collapse
|
4
|
Poh PF, Carey MC, Lee JH, Manning JC, Latour JM. Impact of ethnicity on parental health outcomes and experiences after paediatric intensive care unit discharge: a mixed-methods systematic review. Eur J Pediatr 2022; 181:3817-3829. [PMID: 36098851 DOI: 10.1007/s00431-022-04595-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/18/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
The impact of ethnicity on parental health outcome after paediatric intensive care unit (PICU) discharge remains unclear. Thirteen medical and healthcare databases, unpublished studies and grey literature were searched up to November 5, 2021. We performed a mixed-method systematic review to understand the impact of ethnicity on parental outcomes after PICU discharge, including eight quantitative and eight qualitative studies. Among 1529 parents included, 1064 (72%) were White. Higher prevalence of post-traumatic stress disorder was seen in Black parents (17% White vs 36% Black, p = .03). Latino ethnicity was found to have protective effect against anxiety as compared to White parents (coefficient - 4.27, p < .001). A total of 91 findings were aggregated into 14 categories, and the five synthesized themes from the eight qualitative studies were long-term psychological impact after PICU, use of coping strategies, challenges of re-integration, changes in relationships and the utilization of formal support services and resources. Mixed-method synthesis found that parents of ethnic minority group were underrepresented (18%) and had higher attrition rates in a longitudinal study as compared to White parents following childhood critical illness. Conclusion: There are significant gaps in evidence related to the impact of ethnicity on long-term parental health outcomes after PICU discharge. Ethnic diversity and inclusiveness in long-term PICU research may aid understanding of the parental experiences and outcomes to close the gap in health disparity.
Collapse
Affiliation(s)
- Pei-Fen Poh
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK. .,Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Matthew C Carey
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.,Faculty of Health, The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence, University of Plymouth, Plymouth, UK
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Centre for Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.,Faculty of Health, The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence, University of Plymouth, Plymouth, UK.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia.,Department of Nursing, Hunan Children's Hospital, Changsha, China
| |
Collapse
|
5
|
Hong S, Satyshur MD, Burnett-Zeigler I. The association of mindfulness and depression stigma among African American women participants in a mindfulness-based intervention: A pilot study. Transcult Psychiatry 2022; 60:244-254. [PMID: 35505619 DOI: 10.1177/13634615221076709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depression stigma is a potential barrier to engagement in and efficacy of depression treatment. This pilot study examined the association of mindfulness with depression stigma among participants in an eight-week mindfulness-based intervention for depressive symptoms. Thirty-one African American women with depressive symptoms were recruited from an urban Federally Qualified Health Center (FQHC) to participate in a mindfulness intervention (M-Body). Mindfulness, depressive symptoms, and depression stigma were assessed at baseline, eight weeks, and 16 weeks. Focus groups were conducted to examine participants' subjective experiences with the mindfulness intervention. Mindfulness significantly increased from baseline to eight weeks. There was a non-significant decrease in depression from baseline to eight weeks and a significant decrease in depression from baseline to 16 weeks. Depression stigma significantly increased from baseline to eight weeks and significantly decreased from eight to 16 weeks; however, depression stigma did not return to the baseline. An exploratory qualitative analysis of focus group data revealed themes related to direct and indirect factors that may perpetuate and maintain depression stigma. This is one of the first studies to explicitly explore the relationship between mindfulness, depression symptoms, and depression stigma among African American women.
