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Gardea-Resendez M, Ortiz-Orendain J, Miola A, Fuentes Salgado M, Ercis M, Coombes BJ, Gruhlke PM, Bostwick JM, Michel I, Vande Voort JL, Ozerdem A, McKean A, Frye MA, Taylor-Desir M. Racial differences in pathways to care preceding first episode mania or psychosis: a historical cohort prodromal study. Front Psychiatry 2023; 14:1241071. [PMID: 37732076 PMCID: PMC10507622 DOI: 10.3389/fpsyt.2023.1241071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Background There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Methods Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). Results A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. Conclusion These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.
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Affiliation(s)
- Manuel Gardea-Resendez
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Javier Ortiz-Orendain
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Alessandro Miola
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | | | - Mete Ercis
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Brandon J. Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Peggy M. Gruhlke
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - J. Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ian Michel
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Aysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Alastair McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Monica Taylor-Desir
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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2
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Chen BC, Lui JHL, Benson LA, Lin YJR, Ponce NA, Innes-Gomberg D, Lau AS. After the Crisis: Racial/Ethnic Disparities and Predictors of Care Use Following Youth Psychiatric Emergencies. JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 2022; 52:360-375. [DOI: 10.1080/15374416.2022.2127103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | - Joyce H. L. Lui
- Department of Psychology, University of California
- Department of Psychology, University of Maryland
| | | | | | | | | | - Anna S. Lau
- Department of Psychology, University of California
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3
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Espinoza-Kulick MAV, Cerdeña JP. "We Need Health for All": Mental Health and Barriers to Care among Latinxs in California and Connecticut. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12817. [PMID: 36232112 PMCID: PMC9565216 DOI: 10.3390/ijerph191912817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Latinx (im)migrant groups remain underserved by existing mental health resources. Past research has illuminated the complex factors contributing to this problem, including migration-related trauma, discrimination, anti-immigrant policies, and structural vulnerability. This paper uses decolonial-inspired methods to present and analyze results from two studies of Latinx (im)migrant communities in central California and southern Connecticut in the United States. Using mixed quantitative and qualitative analysis, we demonstrate the intersectional complexities to be addressed in formulating effective mental health services. Relevant social and structural factors including knowledge of mental health, access to insurance, and experiencing discrimination were significantly associated with anxiety symptoms, based on linear regression analysis. Ethnographic interviews demonstrate how complex trauma informs mental health needs, especially through the gendered experiences of women. Overlapping aspects of gender, language barriers, fear of authorities, and immigration status contoured the lived experiences of Latinx (im)migrants. Thematic analyses of open-ended survey responses also provide recommendations for solutions based on the experiences of those directly affected by these health disparities, particularly relating to healthcare access, affordability, and capacity. Building from these findings and past research, we recommend the adoption of a comprehensive model of mental health service provision for Latinx (im)migrants that takes into account Indigenous language access, structural competency, expanded health insurance, and resources for community health workers.
