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Hempeler C, Schneider-Reuter L, Windel AS, Carlet J, Philipsen L, Juckel G, Gather J, Yeboah A, Faissner M. Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis. Psychiatr Serv 2024:appips20230252. [PMID: 38938095 DOI: 10.1176/appi.ps.20230252] [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: 06/29/2024]
Abstract
OBJECTIVE Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care. METHODS The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989-December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed. RESULTS Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices. CONCLUSIONS Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training.
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Affiliation(s)
- Christin Hempeler
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Lydia Schneider-Reuter
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Anne-Sophie Windel
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Jona Carlet
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Lea Philipsen
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Georg Juckel
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Amma Yeboah
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Mirjam Faissner
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
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Doan TT, Hutton DW, Wright DR, Prosser LA. Estimating Transition Probabilities for Modeling Major Depression in Adolescents by Sex and Race or Ethnicity Combinations in the USA. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:375-390. [PMID: 38253972 DOI: 10.1007/s40258-024-00872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE About one-fifth of US adolescents experienced major depressive symptoms, but few studies have examined longitudinal trends of adolescents developing depression or recovering by demographic factors. We estimated new transition probability inputs, and then used them in a simulation model to project the epidemiologic burden and trajectory of depression of diverse adolescents by sex and race or ethnicity combinations. METHODS Transition probabilities were first derived using parametric survival analysis of data from the National Longitudinal Study of Adolescent to Adult Health and then calibrated to cross-sectional data from the National Survey on Drug Use and Health. We developed a cohort state-transition model to simulate age-specific depression outcomes of US adolescents. A hypothetical adolescent cohort was modeled from 12-22 years with annual transitions. Model outcomes included proportions of youth experiencing depression, recovery, or depression-free cases and were reported for a US adolescent population by sex, race or ethnicity, and sex and race or ethnicity combinations. RESULTS At 22 years of age, approximately 16% of adolescents had depression, 12% were in recovery, and 72% had never developed depression. Depression prevalence peaked around 16-17 years-old. Adolescents of multiracial or other race or ethnicity, White, American Indian or Alaska Native, and Hispanic, Latino, or Spanish descent were more likely to experience depression than other racial or ethnic groups. Depression trajectories generated by the model matched well with historical observational studies by sex and race or ethnicity, except for individuals from American Indian or Alaska Native and multiracial or other race or ethnicity backgrounds. CONCLUSIONS This study validated new transition probabilities for future use in decision models evaluating adolescent depression policies or interventions. Different sets of transition parameters by demographic factors (sex and race or ethnicity combinations) were generated to support future health equity research, including distributional cost-effectiveness analysis. Further data disaggregated with respect to race, ethnicity, religion, income, geography, gender identity, sexual orientation, and disability would be helpful to project accurate estimates for historically minoritized communities.
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Affiliation(s)
- Tran T Doan
- Department of Pediatrics, University of Pittsburgh School of Medicine, 3414 Fifth Avenue, 1st Floor, Pittsburgh, PA, 15213-3205, USA.
| | - David W Hutton
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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Weisenburger RL, Mullarkey MC, Labrada J, Labrousse D, Yang MY, MacPherson AH, Hsu KJ, Ugail H, Shumake J, Beevers CG. Conversational assessment using artificial intelligence is as clinically useful as depression scales and preferred by users. J Affect Disord 2024; 351:489-498. [PMID: 38290584 DOI: 10.1016/j.jad.2024.01.212] [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] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Depression is prevalent, chronic, and burdensome. Due to limited screening access, depression often remains undiagnosed. Artificial intelligence (AI) models based on spoken responses to interview questions may offer an effective, efficient alternative to other screening methods. OBJECTIVE The primary aim was to use a demographically diverse sample to validate an AI model, previously trained on human-administered interviews, on novel bot-administered interviews, and to check for algorithmic biases related to age, sex, race, and ethnicity. METHODS Using the Aiberry app, adults recruited via social media (N = 393) completed a brief bot-administered interview and a depression self-report form. An AI model was used to predict form scores based on interview responses alone. For all meaningful discrepancies between model inference and form score, clinicians performed a masked review to determine which one they preferred. RESULTS There was strong concurrent validity between the model predictions and raw self-report scores (r = 0.73, MAE = 3.3). 90 % of AI predictions either agreed with self-report or with clinical expert opinion when AI contradicted self-report. There was no differential model performance across age, sex, race, or ethnicity. LIMITATIONS Limitations include access restrictions (English-speaking ability and access to smartphone or computer with broadband internet) and potential self-selection of participants more favorably predisposed toward AI technology. CONCLUSION The Aiberry model made accurate predictions of depression severity based on remotely collected spoken responses to a bot-administered interview. This study shows promising results for the use of AI as a mental health screening tool on par with self-report measures.
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Affiliation(s)
- Rachel L Weisenburger
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States of America.
| | | | | | - Daniel Labrousse
- Department of Psychiatry, Georgetown University Medical Center, United States of America
| | - Michelle Y Yang
- Department of Psychiatry, Georgetown University Medical Center, United States of America
| | - Allison Huff MacPherson
- Department of Family and Community Medicine, College of Medicine, University of Arizona, United States of America
| | - Kean J Hsu
- Department of Psychiatry, Georgetown University Medical Center, United States of America; Department of Psychology, National University of Singapore, Singapore
| | - Hassan Ugail
- Centre for Visual Computing, University of Bradford, United Kingdom of Great Britain and Northern Ireland
| | | | - Christopher G Beevers
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States of America
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Tiruneh YM, Anwoju O, Harrison AC, Garcia MT, Elbers SK. Examining Health-Seeking Behavior among Diverse Ethnic Subgroups within Black Populations in the United States and Canada: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:368. [PMID: 38541367 PMCID: PMC10970228 DOI: 10.3390/ijerph21030368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 07/13/2024]
Abstract
The Black populations, often treated as ethnically homogenous, face a constant challenge in accessing and utilizing healthcare services. This study examines the intra-group differences in health-seeking behavior among diverse ethnic subgroups within Black communities. A cross-sectional analysis included 239 adults ≥18 years of age who self-identified as Black in the United States and Canada. Multiple logistic regression assessed the relationship between health-seeking behaviors and ethnic origin, controlling for selected social and health-related factors. The mean age of the participants was 38.6 years, 31% were male, and 20% were unemployed. Sixty-one percent reported a very good or excellent health status, and 59.7% were not receiving treatment for chronic conditions. Advancing age (OR = 1.05, CI: 1.01-1.09), female gender (OR = 3.09, CI: 1.47-6.47), and unemployment (OR = 3.46, CI: 1.35-8.90) were associated with favorable health-seeking behaviors. Compared with the participants with graduate degrees, individuals with high school diplomas or less (OR = 3.80, CI: 1.07-13.4) and bachelor's degrees (OR = 3.57, CI: 1.3-9.23) were more inclined to have engaged in favorable health-seeking behavior compared to those with graduate degrees. Across the Black communities in our sample, irrespective of ethnic origins or country of birth, determinants of health-seeking behavior were age, gender, employment status, and educational attainment.
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Affiliation(s)
- Yordanos M. Tiruneh
- School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Ariel C. Harrison
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Martha T. Garcia
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Shauna K. Elbers
- School of Interdisciplinary Arts and Sciences, University of Washington Bothell, Bothell, WA 98011, USA;
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Lieff SA, Mijanovich T, Yang L, Silver D. Impacts of the Affordable Care Act Medicaid Expansion on Mental Health Treatment Among Low-income Adults Across Racial/Ethnic Subgroups, 2010-2017. J Behav Health Serv Res 2024; 51:57-73. [PMID: 37673829 DOI: 10.1007/s11414-023-09861-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
This study examines whether the Affordable Care Act (ACA) Medicaid expansion (ME) was associated with changes in racial/ethnic disparities in insurance coverage, utilization, and quality of mental health care among low-income adults with probable mental illness using the National Survey on Drug Use and Health with state identifiers. This study employed difference-in-difference models to compare ME states to non-expansion states before (2010-2013) and after (2014-2017) expansion and triple difference models to examine these changes across non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic/Latino racial/ethnic subgroups. Insurance coverage increased significantly for all racial/ethnic groups in expansion states relative to non-expansion states (DD: 9.69; 95% CI: 5.17, 14.21). The proportion low-income adults that received treatment but still had unmet need decreased (DD: -3.06; 95% CI: -5.92, -0.21) and the proportion with unmet need and no mental health treatment increased (DD: 2.38; 95% CI: 0.03, 4.73). ME was not associated with reduced disparities.
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Affiliation(s)
- Sarah A Lieff
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Tod Mijanovich
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Lawrence Yang
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Diana Silver
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY, USA
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Lapping-Carr L, Dennard A, Wisner KL, Tandon SD. Perinatal Depression Screening Among Sexual Minority Women. JAMA Psychiatry 2023; 80:1142-1149. [PMID: 37531104 PMCID: PMC10398540 DOI: 10.1001/jamapsychiatry.2023.2619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/31/2023] [Indexed: 08/03/2023]
Abstract
Importance A substantial number of births in the US are to sexual minority women (17% based on a nationally representative survey), yet there is little research on perinatal depression screening rates or symptom endorsement among sexual minority women (including women who identify as lesbian, bisexual, queer, pansexual, asexual, demisexual, and kinky as well as other-identified women who have sex with women). High rates of risk factors for perinatal depression (eg, intimate partner violence and history of mental illness) among sexual minority individuals magnify this gap in the literature. Objective To describe the prevalence of female-identified sexual minority people giving birth in an academic medical center and compare perinatal depression screening rates and scores among sexual minority women and heterosexual cisgender women. Design, Setting, and Participants This retrospective cohort study used deidentified medical record review of 18 243 female-identified individuals who gave birth at an academic medical center in Chicago, Illinois, between January 1 and December 31, 2019. Data were analyzed from April 5, 2021, to August 1, 2022. Main Outcomes and Measures Proportion of women identified as having sexual minority status in the medical record, rates of standard care administration of the 9-item Patient Health Questionnaire between sexual minority women and heterosexual women, and depression screening scores and rates of positive depression screening results for sexual minority and heterosexual women. Results Among 18 243 women (mean [SD] age, 33.8 [5.1] years; 10 453 [57.3%] of non-Hispanic White race and ethnicity), only 280 (1.5%; 95% CI, 1.3%-1.7%) were identified as having sexual minority status in the medical record. Significantly more sexual minority women vs heterosexual women attended at least 1 prenatal care visit (56 [20.0%] vs 2459 [13.7%]; P = .002) and at least 1 postpartum care visit (52 [18.6%] vs 2304 [12.8%]; P = .004). Sexual minority women were more likely to be screened for depression during postpartum care (odds ratio, 1.77; 95% CI, 1.22-2.52; P = .002) and more likely to screen positive for depression during the postpartum period (odds ratio, 2.38; 95% CI, 0.99-5.02; P = .03) than heterosexual women. Conclusions and Relevance In this cohort study, sexual minority women identified in the medical record were highly engaged in obstetric care yet at high risk of postpartum depression. In addition, their sexual orientation was largely undocumented in medical records. These results highlight the need for investigations that include strategies for measuring sexual orientation because medical record review is unlikely to reliably capture these sexual identities during the perinatal period.
