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Meiselbach MK, Ettman CK, Shen K, Castrucci BC, Galea S. Unmet need for mental health care is common across insurance market segments in the United States. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae032. [PMID: 38756925 PMCID: PMC10986235 DOI: 10.1093/haschl/qxae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 05/18/2024]
Abstract
A substantial proportion of individuals with depression in the United States do not receive treatment. While access challenges for mental health care have been documented, few recent estimates of unmet mental health needs across insurance market segments exist. Using nationally representative survey data with participant-reported depression symptom severity and mental health care use collected in Spring 2023, we assessed access to mental health care among individuals with similar levels of depression symptom severity with commercial, Medicare, Medicaid, and no insurance. Among individuals who reported symptoms consistent with moderately severe to severe depression, 37.8% did not have a diagnosis for depression (41.0%, 28.1%, 33.6%, and 56.3% with commercial, Medicare, Medicaid, and no insurance), 51.9% did not see a mental health specialist (49.7%, 51.7%, 44.9%, and 91.8%), and 32.4% avoided mental health care due to affordability in the past 12 months (30.2%, 34.0%, 21.1%, and 54.8%). There was substantial unmet need for mental health treatment in all insurance market segments, but especially among individuals without insurance.
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Affiliation(s)
- Mark K Meiselbach
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Catherine K Ettman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Karen Shen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA 02118, United States
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Vasiliadis HM, Spagnolo J, Fleury MJ, Gouin JP, Roberge P, Bartram M, Grenier S, Shen-Tu G, Vena JE, Wang J. Factors associated with mental health service use during the pandemic: Initiation and barriers. Int J Soc Psychiatry 2024; 70:59-69. [PMID: 37646244 PMCID: PMC10860360 DOI: 10.1177/00207640231194489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Scarce are the studies focusing on initiation of new mental health service use (MHSU) and distinguishing individuals who have sought services but have been unsuccessful in accessing these. AIMS Assessing the factors associated with initiating new MHSU as compared to no MHSU due to self-reported no need, no MHSU due to health system and personal barriers and MHSU using resources already in place. METHODS The sample included participants (n = 16,435) in the five established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) who responded to the CanPath COVID-19 health surveys (May-December 2020 and January-June 2021). Multinomial regression analyses were carried out to study MHSU since the pandemic (March 2020) as a function of predisposing, enabling and need factors. Analyses were carried out in the overall sample and restricted to those with moderate and severe symptoms (MSS) of depression and/or anxiety (n = 2,237). RESULTS In individuals with MSS of depression and/or anxiety, 14.4% reported initiating new MHSU, 22.0% had no MHSU due to barriers and personal reasons and 36.7% had no MHSU due to self-reported no need. Age, living alone, lower income, a decrease in income during the pandemic and health professional status were associated with MHSU. Younger adults were more likely to initiate MHSU during the pandemic than older adults who reported not being comfortable to seek mental health care or self-reported no need. Individuals living alone and with lower income were more likely to report not being able to find an appointment for mental health care. CONCLUSIONS Awareness campaigns focusing on older adults that explain the importance of seeking treatment is needed, as well as sensitising health professionals as to the importance of informing and aiding individuals at risk of social isolation and lower socio-economic status as to available mental health resources and facilitating access to care.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, QC, Canada
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, QC, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Verdun, QC, Canada
- McGill University, Montreal QC, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montreal, QC, Canada
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Pasquale Roberge
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy & Administration, Carleton University, Ottawa, ON, Canada
| | - Sébastien Grenier
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
- Département de psychologie, Université de Montréal, Montréal, QC, Canada
| | - Grace Shen-Tu
- Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Jennifer E. Vena
- Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Goldman-Mellor S, Plancarte V, Perez-Lua F, Payán DD, De Trinidad Young ME. Mental health among rural Latino immigrants during the COVID-19 pandemic. SSM - MENTAL HEALTH 2023; 3:100177. [PMID: 36570024 PMCID: PMC9758750 DOI: 10.1016/j.ssmmh.2022.100177] [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: 10/12/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The mental health of the United States' Latino population significantly deteriorated during the SARS-CoV-2 (COVID-19) pandemic, and Latino immigrants living in rural areas faced unique vulnerabilities. However, few studies have specifically examined the mental health burden and experiences of rural Latino immigrants during the COVID pandemic. To understand the mental health experiences of first- and second-generation Latinos in rural areas, we conducted semi-structured interviews with 35 Latino residents of rural California counties during July 2020-February 2021 and screened all respondents for major depression and generalized anxiety symptoms using the Patient Health Questionnaire [PHQ]-2 and Generalized Anxiety Disorder [GAD]-2 screeners. We explored the prevalence of symptoms of depression and anxiety in our sample, iteratively analyzed participants' narratives regarding the mental health impact of the pandemic, and used their mental health screener status to contextualize these narratives. Results indicated that nearly all respondents viewed mental health as a major concern, and 34% (n = 12) of respondents screened positive for major depression or generalized anxiety disorder. Respondents connected their mental health concerns to experiences of financial precarity, fear of contracting COVID-19, social isolation, and the challenges of remote schooling. Additional themes emerged around problems accessing the mental health care system, the utility of pre-pandemic mental health services, and using healthy coping mechanisms to alleviate psychological problems. Respondents' narratives tended to focus on the mental health challenges facing their family members, particularly their children. Our findings suggest that mental health intervention models that engage with multiple family members, policies that support infrastructure for encouraging exercise and outdoor activity, and ensuring access to culturally and linguistically appropriate mental health care for Latino communities may be important for protecting population mental health.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA,Health Sciences Research Institute, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA,Corresponding author. Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| | - Vivianna Plancarte
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| | - Fabiola Perez-Lua
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| | - Denise Diaz Payán
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA,Health Sciences Research Institute, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| | - Maria-Elena De Trinidad Young
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA,Health Sciences Research Institute, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
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Taylor MM, Deb A, Frazier B, Lueken JR, Das M, Molke J, Fitzgerald E, Ullian T, Nair R, Couch M, Turbyfill C, Horter L, Joshi C, DeLuca N. Evaluation of the impact of guideline communication from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services among US healthcare providers: COVID-19 prevention counselling guidance. Nurs Open 2023; 10:7437-7445. [PMID: 37254439 PMCID: PMC10563432 DOI: 10.1002/nop2.1862] [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] [Received: 07/04/2022] [Revised: 10/05/2022] [Accepted: 05/09/2023] [Indexed: 06/01/2023] Open
Abstract
AIM To evaluate healthcare provider awareness and uptake of the Centers for Medicare & Medicaid Services (CMS) billing for coronavirus disease 2019 (COVID-19) prevention counselling and the delivery of prevention counselling to patients awaiting severe acute respiratory syndrome coronavirus 2 test results. DESIGN Cross sectional survey of US-based healthcare providers in February 2021. METHODS Analysis of associations with healthcare provider-reported awareness of CMS prevention counselling guidance and billing with provider type, specialty, and work setting. RESULTS A total of 1919 healthcare providers responded to the survey. Overall, 38% (726/1919) of providers reported awareness of available CMS reimbursement for COVID-19 patient counselling and 29% (465/1614) of CMS billing-eligible providers reported billing for this counselling. Among physicians, those aware of CMS guidance were significantly more likely to bill (58%) versus those unaware (10%). Among RNSights respondents eligible for CMS billing (n = 114), 31% of those aware of the guidance reported billing as compared to 0% of those not aware.