Collapse
Affiliation(s)
| | | | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, 12244Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
6
|
Charlesworth CJ, Zhu JM, Horvitz-Lennon M, McConnell KJ. Use of behavioral health care in Medicaid managed care carve-out versus carve-in arrangements. Health Serv Res 2021; 56:805-816. [PMID: 34312839 DOI: 10.1111/1475-6773.13703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate differences in access to behavioral health services for Medicaid enrollees covered by a Medicaid entity that integrated the financing of behavioral and physical health care ("carve-in group") versus a Medicaid entity that separated this financing ("carve-out group"). DATA SOURCES/STUDY SETTING Medicaid claims data from two Medicaid entities in the Portland, Oregon tri-county area in 2016. STUDY DESIGN In this cross-sectional study, we compared differences across enrollees in the carve-in versus carve-out group, using a machine learning approach to incorporate a large set of covariates and minimize potential selection bias. Our primary outcomes included behavioral health visits for a variety of different provider types. Secondary outcomes included inpatient, emergency department, and primary care visits. DATA COLLECTION We used Medicaid claims, including adults with at least 9 months of enrollment. PRINCIPAL FINDINGS The study population included 45,786 adults with mental health conditions. Relative to the carve-out group, individuals in the carve-in group were more likely to access outpatient behavioral health (2.39 percentage points, p < 0.0001, with a baseline rate of approximately 73%). The carve-in group was also more likely to access primary care physicians, psychologists, and social workers and less likely to access psychiatrists and behavioral health specialists. Access to outpatient behavioral health visits was more likely in the carve-in arrangement among individuals with mild or moderate mental health conditions (compared to individuals with severe mental illness) and among black enrollees (compared to white enrollees). CONCLUSIONS Financial integration of physical and behavioral health in Medicaid managed care was associated with greater access to behavioral health services, particularly for individuals with mild or moderate mental health conditions and for black enrollees. Recent changes to incentivize financial integration should be monitored to assess differential impacts by illness severity, race and ethnicity, provider types, and other factors.
Collapse
Affiliation(s)
- Christina J Charlesworth
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Jane M Zhu
- Division of General Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Marcela Horvitz-Lennon
- RAND Corporation, Cambridge Heath Alliance and Harvard Medical School, Boston, Massachusetts, USA
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
7
|
Distelberg B, Castronova M, Tapanes D, Allen J, Puder D. Evaluation of the Healthcare Cost Offsets of Mend: A Family Systems Mental Health Integration Approach. FAMILY PROCESS 2021; 60:331-345. [PMID: 32602566 DOI: 10.1111/famp.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Behavioral and physical health integration has been shown to be beneficial for overall health outcomes, as well as financial benefits. The current research clearly shows benefits, but lacks evidence specific to couples and family therapy (CFT) as a medium or profession within mental health integrated sites. This study tests the cost offsets of Mastering Each New Directions (MEND), a family system psychosocial approach to chronic illness (CI). Using retrospective charges from 107 CI adult patients, MEND (with an average of 25 sessions) was estimated to produce a 12-month cost savings of $16,684 or a 34.3% reduction in healthcare costs. This reduction significantly outweighed the cost of the intervention for a total net savings of $9,251 per participant in 12 months. Variations in cost reductions by demographic and treatment dosage are explored, and results suggest that a family systems psychosocial intervention can offer a health system an overall cost savings.
Collapse
Affiliation(s)
- Brian Distelberg
- Behavioral Medicine Center, Loma Linda University, Loma Linda, CA, USA
| | | | - Daniel Tapanes
- Loma Linda University Health Behavioral Medicine Center, Redlands, CA, USA
| | - Jesse Allen
- Loma Linda University Health Behavioral Medicine Center, Redlands, CA, USA
| | - David Puder
- Loma Linda University Health Behavioral Medicine Center, Redlands, CA, USA
| |
Collapse
|
8
|
Bobashev G, Warren L, Wu LT. Predictive model of multiple emergency department visits among adults: analysis of the data from the National Survey of Drug Use and Health (NSDUH). BMC Health Serv Res 2021; 21:280. [PMID: 33766009 PMCID: PMC7995604 DOI: 10.1186/s12913-021-06221-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background In this methodological paper, we use a novel, predictive approach to examine how demographics, substance use, mental and other health indicators predict multiple visits (≥3) to emergency departments (ED) within a year. Methods State-of-the-art predictive methods were used to evaluate predictive ability and factors predicting multiple visits to ED within a year and to identify factors that influenced the strength of the prediction. The analysis used public-use datasets from the 2015–2018 National Surveys on Drug Use and Health (NSDUH), which used the same questionnaire on the variables of interest. Analysis focused on adults aged ≥18 years. Several predictive models (regressions, trees, and random forests) were validated and compared on independent datasets. Results Predictive ability on a test set for multiple ED visits (≥3 times within a year) measured as the area under the receiver operating characteristic (ROC) reached 0.8, which is good for a national survey. Models revealed consistency in predictive factors across the 4 survey years. The most influential variables for predicting ≥3 ED visits per year were fair/poor self-rated health, being nervous or restless/fidgety, having a lower income, asthma, heart condition/disease, having chronic obstructive pulmonary disease (COPD), nicotine dependence, African-American race, female sex, having diabetes, and being of younger age (18–20). Conclusions The findings reveal the need to address behavioral and mental health contributors to ED visits and reinforce the importance of developing integrated care models in primary care settings to improve mental health for medically vulnerable patients. The presented modeling approach can be broadly applied to national and other large surveys. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06221-w.