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Affiliation(s)
- Leiszle Lapping-Carr
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ashley Dennard
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine L. Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S. Darius Tandon
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
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Lee YJ, Palmer J, Cline AC, Lee H. Factors Influencing the Health Care Utilization Among People With Depression and/or Anxiety Symptoms. J Am Psychiatr Nurses Assoc 2023:10783903231197655. [PMID: 37724452 PMCID: PMC10988633 DOI: 10.1177/10783903231197655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND This analysis aimed to examine the factors predictive of service utilization among patients with anxiety and/or depression. Quick and appropriate treatment for anxiety and depression can reduce disease burden and improve social functioning. Currently, less than half of the population with comorbid anxiety and depression receives the recommended treatment. AIMS This analysis aims to identify factors predictive of utilizing mental health treatment for those with anxiety and/or depression by analyzing intrinsic, patient-centered factors. METHOD This study is a cross-sectional cohort analysis using National Health Interview Survey (NHIS) 2019 data. The sample size is 7,156 adults aged 18 to 64 with family incomes ≤100% of the federal poverty level. We used multivariate logistic regression analysis to identify factors predictive of care utilization in this population. Variables of interest include scores on Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7), service utilization, level of social functioning, having a usual source for care, and previous mental health care utilization. Additional covariates were age, gender, race, country of origin, education, marital status, and insurance coverage. RESULTS Twenty-one percent of respondents reported using mental health services. Factors predictive of care utilization were older age, female gender, limited social functioning, having a usual source of care, and insurance coverage. CONCLUSION There are significant barriers to receiving quick and appropriate care for anxiety and/or depression. Strategies should focus on reducing barriers for young adults, men, and the uninsured/underinsured. Strategies for integrating mental health services into primary care could increase the percentage of people with anxiety and/or depression who receive services.
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Affiliation(s)
- Young Ji Lee
- Young Ji Lee, PhD, MSN, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Josh Palmer
- Joshua Palmer, DNP, PMHNP-BC, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Alice Curtis Cline
- Alice Curtis Cline, MSN, CNM. PhD, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Heeyoung Lee
- Heeyoung Lee, PhD, PMHNP-BC, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Beauchamp AM, Kalra A, Scroggins H, Pahl B, Pitt A, Skaliks A, Jetelina KK. Identifying violence against persons at a safety-net hospital: Evidence from the first 6 months of implementation. Health Serv Res 2023; 58:800-806. [PMID: 35502497 PMCID: PMC10315384 DOI: 10.1111/1475-6773.13997] [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: 11/29/2022] Open
Abstract
OBJECTIVE To examine the prevalence and predictors of screening for violence against persons and victim service utilization within an integrated safety-net health system. STUDY SETTING Emergency Department (ED) at Parkland Hospital-Dallas County's largest safety-net provider of services for minority and underinsured and uninsured patients. STUDY DESIGN Prospective, longitudinal study during the first 6 months of a universal violence against persons screener. DATA COLLECTION Health records were extracted for all patients with a visit to the ED between January and July, 2021. Modeling described the patient population across screening (screened vs. not screened) and, among those screened, the results (positive vs. negative), average time spent in the ED, and referral patterns for victim services. PRINCIPAL FINDINGS During the study period, 65,563 unique patients with 95,555 encounters occurred. Seventy-one percent (n = 67,535) were screened for violence against persons and, of those, 2% screened positive (n = 1349). Of the patients who screened positive, 1178 (87%) were referred to and 806 (60%) received care at victim services. Implementing screening did not increase the length of stay at ED. CONCLUSIONS Systematic implementation of comprehensive violence screening at a safety-net system can result in robust identification and timely referrals to victim services.
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Affiliation(s)
- Alaina M. Beauchamp
- Department of Epidemiology, Human Genetics, & Environmental SciencesThe University of Texas Health Science Center at Houston School of Public HealthDallasTexasUSA
| | - Anjali Kalra
- Department of Epidemiology, Human Genetics, & Environmental SciencesThe University of Texas Health Science Center at Houston School of Public HealthDallasTexasUSA
- UT Southwestern Medical SchoolUT Southwestern Medical CenterDallasTexasUSA
| | | | - Brittany Pahl
- Forensic Nursing and Community ProgramsParkland Health and Hospital SystemDallasTexasUSA
| | - Amanda Pitt
- Parkland Health and Hospital SystemDallasTexasUSA
| | - Andrea Skaliks
- Victim Intervention Program/Rape Crisis CenterParkland Health and Hospital SystemDallasTexasUSA
| | - Katelyn K. Jetelina
- Department of Epidemiology, Human Genetics, & Environmental SciencesThe University of Texas Health Science Center at Houston School of Public HealthDallasTexasUSA
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9
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Kimerling R, Zulman DM, Lewis ET, Schalet BD, Reise SP, Tamayo GC. Clinical Validity of the PROMIS Healthcare Engagement 8-Item Short Form. J Gen Intern Med 2023; 38:2021-2029. [PMID: 37118561 PMCID: PMC10361929 DOI: 10.1007/s11606-022-07992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/22/2022] [Indexed: 04/30/2023]
Abstract
BACKGROUND Healthcare engagement is a key measurement target for value-based healthcare, but a reliable and valid patient-reported measure has not yet been widely adopted. OBJECTIVE To assess the validity of a newly developed patient-reported measure of healthcare engagement, the 8-item PROMIS Healthcare Engagement (PHE-8a). DESIGN Prospective cohort study of the association between healthcare engagement and quality of care over 1 year. We fit mixed effects models of quality indicators as a function of engagement scores, adjusting for age, race/ethnicity, rural residence, and risk scores. PARTICIPANTS National stratified random sample of 9552 Veterans receiving Veterans Health Administration care for chronic conditions (hypertension, diabetes) or mental health conditions (depression, post-traumatic stress disorder). MAIN MEASURES Patient experience: Consumer Assessment of Health Plans and Systems communication and self-management support composites; no-show rates for primary care and mental health appointments; use of patient portal My HealtheVet; and Healthcare Effectiveness Data and Information Set electronic quality measures: HbA1c poor control, controlling high blood pressure, and hyperlipidemia therapy adherence. KEY RESULTS Higher engagement scores were associated with better healthcare quality across all outcomes, with each 5-point increase (1/2 standard deviation) in engagement scores associated with statistically significant and clinically meaningful gains in quality. Across the continuum of low to high engagement scores, we observed a concomitant reduction in primary care no-show rates of 37% and 24% for mental health clinics; an increased likelihood of My HealtheVet use of 15.4%; and a decreased likelihood of poor diabetes control of 44%. CONCLUSIONS The PHE-8a is a brief, reliable, and valid patient-reported measure of healthcare engagement. These results confirm previously untested hypotheses that patient engagement can promote healthcare quality.
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Affiliation(s)
- Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA.
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Eleanor T Lewis
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC, USA
| | - Benjamin D Schalet
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Steven P Reise
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Gisselle C Tamayo
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
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Romero SA, Rasmussen A, Raue PJ. Treatment Decision-Making Preferences of Older Depressed Minority Primary Care Patients. Community Ment Health J 2023; 59:719-727. [PMID: 36445539 DOI: 10.1007/s10597-022-01055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022]
Abstract
Little research examined the decision-making preferences of older, racially and ethnically diverse minority patients with untreated depression. The study's aims were to identify decision-making preferences and the characteristics associated with a more active preference in the decision-making process for general medical and depression treatment decisions. We assessed the preferred involvement in making general medical and depression treatment decisions of 201 older primary care patients with untreated depression. Linear regressions examined the association of sociodemographic and clinical characteristics with decision-making preference for both decision types. Majority of patients preferred shared decision-making for general medical and depression treatments. Female gender was associated with a preference for active decision-making for depression treatment. For this sample older depressed patients preferred sharing the decision-making responsibilities with physicians. To improve communication and the initiation and adherence to mental health care, physicians must consider older, minority patients' preferences for involvement in the decision-making process.
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Affiliation(s)
- Sara A Romero
- Harvard Medical School, 641 Huntington Avenue, 02115, Boston, MA, USA.
| | | | - Patrick J Raue
- University of Washington Medical Center, Seattle, WA, USA
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11
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Constante HM, Bastos JL, Ruiz MA. The more you need, the less you get: Intersectionality and the inverse care law in the Brazilian depression care cascade. ETHNICITY & HEALTH 2023; 28:488-502. [PMID: 35608907 DOI: 10.1080/13557858.2022.2078483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Substantial research has shown that the population distribution of major depressive disorder (MDD) is strongly influenced by race, gender, and socioeconomic position. However, a deeper understanding of inequities in access to care for MDD according to these social markers is yet to be reached. We use data from the 2019 Brazilian National Health Survey, which includes 87,187 respondents aged 18 years and over, to test two hypotheses derived from the inverse care law: women, Black, and low-education respondents have higher frequencies of MDD, but lower access to each step of the depression care cascade, including diagnosis by a health professional, regular healthcare visits, and access to specialised treatment (H1); low-education Black women show the highest MDD frequency and the lowest access to care across the entire cascade (H2). Partially supporting H1 and H2, our results reveal a bottleneck in the first step of the depression care cascade. While no racial inequities were observed in the MDD prevalence, Black individuals were less likely than whites to be diagnosed by a health professional (OR 0.74). Women (OR 2.64) and low-education (OR 1.18) were more likely to have probable MDD in relation to men and high-education respondents, respectively, but only women (OR 1.58) were more likely to be diagnosed. Low-education Black women were equally more likely to have probable MDD (OR 3.11) than high-education white men. Conversely, high-education white women emerged as the most likely to be diagnosed with MDD (OR 1.63). Our findings suggest the inverse care law applies to the depression care cascade in Brazil through indication that its healthcare system perpetuates a multilayered system of oppression that overlooks multiply marginalised individuals. We also show that adequate screening by health care professionals should mitigate the complex patterns of inequity revealed by our study.
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Affiliation(s)
- Helena M Constante
- Graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Brazil
| | - João L Bastos
- Graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Brazil
| | - Milagros A Ruiz
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
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12
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Hurd NM, Young AS. Introduction to the Special Issue: Advancing Racial Justice in Clinical Child and Adolescent Psychology. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:311-327. [PMID: 37141558 PMCID: PMC10213141 DOI: 10.1080/15374416.2023.2202255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Relative to White youth, racially and ethnically marginalized youth in the U.S. are less likely to initiate treatment, stay in treatment, and receive adequate care. This special issue attends to racial injustice in clinical child and adolescent psychology. While numerous factors drive these racial disparities, this special issue focuses specifically on opportunities and responsibilities we have as mental health providers, teachers, mentors, researchers, and gatekeepers to make our field more racially just. In this introduction to the special issue, we review barriers and solutions across multiple contexts including structural, institutional, and practice-based. We also discuss challenges and opportunities to diversify our field and increase the representation of racially and ethnically marginalized practitioners and scholars in clinical child and adolescent psychology. We then briefly review the special issue articles and make final recommendations for how to move the field forward.
