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Loeb TB, Viducich I, Smith-Clapham AM, Adkins-Jackson P, Zhang M, Cooley-Strickland M, Davis T, Pemberton JV, Wyatt GE. Unmet need for mental health services utilization among under-resourced Black and Latinx adults. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:149-159. [PMID: 36521110 PMCID: PMC10267286 DOI: 10.1037/fsh0000750] [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] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Substantial unmet need for mental health services (MHS) exists in the United States, with pronounced disparities among people of color. Research highlights the need to identify facilitators and barriers to MHS utilization among Black and Latinx individuals to better promote overall health. We tested an expanded model of MHS use based on Andersen's (1995) conceptual framework of health care utilization. Associations were examined between sociodemographic variables, trauma and adversity burden, living with HIV, and unmet need for MHS in a community sample of underresourced Black and Latinx individuals. Barriers to MHS utilization are described. METHODS Five-hundred participants completed the UCLA Life Adversities Screener (LADS), sociodemographic measures, and items assessing need for and barriers to MHS. RESULTS 228 (46%) participants reported a need for MHS; of these, 115 (51%) reported receiving MHS. A binomial logistic regression model estimated the relative contribution of the LADS on need for MHS. Severity of LADS, younger age, and living with HIV predicted unmet need for MHS. Barriers to MHS included financial and time constraints and health system-related issues. One-way analysis of variance (ANOVA) tests revealed differences in mental health symptoms by MHS need. DISCUSSION The unmet need for MHS in this sample of Black and Latinx individuals highlights the importance of addressing the systemic roots of trauma and adversity burden, and eliminating structural barriers to treatment to reduce existing health and mental health inequities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Tamra B Loeb
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
| | - Isabella Viducich
- Luskin School of Social Welfare, University of California, Los Angeles
| | - Amber M Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
| | | | - Muyu Zhang
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
| | - Michele Cooley-Strickland
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
| | - Teri Davis
- Department of Clinical Psychology, Chicago School of Professional Psychology
| | - Jennifer V Pemberton
- Department of Educational Psychology and Counseling, California State University
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
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2
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Ding R, Zhu D, Wang Y, Yong M, Shi X, He P. Medical service utilisation and direct medical cost of depression: a cross-sectional analysis of urban medical claims data from China. BMJ Open 2022; 12:e056422. [PMID: 36171041 PMCID: PMC9528634 DOI: 10.1136/bmjopen-2021-056422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Depression is becoming a growing cause of disability, suicides and disease burden. It incurred substantial costs to societies all over the world. Estimating the medical costs of depression will provide implications for related policies and interventions. However, there is scarce of evidence on the economic costs of depression in China. The aim of this study is to assess depression-related medical service utilisation, the direct medical costs of depression and potential associated factors. SETTINGS This study used data that comprised 5% random sample of claims data from China's Urban Basic Medical Insurance between January 2013 and December 2016. Beneficiaries' demographic information, diagnoses and cost of outpatient and inpatient services were recorded in the data set. PARTICIPANTS 26 123 patients with depression were identified as the study population in this study. PRIMARY AND SECONDARY OUTCOME MEASURES The information on health service utilisation and cost was extracted based on the condition that depression was claimed as the index disease. RESULTS From 2013 to 2016, weighted average annual total medical cost of depression in urban China was RMB2706.92, and the annual out-of-pocket cost was RMB786.4. The annual total medical cost of depression among urban residents in China was estimated to be 4.4 billion RMB (95% CI 4.15 to 4.67) (US$ 0.70, 95% CI 0.66 to 0.74). Nearly 65% of medical costs (RMB 1795.7 or US$ 285.0) were accounted by inpatient expenditure, and tertiary hospitals were the main provider of depression treatment. Depression-related medical care utilisation and direct costs were associated with gender, age, insurance status, severity of depression and diagnosis. Medication costs and medical service contributed to 41.7% and 56.6% of the average depression-related medical costs. CONCLUSION Depression poses a considerable burden on both the health system and the individual in urban China. Specific policies to strengthen the mental health resources in primary and secondary hospitals are in urgent need, and effective treatment strategies are important to prevent a progression and recurrence of depression, as well as an increase in medical cost.