Collapse
Affiliation(s)
- Georgiy Bobashev
- RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Lauren Warren
- RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University School of Medicine, Box 3903, Durham, NC, 27710, USA.
| |
Collapse
|
9
|
Corbett J, Olafunmiloye T, Betancourt JR. The Business Case for Mental Health Equity. Psychiatr Clin North Am 2020; 43:429-438. [PMID: 32773072 DOI: 10.1016/j.psc.2020.04.001] [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: 11/18/2022]
Abstract
More than 47 million Americans experience mental illness each year, and more than 9.2 million suffer from mental health and substance use disorders. More than 60% of adults with mental illness and 81% of those with substance use disorders do not receive treatment. As the human and financial costs from our nation's mental health and substance use disorders crisis escalate, a strong business case to better address this crisis has emerged. This article describes the root causes and cost of disparities and offers an innovative perspective on aligning stakeholders to make the business case for equity in treatment and outcomes.
Collapse
Affiliation(s)
- James Corbett
- Initium Health, EO Health, 1401 Wewatta Street Suite 103, Denver, CO 80202, USA. https://twitter.com/JCETHICIST
| | - Temi Olafunmiloye
- The Disparities Solutions Center, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph R Betancourt
- Equity and Inclusion Administration, The Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch Building, Room 127, Boston, MA 02114, USA.
| |
Collapse
|
10
|
Nonsuicidal Self-Injury Among African American and Hispanic Adolescents and Young Adults: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:367-377. [PMID: 32671672 DOI: 10.1007/s11121-020-01147-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While African American and Hispanic adolescents and young adults living in the USA are exposed to myriad stressors that may increase their risk for mental health difficulties, few studies have examined nonsuicidal self-injury (NSSI) among these youth. The purpose of this systematic review was to critically examine and synthesize current literature on NSSI among these understudied youth. Using multiple search terms related to NSSI, race/ethnicity, and developmental stage, electronic literature searches of PubMed, PsychINFO, and Google Scholar databases retrieved 3036 relevant articles published in the English language between 2000 and 2018; manual reference checks yielded an additional 17 articles. Ultimately, a total of 52 full-text studies were assessed for eligibility, and 15 articles were included in the present review. Although the majority of studies reported higher prevalence of NSSI among non-Hispanic White youth, evidence suggests that African American males are also at high risk of engaging in self-harm. Emotional dysregulation emerged as a common risk factor, while social support and feelings of connection were protective for some African American and Hispanic youth. Although racism and discrimination were not linked to NSSI in the reviewed studies, this remains an important area of future research for prevention and intervention efforts.
Collapse
|
11
|
Cobb S, Bazargan M, Sandoval JC, Wisseh C, Evans MC, Assari S. Depression Treatment Status of Economically Disadvantaged African American Older Adults. Brain Sci 2020; 10:brainsci10030154. [PMID: 32156089 PMCID: PMC7139636 DOI: 10.3390/brainsci10030154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background: It is known that depression remains largely untreated in underserved communities. Hence, it is desirable to gain more knowledge on the prevalence and correlates of untreated depression among African-American (AA) older adults in economically disadvantaged areas. This knowledge may have the public health benefit of improving detection of AA older adults with depression who are at high risk of not receiving treatment, thereby reducing this health disparity. Objective: To study health and social correlates of untreated depression among AA older adults in economically disadvantaged areas. Methods: Between 2015 and 2018, this cross-sectional survey was conducted in South Los Angeles. Overall, 740 AA older adults who were 55+ years old entered this study. Independent variables were age, gender, living arrangement, insurance type, educational attainment, financial strain, chronic medical conditions, and pain intensity. Untreated depression was the dependent variable. Logistic and polynomial regression models were used to analyze these data. Results: According to the polynomial regression model, factors such as number of chronic medical conditions and pain intensity were higher in individuals with depression, regardless of treatment status. As our binary logistic regression showed, age, education, and number of providers were predictive of receiving treatment for depression. Conclusion: Age, educational attainment, number of providers (as a proxy of access to and use of care) may be useful to detect AA older adults with depression who are at high risk of not receiving treatment. Future research may focus on decomposition of the role of individual-level characteristics and health system-level characteristics that operate as barriers and facilitators to AA older adults receiving treatment for depression.