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Affiliation(s)
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
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13
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Progovac AM, Mullin BO, Yang X, Kibugi L(T, Mwizerwa D, Hatfield LA, Schuster MA, McDowell A, Cook BL. Despite Higher Rates of Minimally Recommended Depression Treatment, Transgender and Gender Diverse Medicare Beneficiaries with Depression Have Poorer Mental Health Outcomes: Analysis of 2009–2016 Medicare Data. Transgend Health 2023. [DOI: 10.1089/trgh.2022.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Rosenfeld EA, Lyman C, Roberts JE. Development of an mHealth App-Based Intervention for Depressive Rumination (RuminAid): Mixed Methods Focus Group Evaluation. JMIR Form Res 2022; 6:e40045. [PMID: 36512400 PMCID: PMC9795400 DOI: 10.2196/40045] [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] [Received: 06/03/2022] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Depression is a common mental health condition that poses a significant public health burden. Effective treatments for depression exist; however, access to evidence-based care remains limited. Mobile health (mHealth) apps offer an avenue for improving access. However, few mHealth apps are informed by evidence-based treatments and even fewer are empirically evaluated before dissemination. To address this gap, we developed RuminAid, an mHealth app that uses evidence-based treatment components to reduce depression by targeting a single key depressogenic process-rumination. OBJECTIVE The primary objective of this study was to collect qualitative and quantitative feedback that could be used to improve the design of RuminAid before the software development phase. METHODS We reviewed empirically supported interventions for depression and rumination and used the key aspects of each to create a storyboard version of RuminAid. We distributed an audio-guided presentation of the RuminAid storyboard to 22 individuals for viewing and solicited user feedback on app content, design, and perceived functionality across 7 focus group sessions. RESULTS The consumer-rated quality of the storyboard version of RuminAid was in the acceptable to good range. Indeed, most participants reported that they thought RuminAid would be an engaging, functional, and informational app. Likewise, they endorsed overwhelming positive beliefs about the perceived impact of RuminAid; specifically, 96% (21/22) believed that RuminAid will help depressed ruminators with depression and rumination. Nevertheless, the results highlighted the need for improved app aesthetics (eg, a more appealing color scheme and modern design). CONCLUSIONS Focus group members reported that the quality of information was quite good and had the potential to help adults who struggle with depression and rumination but expressed concern that poor aesthetics would interfere with users' desire to continue using the app. To address these comments, we hired a graphic designer and redesigned each screen to improve visual appeal. We also removed time gating from the app based on participant feedback and findings from related research. These changes helped elevate RuminAid and informed its initial software build for a pilot trial that focused on evaluating its feasibility and acceptability.
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Affiliation(s)
- Eve A Rosenfeld
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Menlo Park, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cassondra Lyman
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | - John E Roberts
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY, United States
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Tadesse A, Huang J. Women's Participation in a Savings Group and Depression: a Community-Based Financial Capability Intervention in Mozambique. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022; 10:49-59. [PMID: 36337380 PMCID: PMC9628344 DOI: 10.1007/s40609-022-00251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 05/05/2023]
Abstract
Background As one of the fastest growing community-based financial capability approaches, village savings and loan group (VSLG) is an organized group and formal entity that creates opportunities for participants to save and access financial assets. VSLG has potentially positive impacts on increasing women's financial resources and social support and further improves their mental health. Participation in a VSLG not only increases women's opportunities for asset-building and income generation, but also facilitates trust and promotes social capital development. However, few studies have examined the association between the VSLG participation and women's depression status. To fill the knowledge gap, we examined the association between the VSLG participation and depressive symptoms among low-income women in Mozambique. Methods The data was collected as part of the VSLG program evaluation. The study applied a posttest-only comparison group quasi-experimental design and sampled female VSLG participants and non-participants from three sub-villages in the Sofala province, Mozambique. A multi-stage sampling technique was employed, and a total of 205 women were randomly selected, including 105 VSLG participants and 100 non-participants. Depressive symptoms were measured using the short version of the Edinburgh Depression Scale (EDS) with a summative score ranging from 7 to 28. Using the cutoff value at a score of 14, we created a dichotomous depression indicator. Linear and logit models were used to examine the associations of the VSLG participation and the participation duration with the depression score and the presence of depression controlling for demographic variables. Results The VSLG participants had a statistically lower mean depression score of 12.2 (SD = 4.4) compared to non-participants (15.0, SD = 4.0, p < .001). The regression analysis suggested that the VSLG participants had a mean depression score of 2.7 lower than the non-participants (p < .001). Nearly 60% of the non-participants reported the presence of depression; however, this percentage is 31% for participants (p < .001). The multivariate logit model indicated the odds of the presence of depression for participants are .34 of that for non-participants. Similar results were obtained when the VSLG program duration was used as an independent variable. Conclusions Study findings showed a positive association between the VSLG participation and women's mental health. Future research should further explore the intervention mechanisms and assess how the VSLG participation affects women's mental health. Findings also provided important insights into developing community-based financial capability interventions to improve low-income women's mental health.
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Affiliation(s)
- Aweke Tadesse
- Saint Louis University, 3550 Lindell Blvd., Tegeler Hall 309, St. Louis, MO 63103 USA
| | - Jin Huang
- Saint Louis University, 3550 Lindell Blvd., Tegeler Hall 309, St. Louis, MO 63103 USA
- Center for Social Development, Washington University in St. Louis, St. Louis, MO 63112 USA
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16
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Paula CS, Ziebold C, Ribeiro WS, Pan PM, Mari JJ, Bressan R, Miguel EC, Rohde LA, Salum GA, Evans-Lacko S. THE INFLUENCE OF CAREGIVER ATTITUDES AND SOCIO-ECONOMIC GROUP ON FORMAL AND INFORMAL MENTAL HEALTH SERVICE USE AMONGST YOUTH. Eur Psychiatry 2022; 65:e34. [PMID: 35684952 PMCID: PMC9251818 DOI: 10.1192/j.eurpsy.2022.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cristiane Silvestre Paula
- Programa de Pós-Graduação em Distúrbios do Desenvolvimento e Centro Mackenzie de Pesquisa sobre a Infância e Adolescência-Universidade Presbiteriana Mackenzie (UPM), São Paulo-SP, Brazil
| | - Carolina Ziebold
- Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Wagner S Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science-LSE
| | - Pedro Mario Pan
- Laboratório de Neurociências Integrativas (LiNC), Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Jair Jesus Mari
- Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Rodrigo Bressan
- LiNC - Lab Integrative Neuroscience, Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP); Instituto Ame Sua Mente. São Paulo-SP, Brazil
| | | | - Luiz Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil
| | - Giovanni A Salum
- Section on Negative Affect and Social Processes - Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; National Institute of Developmental Psychiatry
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science-LSE
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17
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Huang V, Miranda SP, Dimentberg R, Shultz K, McClintock SD, Malhotra NR. Effect of Household Income on Short-Term Outcomes Following Cerebellopontine Angle Tumor Resection. Skull Base Surg 2022; 83:e31-e39. [PMID: 35832987 DOI: 10.1055/s-0040-1722664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
Objectives The objective of this study is to elucidate the impact of income on short-term outcomes in a cerebellopontine angle (CPA) tumor resection population. Design This is a retrospective regression analysis. Setting This study was done at a single, multihospital, urban academic medical center. Participants Over 6 years (from June 7, 2013, to April 24, 2019), 277 consecutive CPA tumor cases were reviewed. Main Outcome Measures Outcomes studied included readmission, emergency department evaluation, unplanned return to surgery, return to surgery after index admission, and mortality. Univariate analysis was conducted among the entire population with significance set at a p -value <0.05. The population was divided into quartiles based on median household income and univariate analysis conducted between the lowest (quartile 1 [Q1]) and highest (quartile 4 [Q4]) socioeconomic quartiles, with significance set at a p -value <0.05. Stepwise regression was conducted to determine the correlations among study variables and to identify confounding factors. Results Regression analysis of 273 patients demonstrated decreased rates of unplanned reoperation ( p = 0.015) and reoperation after index admission ( p = 0.035) at 30 days with higher standardized income. Logistic regression between the lowest (Q1) and highest (Q4) socioeconomic quartiles demonstrated decreased unplanned reoperation ( p = 0.045) and decreasing but not significant reoperation after index admission ( p = 0.15) for Q4 patients. No significant difference was observed for other metrics of morbidity and mortality. Conclusion Higher socioeconomic status is associated with decreased risk of unplanned reoperation following CPA tumor resection.
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Affiliation(s)
- Vincent Huang
- Department of Neurosurgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Stephen P Miranda
- Department of Neurosurgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ryan Dimentberg
- Department of Neurosurgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Kaitlyn Shultz
- Department of Mathematics, West Chester University of Pennsylvania, West Chester, Pennsylvania, United States
| | - Scott D McClintock
- Department of Mathematics, West Chester University of Pennsylvania, West Chester, Pennsylvania, United States
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Cheng AL, Bradley EC, Brady BK, Calfee RP, Klesges LM, Colditz GA, Prather H. The Influence of Race, Sex, and Social Disadvantage on Self-reported Health in Patients Presenting With Chronic Musculoskeletal Pain. Am J Phys Med Rehabil 2022; 101:211-216. [PMID: 33935150 PMCID: PMC8558108 DOI: 10.1097/phm.0000000000001774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study was to better address sociodemographic-related health disparities. This study examined which sociodemographic variables most strongly correlate with self-reported health in patients with chronic musculoskeletal pain. DESIGN This single-center, cross-sectional study examined adult patients, followed by a physiatrist for chronic (≥4 yrs) musculoskeletal pain. Sociodemographic variables considered were race, sex, and disparate social disadvantage (measured as residential address in the worst vs. best Area Deprivation Index national quartile). The primary comparison was the adjusted effect size of each variable on physical and behavioral health (measured by Patient-Reported Outcomes Measurement Information System [PROMIS]). RESULTS In 1193 patients (age = 56.3 ± 13.0 yrs), disparate social disadvantage was associated with worse health in all domains assessed (PROMIS Physical Function Β = -2.4 points [95% confidence interval = -3.8 to -1.0], Pain Interference = 3.3 [2.0 to 4.6], Anxiety = 4.0 [1.8 to 6.2], and Depression = 3.7 [1.7 to 5.6]). Black race was associated with greater anxiety than white race (3.2 [1.1 to 5.3]), and female sex was associated with worse physical function than male sex (-2.5 [-3.5 to -1.5]). CONCLUSIONS Compared with race and sex, social disadvantage is more consistently associated with worse physical and behavioral health in patients with chronic musculoskeletal pain. Investment to ameliorate disadvantage in geographically defined communities may improve health in sociodemographically at-risk populations.
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Affiliation(s)
- Abby L Cheng
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ethan C Bradley
- The Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Brian K Brady
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ryan P Calfee
- Department of Orthopaedic Surgery, Division of Hand and Microsurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Lisa M Klesges
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Heidi Prather
- Weill Cornell Medical College, New York City, NY, USA
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Adolescent depression screening in primary care: Who is screened and who is at risk? J Affect Disord 2022; 299:318-325. [PMID: 34910961 DOI: 10.1016/j.jad.2021.12.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Limited research has simultaneously focused on sociodemographic differences in who receives recommended adolescent depression screening in primary care and who endorses elevated depression and suicide risk on these screeners. We describe screening and risk rates in a large pediatric primary care network in the United States after the network expanded its universal depression screening guideline to cover all well-visits (i.e., annual medical checkups) for adolescents ages 12 and older. METHODS Between November 15, 2017 and February 1, 2020, there were 122,682 well-visits for adolescents ages 12-17 (82,531 unique patients). The Patient Health Questionnaire - Modified for Teens (PHQ-9-M) was administered to screen for depression. RESULTS A total of 99,961 PHQ-9-Ms were administered (screening rate=81.48%). The likelihood of screening was higher among adolescents who were female, 12-14 years of age at their first well-visit during the study, White, Hispanic/Latino, or publicly-insured (i.e., Medicaid-insured). Additionally, 5.92% of adolescents scored in the threshold range for depression symptoms and 7.19% endorsed suicidality. Heightened depression and suicide risk were observed among adolescents who were female, 15-17 years of age at their first well-visit during the study, Black, Hispanic/Latino, attending urban primary care practices, or Medicaid-insured. Odds of endorsing suicidality were also higher among teens who identified as other races. LIMITATIONS Limitations related to data available in the electronic health record and reliance on data from a single hospital system are noted. CONCLUSIONS Findings highlight misalignments in screening and risk status that are important to address to ensure more equitable screening implementation and health outcomes.