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Affiliation(s)
- Melanie M. Taylor
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Arkaprava Deb
- Hospital and Ambulatory Policy GroupCenters for Medicare and Medicaid ServicesWoodlawnMarylandUSA
| | - Bernita Frazier
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - James Reiss Lueken
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Mansi Das
- Office of the Assistant Director of CommunicationsCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | | | | | - Caitlin Turbyfill
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Libby Horter
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Cecilia Joshi
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Nickolas DeLuca
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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French A, Jones KA, Bettger JP, Maslow GR, Cholera R, Giri A, Swietek K, Tchuisseu YP, Repka S, Freed S, Whitaker R. Telehealth Utilization Among Adult Medicaid Beneficiaries in North Carolina with Behavioral Health Conditions During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01730-2. [PMID: 37584807 PMCID: PMC11006092 DOI: 10.1007/s40615-023-01730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE We examined factors associated with telehealth utilization during COVID-19 among adult Medicaid beneficiaries with behavioral health conditions. DATA SOURCES AND STUDY SETTING NC Medicaid 2019-2021 beneficiary and claims data. STUDY DESIGN This retrospective cohort study examined and compared behavioral health service use pre-COVID-19 (03/01/2019 to 02/28/2020) and during COVID-19 (04/01/2020 to 03/31/2021). Telehealth users included those with at least one behavioral health visit via telehealth during COVID-19. Descriptive statistics were calculated for overall sample and by telehealth status. Multilevel modified Poisson generalized estimating equation examined associations between telehealth use and patient- and area-level characteristics. DATA COLLECTION/EXTRACTION METHODS We identified individuals ages ≥ 21-64, diagnosed with a behavioral health condition, and had at least one behavioral-health specific visit before COVID-19. PRINCIPAL FINDINGS Almost two-thirds of the cohort received behavioral health services during COVID-19, with half of these beneficiaries using telehealth. Non-telehealth users had steeper declines in service use from pre- to during COVID-19 compared to telehealth users. Beneficiaries identifying as Black, multiracial or other were significantly less likely to use telehealth (ARR = 0.86; 95% CI: (0.83, 0.89)); (ARR = 0.92; 95% CI: (0.87, 0.96)) compared to White beneficiaries. Those eligible for Medicaid through the blind/disabled programs and who qualified for a state-specific specialized behavioral health plan were more likely to use telehealth (17% and 20%, respectively). CONCLUSIONS During the pandemic, telehealth facilitated continuity of care for beneficiaries with behavioral health conditions. Future research should aim to investigate how to reduce the digital divide and ensure equitable access to telehealth.
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Affiliation(s)
- Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, 1700 N. Broad Street, Suite 300, Philadelphia, PA, 19121, USA
| | - Gary R Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA
- Department of Pediatrics, Duke University School of Medicine, 4020 N Roxboro St, Box 3675, Durham, NC, 27710, USA
| | - Rushina Cholera
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, 4020 N Roxboro St, Box 3675, Durham, NC, 27710, USA
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Abhigya Giri
- The George Washington University Biostatistics Center, 6110 Executive Blvd, Rockville, MD, 20852, USA
| | - Karen Swietek
- NORC at the University of Chicago, 1 Broadway, 14Th Floor, Cambridge, MA, 02142, USA
| | - Yolande Pokam Tchuisseu
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Samantha Repka
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Salama Freed
- Health Policy and Management, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, 6th Floor, Washington, DC, 20052, USA
| | - Rebecca Whitaker
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