Collapse
Affiliation(s)
- Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Jessica Castro Sandoval
- School of Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Cheryl Wisseh
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 91606, USA
| | - Meghan C. Evans
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Correspondence: ; Tel.: +1-734-363-2678
| |
Collapse
|
12
|
Hall GCN, Berkman ET, Zane NW, Leong FTL, Hwang WC, Nezu AM, Nezu CM, Hong JJ, Chu JP, Huang ER. Reducing mental health disparities by increasing the personal relevance of interventions. ACTA ACUST UNITED AC 2020; 76:91-103. [PMID: 32118456 DOI: 10.1037/amp0000616] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One of the most persistent health disparities is the underutilization of mental health services by people of color. Neither evidence-based treatments (universal focus) nor culturally adapted treatments (group focus) have reduced these disparities. We propose the personal relevance of psychotherapy (PROP) model, which integrates universal, group, and individual dimensions to determine the personal relevance of interventions. A cultural example of personal relevance among people of East Asian ancestry involves "face" (i.e., one's prestige and position in society), which may moderate treatment outcomes. Pragmatic intervention approaches focused on helping individuals cope with specific external problems, compared to managing a "personal" disease, can effectively "restore" face. Thus, social problem-solving interventions may be more personally relevant to many people of East Asian ancestry than are approaches that are internally focused. In addition, we posit that social neuroscience can offer unique opportunities above and beyond self-report measures when assessing the impact of PROP and the personal relevance of interventions for diverse populations. Our preliminary evidence upon testing this hypothesis indicated that among Asian Americans, exposure to problem-solving therapy content elicited significantly greater neural activity in brain areas associated with personal relevance compared to exposure to cognitive-behavioral therapy content. Identifying personally relevant interventions has the potential to reduce mental health disparities by increasing engagement with mental health services for diverse groups. The increased client engagement produced by personally relevant interventions also has the potential to make mental health services more effective for diverse groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Nolan W Zane
- Department of Psychology, University of California, Davis
| | | | | | | | | | - Janie J Hong
- Redwood Center for Cognitive Behavior Therapy and Research
| | - Joyce P Chu
- Department of Psychology, Palo Alto University
| | - Ellen R Huang
- Department of Psychology, University of Oregon, Eugene
| |
Collapse
|
13
|
Noel-London K, Breitbach A, Belue R. Filling the Gaps in Adolescent Care and School Health Policy-Tackling Health Disparities through Sports Medicine Integration. Healthcare (Basel) 2018; 6:healthcare6040132. [PMID: 30428510 PMCID: PMC6316866 DOI: 10.3390/healthcare6040132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 12/29/2022] Open
Abstract
The School-Based Health Centre (SBHC) model of healthcare delivery in community health is designed to address the unique needs of adolescents. Through a collaborative interprofessional approach, they aim to provide comprehensive care with the goal of reducing health disparities in underserved, at-risk adolescents. Integration of sports medicine health professionals is a novel approach to increasing available services, as well as patient utilization, while addressing multiple public health issues, including lack of athletic training services for youth athletes.
Collapse
Affiliation(s)
- Kemba Noel-London
- College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, USA.
| | - Anthony Breitbach
- Doisy College of Health Sciences, Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO 63104, USA.
| | - Rhonda Belue
- College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, USA.