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Rhead RD, Woodhead C, Ahmad G, Das-Munshi J, McManus S, Hatch SL. A comparison of single and intersectional social identities associated with discrimination and mental health service use: data from the 2014 Adult Psychiatric Morbidity Survey in England. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2049-2063. [PMID: 35254450 PMCID: PMC9477952 DOI: 10.1007/s00127-022-02259-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
Inequities in mental health service use (MHSU) and treatment are influenced by social stratification processes linked to socially contextualised interactions between individuals, organisations and institutions. These complex relations underpin observed inequities and their experience by people at the intersections of social statuses. Discrimination is one important mechanism influencing such differences. We compared inequities in MHSU/treatment through single and intersectional status analyses, accounting for need. We assessed whether past-year discrimination differentially influences MHSU/treatment across single and intersecting statuses. Data came from a population survey (collected 2014-2015) nationally representative of English households (N = 7546). We used a theory and datadriven approach (latent class analysis) which identified five intersectional groups in the population comprising common combinations of social statuses. Single status analyses identified characteristics associated with MHSU/treatment (being a sexual minority (adjusted odds ratio (AOR) 1.65 95% CI:1.09-2.50), female (AOR 1.71, 95% CI:1.45-2.02), economically inactive (AOR 2.02, 95% CI:1.05-3.90), in the most deprived quintile (AOR 1.33, 95% CI:1.02-1.74), and Black (AOR 0.36 95% CI:0.20-0.66)). Intersectional analyses detected patterns not apparent from single status analyses. Compared to the most privileged group ("White British, highly educated, employed, high social class"), "Retired White British" had greater odds of MHSU/treatment (AOR 1.88, 95% CI:1.53-2.32) while "Employed migrants" had lower odds (AOR 0.39, 95% CI:0.27-0.55). Past-year discrimination was associated with certain disadvantaged social statuses and greater MHSU/treatment but-except for sexual minorities-adjusting for discrimination had little influence using either analytic approach. Observing patterns only by single social statuses masks potentially unanticipated and contextually varying inequities. The latent class approach offers policy-relevant insights into patterns and mechanisms of inequity but may mask other key intersectional patterns by statuses less common or under represented in surveys (e.g. UK-born ethnic minority groups). We propose multiple, context-relevant, theory-driven approaches to intersectional understanding of mental health inequalities.
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Affiliation(s)
- Rebecca D. Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Gargie Ahmad
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,South London and Maudsley (SLaM) NHS Trust, London, UK
| | - Sally McManus
- National Centre for Social Research, London, UK ,Violence and Society Centre, City, University of London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
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21
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Gorman DC, Ham SA, Staab EM, Vinci LM, Laiteerapong N. Medical Assistant Protocol Improves Disparities in Depression Screening Rates. Am J Prev Med 2021; 61:692-700. [PMID: 34284914 PMCID: PMC8627913 DOI: 10.1016/j.amepre.2021.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/16/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression is a prevalent condition for which screening rates remain low and disparities in screening exist. This study examines the impacts of a medical assistant screening protocol on the rates of depression screening, overall and by sociodemographic groups, in a primary care setting. METHODS Between September 2016 and August 2018, a quasi-experimental study of adult primary care visits was conducted at an urban academic clinic to ascertain the change in the rates of completion of the Patient Health Questionnaire-2 after the implementation of a medical assistant protocol (intervention) versus that of physician-only screening (control arm). Analyses were conducted between April 2019 and April 2020 and used interrupted time-series models with generalized estimating equations. RESULTS A total of 45,157 visits by 21,377 unique patients were included. Overall, screening increased from 18% (physician-only screening) to 57% (medical assistant protocol) (p<0.0001). Screening increased for all measured demographics. With physician screening, depression screening was less likely to occur at visits by women (than at visits by men; OR=0.91, 95% CI=0.85, 0.98) and at visits by Black/African American patients (than at visits by White; OR=0.91, 95% CI=0.84, 0.99). However, with the medical assistant protocol, depression screening was more likely to occur at visits by women (than at visits by men; OR=1.07, 95% CI=1.0002, 1.14) and at visits by Black/African American patients (than at visits by White; OR=1.11, 95% CI=1.02, 1.20). In addition, age-related disparities were mitigated for visits by patients aged 40-64 and ≥65 years (e.g., age ≥65 years: physician, OR=0.66, 95% CI=0.59, 0.73; medical assistant protocol, OR=0.78, 95% CI=0.71, 0.85), compared with visits by patients aged 18-39 years. CONCLUSIONS Implementation of a medical assistant protocol in a primary care setting may significantly increase depression screening rates while mitigating or removing sociodemographic disparities.
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Affiliation(s)
- Deirdre C Gorman
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Sandra A Ham
- Center for Health and The Social Sciences, The University of Chicago, Chicago, Illinois
| | - Erin M Staab
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Lisa M Vinci
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Neda Laiteerapong
- Department of Medicine, The University of Chicago, Chicago, Illinois.
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Coley RY, Johnson E, Simon GE, Cruz M, Shortreed SM. Racial/Ethnic Disparities in the Performance of Prediction Models for Death by Suicide After Mental Health Visits. JAMA Psychiatry 2021; 78:726-734. [PMID: 33909019 PMCID: PMC8082428 DOI: 10.1001/jamapsychiatry.2021.0493] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Clinical prediction models estimated with health records data may perpetuate inequities. OBJECTIVE To evaluate racial/ethnic differences in the performance of statistical models that predict suicide. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic/prognostic study, performed from January 1, 2009, to September 30, 2017, with follow-up through December 31, 2017, all outpatient mental health visits to 7 large integrated health care systems by patients 13 years or older were evaluated. Prediction models were estimated using logistic regression with LASSO variable selection and random forest in a training set that contained all visits from a 50% random sample of patients (6 984 184 visits). Performance was evaluated in the remaining 6 996 386 visits, including visits from White (4 031 135 visits), Hispanic (1 664 166 visits), Black (578 508 visits), Asian (313 011 visits), and American Indian/Alaskan Native (48 025 visits) patients and patients without race/ethnicity recorded (274 702 visits). Data analysis was performed from January 1, 2019, to February 1, 2021. EXPOSURES Demographic, diagnosis, prescription, and utilization variables and Patient Health Questionnaire 9 responses. MAIN OUTCOMES AND MEASURES Suicide death in the 90 days after a visit. RESULTS This study included 13 980 570 visits by 1 433 543 patients (64% female; mean [SD] age, 42 [18] years. A total of 768 suicide deaths were observed within 90 days after 3143 visits. Suicide rates were highest for visits by patients with no race/ethnicity recorded (n = 313 visits followed by suicide within 90 days, rate = 5.71 per 10 000 visits), followed by visits by Asian (n = 187 visits followed by suicide within 90 days, rate = 2.99 per 10 000 visits), White (n = 2134 visits followed by suicide within 90 days, rate = 2.65 per 10 000 visits), American Indian/Alaskan Native (n = 21 visits followed by suicide within 90 days, rate = 2.18 per 10 000 visits), Hispanic (n = 392 visits followed by suicide within 90 days, rate = 1.18 per 10 000 visits), and Black (n = 65 visits followed by suicide within 90 days, rate = 0.56 per 10 000 visits) patients. The area under the curve (AUC) and sensitivity of both models were high for White, Hispanic, and Asian patients and poor for Black and American Indian/Alaskan Native patients and patients without race/ethnicity recorded. For example, the AUC for the logistic regression model was 0.828 (95% CI, 0.815-0.840) for White patients compared with 0.640 (95% CI, 0.598-0.681) for patients with unrecorded race/ethnicity and 0.599 (95% CI, 0.513-0.686) for American Indian/Alaskan Native patients. Sensitivity at the 90th percentile was 62.2% (95% CI, 59.2%-65.0%) for White patients compared with 27.5% (95% CI, 21.0%-34.7%) for patients with unrecorded race/ethnicity and 10.0% (95% CI, 0%-23.0%) for Black patients. Results were similar for random forest models, with an AUC of 0.812 (95% CI, 0.800-0.826) for White patients compared with 0.676 (95% CI, 0.638-0.714) for patients with unrecorded race/ethnicity and 0.642 (95% CI, 0.579-0.710) for American Indian/Alaskan Native patients and sensitivities at the 90th percentile of 52.8% (95% CI, 50.0%-55.8%) for White patients, 29.3% (95% CI, 22.8%-36.5%) for patients with unrecorded race/ethnicity, and 6.7% (95% CI, 0%-16.7%) for Black patients. CONCLUSIONS AND RELEVANCE These suicide prediction models may provide fewer benefits and more potential harms to American Indian/Alaskan Native or Black patients or those with undrecorded race/ethnicity compared with White, Hispanic, and Asian patients. Improving predictive performance in disadvantaged populations should be prioritized to improve, rather than exacerbate, health disparities.
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Affiliation(s)
- R. Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle,Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle
| | | | - Maricela Cruz
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Susan M. Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle,Department of Biostatistics, University of Washington School of Public Health, Seattle
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Ametaj AA, Smith AM, Valentine SE. A Stakeholder-Engaged Process for Adapting an Evidence-Based Intervention for Posttraumatic Stress Disorder for Peer Delivery. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:793-809. [PMID: 33813717 DOI: 10.1007/s10488-021-01129-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Peer providers represent a growing sector of the U.S. workforce, yet guidance is needed on best practices for adapting behavioral health interventions for peer delivery. METHODS We utilized the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME; Wiltsey Stirman et al. 2013, 2019) to describe how we systematically adapted Skills Training in Affective and Interpersonal Regulation (STAIR) for posttraumatic stress disorder (PTSD) for peer delivery. Our process was iterative and relied on engagement of multiple stakeholders, including a work group of organizational leaders (N = 5), peer interventionists (N = 4), intervention experts (N = 2), and trial participants (N = 18). The FRAME was used to guide rapid coding across multiple data sources, including researcher field notes, meeting minutes, and intervention manual documents, and content analysis of semi-structured interviews with peer interventionists and trial participants. RESULTS Phase 1 (pre-trial) focused on modifications for fit with the local context and peer model. Key modifications focused on improving intervention design and packaging, removing clinical and stigmatizing language, and addressing peer interventionist training gaps. We used a hybrid approach to delivery, whereby we integrated peer model principles (self-disclosure, mutuality) into a directive approach. Phase 2 (trial) included reactive fidelity-consistent adaptations, such as additional educational resources. Phase 3 (post-trial) focused on adaptations to support roll-out of the intervention at the peer organization (e.g., group format). CONCLUSION Our stakeholder-engaged process may serve as a helpful exemplar to others tailoring interventions for peer delivery. Future research is needed to understand the role of stakeholder engagement and adaptation in implementation success.