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Affiliation(s)
- Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yanshang Wang
- China Center for Health Development Studies, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Ma Yong
- China Health Insurance Research Association, Beijing, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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Liu S, Müller S, Dolan RJ, Zhao X, Zheng JC, Heinz A. Opportunities, risks and challenges in global mental health and population neuroscience: a case of Sino-German cooperation. Eur Arch Psychiatry Clin Neurosci 2021; 271:1027-1034. [PMID: 32729097 PMCID: PMC8354880 DOI: 10.1007/s00406-020-01176-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/22/2020] [Indexed: 01/10/2023]
Abstract
Large scale prospective cohorts have now been established across several countries, and continents, and among the aims include an assessment of the developmental trajectory of mental disorders. This level of international cooperation helps transfer research findings to new social contexts as well as enabling an assessment of which findings can be replicated, and which interventions are most effective, in different social and cultural settings. However, data sharing across different regional and national health care systems requires a careful consideration of different standards in ethical research, data protection and patient care, including respect for patients' rights, in cooperating jurisdictions. In our review, we discuss ethical, legal and practical challenges associated with such cooperation with a focus on research participants, specifically patient recruitment, by considering the instance of China and Germany. Our broader aim is to promote international cooperation by identifying key challenges that arise in international cooperation, and to facilitate an exchange in relation to legal and practical approaches.
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Affiliation(s)
- Shuyan Liu
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany.
| | - Sabine Müller
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany
| | - Raymond J Dolan
- Max Planck Centre for Computational Psychiatry and Ageing Research & Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Xudong Zhao
- Pudong Mental Health Centre, Tongji University School of Medicine, Shanghai, China
| | - Jialin C Zheng
- Center for Translational Neurodegeneration and Regenerative Therapy, Shanghai Tenth People's Hospital affiliated to Tongji University School of Medicine, Shanghai, China
- Collaborative Innovation Center for Brain Science, Tongji University, Shanghai, China
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, USA
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany
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Dong E, Xu J, Sun X, Xu T, Zhang L, Wang T. Differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce: a longitudinal study in China. ACTA ACUST UNITED AC 2021; 79:78. [PMID: 34001268 PMCID: PMC8130126 DOI: 10.1186/s13690-021-00597-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/29/2021] [Indexed: 01/05/2023]
Abstract
Background The distribution of health-care resources is foundational to achieving fairness and having access to health service. China and its local Shanghai’s government have implemented measures to allocate health-care resources with the equity as one of the major goals since 2009-health-care reform. The aim of this study was to analyze differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce in Shanghai over 7 years. Methods The study was conducted using 2010–2016 data to analyze health-resource allocation on institutions, beds, and workforce in Shanghai, China. The annual growth rate (AGR) was used to evaluate the time trends of health-care resource from 2010 to 2016, and Theil index was calculated to measure inequality of five indicators of health-care resource allocation during this study period. Results All quantities of health-care resources per 1000 people increased across Shanghai districts from 2010 to 2016. Compared with suburban districts, the central districts had higher ratios on five health-care resource indicators, and faster average growth in the bed and nurse indicator. The Theil of the indicators, except for doctors in hospitals, all exhibited downward time trends. Conclusions Regional difference between urban and rural areas and inequality between institution and workforce, especially for doctors, still existed. Some targeted measures including but not limited to income raising, facilitation of transportation conditions, investment of more fiscal funds, enhancement of health-care service provision for rural residents should be fully considered to narrow resource distribution gap between urban and rural districts and mitigate the inequality of health-care resource allocation. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00597-1.