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Affiliation(s)
| | - Jessica P. Cerdeña
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
- Institute for Collaboration on Health, Implementation, and Policy (InCHIP), University of Connecticut, Storrs, CT 06269, USA
- Department of Anthropology, University of Connecticut, Storrs, CT 06269, USA
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4
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Moriya AS, Xu L. The complex relationships among race/ethnicity, social determinants, and opioid utilization. Health Serv Res 2021; 56:310-322. [PMID: 33395731 DOI: 10.1111/1475-6773.13619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To examine individual- and community-level factors associated with racial/ethnic differences in individuals' opioid prescription use. DATA SOURCES Outpatient opioid prescription utilization and demographic, socioeconomic, and health characteristics from a nationally representative sample of the US noninstitutionalized civilian population obtained from 2013-2016 Medical Expenditure Panel Survey (MEPS) data and combined with 2012-2016 American Community Survey data and 2015 Health Area Resources File data. STUDY DESIGN We use the Oaxaca-Blinder decomposition method to disaggregate racial/ethnic differences in prescription opioid utilization into differences explained by underlying predisposing, enabling and need characteristics, and unexplained differences. DATA COLLECTION/EXTRACTION METHODS We use restricted-use geographic identifiers to supplement the MEPS data with information on community characteristics and local health care resources. PRINCIPAL FINDINGS The average annual rate of any outpatient opioid prescription use was higher for non-Hispanic whites (15.8%; standard errors [SE]: 0.3) than for non-Hispanic blacks and Hispanics by 1.4 percentage points (SE: 0.5) and 6.2 percentage points (SE: 0.4), respectively. The smaller difference between non-Hispanic blacks and whites is not explained by the differences in the risk factors, while almost all the difference between Hispanics and non-Hispanic whites can be explained by the differences in the means of the risk factors. The differences in the prevalence of pain, the rate of being United States-born, and the racial/ethnic composition of the community explain 2.4 (SE: 0.2), 1.4 (SE: 0.3), and 1.9 (SE: 0.4) percentage-point differences, respectively. Pain prevalence explains the difference regardless of opioid potency, while foreign-born status and community racial/ethnic composition explain the difference in higher-potency opioid utilization only. CONCLUSIONS This study underscores the importance of accounting for both individual and community characteristics when investigating patterns in opioid use. Our results could assist policy makers in tailoring strategies to promote safer and more effective pain management based on individual and community characteristics.
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Affiliation(s)
- Asako S Moriya
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Rockville, Maryland, USA
| | - Lanlan Xu
- Center for Medicare & Medicaid Innovation (CMMI), Centers for Medicare & Medicaid Services (CMS), Baltimore, Maryland, USA
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5
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Stafford AM, Draucker CB. Barriers to and Facilitators of Mental Health Treatment Engagement Among Latina Adolescents. Community Ment Health J 2020; 56:662-669. [PMID: 31853694 PMCID: PMC8084018 DOI: 10.1007/s10597-019-00527-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
Latina adolescents are more likely to experience depressive symptoms and less likely to receive mental health treatment than White peers. The purpose of this study is to describe barriers to and facilitators of engagement in depression treatment among Latina adolescents. Twenty-five Latina young women (mean age = 16.7 years) with a history of depressive symptoms during adolescence participated in this qualitative descriptive study. Participants were recruited from clinical and community settings and were interviewed about their experiences with depression treatment. Using qualitative content analysis, we identified barriers to and facilitators of engagement in treatment for depression. Barriers included beliefs about depression and its treatments, negative experiences with treatment, and logistical problems. Facilitators included positive treatment outcomes, meaningful connection with a therapist, and family support of depression treatment. Mental health providers should minimize barriers and maximize facilitators to promote mental health treatment use and engagement among Latina adolescents with depressive symptoms.
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Affiliation(s)
- Allison McCord Stafford
- Duke University School of Nursing, 307 Trent Dr. DUMC 3322, Durham, NC, 27710, USA.
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA.
| | - Claire Burke Draucker
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA
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6
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Stafford AM, Aalsma MC, Bigatti S, Oruche U, Draucker CB. Getting a Grip on My Depression: How Latina Adolescents Experience, Self-Manage, and Seek Treatment for Depressive Symptoms. QUALITATIVE HEALTH RESEARCH 2019; 29:1725-1738. [PMID: 30810095 PMCID: PMC6935425 DOI: 10.1177/1049732319831043] [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
Latina (female) adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than their non-Latina White peers. We aimed to develop a framework that explains how Latina adolescents experience, self-manage, and seek treatment for depressive symptoms. Latina young women (n = 25, M age = 16.8 years) who experienced depressive symptoms during adolescence were recruited from clinical and community settings and interviewed about experiences with depressive symptoms. The framework was developed using constructivist grounded theory methods. Participants experienced a psychosocial problem that we labeled being overburdened and becoming depressed. They responded to this problem through a five-phase psychosocial process that we labeled Getting a Grip on My Depression. Family members, peer groups, and mainstream authorities were influential in how participants experienced these phases. Future research should further develop this framework in diverse samples of Latino/a youth. Clinicians can use this framework in discussions with Latina adolescents about depressive symptoms.