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Abramovich A, Pang N, Kim KV, Stark RK, Lange S, Chaiton M, Logie CH, Hamilton HA, Kidd SA. A longitudinal investigation of the effects of the COVID-19 pandemic on 2SLGBTQ+ youth experiencing homelessness. PLoS One 2023; 18:e0288591. [PMID: 37459299 PMCID: PMC10351701 DOI: 10.1371/journal.pone.0288591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The objective of this study was to examine the impacts of the coronavirus 2019 (COVID-19) pandemic on various dimensions of wellbeing among 2SLGBTQ+ youth experiencing homelessness over a 12-month period during the COVID-19 pandemic. METHODS 2SLGBTQ+ youth (recruited using a convenience sampling method) participated in three online surveys to assess mental health (depression, anxiety, suicidality), substance and alcohol use, health care access, and violence for 12-months between 2021-2022. Quantitative data analysis included non-parametric one-sample proportion tests, paired t-test and McNemar's test. Longitudinal data collected across all three timepoints were treated as paired data and compared to baseline data using non-parametric exact multinomial tests, and if significant, followed by pairwise post-hoc exact binomial tests. For the purposes of analysis, participants were grouped according to their baseline survey based on pandemic waves and public health restrictions. RESULTS 2SLGBTQ+ youth experiencing homelessness (n = 87) reported high rates of mental health challenges, including anxiety and depression, over 12-months during the pandemic. Youth participants reported experiencing poor mental health during the early waves of the pandemic, with improvements to their mental health throughout the pandemic; however, results were not statistically significant. Likewise, participants experienced reduced access to mental health care during the early waves of the pandemic but mental health care access increased for youth throughout the pandemic. CONCLUSION Study results showed high rates of mental health issues among 2SLGBTQ+ youth, but reduced access to mental health care, due to the COVID-19 pandemic. Findings highlight the need for 2SLGBTQ+ inclusive and affirming mental health care and services to address social and mental health issues that have been exacerbated by the pandemic.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Kawon Victoria Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rowen K. Stark
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Hayley A. Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Vasiliadis HM, Spagnolo J, Fleury MJ, Gouin JP, Roberge P, Bartram M, Grenier S, Shen-Tu G, Vena JE, Wang J. Mental health service use and associated predisposing, enabling and need factors in community living adults and older adults across Canada. BMC Health Serv Res 2023; 23:357. [PMID: 37046270 PMCID: PMC10091342 DOI: 10.1186/s12913-023-09335-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES Using Andersen's model of health care seeking behavior, we examined the predisposing, enabling, and need factors associated with mental health service use (MHSU) during the first wave of the COVID-19 pandemic across Canada. METHODS The sample included n = 45,542 participants in the 5 established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) and who responded to the CanPath COVID-19 health survey (May-December 2020), with complete data on MHSU. Multivariable logistic regression analyses were carried out to study MHSU as a function of predisposing, enabling, and need factors. Analyses were stratified by regional cohort. RESULTS Among the need factors, individuals reporting moderate/severe symptoms of depression and anxiety and poorer self-rated mental health were more likely to report MHSU. Among the enabling factors, receipt of informational/financial/practical support was associated with increased MHSU. While income was not consistently associated with MHSU, reported decrease in income was marginally associated with reduced MHSU. Among the predisposing factors, identifying as female or other gender minority was associated with increased MHSU, as was the presence of past-year cannabis use. In contrast, older age and alcohol consumption were associated with reduced MHSU. CONCLUSION Need factors were consistently associated with MHSU. Although income inequities in MHSU were not observed, changes such as reduced income during the pandemic may lead to barriers in accessing mental health services. Future research should focus on better identifying contextual enabling factors and policies that overcome financial barriers to MHSU.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada.
- Centre de recherche Charles-Le Moyne, 150, place Charles‑Le Moyne, C. P. 200, J4K 0A8, Longueuil (Québec), Canada.