| |
Collapse
|
14
|
Yucel A, Essien EJ, Sanyal S, Mgbere O, Aparasu RR, Bhatara VS, Alonzo JP, Chen H. Racial/ethnic differences in the treatment of adolescent major depressive disorders (MDD) across healthcare providers participating in the medicaid program. J Affect Disord 2018; 235:155-161. [PMID: 29656260 DOI: 10.1016/j.jad.2018.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/09/2018] [Accepted: 04/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND To examine whether racial/ethnic differences in receipt of MDD treatment could be explained by the specialty of provider diagnosing the adolescent. METHOD Adolescents (10-20 years-old) with ≥2 MDD diagnoses were identified using 2005-2007 Medicaid data from Texas. Patients were categorized based on the types of provider who gave the initial MDD diagnosis (psychiatrist (PSY-I), social worker/psychologist (SWP-I), and primary care physician (PCP-I)). Within the sub-cohorts identified by each type of provider, patients were further divided by racial/ethnic groups. RESULTS Of the 13,234-new pediatric MDD cases diagnosed, 61% were SWP-I, 33% PSY-I and 6% PCP-I. Results of the analysis using general linear multi-level model showed that being first diagnosed by a psychiatrist was associated with higher chance of receiving MDD related treatment (PCP-I vs. PSY-I (OR: 0.54, 95%CI: 0.4-0.7) and SWP-I vs. PSY-I (OR: 0.17, 95%CI: 0.1-0.2)). Specifically, regarding the receipt of pharmacotherapy, an interaction effect was detected between types of identifying providers and patients' race/ethnicity. The analysis stratified by race/ethnicity found Whites received comparable treatment regardless being PCP-Is or PSY-Is, while for Hispanics, being first identified by a PCP was associated with lower likelihood of receiving treatment as compared to being first identified by a psychiatrist. Further analysis stratified by provider types showed that a significant racial/ethnic variation in medication utilization was observed in PCP-Is, but not in PSY-Is. CONCLUSION For adolescents with MDD, being first diagnosed by a psychiatrist was associated with higher treatment rate and reduced racial/ethnic variation in the utilization of pharmacotherapy.
Collapse
Affiliation(s)
- Aylin Yucel
- University of Houston College of Pharmacy, Houston, TX, USA.
| | - Ekere J Essien
- University of Houston College of Pharmacy, Houston, TX, USA.
| | - Swarnava Sanyal
- University of Houston College of Pharmacy, Houston, TX, USA.
| | - Osaro Mgbere
- Bureau of Epidemiology, Houston Health Department.
| | | | | | - Joy P Alonzo
- University of Houston College of Pharmacy, Houston, TX, USA.
| | - Hua Chen
- University of Houston College of Pharmacy, Houston, TX, USA.
| |
Collapse
|
15
|
Niazi S, Frank RD, Sharma M, Roy V, Ames S, Rummans T, Spaulding A, Sher T, Ailawadhi M, Bhatia K, Ahmed S, Tan W, Chanan-Khan A, Ailawadhi S. Impact of psychiatric comorbidities on health care utilization and cost of care in multiple myeloma. Blood Adv 2018; 2:1120-1128. [PMID: 29776984 PMCID: PMC5965054 DOI: 10.1182/bloodadvances.2018016717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
Approximately one third of cancer patients suffer from comorbid mood disorders that are associated with increased cost and poorer outcomes. The majority of patients with multiple myeloma (MM) are treated with corticosteroids; as many as three fourths of those taking corticosteroids develop neuropsychiatric complications, likely increasing morbidity and cost of care. MM patients diagnosed between 1991 and 2010 and reported in the Surveillance Epidemiology, and End Results-Medicare database were characterized as MM-Only, MM+Psychiatric (any psychiatric condition, preexisting or post-MM), or MM+Depression (depression as the only psychiatric diagnosis, preexisting or post-MM). Differences in demographic characteristics, occurrence of clinical myeloma-defining events (MDEs), health care utilization (inpatient, outpatient, ambulatory claims), and cost of care during the first 6 months of MM diagnosis were analyzed. Psychiatric comorbidities were reported more frequently in females, and racial minorities had lower rates of psychiatric comorbidities. All clinical MDEs were more common in the MM+Psychiatric and MM+Depression groups; within them, the majority were more common in patients diagnosed with the psychiatric condition or depression after MM compared with it being a preexisting condition. Health care utilization in all treatment settings was higher in those with psychiatric comorbidities. Cost of care within the first 6 months after MM diagnosis was significantly higher in the MM+Psychiatric and MM+Depression groups. This increase in cost was more pronounced for patients from racial minorities diagnosed with a psychiatric condition, including depression. Psychiatric comorbidities significantly impact the clinical presentations, health care utilization, and cost among patients with MM. These findings need to be addressed for improved survivorship of MM patients.