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Affiliation(s)
| | - Matthew C Aalsma
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Silvia Bigatti
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Ukamaka Oruche
- Indiana University School of Nursing, Indianapolis, Indiana, USA
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Concepcion Zayas MT, Fortuna LR, Cullins LM. Depression in Latino and Immigrant Refugee Youth: Clinical Opportunities and Considerations. Child Adolesc Psychiatr Clin N Am 2019; 28:483-495. [PMID: 31076122 DOI: 10.1016/j.chc.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article reviews the risk and protective factors and symptom presentation of depression in Latino and immigrant refugee children and adolescents. The significance of culture, linguistics, and community in the emergence of depression in Latino and immigrant refugee children and adolescents and their families is explored. The article provides practical implications for diagnosis and treatment of depression in this special population of youth.
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Affiliation(s)
| | - Lisa R Fortuna
- Boston Medical Center, Boston University School of Medicine, Doctors Office Building, 720 Harrison Avenue, Room 907, Boston, MA 02118, USA
| | - Lisa M Cullins
- George Washington University School of Medicine, Washington, DC, USA.
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8
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Alawieh A, Zhao J, Feng W. Factors affecting post-stroke motor recovery: Implications on neurotherapy after brain injury. Behav Brain Res 2018; 340:94-101. [PMID: 27531500 PMCID: PMC5305670 DOI: 10.1016/j.bbr.2016.08.029] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/27/2016] [Accepted: 08/12/2016] [Indexed: 02/05/2023]
Abstract
Neurological disorders are a major cause of chronic disability globally among which stroke is a leading cause of chronic disability. The advances in the medical management of stroke patients over the past decade have significantly reduced mortality, but at the same time increased numbers of disabled survivors. Unfortunately, this reduction in mortality was not paralleled by satisfactory therapeutics and rehabilitation strategies that can improve functional recovery of patients. Motor recovery after brain injury is a complex, dynamic, and multifactorial process in which an interplay among genetic, pathophysiologic, sociodemographic and therapeutic factors determines the overall recovery trajectory. Although stroke recovery is the most well-studied form of post-injury neuronal recovery, a thorough understanding of the pathophysiology and determinants affecting stroke recovery is still lacking. Understanding the different variables affecting brain recovery after stroke will not only provide an opportunity to develop therapeutic interventions but also allow for developing personalized platforms for patient stratification and prognosis. We aim to provide a narrative review of major determinants for post-stroke recovery and their implications in other forms of brain injury.
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Affiliation(s)
- Ali Alawieh
- Medical Scientist Training Program, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Jing Zhao
- Minhang District Central Hospital, Fudan University, Shanghai, 201199, China
| | - Wuwei Feng
- Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, SC, 29425, USA; Department of Health Science and Research, The Center of Rehabilitation Science in Neurological Conditions, College of Health Professions, Medical University of South Carolina, Charleston, SC, 29425, USA.