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada
- Centre de recherche Charles-Le Moyne, 150, place Charles‑Le Moyne, C. P. 200, J4K 0A8, Longueuil (Québec), Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, 6875 boul., H4H 1R3, LaSalleVerdun (Québec), Canada
- McGill University, 845 Sherbrooke St W, H3A 0G4, Montreal (Québec), Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, 7141 Sherbrooke West, H4B 1R6, Montreal (Québec), Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4545 Queen Mary Rd, H3W 1W6, Montreal (Québec), Canada
| | - Pasquale Roberge
- Département de médecine familiale et d'urgence, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, 12e Avenue N Porte 6, J1H 5N4, Sherbrooke (Québec), Canada
| | - Mary Bartram
- Mental Health Commission of Canada, 350 Albert St #1210, K1R 1A4, Ottawa (Ontario), Canada
- School of Public Policy & Administration, Carleton University, 1125 Colonel By Drive, K1S 5B6, Ottawa (Ontario), Canada
| | - Sébastien Grenier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4545 Queen Mary Rd, H3W 1W6, Montreal (Québec), Canada
- Département de psychologie, Université de Montréal, 90, avenue Vincent d'Indy, H2V 2S9, Montréal (Québec), Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, 1820 Richmond Road SW, T2T 5C7, Calgary (Alberta), Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, 1820 Richmond Road SW, T2T 5C7, Calgary (Alberta), Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, B3H 1V7, Halifax (Nova Scotia), Canada
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Asfaw A. Association between reasons for not working and reporting of major depression and anxiety symptoms among U.S. adult population during the COVID-19 pandemic. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2023; 38:293-320. [PMID: 37608841 PMCID: PMC10440807 DOI: 10.1080/15555240.2023.2181178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/05/2023] [Indexed: 02/27/2023]
Abstract
COVID-19 continues to take a large toll on the mental health of the not working population, particularly of those who were unable to work. This study, using the Household Pulse Survey, estimated the association between reasons for not working and major depression and anxiety symptoms (MDAS). The lowest MDAS was reported by retirees. Individuals who were unable to work because of transportation problems, layoffs, COVID-19 concerns, and sickness or disability reported the highest MDAS. Mediation analysis showed that the direct and indirect effects of reasons for not working were much higher for those individuals who were unable to work than for individuals who were working or decided not to work.
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Affiliation(s)
- Abay Asfaw
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Washington, DC, USA
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McConnell KJ, Watson K, Choo E, Zhu JM. Geographical Variations In Emergency Department Visits For Mental Health Conditions For Medicaid Beneficiaries. Health Aff (Millwood) 2023; 42:172-181. [PMID: 36745838 PMCID: PMC11203219 DOI: 10.1377/hlthaff.2022.00796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite Medicaid's importance as a payer and source of coverage for mental health care, relatively little is known about how prevalence, access, and quality might vary among Medicaid beneficiaries. This study used national Medicaid data from 2018 to assess regional variations in emergency department (ED) visits for mental health conditions, a measure that may reflect unmet needs for behavioral health care. We found substantial variations, with rates in the region with the highest visit rates eight times higher than those in the region with the lowest rates. Many regions with high rates of ED visits for mental health conditions also had high rates of outpatient mental health use. Regional patterns differed substantially, with some regions exhibiting high rates of ED visits related to anxiety but low rates for schizophrenia and vice versa. The presence of large variations in ED visits for mental health conditions, with substantial differences in the composition across regions, suggests a need for context-specific solutions, including assessments of the ways in which mental health benefits are structured at the state Medicaid agency level and of differences in provider accessibility and an understanding of the types of mental illness underlying high rates of use.
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Affiliation(s)
- K John McConnell
- K. John McConnell , Oregon Health & Science University, Portland, Oregon
| | | | - Esther Choo
- Esther Choo, Oregon Health & Science University
| | - Jane M Zhu
- Jane M. Zhu, Oregon Health & Science University
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10
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Stoeckl SE, Torres-Hernandez E, Camacho E, Torous J. Assessing the Dynamics of the Mental Health Apple and Android App Marketplaces. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 8:1-8. [PMID: 36712910 PMCID: PMC9873536 DOI: 10.1007/s41347-023-00300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/26/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
Barriers to mental health care, including stigma, costs, and mental health professional shortages, have been exacerbated by the COVID-19 pandemic. Smartphone apps have the potential to increase scalability and improve access to mental health information, support, and interventions. However, evaluating these apps and selecting ones for use in care remain challenging, especially as apps are often updating and changing. Recommending apps requires knowledge of how stable apps are as the experience of one user several months ago may or may not be the same. A sample of 347 apps of the 650 apps on the M-health Index and Navigation Database (MIND) https://mindapps.org were reviewed between September 1, 2021, and January 5, 2022. Apps were selected by time since their last review, with updates occurring on average approximately 4 months from the last review. Eleven trained app evaluators reviewed apps across 105 evaluation criteria in 9 categories. Results were compared to initial ratings, identifying the changes that occurred. The average app updates every 433 days, though 19% were updated in the last 3 months and some nearly weekly. Changes in privacy and features made up the highest percentage of changes, both at 38%. The most frequently observed privacy-related change was increased privacy policy reading level. Functionality parameters changed in 28% of apps. The most common functionality change was the removal of an accessibility feature. Clinical foundations changed in 18% of apps and 9% added supporting studies. Cost structure changed in 17% of apps, with 10% adding a fee for use of the app. Engagement features changed in 17% of the apps, with additions and removals of validated assessments or screeners most common. The dynamic nature of the app stores is reflected in app privacy, features, and functionality. These changes, reflected by the increased reading levels required to understand privacy policies, the decrease in accessibility features, and the additions of fees to access mobile apps, reflect the need to constantly review apps and understand how they are evolving. Patient and clinicians should use the most recent and updated possible when evaluating apps.