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Affiliation(s)
- Enhong Dong
- School of Nursing and Health Management, Shanghai University of Medicine & Health Science, 279 Zhouzhu Road, Pudong New District, Shanghai, 201318, China.,School of Media and Communication, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jie Xu
- Emergency Department, Dezhou People's Hospital, Dezhou, 253003, Shandong Province, China
| | - Xiaoting Sun
- Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, 200072, China
| | - Ting Xu
- School of Nursing and Health Management, Shanghai University of Medicine & Health Science, 279 Zhouzhu Road, Pudong New District, Shanghai, 201318, China
| | - Lufa Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Tao Wang
- Department of Orthopaedics and Traumatology, Shanghai East Hospital Tongji University School of Medicine, Shanghai, 200127, China. .,College of Arts and Media, Tongji University, Shanghai, 200092, China.
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Chen N, Zhou L, Huang J, Yu W, Chen C, Jin H, Shi X, Yu Z, Liu Q, Yang Y, Wang Z, Shi J. Identifying multimorbidity patterns of non-communicable diseases in paediatric inpatients: a cross-sectional study in Shanghai, China. BMJ Open 2021; 11:e042679. [PMID: 33795295 PMCID: PMC8023737 DOI: 10.1136/bmjopen-2020-042679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To enhance the understanding of non-communicable disease (NCD) multimorbidity in children who are inpatients by delineating the characteristics of and identifying patterns among paediatric inpatients with multimorbidity in China. DESIGN Cross-sectional study. SETTING Paediatric wards (n=17) in Pudong New Area, Shanghai, China. PARTICIPANTS A total of 193 432 paediatric inpatients in the electronic health record systems of 17 hospitals from 2011 to 2016 participated in the study, and 91 004 children with NCDs were extracted and classified based on International Classification of Diseases, 10th version codes. MAIN OUTCOME MEASURES Number of the NCDs and multimorbidity patterns of the paediatric inpatients. RESULTS In total, 47.05% (95% CI 46.83 to 47.27) of the paediatric inpatients had one or more chronic diseases, and 16.30% (95% CI 16.14 to 16.46) had multimorbidity. Congenital anomalies accounted for 19.43% (95% CI 19.25 to 19.61) of the principal diagnoses among the paediatric inpatients. Five common multimorbidity patterns were identified: a neurological-respiratory cluster, a neurological-respiratory-ear cluster, a cardiovascular-circulatory cluster, a genitourinary cluster (boy group) and a musculoskeletal-connective cluster (10-18 years age group). CONCLUSIONS Multimorbidity in paediatric inpatients suggests that decisions about reasonable allocation of paediatric inpatient resources should be fully considered. Multimorbidity patterns in paediatric inpatients revealed that prevention, including innovative treatments targeting children, should be further studied.
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Affiliation(s)
- Ning Chen
- Tongji University School of Medicine, Shanghai, China
| | - Liang Zhou
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Chen
- Pengpuxincun Community Health Service Center, Shanghai, China
| | - Hua Jin
- Department of General Practice, Tongji University Affiliated Yangpu Hospital, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Xiaoxiao Shi
- Department of General Practice, Tongji University Affiliated Yangpu Hospital, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Zhaohu Yu
- Department of Neurosurgery, Navy 971 Hospital, Qingdao, China
| | - Qian Liu
- Tongji University School of Economics and Management, Shanghai, China
| | - Yan Yang
- Tongji University School of Economics and Management, Shanghai, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- General Practice Center, Southern Medical University Affiliated Nanhai Hospital, Guangzhou, China
| | - Jianwei Shi
- Department of General Practice, Tongji University Affiliated Yangpu Hospital, Shanghai, China
- Department of Health Service Management, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ma Y, Rosenheck R, He H. Psychological stress among health care professionals during the 2019 novel coronavirus disease Outbreak: Cases from online consulting customers. Intensive Crit Care Nurs 2020; 61:102905. [PMID: 32712069 PMCID: PMC7321034 DOI: 10.1016/j.iccn.2020.102905] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND During the 2019 novel coronavirus disease (COVID-19) outbreak, online consulting has been widely used to address mental health problems, including health care professionals (HCPs) caring for COVID-19 patients who experienced substantial psychological distress. AIM To explore the severity of perceived stress and potential correlates among the HCPs seeking online mental health services during the COVID-19 outbreak. METHODS A descriptive study was conducted among 34 HCPs to assess levels of psychological distress using the Perceived Stress Scale (PSS-10), Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder (GAD-7) questionnaire. The HCPs working in different departments were compared using χ2-test for categorized