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Affiliation(s)
- Amantia A Ametaj
- Department of Epidemiology, Harvard Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Ash M Smith
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA
| | - Sarah E Valentine
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA. .,Department of Psychiatry, Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
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Dunne J, Flores M, Gawande R, Schuman-Olivier Z. Losing trust in body sensations: Interoceptive awareness and depression symptom severity among primary care patients. J Affect Disord 2021; 282:1210-1219. [PMID: 33601698 PMCID: PMC10398840 DOI: 10.1016/j.jad.2020.12.092] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Interoceptive dysfunction is emerging as an important biomarker for mental illnesses, such as depression which is a leading cause of disability and death worldwide. Little empirical research explains the relationship between interoception and depression. METHODS Using multivariable linear regression models and cross-sectional baseline data from a randomized control trial of primary care patients (N = 281), we analyzed the relationship between depression severity (none/slight, mild, and moderate/severe via the PROMIS depression scale) and the Multidimensional Assessment of Interoceptive Awareness (MAIA) subscales (noticing, not distracting, not worrying, attention regulation, emotional awareness, selfregulation, body listening and trusting). RESULTS Adjusted results suggest moderate/severe depression was inversely associated with body trusting (p < .001), body listening (p < .01), noticing (p < .01), emotional awareness (p < .01), and self-regulation (p < .05). Mild depression was inversely associated with body trusting (p <.01). After correction for multiple comparisons, the relationship between MAIA body trusting and mild and moderate/severe depression remained significant. LIMITATIONS Our findings may not be generalizable to other populations or healthcare settings. Additionally, findings cannot be interpreted as causal due to our inability to establish temporality. CONCLUSIONS Lack of body trust appears important for understanding how individuals with depression interpret or respond to interoceptive stimuli and may represent the leading edge of interoceptive dysregulation seen in depressive disorders. Our findings support a hypothesis about mechanisms of action underlying hypoactivation in depression. Further, these results support clinical identification of subtypes of depression, such as those with high levels of co-occurring anxiety.
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Affiliation(s)
- Julie Dunne
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Boston College, W. F. Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA.
| | - Michael Flores
- Cambridge Health Alliance, Health Equity Research Lab, 1035 Cambridge Street, Suite 26, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Richa Gawande
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
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25
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Millender E, Barile JP, R Bagneris J, Harris RM, De Faria L, Wong FY, Crusto CA, Taylor JY. Associations between social determinants of health, perceived discrimination, and body mass index on symptoms of depression among young African American mothers. Arch Psychiatr Nurs 2021; 35:94-101. [PMID: 33593522 PMCID: PMC7890049 DOI: 10.1016/j.apnu.2020.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/09/2020] [Accepted: 09/12/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The association between symptoms of depression and risks for cardiovascular disease (CVD) remains equivocal for African American (AA) mothers. We examined the association between social determinants of health (perceived discrimination), and cardiovascular risk (BMI) on symptoms of depression in a sample of young AA mothers. METHODS Secondary data from 219 adult AA mothers between the ages of 21 and 46 with an average BMI of 29.8 and yearly family income of $14,999 were analyzed using a latent growth model that evaluated four time points to assess changes in symptoms of depression. RESULTS Initial BMI was significantly associated with initial symptoms of depression (b = 0.12, p = .019). Perceived discrimination (unfair treatment) was associated with higher initial symptoms of depression (b = 1.14, p = .017). CONCLUSION The findings suggest that elevated BMI and perceived discrimination are associated with higher reported symptoms of depression among young, socioeconomically disadvantaged AA mothers. These results advance the scientific understanding of young AA mothers' risk for symptoms of depression and CVD by elucidating the impact of perceived discrimination and social experiences on mental health. Further studies of SDoH and CVD risk factors and perceived racism and depression are needed to shed light on the long-term mental health impact on AA mothers and their children.
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Affiliation(s)
- Eugenia Millender
- Center for Population Sciences and Health Equity Associate Professor, College of Nursing, Florida State University, 2010 Levy Ave., Tallahassee, FL 32310, United States of America.
| | - John P Barile
- Department of Psychology, the University of Hawai'i at Mānoa, 2530 Dole St., Sakamaki Hall C404, Honolulu, HI 96822-2294, United States of America.
| | - Jessica R Bagneris
- Center for Population Sciences and Health Equity Associate Professor, College of Nursing, Florida State University, 2010 Levy Ave., Tallahassee, FL 32310, United States of America.
| | - Rachel M Harris
- Center for Population Sciences and Health Equity Associate Professor, College of Nursing, Florida State University, 2010 Levy Ave., Tallahassee, FL 32310, United States of America.
| | - Ludmila De Faria
- Clinical Associate Professor, Department of Psychiatry, University of Florida, United States of America.
| | - Frank Y Wong
- Center for Population Sciences and Health Equity Associate Professor, College of Nursing, Florida State University, 2010 Levy Ave., Tallahassee, FL 32310, United States of America.
| | - Cindy A Crusto
- Department of Psychiatry, Yale University School of Medicine, 300 George St, New Haven, CT 06511, United States of America; Department of Psychology, University of Pretoria, cnr Lynwood Road and Roper Street, Hatfield Pretoria 0002, South Africa.
| | - Jacquelyn Y Taylor
- Columbia University School of Nursing and Center for Research on People of Color, 560 W 168th Street, Room 605, New York, New York 10032, United States of America.
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26
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Huang V, Miranda SP, Dimentberg R, Glauser G, Shultz K, McClintock SD, Malhotra NR. The role of socioeconomic status on outcomes following cerebellopontine angle tumor resection. Br J Neurosurg 2021; 36:196-202. [PMID: 33423556 DOI: 10.1080/02688697.2020.1866165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE It is well documented that the interaction between many social factors can affect clinical outcomes. However, the independent effects of economics on outcomes following surgery are not well understood. The goal of this study is to investigate the role socioeconomic status has on postoperative outcomes in a cerebellopontine angle (CPA) tumor resection population. MATERIALS AND METHODS Over 6 years (07 June 2013 to 24 April 2019), 277 consecutive CPA tumor cases were reviewed at a single, multihospital academic medical center. Patient characteristics obtained included median household income, Charlson Comorbidity Index (CCI), race, BMI, tobacco use, amongst 23 others. Outcomes studied included readmission, ED evaluation, unplanned return to surgery (during and after index admission), return to surgery after index admission, and mortality within 90 days, in addition to reoperation and mortality throughout the entire follow-up period. Univariate analysis was conducted amongst the entire population with significance set at a p value <0.05. The population was divided into quartiles based on median household income and univariate analysis conducted between the lowest (Q1) and highest (Q4) socioeconomic quartiles, with significance set at a p value <0.05. Stepwise regression was conducted to determine the correlations amongst study variables and identify confounding factors. RESULTS Regression analysis of 273 patients did not find household income to be associated with any of the long-term outcomes assessed. Similarly, a Q1 vs Q4 comparison did not yield significantly different odds of outcomes assessed. CONCLUSION Although not statistically significant, the odds ratios suggest socioeconomic status may have a clinically significant effect on postsurgical outcomes. Further studies in larger, matched populations are necessary to validate these findings.
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Affiliation(s)
- Vincent Huang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen P Miranda
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Dimentberg
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kaitlyn Shultz
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, PA, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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27
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Ride J, Huang L, Mulraney M, Hiscock H, Coghill D, Sawyer M, Sciberras E, Dalziel K. Is 'minimally adequate treatment' really adequate? investigating the effect of mental health treatment on quality of life for children with mental health problems. J Affect Disord 2020; 276:327-334. [PMID: 32871663 DOI: 10.1016/j.jad.2020.07.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/29/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Minimally adequate treatment (MAT) is intended to represent treatment minimally sufficient for common mental health problems. For children, MAT has been defined over a twelve-month period as either eight or more mental health visits, or four to seven visits plus relevant medication. MAT is used to identify those missing out on adequate care, but it is unknown whether MAT improves children's outcomes. METHODS This paper examines whether MAT is associated with improved outcomes for children. It uses survey data from the nationally representative Longitudinal Study of Australian children on 596 children with mental health problems based on the Strengths and Difficulties Questionnaire at ages 8-15 years, linked to health service administrative data from 2012 to 2016. Statistical analysis examines the association of MAT with later quality of life (Pediatric Quality of Life Inventory), using a lagged dependent variable model to account for time-varying unobserved confounding. RESULTS Compared to children with lower levels of treatment, those who received MAT between baseline and follow up had no statistically significant improvement in either quality of life or mental health symptoms. LIMITATIONS The observational data provide insight into real-world practice but require statistical methods to account for selection into treatment. CONCLUSIONS While clinical trials show mental health treatments can be efficacious, this study shows no evidence that children receiving MAT in routine practice have better outcomes. These findings demonstrate the need for better understanding of the nature and impact of children's mental health care as it is delivered and received in routine practice.
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Affiliation(s)
- Jemimah Ride
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Li Huang
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Melissa Mulraney
- Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia; Health Services Research Unit, Royal Children's Hospital, Australia
| | - David Coghill
- Department of Paediatrics, University of Melbourne, Australia; Department of Psychiatry, University of Melbourne, Australia
| | | | | | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia
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Differential Experiences of Mental Health among Trans/Gender Diverse Adults in Michigan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186805. [PMID: 32961959 PMCID: PMC7557385 DOI: 10.3390/ijerph17186805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Abstract
Transgender and gender diverse individuals experience high rates of health disparities, as compared with their cisgender (non-transgender) counterparts. One area in which these disparities is most grave is that of mental health, with some studies indicating transgender and gender diverse individuals as having a 40% rate of lifetime suicide attempts and similarly high rates of depression, anxiety, and suicidal ideation. These rates vary further within this population, with differential rates seen across sociodemographic factors, including race/ethnicity, gender, sexual orientation, disability status, education level, and income. This study explores mental health experiences across different social identities, using data from the 2018 Michigan Trans Health Survey (N = 659), a community-based participatory action research project collected in Michigan, United States, analyzed using chi-square tests of independence and logistic regressions. Findings indicate incredibly high rates of mental health concerns; 72.2% had been diagnosed with depression in their lifetime and 73.0% had been diagnosed with anxiety in their lifetime. In the past year, 49.9% had had non-suicidal self-injury (NSSI) thoughts, 45.4% had suicidal thoughts, 26.3% engaged in NSSI, and 7.7% had attempted suicide. Bivariate regressions showed some nuanced experiences of rates of mental health diagnoses and experiences, such as greater odds of experiencing all mental health disparities among those with disabilities, and differential odds across gender in regard to ever having a depression diagnosis, non-suicidal self-injury thoughts and engaging in non-suicidal self-injury behavior. This indicates a need for social workers, counselors, therapists, and other human services professionals to act more intentionally and with an intersectional lens when it comes to exploring the mental health of transgender and gender diverse persons.