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Affiliation(s)
- S. E. Stoeckl
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02446 USA
| | | | - Erica Camacho
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02446 USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02446 USA
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Introduction: Journaling and Mental Health during COVID-19: Insights from the Pandemic Journaling Project. SSM - MENTAL HEALTH 2022; 2:100141. [PMID: 36590985 PMCID: PMC9792128 DOI: 10.1016/j.ssmmh.2022.100141] [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: 03/29/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 01/09/2023] Open
Abstract
In this article, we introduce the SSM-MH Special Issue "Journaling and Mental Health during COVID-19: Insights from the Pandemic Journaling Project," which presents findings from the Pandemic Journaling Project (PJP). PJP is an online journaling platform and mixed-methods research study created in May 2020 to provide ordinary people around the world an opportunity to chronicle the impact of the COVID-19 pandemic in their lives-for themselves and for posterity. The essays in this collection demonstrate how journaling via an online platform can help illuminate experiences of mental wellbeing and distress, with important implications for both research and clinical practice. We begin by introducing the Pandemic Journaling Project and describing our procedures for generating the data subsets analyzed in the papers collected here. We then outline the principal interventions of the special issue as a whole, introduce the papers, and identify a number of cross-cutting themes and broader contributions. Finally, we point toward key questions for future research and therapeutic practice by highlighting the three-fold value of online journaling as a research method, a therapeutic strategy, and a tool for advancing social justice. We focus in particular on how this innovative methodological approach holds promise as both a modality for psychotherapeutic intervention and a form of grassroots collaborative ethnography. We suggest that our methods create new opportunities for confronting the impact of pandemics and other large-scale events that generate radical social change and affect population-level mental health.
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12
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Rudenstine S, Schulder T, Bhatt KJ, McNeal K, Ettman CK, Galea S. Long-COVID and comorbid depression and anxiety two years into the COVID-19 pandemic. Psychiatry Res 2022; 317:114924. [PMID: 37732865 PMCID: PMC9597528 DOI: 10.1016/j.psychres.2022.114924] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/16/2022] [Accepted: 10/22/2022] [Indexed: 11/24/2022]
Abstract
Long-COVID, or the persistence of COVID-19 symptoms for months after initial infection, has been shown to impact the lives of those affected. The current study sought to investigate the relationships between long-COVID, COVID-19 related stress, depression, anxiety, and comorbid depression and anxiety outcomes. Data were collected in Winter 2021-2022 from a population of adults enrolled in at least one course across multiple City University of New York (CUNY) campuses. Frequencies and chi-square tests were computed to assess for demographics and relationships to probable diagnoses of depression and anxiety, and binary logistic regressions were computed to assess for the odds of probable comorbid depression and anxiety based on demographics, stressors, and long-COVID. Women participants reported higher odds of probable depression outcomes, and stressor levels were significant correlates of probable anxiety outcomes. Women participants, 3.2 [1.5-6.9], as compared to men, lower-SES participants, 2.16 [1.1-4.2], as compared to higher-SES participants, participants with higher COVID-19 related stress levels, 4.8 [2.0-12.0], as compared to those with low levels, and participants with long-COVID, 3.7 [1.9-7.0], as compared to those without, all had higher odds of probable comorbid depression and anxiety. Findings highlight the importance of social location, stress, and long-COVID, in tandem, as correlates of psychological health during the shifting pandemic.