variables and t-test for continuous ones, followed by the analysis of covariate (ANCOVA) to compare the perceived stress. Linear regression for the PSS-10 score was performed to identify potential correlates of stress. RESULTS The sample overall (n = 34) showed a relatively moderate level of perceived stress (PSS mean = 15.71 ± 4.02) with 38% identified as depressed (PHQ-9 ≥ 5) and 24% as suffering from anxiety (GAD-7 ≥ 5). Those working at intensive care units (ICUs) or in departments of respiratory medicine (RM) demonstrated significantly higher perceived stress than those at other departments (adjusted mean: 17.48 ± 0.96 vs. 13.06 ± 1.25, p = .018, partial η2 = 0.173). High perceived stress was most strongly associated with being depressed (beta = 0.486, p = .002) and working at ICUs/RM (beta = 0.345, p = .023). CONCLUSIONS The psychological health status of frontline health care professionals during the 2019 novel coronavirus outbreak warrants clinical attention. Online mental health services has played a major role although its effectiveness and barriers to its utilisation require further evaluation.
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Affiliation(s)
- Yarong Ma
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Robert Rosenheck
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Hongbo He
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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7
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Yao H, Chen JH, Xu YF. Rethinking online mental health services in China during the COVID-19 epidemic. Asian J Psychiatr 2020; 50:102015. [PMID: 32247261 PMCID: PMC7271098 DOI: 10.1016/j.ajp.2020.102015] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Hao Yao
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jian-Hua Chen
- Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Yi-Feng Xu
- Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
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Qiu D, Li Y, Li L, He J, Ouyang F, Xiao S. Policies to Improve the Mental Health of People Influenced by COVID-19 in China: A Scoping Review. Front Psychiatry 2020; 11:588137. [PMID: 33362605 PMCID: PMC7759550 DOI: 10.3389/fpsyt.2020.588137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background: In response to the potentially concurrent mental health crisis due to the COVID-19 outbreak, there have been ongoing mental health policies put in place in China. This review aims to systematically synthesize the implemented national-level mental health policies released by the Chinese government during the COVID-19 outbreak, and summarize the implementation of those mental health policies. Methods: Six databases and two websites were systematically searched, including published studies and gray literature published between December 1, 2019 and October 29, 2020. Results: A total of 40 studies were included. Among them, 19 were national-level policies on mental health released by the Chinese government, and 21 studies reported data on the implementation of those mental health policies. Mental health policies were issued for COVID-19 patients, suspected cases, medical staff, the general population, patients with mental illness, and mental institutions. In the early stage of the COVID-19 epidemic, attention was paid to psychological crisis intervention. In the later stage of the epidemic, the government focused mainly on psychological rehabilitation. During the COVID-19 outbreak, more than 500 psychiatrists from all over China were sent to Wuhan, about 625 hotlines were notified in 31 provinces, several online psychological consultation platforms were established, social software such as TikTok, Weibo, and WeChat were used for psychological education, and many books on mental health were published. Responding quickly, maximizing the use of resources, and emphasizing the importance of policy evaluation and implementation quality were characteristics of the mental health policies developed during the COVID-19 outbreak. Challenges facing China include a low rate of mental health service utilization, a lack of evaluation data on policy effects, and no existing national-level emergency response system and designated workforce to provide psychological crisis interventions during a national emergency or disaster. Conclusions: This review suggests that China has responded quickly and comprehensively to a possible mental health crisis during the COVID-19 outbreak, appropriate mental health policies were released for different members of the population. As the epidemic situation continues to change, the focus of mental health policies has been adjusted accordingly. However, we should note that there has been a lack of separate policies for specific mental health issues during the COVID-19 outbreak.
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Affiliation(s)
- Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Ling Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jun He
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Feiyun Ouyang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
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