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29
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Garcia ME, Hinton L, Gregorich SE, Livaudais-Toman J, Kaplan C, Karliner L. Unmet Mental Health Need Among Chinese and Latino Primary Care Patients: Intersection of Ethnicity, Gender, and English Proficiency. J Gen Intern Med 2020; 35:1245-1251. [PMID: 31667737 PMCID: PMC7174511 DOI: 10.1007/s11606-019-05483-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/09/2019] [Accepted: 10/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ethnic minorities who present with mental health symptoms in primary care are less likely to receive treatment than non-Hispanic whites; language barriers may magnify this disparity. OBJECTIVE We examined the contributions of ethnicity, gender, and English proficiency to unmet mental health need. DESIGN Cross-sectional study. PARTICIPANTS Chinese and Latino primary care patients with a preferred language of English, Cantonese, Mandarin, or Spanish. MAIN MEASURES Participants were interviewed within 1 week of a primary care visit and asked whether in the prior year they (1) needed help with emotional or mental health symptoms and (2) had seen a primary care physician or a mental health professional for these symptoms. Among those who reported "mental health need," we defined "unmet mental health need" as no reported use of services for these symptoms. Regression models explored independent and interaction effects among ethnicity, gender, and English proficiency, on the two outcomes. KEY RESULTS Among 1149 participants (62% women; 262 Chinese, with English proficiency [EP], 532 Chinese, with limited English proficiency [LEP], 172 Latino with EP; and 183 Latino with LEP), 33% reported mental health need. Among Chinese, but not Latino, participants, those with LEP were more likely than those with EP to report mental health need (AOR 2.55, 95% CI 1.73-3.76). Women were more likely to report mental health need than men (AOR 1.35, 1.03-1.79) regardless of ethnicity or English proficiency. Among participants reporting mental health need, 41% had unmet mental health need. Men with LEP, compared with those with EP, were more likely to have unmet mental health need regardless of ethnicity (AOR 2.53, 1.06-6.04). CONCLUSIONS We found high levels of mental health symptoms and unmet mental health need in both Chinese and Latino primary care patients. These results affirm the need to implement depression screening and targeted treatment interventions for patient subgroups at highest risk of untreated symptoms, such as men with LEP.
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Affiliation(s)
- Maria E Garcia
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, CA, USA.
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Division of General Internal Medicine, UCSF, San Francisco, CA, USA.
| | - Ladson Hinton
- Latino Aging Research Resource Center, University of California, Davis, Davis, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, USA
| | - Steven E Gregorich
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, CA, USA
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, UCSF, San Francisco, CA, USA
| | - Jennifer Livaudais-Toman
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Celia Kaplan
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, CA, USA
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, UCSF, San Francisco, CA, USA
| | - Leah Karliner
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, CA, USA
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, UCSF, San Francisco, CA, USA
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Simonetti JA, Piegari R, Maynard C, Brenner LA, Mori A, Post EP, Nelson K, Trivedi R. Characteristics and Injury Mechanisms of Veteran Primary Care Suicide Decedents with and without Diagnosed Mental Illness. J Gen Intern Med 2020:10.1007/s11606-020-05787-1. [PMID: 32219647 DOI: 10.1007/s11606-020-05787-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/09/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND In the United States, suicide rates are increasing among nearly all age groups. Primary care is a critical setting for suicide prevention, where interventions often rely on identifying mental health conditions as indicators of elevated suicide risk. OBJECTIVE Quantify the proportion of suicide decedents within primary care who had no antecedent mental health or substance use diagnosis. DESIGN Retrospective cohort study. PARTICIPANTS Veterans who received Veterans Health Administration (VHA) primary care any time from 2000 to 2014 and died by suicide before 2015 (n = 27,741). MAIN MEASURES We categorized decedents by whether they had any mental health or substance use diagnosis (yes/no) using ICD-9 codes available from VHA records. We compared sociodemographic, clinical, and suicide mechanism characteristics between groups using chi-square, Student's T, or Wilcoxon tests. RESULTS Forty-five percent of decedents had no mental health or substance use diagnosis. Decedents without such a diagnosis were older (68 vs. 57 years, p < 0.001), and more likely to be male (98.3% vs. 95.8%, p < 0.001), non-Hispanic White (90.6% vs. 87.9%, p < 0.001), married/partnered (50.4% vs. 36.6%, p < 0.001), and without military service-connected disability benefits (72.6% vs. 56.9%, p < 0.001). They were also more likely to die from firearm injury (78.9% vs. 60.7%, p < 0.001). There were statistically significant differences in physical health between groups, but the magnitudes of those differences were small. Decedents without a mental health or substance use diagnosis had significantly shorter durations of enrollment in VHA healthcare, less healthcare utilization in their last year of life, and had little utilization aside from primary care visits. CONCLUSIONS AND RELEVANCE From 2000 to 2014, of nearly thirty thousand VHA primary care patients who died by suicide, almost half had no antecedent mental health or substance use diagnosis. Within VHA primary care settings, suicide risk screening for those with and without such a diagnosis is indicated.
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Affiliation(s)
- Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Rocky Mountain Regional VA Medical Center, G3-189, 1700 N Wheeling St, Aurora, CO, 80045, USA.
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, Washington, D.C., USA.
- Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
| | - Rebecca Piegari
- Department of Veterans Affairs, Clinical Systems Development and Evaluation, Veterans Health Administration, Washington, D.C., USA
| | - Charles Maynard
- VHA Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Rocky Mountain Regional VA Medical Center, G3-189, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Alaina Mori
- VHA Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Edward P Post
- VA HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karin Nelson
- VHA Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- General Medicine Service, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Ranak Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Division of Public Mental Health and Population Sciences, Stanford University, Palo Alto, CA, USA
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31
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Travers JL, Le C, Desai MM, Merrill JA. Factors Associated with Dissatisfaction in Medical Care Quality among Older Medicare Beneficiaries Suffering from Mental Illness. J Aging Soc Policy 2019; 33:51-66. [DOI: 10.1080/08959420.2019.1628624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jasmine L. Travers
- Postdoctoral Fellow, National Clinician Scholars Program, Yale Schools of Medicine and Nursing, New Haven, Connecticut, USA
| | - Cindy Le
- MPH Candidate, Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | - Mayur M. Desai
- Associate Professor of Epidemiology, Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jacqueline A. Merrill
- Professor of Nursing,Department of Biomedical Informatics at Columbia University Medical Center, Columbia University School of Nursing, New York, New York, USA
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McClendon J, Jackson JJ, Bogdan R, Oltmanns TF. Trajectories of racial and gender health disparities during later midlife: Connections to personality. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2019; 25:359-370. [PMID: 30525775 PMCID: PMC6557706 DOI: 10.1037/cdp0000238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We examined race/gender effects on initial levels and trajectories of self-reported physical and mental health, as well as the moderating role of personality. We hypothesized that health disparities would remain stable or decrease over time, and that at-risk personality traits (e.g., neuroticism) would have a more robust negative impact on health for Black participants. METHOD Analyses utilized 6 waves of data from a community sample of 1,577 Black and White adults (mean age 60 years), assessed every 6 months for 2.5 years. Using multigroup latent growth curve modeling, we examined initial levels and changes in health among White men, White women, Black men, and Black women. RESULTS Black participants reported lower initial physical health than Whites. Women's physical health was stable over time, whereas men's declined. There were no disparities in mental health. Higher agreeableness was associated with higher initial levels of physical health only among Black men and White women. All other personality traits were associated with physical and mental health similarly across race and gender. CONCLUSIONS Race and gender influence health trajectories. Most personality- health associations replicated across race and gender, except for agreeableness with physical health. An intersectional framework considering more than one aspect of social identity is crucial for understanding health disparities. Future studies may benefit from including large, diverse samples of participants and further examining the moderating effects of race and gender on personality associations with a variety of health outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Juliette McClendon
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Joshua J Jackson
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Thomas F Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis
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Khaled SM. Prevalence and potential determinants of subthreshold and major depression in the general population of Qatar. J Affect Disord 2019; 252:382-393. [PMID: 31003107 DOI: 10.1016/j.jad.2019.04.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/28/2019] [Accepted: 04/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a paucity of epidemiological studies of depression in war-free Arab countries. This study estimated the prevalence and potential determinants of Subthreshold (SUBDE) and Major Depressive Episode (MDE) in migrants and non-migrants typical of Qatar and neighboring Gulf countries. METHODS A telephone survey of a probability-based sample of 2,424 participants was conducted in February 2017. The sample was divided based on nationality and income: Low-Income Migrants (LIMs), High Income Migrants (HIMs), and non-migrants or Qatari Nationals (QNs). Participants completed the nine-item Physician Health Questionnaire (PHQ-9). Ethnicity, sociodemographics, health- and work-related information was collected. Bivariate and multinomial logistic regression analyses were used. RESULTS Overall prevalence of any depression ranged between 4.2% (95% CI: 3.3-5.3) and 6.6% (95% CI: 5.4-7.9) for a cut-off of 12 and 10, respectively. The diagnostic algorithm for SUBDE and MDE resulted in estimates of 5.5% (95% CI: 4.4-6.8) and 3.6% (95% CI: 2.8-4.5), respectively. SUBDE, but not MDE rates, were significantly increased in LIMs (OR=2.96, p = 0.004) and HIMs (OR = 2.00, p = 0.014) compared with non-migrants. Arab ethnicity was significantly associated with SUBDE: relative to South Asians (OR = 3.77, p < 0.001) and other ethnicities (OR = 3.61, p = 0.029). Arab ethnicity was significantly associated with MDE: relative to South Asians (OR = 10.42, p < 0.001) and South East Asians (OR = 3.54, p = 0.007). LIMITATIONS Clinical diagnostic interviews for depression were not included. CONCLUSION Using the PHQ-9, depression prevalence in Qatar was comparable to general population estimates from Western countries. Migrant status and ethnicity were associated with SUBDE and MDE with implications for early screening and community intervention.
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Affiliation(s)
- Salma M Khaled
- Social and Economic Survey Research Institute, Qatar University, Doha, Qatar.
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Narain K, Xu H, Azocar F, Ettner SL. Racial/ethnic disparities in specialty behavioral health care treatment patterns and expenditures among commercially insured patients in managed behavioral health care plans. Health Serv Res 2019; 54:575-585. [PMID: 30734279 PMCID: PMC6505415 DOI: 10.1111/1475-6773.13121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To document differences among racial/ethnic/gender groups in specialty behavioral health care (BH) utilization/expenditures; examine whether these differences are driven by probability vs intensity of treatment; and identify whether differences are explained by socioeconomic status (SES). DATA SOURCE The cohort consists of adults continuously enrolled in Optum plans with BH benefits during 2013. STUDY DESIGN We modeled each outcome using linear regressions among the entire sample stratified by race/ethnicity, language and gender. Then, we estimated logistic regressions of the probability that an enrollee had any spending/use in a given service category (service penetration) and linear regressions of spending/use among the user subpopulation (treatment intensity). Lastly, all analyses were rerun with SES controls. DATA COLLECTION This study links administrative data from a managed BH organization to a commercial marketing database. PRINCIPAL FINDINGS We found that in many cases, racial/ethnic minorities had lower specialty BH expenditures/utilization, relative to whites, primarily driven by differences in service penetration. Among women, relative to whites, Asian non-English speakers, Asian English speakers, Hispanic non-English speakers, Hispanic English speakers, and blacks had $106, $95, $90, $48, and $61 less in total expenditures. SES explained racial/ethnic differences in treatment intensity but not service penetration. CONCLUSIONS In this population, SES was not a major driver of racial/ethnic differences in specialty BH utilization. Future studies should explore the role of other factors not studied here, such as stigma, cultural competence, and geography.