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9
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Cook BL, Carson NJ, Kafali EN, Valentine A, Rueda JD, Coe-Odess S, Busch S. Examining psychotropic medication use among youth in the U.S. by race/ethnicity and psychological impairment. Gen Hosp Psychiatry 2017; 45:32-39. [PMID: 28274336 PMCID: PMC7598773 DOI: 10.1016/j.genhosppsych.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinical practice guidelines underscore the need for careful evaluation of the risk-benefit ratio of psychotropic medications treating mental health disorders among youth. While it is well known that racial/ethnic disparities exist in psychotropic medication use, little is known about whether these differences are driven by over-prescribing among white youth, under-prescribing among minority youth, or both. To build evidence in this area, this study examined racial/ethnic differences in the prescription of psychotropic medications among youth with and without psychological impairment. METHODS Secondary data on two-year medication use from the 2004-2011 Medical Expenditure Panel Surveys were analyzed. We capitalized on two-year panel data, creating variables that allow for differential sequencing of psychological impairment and medication prescription (e.g., impairment in year 1 or year 2, and a psychotropic medication fill in year 2). Statistical differences were determined using unadjusted rate comparisons and logistic regression models, after adjustment for socio-contextual and health status characteristics. RESULTS Compared to Black and Latino youth with psychological impairment, White youth were more likely to be prescribed psychotropic medications when impaired. Among youth never having psychological impairment, White youth were also more likely to be prescribed medications compared to their racial/ethnic minority counterparts. CONCLUSIONS Differences in rates of medication use among youth with and without impairment suggest poor medication targeting across racial/ethnic groups. These results, combined with recent psychotropic medication risk warnings and concerns over increases in psychotropic medication use among youth, suggest that a continued emphasis on accurate targeting of prescribing patterns is needed across racial/ethnic groups.
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Affiliation(s)
- Benjamin Lê Cook
- Health Equity Research Lab/Center for Multicultural Mental Health Research, Cambridge Health Alliance, United States; Department of Psychiatry, Harvard Medical School, United States.
| | - Nicholas J. Carson
- Health Equity Research Lab/Center for Multicultural Mental Health Research, Cambridge Health Alliance, United States,Department of Psychiatry, Harvard Medical School, United States
| | | | - Anne Valentine
- Heller School for Social Policy and Management, United States.
| | | | | | - Susan Busch
- Yale School of Public Health, United States.
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10
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Marrast L, Himmelstein DU, Woolhandler S. Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:810-24. [PMID: 27520100 DOI: 10.1177/0020731416662736] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children's and young adults' receipt of mental health and substance abuse care using nationally representative data from the 2006-2012 Medical Expenditure Panel Surveys. Blacks' and Hispanics' visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care.
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Affiliation(s)
| | - David U Himmelstein
- City University of New York at Hunter College, School of Public Health, New York, NY, USA Harvard Medical School, Boston, MA
| | - Steffie Woolhandler
- City University of New York at Hunter College, School of Public Health, New York, NY, USA Harvard Medical School, Boston, MA
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11
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Lê Cook B, Brown JD, Loder S, Wissow L. Acculturation differences in communicating information about child mental health between Latino parents and primary care providers. J Immigr Minor Health 2014; 16:1093-102. [PMID: 24705736 PMCID: PMC4185306 DOI: 10.1007/s10903-014-0010-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Significant Latino-white disparities in youth mental health care access and quality exist yet little is known about Latino parents' communication with providers about youth mental health and the role of acculturation in influencing this communication. We estimated regression models to assess the association between time in the US and the number of psychosocial issues discussed with the medical assistant (MA) and doctor, adjusting for child and parent mental health and sociodemographics. Other proxies of acculturation were also investigated including measures of Spanish and English language proficiency and nativity. Parent's length of time in the US was positively associated with their communication of: their child's psychosocial problems with their child's MA, stress in their own life with their child's MA, and their child's school problems with their child's doctor. These differences were especially apparent for parents living in the US for >10 years. Parent-child language discordance, parent and child nativity were also significantly associated with communication of psychosocial problems. Greater provider and MA awareness of variation in resistance to communicating psychosocial issues could improve communication, and improve the prevention, diagnosis and treatment of youth mental illness.