Collapse
Affiliation(s)
- Shehzad Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Ryan D Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; and
| | | | | | - Steve Ames
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Teresa Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Aaron Spaulding
- Division of Healthcare Policy and Research, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Cook BL, Trinh NH, Li Z, Hou SSY, Progovac AM. Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004-2012. Psychiatr Serv 2017; 68:9-16. [PMID: 27476805 PMCID: PMC5895177 DOI: 10.1176/appi.ps.201500453] [Citation(s) in RCA: 268] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study compared trends in racial-ethnic disparities in mental health care access among whites, blacks, Hispanics, and Asians by using the Institute of Medicine definition of disparities as all differences except those due to clinical appropriateness, clinical need, and patient preferences. METHODS Racial-ethnic disparities in mental health care access were examined by using data from a nationally representative sample of 214,597 adults from the 2004-2012 Medical Expenditure Panel Surveys. The main outcome measures included three mental health care access measures (use of any mental health care, any outpatient care, and any psychotropic medication in the past year). RESULTS Significant disparities were found in 2004-2005 and in 2011-2012 for all three racial-ethnic minority groups compared with whites in all three measures of access. Between 2004 and 2012, black-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.2% to 10.8% and from 7.6% to 10.0%. Similarly, Hispanic-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.4% to 10.9% and 7.3% to 10.3%. CONCLUSIONS No reductions in racial-ethnic disparities in access to mental health care were identified between 2004 and 2012. For blacks and Hispanics, disparities were exacerbated over this period. Clinical interventions that improve identification of symptoms of mental illness, expansion of health insurance, and other policy interventions that remove financial barriers to access may help to reduce these disparities.
Collapse
Affiliation(s)
- Benjamin Lê Cook
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Nhi-Ha Trinh
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Zhihui Li
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Sherry Shu-Yeu Hou
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| | - Ana M Progovac
- Dr. Cook is with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). He is also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts, where Ms. Hou and Dr. Progovac are affiliated. Dr. Progovac is also with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Trinh is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Ms. Li is with the Department of Global Health and Population, Harvard School of Public Health, Boston
| |
Collapse
|
17
|
Ali MM, Chen J, Mutter R, Novak P, Mortensen K. The ACA's Dependent Coverage Expansion and Out-of-Pocket Spending by Young Adults With Behavioral Health Conditions. Psychiatr Serv 2016; 67:977-82. [PMID: 27181735 PMCID: PMC6458594 DOI: 10.1176/appi.ps.201500346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Young adults with behavioral health conditions (mental or substance use disorders) often lack access to care. In 2010, the Affordable Care Act (ACA) extended eligibility for dependent coverage under private health insurance, allowing young adults to continue on family plans until age 26. The objective of this study was to analyze out-of-pocket (OOP) spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. The study examined the population of young adults with behavioral health conditions overall and by race and ethnicity. METHODS The study analyzed 2008-2009 and 2011-2012 nationally representative data from the Medical Expenditure Panel Survey with zero-or-one inflated beta regression models in a difference-in-differences framework to estimate the impact of the ACA's dependent coverage expansion. OOP spending was examined as a share of total health care expenditures among young adults with behavioral health disorders. The study compared the treatment group of individuals ages 19-25 (unweighted N=1,158) with a group ages 27-29 (unweighted N=668). RESULTS Young adults ages 19-25 with behavioral health disorders were significantly less likely than the older group to have high levels of OOP spending after the implementation of the ACA's dependent coverage expansion. The reduction was pronounced among young adults from racial-ethnic minority groups. CONCLUSIONS The extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group.
Collapse
Affiliation(s)
- Mir M Ali
- Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables
| | - Jie Chen
- Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables
| | - Ryan Mutter
- Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables
| | - Priscilla Novak
- Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables
| | - Karoline Mortensen
- Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables
| |
Collapse
|
18
|
Harrington C, Kang T. Disparities in Service Use and Expenditures for People With Intellectual and Developmental Disabilities in California in 2005 and 2013. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:1-18. [PMID: 26824130 DOI: 10.1352/1934-9556-54.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined service use and expenditures for people with intellectual and developmental disabilities (IDD) living at home and in the community in California in 2005 and 2013. The number of people assessed for IDD services increased, along with the percentage of individuals who did not receive any services between 2005 and 2013. Controlling for client needs, children age 3-21 were less likely than other age groups to receive any services using logistic regressions. All racial and ethnic minority groups were less likely to receive any services than were white populations. Females, younger people, and all racial and ethnic minority groups who received services had significantly lower expenditures, with wide geographic variations. The disparities by age, gender, race/ethnicity, and geography have persisted over time in California.
Collapse
Affiliation(s)
- Charlene Harrington
- Charlene Harrington, University of California San Francisco, Department of Social & Behavioral Sciences, San Francisco, California; and
| | - Taewoon Kang
- Taewoon Kang, University of California San Francisco, Institute for Health and Aging, San Francisco, California
| |
Collapse
|