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Affiliation(s)
- Kimberly Narain
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of MedicineUniversity of California, Los AngelesLos AngelesCalifornia
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of MedicineUniversity of California, Los AngelesLos AngelesCalifornia
| | | | - Susan L. Ettner
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of MedicineUniversity of California, Los AngelesLos AngelesCalifornia
- Department of Health Policy and ManagementFielding School of Public HealthUniversity of California, Los AngelesLos AngelesCalifornia
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Haley SJ, Moscou S, Murray S, Rieckmann T, Wells KL. The availability of alcohol, tobacco and other drug services for adults in New York State Community Health Centers. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2018.1562577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sean J. Haley
- Department of Health Policy and Management, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | | | - Sharifa Murray
- Ross University School of Medicine, Roseau, Commonwealth of Dominica, West Indies
| | - Traci Rieckmann
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Kameron L. Wells
- Department of Clinical Affairs, Community Health Care Association of New York State, New York, NY, USA
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Wang N, Xie X. Associations of health insurance coverage, mental health problems, and drug use with mental health service use in US adults: an analysis of 2013 National Survey on Drug Use and Health. Aging Ment Health 2019; 23:439-446. [PMID: 29469591 DOI: 10.1080/13607863.2018.1441262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the prevalence of mental health service use among US adults, examine the associations of mental health service use with health insurance coverage, mental health problems and drug use, and detect health disparities. METHODS This was a cross-sectional study with 5,434 adults receiving mental health service out of 37,424 adult respondents from the 2013 National Survey on Drug Use and Health. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors with mental health service use. RESULTS The overall prevalence of mental health services use was 14.7%. Our results showed that being female, aging, having a major depressive episode, serious psychological distress, and illicit drug or alcohol abuse/dependence were positively associated with mental health service use; whereas being African American, Asian or Hispanic ethnicity, married, and having any form of insurance were negatively associated with mental health service use . Stratified analysis by insurance types showed that Medicaid/CHIP, CHAMPUS, and other insurance were positively associated with mental health service use. CONCLUSIONS Health insurance coverage, mental health problems, and drug abuse or dependence were associated with mental health service use in US adults. Furthermore, adults with different insurances had disparities in access of mental health service.
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Affiliation(s)
- Nianyang Wang
- a Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - Xin Xie
- b Department of Economics and Finance, College of Business and Technology , East Tennessee State University , Johnson City , TN , USA
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Iyer AS, Holm KE, Bhatt SP, Kim V, Kinney GL, Wamboldt FS, Jacobs MR, Regan EA, Armstrong HF, Lowe KE, Martinez CH, Dransfield MT, Foreman MG, Shinozaki G, Hanania NA, Wise RA, Make BJ, Hoth KF. Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD - A cross sectional analysis of the COPDGene cohort. J Psychosom Res 2019; 118:18-26. [PMID: 30782350 PMCID: PMC6383809 DOI: 10.1016/j.jpsychores.2019.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the frequency of anxiety/depressive symptoms and use of anxiolytic-hypnotics/antidepressants in smokers with and without COPD and to identify characteristics associated with having unmedicated symptoms. METHODS Cross-sectional analysis of ambulatory, current/former smokers ≥10 pack years enrolled in the COPDGene study. We measured anxiety/depressive symptoms using the Hospital Anxiety and Depression Scale (subscales ≥8), recorded anxiolytic-hypnotic/antidepressant use, and defined unmedicated symptoms as elevated anxiety/depressive symptoms and not on medications. Regression analysis identified characteristics associated with having unmedicated symptoms. KEY RESULTS Of 5331 current/former smokers (45% with and 55% without COPD), 1332 (25.0%) had anxiety/depressive symptoms. Anxiety symptoms were similar in frequency in smokers with and without COPD (19.7% overall), while depressive symptoms were most frequent in severe-very severe COPD at 20.7% (13.1% overall). In the entire cohort, 1135 (21.2%) were on medications. Anxiolytic-hypnotic use was highest in severe-very severe COPD (range 7.6%-12.0%), while antidepressant use showed no significant variation in smokers with and without COPD (range 14.7%-17.1%). Overall, 881 (66% of those with symptoms) had unmedicated symptoms, which was associated with African American race (adjusted OR 2.95, 95% CI 2.25-3.87), male gender (adjusted OR 1.93, 95% CI 1.57-2.36), no health insurance (adjusted OR 2.38, 95% CI 1.30-4.35), severe-very severe COPD (adjusted OR 1.48, 95% CI 1.04-2.11), and higher respiratory symptoms/exacerbation history (adjusted OR 2.21, 95% CI 1.62-3.02). CONCLUSIONS Significant unmet mental health care needs exist in current and former smokers with and without COPD. One in five have unmedicated symptoms, identified by key demographic and clinical characteristics. PRIMARY FUNDING SOURCE National Institutes of Health and The COPD Foundation.
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Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Frederick S Wamboldt
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Michael R Jacobs
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA
| | - Elizabeth A Regan
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Hilary F Armstrong
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine E Lowe
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Marilyn G Foreman
- Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gen Shinozaki
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Nicola A Hanania
- Division of Pulmonary/Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Pulmonary, Critical Care, and Sleep Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Murillo LA, Grekoff GA, Sheffield JC. Assessing the effect of patient to provider language discordance on depression screening utilizing the Patient Health Questionnaire: an epidemiology study. Fam Pract 2019; 36:27-31. [PMID: 30299462 DOI: 10.1093/fampra/cmy097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As depression screening becomes a standard in primary care, the question remains of how effective and equitable screening can be implemented to avoid cultural and language-related disparities. METHODS In this retrospective cohort study, rates of depression screening were compared for 3626 adult patients at a family medicine residency-based health centre in Pennsylvania, USA. The PHQ-2/PHQ-9 modality was verbally administered by nursing staff at the time of patient intake as part of a universal screening initiative. Chi-square analysis was used to determine the univariate associations of performed depression screening with variables of language, ethnicity, gender and number of office visits. A binary logistic regression was then performed to measure whether univariate associations remain significant after correction for other variables. RESULTS Chi-square analysis revealed significant differences in screening based on univariate associations of language, gender and number of office visits. No significant difference was found for age or ethnicity. Binary logistic regression revealed the following odds ratio of being screened for depression for each variable: Spanish language (OR = 0.694, CI = 0.559 to 0.862), female gender (OR = 1.155, CI = 1.005 to 1.328) and office visit frequency of three or more office visits per year (OR = 2.103, CI = 1.835 to 2.410). CONCLUSIONS Spanish-speaking adults were significantly less likely to be screened for depression than their English-speaking counterparts. Women were more likely to be screened than men, and the odds of screening increased with more frequent exposure to the office. Future studies should be directed at validating these findings in multiple clinical settings.
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Affiliation(s)
- Luis A Murillo
- Reading Hospital Department of Family Medicine Residency, Tower Health, West Reading, USA
| | - Georgi Alex Grekoff
- Reading Hospital Department of Family Medicine Residency, Tower Health, West Reading, USA
| | - John C Sheffield
- Reading Hospital Department of Family Medicine Residency, Tower Health, West Reading, USA
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Dallo FJ, Prabhakar D, Ruterbusch J, Schwartz K, Peterson EL, Liu B, Ahmedani BK. Screening and follow-up for depression among Arab Americans. Depress Anxiety 2018; 35:1198-1206. [PMID: 30099819 DOI: 10.1002/da.22817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 05/15/2018] [Accepted: 07/01/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The authors compared proportions and associations of depression screening, major depression, and follow-up care of Arab Americans compared to non-Hispanic whites, non-Hispanic blacks, Asians, and Hispanics. METHODS Administrative data was electronically abstracted from a large health system in metropolitan Detroit among 97,918 adult patients in 2014 and 2015. A valid and reliable surname list was used to identify Arab Americans. Using chi-squares, we examined the relationship between race/ethnicity and depression screening, major depression, and follow-up care. We calculated odds ratios (OR) and 95% confidence intervals (CI) to examine the relationship between the main independent variable of race/ethnicity and the dependent variables of depression screening and major depression while controlling for confounders. RESULTS Arab American women were 23% less likely to be screened for depression compared to non-Hispanic white women (OR = 0.77; 95% CI = 0.70, 0.86). The age- and sex-adjusted proportions of major depression were 5.5% for Arab Americans compared to 7.0% for Hispanics, 6.0% for non-Hispanic blacks, 5.9% for non-Hispanic whites, and 1.5% for Asians. Arab Americans with major depression were less likely to follow up with a behavioral specialist and more likely to follow up with a primary care physician compared to other racial and ethnic groups. CONCLUSIONS Our study adds to the discourse on depression care among Arab Americans by highlighting the existing disparities related to adequate screening and appropriate management of depression. Future studies should include information about the influences of acculturation, culture, stigma, family, and religion on depression care.
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Affiliation(s)
- Florence J Dallo
- Public and Environmental Wellness, Oakland University, Rochester, Michigan
| | - Deepak Prabhakar
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan
| | - Julie Ruterbusch
- Department of Oncology, Wayne State University, Detroit, Michigan
| | - Kendra Schwartz
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | | | - Bin Liu
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Brian K Ahmedani
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
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Madubata IJ, Odafe MO, Talavera DC, Hong JH, Walker RL. Helplessness Mediates Racial Discrimination and Depression for African American Young Adults. JOURNAL OF BLACK PSYCHOLOGY 2018. [DOI: 10.1177/0095798418811476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial discrimination is associated with depressive symptoms for young African American adults. Yet few studies have examined the psychological mechanisms for this association. The purpose of this preliminary study was to examine the mediating effect of helplessness on the association between perceived racial discrimination and depressive symptoms in a sample of 172 African American young adults. Measures of perceived racial discrimination, depression, and helplessness were administered. Though the majority of the sample reported minimal or no symptoms of depression, approximately 37% of the sample reported dysphoric or more severe depression symptomatology. After controlling for age, perceived racial discrimination was directly and indirectly associated with depressive symptoms via helplessness. These findings provide some insight into the cognitive mechanisms through which depressive symptoms may emerge for African American young adults exposed to racial discrimination.