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Affiliation(s)
- Sasha Rudenstine
- Department of Psychology, City College of New York, 160 Convent Avenue NAC 8/122B, New York, NY 10031, United States.
| | - Talia Schulder
- Department of Psychology, City College of New York, 160 Convent Avenue NAC 8/122B, New York, NY 10031, United States.
| | - Krish J Bhatt
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, United States
| | - Kat McNeal
- Department of Psychology, City College of New York, 160 Convent Avenue NAC 8/122B, New York, NY 10031, United States
| | - Catherine K Ettman
- School of Public Health, Boston University, 715 Albany St, Boston, MA 02118, United States
| | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St, Boston, MA 02118, United States
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13
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Tabler J, Schmitz RM, Charak R, Propst A. Forgone Care among LGBTQ and Non-LGBTQ Americans during the COVID-19 Pandemic: The Role of Health, Social Support, and Pandemic-Related Stress. South Med J 2022; 115:752-759. [PMID: 36191911 PMCID: PMC9512140 DOI: 10.14423/smj.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In this study, we explore the role of Coronavirus Disease 2019 pandemic-related stress, social support, and health on unmet healthcare needs during the Coronavirus Disease 2019 pandemic, particularly among lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) adults. METHODS We collected data using a self-administered online survey of US adults. Using logistic regression, we modeled potential risk and protective factors for not receiving needed care during the pandemic (forgone care) among LGBTQ+ individuals (n = 121), cisgender and heterosexual-identifying women (n = 235), and cisgender and heterosexual-identifying men (n = 62). Limiting analyses to the LGBTQ+ subsample, we also assessed the unique role of LGBTQ+ discrimination and depressive symptoms. RESULTS Logistic regression results suggested that social support was associated with lower odds of forgone care (odds ratio [OR] 0.95, P < 0.01). Furthermore, better self-rated health and higher levels of income were associated with lower odds of forgone care (OR 0.56, P < 0.001, and OR 0.92, P < 0.05, respectively). Finally, LGBTQ+ individuals experienced uniquely high levels of forgone care, and LGBTQ+ discrimination (OR 1.03, P < 0.05) and depressive symptoms (OR 1.09, P < 0.01) were associated with higher odds of forgone care among LGBTQ+ participants. CONCLUSIONS Future research should examine the unique factors shaping the access to health care of LGBTQ+ adults in the United States, and healthcare practitioners should consider strategies to screen for discrimination and leverage the protective benefits of social support.
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Affiliation(s)
- Jennifer Tabler
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology, Oklahoma State University, Stillwater, and the Department of Psychological Science, the University of Texas Rio Grande Valley, Edinburg
| | - Rachel M. Schmitz
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology, Oklahoma State University, Stillwater, and the Department of Psychological Science, the University of Texas Rio Grande Valley, Edinburg
| | - Ruby Charak
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology, Oklahoma State University, Stillwater, and the Department of Psychological Science, the University of Texas Rio Grande Valley, Edinburg
| | - Aidan Propst
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology, Oklahoma State University, Stillwater, and the Department of Psychological Science, the University of Texas Rio Grande Valley, Edinburg
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14
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Shih E, Aylward BS, Kunkle S, Graziani G. Health-Related Quality of Life among Members using an On-Demand Behavioral Health Platform: A Pilot Observational Study (Preprint). JMIR Form Res 2021; 6:e35352. [PMID: 35802408 PMCID: PMC9308074 DOI: 10.2196/35352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite the well-known adverse health conditions and negative economic outcomes associated with mental health problems, accessing treatment is difficult due to reasons such as availability and cost. As a solution, digital mental health services have flooded the industry, and new studies are quickly emerging that support their potential as an accessible and cost-effective way to improve mental health outcomes. However, many mental health platforms typically use clinical tools such as the Patient Health Questionnaire-9 (PHQ-9) or General Anxiety