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Affiliation(s)
- Benjamin Lê Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Assistant Professor, Department of Psychiatry, Harvard Medical School, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8449, 617-503-8430 (fax),
| | - Jonathan D. Brown
- Mathematica Policy Research, 1100 1st St NE #1200, Washington, DC 20002, (202) 484-9220,
| | - Stephen Loder
- Center for Multicultural Mental Health Research, Cambridge Health, Alliance, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8440, 617-503-8430 (fax),
| | - Larry Wissow
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, #703 Baltimore, MD 21287, 410-614-1243,
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12
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Racial/Ethnic Differences in the Relationship between Obesity and Depression Treatment. J Behav Health Serv Res 2014; 42:486-503. [PMID: 24464180 DOI: 10.1007/s11414-014-9391-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using data from the 2004 to 2008 Medical Expenditure Panel Survey (MEPS), this study examined the relationship between obesity and the treatment of depression across racial/ethnic subgroups, controlling for depressive symptoms, self-rated mental health, health status, and socioeconomic characteristics. The association between obesity and depression-related medication was significant for white women but not for black or Hispanic women. Similarly, the association between obesity and depression-related ambulatory visits was significant for white women but not for black or Hispanic women. The results for men were, in general, mixed and inconsistent. The significant racial/ethnic differences found in the relationship between obesity and depression treatment among women suggest that social and cultural factors might play important roles in depression treatment among women.
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13
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Olfson M, He JP, Merikangas KR. Psychotropic medication treatment of adolescents: results from the National Comorbidity Survey-Adolescent Supplement. J Am Acad Child Adolesc Psychiatry 2013; 52:378-88. [PMID: 23582869 PMCID: PMC3664537 DOI: 10.1016/j.jaac.2012.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/16/2012] [Accepted: 12/17/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the 12-month prevalence of psychotropic medication use among adolescents, and the match between mental disorder diagnoses and past-year antidepressant and stimulant use. METHOD Data are from the National Comorbidity Survey-Adolescent Supplement (2002-2004), a nationally representative survey of 10,123 adolescents aged 13 to 18 years that assesses DSM-IV disorders using a fully structured diagnostic interview, a modified version of the World Health Organization Composite International Diagnostic Interview (CIDI). Rates of 12-month psychotropic medication use are stratified by respondent socio-demographic characteristics, and the distribution of 12-month DSM-IV CIDI disorders is estimated among past-12-month use of antidepressants and stimulants. RESULTS During a 1-year period, 7.0% of adolescents used at least one psychotropic medication; these medications were most commonly antidepressants (3.9%), followed by stimulants (2.8%), anxiolytics (0.8%), antipsychotics (0.5%), and mood stabilizers (0.4%). Nearly three-quarters (74.1%) of adolescents with any past-year psychotropic medication use had at least one CIDI mental disorder, and many had disorders for which the specific medication class is clinically indicated. Among adolescents using antidepressants, 48.8% had a past-12-month depressive or anxiety disorder, and an additional 20.3% had a lifetime depressive or anxiety disorder. Nearly one-half (49.1%) of adolescents using stimulants met past-12-month attention-deficit/hyperactivity disorder (ADHD) criteria, and an additional 13.1% met lifetime criteria for ADHD. CONCLUSIONS Most adolescents who are treated with psychotropic medications have one or more psychiatric disorders and many, albeit far from all, have mental disorders for which the specific medications are clinically indicated.
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Affiliation(s)
- Mark Olfson
- New York State Psychiatric Institute and Columbia University, USA
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14
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Lê Cook B, Barry CL, Busch SH. Racial/ethnic disparity trends in children's mental health care access and expenditures from 2002 to 2007. Health Serv Res 2013; 48:129-49. [PMID: 22716901 PMCID: PMC3449047 DOI: 10.1111/j.1475-6773.2012.01439.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine trends in disparities in children's mental health care. DATA 2002-2007 Medical Expenditure Panel Survey. STUDY DESIGN We used the Institute of Medicine (IOM) definition of health care disparities and estimated two-part expenditure models to examine disparity trends in any mental health care use, any outpatient care, and psychotropic drug use, as well as expenditures in these three categories, conditional on use. We used 2-year longitudinal panel data to determine disparities in care initiation among children with unmet need. PRINCIPAL FINDINGS Assessing trends over time between 2002 and 2007, we identified that disparities persist for blacks and Latinos in receipt of any mental health care, any outpatient care, and any psychotropic drug use. Among those with positive mental health care expenditures, Latino-white disparities in overall mental health care expenditures increased over time. Among children with unmet need, significant disparities in initiation of an episode of mental health care were found, with whites approximately twice as likely as blacks and Latinos to initiate care. CONCLUSIONS Disparities in children's mental health care use are persistent and driven by disparities in initiation, suggesting policies to improve detection or increase initial access to care may be critical to reducing disparities.