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Jones AL, Mor MK, Haas GL, Gordon AJ, Cashy JP, Schaefer JH, Hausmann LRM. The Role of Primary Care Experiences in Obtaining Treatment for Depression. J Gen Intern Med 2018; 33:1366-1373. [PMID: 29948804 PMCID: PMC6082202 DOI: 10.1007/s11606-018-4522-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/03/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Managing depression in primary care settings has increased with the rise of integrated models of care, such as patient-centered medical homes (PCMHs). The relationship between patient experience in PCMH settings and receipt of depression treatment is unknown. OBJECTIVE In a large sample of Veterans diagnosed with depression, we examined whether positive PCMH experiences predicted subsequent initiation or continuation of treatment for depression. DESIGN AND PARTICIPANTS We conducted a lagged cross-sectional study of depression treatment among Veterans with depression diagnoses (n = 27,362) in the years before (Y1) and after (Y2) they completed the Veterans Health Administration's national 2013 PCMH Survey of Healthcare Experiences of Patients. MAIN MEASURES We assessed patient experiences in four domains, each categorized as positive/moderate/negative. Depression treatment, determined from administrative records, was defined annually as 90 days of antidepressant medications or six psychotherapy visits. Multivariable logistic regressions measured associations between PCMH experiences and receipt of depression treatment in Y2, accounting for treatment in Y1. KEY RESULTS Among those who did not receive depression treatment in Y1 (n = 4613), positive experiences in three domains (comprehensiveness, shared decision-making, self-management support) predicted greater initiation of treatment in Y2. Among those who received depression treatment in Y1 (n = 22,749), positive or moderate experiences in four domains (comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of treatment in Y2. CONCLUSIONS In a national PCMH setting, patient experiences with integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support predicted patients' subsequent initiation and continuation of depression treatment over time-a relationship that could affect physical and mental health outcomes.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Maria K Mor
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John P Cashy
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - James H Schaefer
- Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and Deployment, Durham, NC, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Wu C, Chiang M, Harrington A, Kim S, Ziedonis D, Fan X. Racial disparity in mental disorder diagnosis and treatment between non-hispanic White and Asian American patients in a general hospital. Asian J Psychiatr 2018; 34:78-83. [PMID: 29674132 DOI: 10.1016/j.ajp.2018.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/08/2018] [Accepted: 04/01/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE The present study sought to examine the diagnosis and treatment of mental disorders comparing Asian American (AA) and non-Hispanic Whites (WNH) drawn from a population accessing a large general hospital for any reason. Socio-demographic predictors of diagnosis and treatment were also explored. METHODS Data were obtained from de-identified medical records in the Partner Health Care System's Research Patient Data Registry. RESULTS The final sample included 345,070 self-identified WNH and 16,418 self-identified AA's between January 1, 2009 and December 31, 2009. WNH patients were more likely than AA patients to carry a diagnosis of a mental disorder (18.1% vs. 8.6%, p < 0.0001) and were more likely to receive psychotropic medication treatment (15.0% vs 8.5%, p < 0.0001). Logistic regression analyses of the AA cohort identified several risk factors (i.e. language, religion, gender, age) predicting the diagnosis of a mental disorder or use of psychotropic medication. CONCLUSIONS Our findings on the racial disparity in mental disorder diagnosis and treatment between AA and WNH patients suggest that mental disorders are under-recognized and mental health services are under-utilized in the AA community. There remains a need for health care providers to improve screening services and to gain a better understanding of the cultural barriers that hinder mental health care among AA patients.
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Affiliation(s)
- Carrie Wu
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Mathew Chiang
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Amy Harrington
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Sun Kim
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Douglas Ziedonis
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States
| | - Xiaoduo Fan
- Department of Psychiatry, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, United States.
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Abstract
Perinatal depression is a common condition with significant adverse maternal, fetal, neonatal, and early childhood outcomes. The perinatal period is an opportune time to screen, diagnose, and treat depression. Improved recognition of perinatal depression, particularly among low-income women, can lead to improved perinatal health outcomes.
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Moukaddam N, Shah A, Shah AA. Emergency Psychiatry: How Far Have We Come? Psychiatr Ann 2018. [DOI: 10.3928/00485713-20171128-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mehta P, Brown A, Chung B, Jones F, Tang L, Gilmore J, Miranda J, Wells K. Community Partners in Care: 6-Month Outcomes of Two Quality Improvement Depression Care Interventions in Male Participants. Ethn Dis 2017; 27:223-232. [PMID: 28811733 DOI: 10.18865/ed.27.3.223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Limited data exist on approaches to improve depression services for men in under-resourced communities. This article explores this issue using a sub-analysis of male participants in Community Partners in Care (CPIC). DESIGN Community partnered, cluster, randomized trial. SETTING Hollywood-Metropolitan and South Los Angeles, California. PARTICIPANTS 423 adult male clients with modified depression (PHQ-8 score≥10). INTERVENTIONS Depression collaborative care implementation using community engagement and planning (CEP) across programs compared with the more-traditional individual program, technical assistance (Resources for Services, RS). MAIN OUTCOME MEASURES Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), mental wellness, services utilization and settings. RESULTS At screening, levels of probable depression were moderate to high (17.5%-47.1%) among men across services sectors. Intervention effects on primary outcomes (PHQ-8 score and MHRQL) did not differ. Men in CEP compared with RS had improved mental wellness (OR 1.85, 95% CI 1.00-3.42) and reduced hospitalizations (OR .40, 95% CI .16-.98), with fewer mental health specialty medication visits (IRR 0.33, 95% CI .15-.69), and a trend toward greater faith-based depression visits (IRR 2.89, 95% CI .99-8.45). CONCLUSIONS Exploratory sub-analyses suggest that high rates of mainly minority men in under-resourced communities have high prevalence of depression. A multi-sector coalition approach may hold promise for improving community-prioritized outcomes, such as mental wellness and reduced hospitalizations for men, meriting further development of this approach for future research and program design.
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Affiliation(s)
- Pratik Mehta
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif
| | - Anthony Brown
- Healthy African American Families, Los Angeles, Calif
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif.,Center for Health Services and Society, UCLA Semel Institute, Los Angeles, Calif
| | - Felica Jones
- Healthy African American Families, Los Angeles, Calif
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif.,Center for Health Services and Society, UCLA Semel Institute, Los Angeles, Calif
| | - James Gilmore
- Behavioral Health Services, Inc., Los Angeles, Calif
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif.,Center for Health Services and Society, UCLA Semel Institute, Los Angeles, Calif
| | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif.,Center for Health Services and Society, UCLA Semel Institute, Los Angeles, Calif.,Department of Health Services and Society, UCLA Medical Center, Los Angeles, Calif
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Abstract
OBJECTIVE To document racial/ethnic and gender differences in health service use and access after the Affordable Care Act went into effect. DATA SOURCE Secondary data from the 2006-2014 National Health Interview Survey. STUDY DESIGN Linear probability models were used to estimate changes in health service use and access (i.e., unmet medical need) in two separate analyses using data from 2006 to 2014 and 2012 to 2014. DATA EXTRACTION Adult respondents aged 18 years and older (N = 257,560). PRINCIPAL FINDINGS Results from the 2006-2014 and 2012-2014 analyses show differential patterns in health service use and access by race/ethnicity and gender. Non-Hispanic whites had the greatest gains in health service use and access across both analyses. While there was significant progress among Hispanic respondents from 2012 to 2014, no significant changes were found pre-post-health care reform, suggesting access may have worsened before improving for this group. Asian men had the largest increase in office visits between 2006 and 2014, and although not statistically significant, the increase continued 2012-2014. Black women and men fared the worst with respect to changes in health care access. CONCLUSIONS Ongoing research is needed to track patterns of health service use and access, especially among vulnerable racial/ethnic and gender groups, to determine whether existing efforts under health care reform reduce long-standing disparities.
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Manuel JI. The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2017; 17:10-35. [PMID: 30983911 PMCID: PMC6456903 DOI: 10.1080/1533256x.2017.1302887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examined the impact of the Affordable Care Act (ACA) on gender and racial/ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy/binge alcohol use (n=52,496) and those with alcohol use disorder (n=22,966). Difference-in-differences models estimated service-related disparities before (2008-2009) and after (2011-2014) health care reform. A sub-analysis was conducted before (2011-2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy/binge drinking were excluded from SUD treatment and unmet need outcome models due to insufficient cell size. Among heavy/binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. MH treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. While there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.
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Affiliation(s)
- Jennifer I Manuel
- Assistant Professor, Silver School of Social Work, New York University, New York, NY, USA
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Kaye EC, Brinkman TM, Baker JN. Development of depression in survivors of childhood and adolescent cancer: a multi-level life course conceptual framework. Support Care Cancer 2017; 25:2009-2017. [PMID: 28281048 DOI: 10.1007/s00520-017-3659-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/01/2017] [Indexed: 12/25/2022]
Abstract
As therapeutic and supportive care interventions become increasingly effective, growing numbers of childhood and adolescent cancer survivors face a myriad of physical and psychological sequelae secondary to their disease and treatment. Mental health issues, in particular, present a significant problem in this unique patient population, with depression affecting a sizable number of childhood and adolescent cancer survivors. Multiple key determinants impact a survivor's risk of developing depression, with variables traversing across biologic, individual, family, community, and global levels, as well as spanning throughout the life course of human development from the preconception and prenatal periods to adulthood. A multi-level life course conceptual model offers a valuable framework to identify and organize the diverse variables that modulate the risk of developing depression in survivors of childhood and adolescent cancer. This review describes the first multi-level life course perspective applied to development of depression in childhood and adolescent cancer survivors. This conceptual framework may be used to guide the investigation of mental health interventions for SCACs to ensure that key determinants of depression occurrence are adequately addressed across various levels and throughout the life trajectory.
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Affiliation(s)
- Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA.
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA
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Bauldry S, Szaflarski M. Immigrant-based Disparities in Mental Health Care Utilization. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2017; 3:10.1177/2378023116685718. [PMID: 28845455 PMCID: PMC5568671 DOI: 10.1177/2378023116685718] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Studies of immigrant-based disparities in mental health care have been limited by small sample sizes and a lack of measures of different dimensions of acculturation. This study draws on the National Epidemiological Survey on Alcohol and Related Conditions to address these limitations. Results indicate first-generation immigrants have lower rates of utilization for both mood and anxiety disorders. Nativity-based disparities in treatment are particularly notable among people from African and Hispanic origins, while there is little evidence of disparities among people from European origins. Of three dimensions of acculturation, only the identity dimension has a positive association with mental health care utilization.
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Alcántara C, Li X, Wang Y, Canino G, Alegría M. Treatment moderators and effectiveness of Engagement and Counseling for Latinos intervention on worry reduction in a low-income primary care sample. J Consult Clin Psychol 2016; 84:1016-1022. [PMID: 27631958 PMCID: PMC5343668 DOI: 10.1037/ccp0000146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We conducted a secondary analysis of randomized controlled trial data to determine if the Engagement and Counseling for Latinos (ECLA) intervention, a brief, evidence-based, and culturally adapted cognitive-behavioral intervention specifically designed for and effective at treating depression, also reduced co-occurring worry symptoms. We also explored whether delivery modality (telephone, face-to-face) and sociodemographic patient characteristics moderated treatment effectiveness. METHOD Between May 2011 and September 2012, low-income Latino primary care patients (N = 257) with depression from Boston and San Juan were randomized to usual care (n = 86), face-to-face ECLA (n = 84), or telephone ECLA (n = 87) and completed a psychosocial assessment at baseline and 4 months after randomization. We used intention-to-treat analyses with linear regression models with change in worry (4 months from randomization) as the primary outcome and treatment condition as the primary predictor. RESULTS Patients in ECLA experienced significant reductions in worry at 4 months from randomization than those in usual care (PSWQΔ = -3.28, p < .05). Among patients receiving ECLA, those in the telephone condition exhibited greater worry reductions than those in the face-to-face condition (telephone: M = -7.83, SD = 11.45; face-to-face: M = -6.73, SD = 12.23; p < .05). Employment status was the only significant treatment moderator. Unemployed patients did not exhibit any changes in worry irrespective of condition, whereas employed patients exhibited the greatest worry reductions across conditions. CONCLUSIONS Although worry was not a treatment target in ECLA, it also reduced worry among low-income Latinos, which suggests ECLA may have transdiagnostic clinical implications. Telephone-delivered ECLA might hold promise for increasing the uptake of mental health care among employed low-income Latinos. (PsycINFO Database Record
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Affiliation(s)
| | - Xinliang Li
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
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