Disorder-7 (GAD-7). Yet, many individuals that seek out care do not have clinical symptomatology and thus, traditional clinical measures may not adequately capture symptom improvement in general well-being. As an alternative, this study used the health-related quality of life (HRQoL) tool from the Centers for Disease Control and Prevention “Healthy Days” measure. This subjective measure of well-being is an effective way to capture HRQoL and might be better suited as an outcome measure for treatments that include both clinical and subclinical individuals. Objective The purpose of this study was to describe changes in HRQoL in clinical and subclinical members assessing virtual care and to examine the association between text-based behavioral coaching and virtual clinical sessions with changes in HRQoL. Methods A total of 288 members completed the 4-item HRQoL measure at baseline and at 1 month following use of the Ginger on demand behavioral health platform. Baseline anxiety and depression levels were collected using the GAD-7 and PHQ-9, respectively. Results Members completed on average 1.92 (SD 2.16) coaching sessions and 0.91 (SD 1.37) clinical sessions during the assessment month. Paired samples t tests revealed significant reductions in the average number of unhealthy mental health days between baseline (mean 16, SD 8.77 days) and follow-up (mean 13.2, SD 9.02 days; t287=5.73; P<.001), and in the average number of days adversely impacted (meanbaseline 10.9, meanfollow-up 8.19; t287=6.26; P<.001). Both subclinical members (t103=3.04; P=.003) and clinical members (t183=5.5; P<.001) demonstrated significant improvements through reductions in adversely impacted days over a month. Clinical members also demonstrated significant improvements through reductions in unhealthy mental health days (t183=5.82; P<.001). Finally, member engagement with virtual clinical sessions significantly predicted changes in unhealthy mental health days (B=–0.96; P=.04). Conclusions To our knowledge, this study is one of the first to use the HRQoL measure as an outcome in an evaluation of a digital behavioral health platform. Using real-world longitudinal data, our preliminary yet promising results show that short-term engagement with virtual care can be an effective means to improve HRQoL for members with subclinical and clinical symptoms. Further follow-up of reported HRQoL over several months is needed.
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Affiliation(s)
- Emily Shih
- Ginger, San Francisco, CA, United States
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15
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Jackson M, Lee Williams J. COVID-19 mitigation policies and psychological distress in young adults. SSM - MENTAL HEALTH 2021; 2:100027. [PMID: 34608462 PMCID: PMC8482549 DOI: 10.1016/j.ssmmh.2021.100027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has seen an unusually high proportion of the population suffering from mental health difficulties, but of particular concern is the disproportionate increase in psychological distress among younger adults. In this article, we exploit an explanatory sequential mixed-methods design to examine which aspects of the COVID-19 pandemic 18-25-year-olds found most challenging. We report analyses of American Voices Project (AVP) qualitative in-depth interview data, a MyVoice text-message open-ended survey, and Census Bureau Household Pulse Survey (HPS) data, all collected in 2020. Our interview and text-message results show that young adults were distressed about the effects of COVID-19 on the health of loved ones and older Americans. Young adults expressed concerns that the pandemic was not being treated sufficiently seriously by some politicians and the general public. The policy response was seen to be inadequate to the task of containing the disease, and some feared that the pandemic would never end. Statistical analyses of the HPS confirm that young adults' scores on the HPS's anxiety scale were significantly negatively associated with state-level policy responses. Overall, our results show that young adults found virus mitigation strategies challenging, but that a strong policy response was associated with reduced levels of psychological distress. Our results suggest that public health policy might have also operated as mental health policy during the COVID-19 pandemic.
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Affiliation(s)
- Michelle Jackson
- Department of Sociology, 450 Jane Stanford Way, Stanford University, CA, 94305, USA
| | - Joanna Lee Williams
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ, 08854-8020, USA
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