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Affiliation(s)
- Benjamin Lê Cook
- Center for Multicultural Mental Health Research, Department of Psychiatry, Harvard Medical School, Somerville, MA 02143, USA.
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15
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Cook BL, McGuire TG, Zaslavsky AM. Measuring racial/ethnic disparities in health care: methods and practical issues. Health Serv Res 2012; 47:1232-54. [PMID: 22353147 PMCID: PMC3371391 DOI: 10.1111/j.1475-6773.2012.01387.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To review methods of measuring racial/ethnic health care disparities. STUDY DESIGN Identification and tracking of racial/ethnic disparities in health care will be advanced by application of a consistent definition and reliable empirical methods. We have proposed a definition of racial/ethnic health care disparities based in the Institute of Medicine's (IOM) Unequal Treatment report, which defines disparities as all differences except those due to clinical need and preferences. After briefly summarizing the strengths and critiques of this definition, we review methods that have been used to implement it. We discuss practical issues that arise during implementation and expand these methods to identify sources of disparities. We also situate the focus on methods to measure racial/ethnic health care disparities (an endeavor predominant in the United States) within a larger international literature in health outcomes and health care inequality. EMPIRICAL APPLICATION: We compare different methods of implementing the IOM definition on measurement of disparities in any use of mental health care and mental health care expenditures using the 2004-2008 Medical Expenditure Panel Survey. CONCLUSION Disparities analysts should be aware of multiple methods available to measure disparities and their differing assumptions. We prefer a method concordant with the IOM definition.
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Affiliation(s)
- Benjamin Lê Cook
- Department of Psychiatry, Center for Multicultural Mental Health Research, Harvard Medical School, Somerville, MA 02143, USA.
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Bailey RK, Patel M, Barker NC, Ali S, Jabeen S. Major depressive disorder in the African American population. J Natl Med Assoc 2011; 103:548-57. [PMID: 21999029 DOI: 10.1016/s0027-9684(15)30380-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression is a common mental disorder that presents with depressed mood. It can become chronic or recurrent and lead to substantial impairment in an individual's ability to function. At this level, it is identified as major depressive disorder (MDD). Depression and MDD occur across all racial and ethnic groups. Although many depressed patients are treated in primary care, depression in these settings has been underdetected and undertreated. African Americans, especially, who suffer from depression are frequently underdiagnosed and inadequately managed in primary care due to patient, physician, and treatment setting factors. Patient factors include being poor, uninsured, restrictive insurance policies, biological-genetic vulnerability, nonresponsiveness to traditional pharmacological interventions, and stigma (i.e., attitudes and perceptions of mental illness). Physician factors include diagnosis and assessment, physician characteristics, physician bias, and culture; and treatment setting factors include systemic variables such as lack of or poor access to health care, racism, environment, and patient management. African Americans are less likely to receive proper diagnosis and treatment, more likely to have depression for long periods of time, and more likely to suffer greater disability from depression. Understanding patient, physician, and treatment setting factors as contributing barriers that impede effective diagnosis and treatment of depression and MDD in African Americans is critical to effective patient management and discovery. Greater African American participation in clinical research trials also is needed to effectively improve, diagnose, and treat depression in African Americans. This article examines depression among African Americans in the context of gender, culture, and psychosocial determinants, and their engagement in clinical trials.
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Affiliation(s)
- Rahn K Bailey
- Meharry Medical College, Nashville, Tennessee 37208, USA.
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