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Jaramillo ET. Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol. BMJ Open 2024; 14:e088348. [PMID: 38844399 PMCID: PMC11163646 DOI: 10.1136/bmjopen-2024-088348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Severe inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality, presenting a growing public health concern as the United States (US) population ages. These inequities are often attributable to social and environmental factors, including economic insecurity, histories of trauma, gaps in transportation and safety-net services, and disparities in access to policy-making processes rooted in colonialism. This constellation of factors renders racial-minority and ethnic-minority older adults 'structurally vulnerable' to mental ill health. Fewer data exist on protective factors associated with social and environmental contexts, such as social support, community attachment and a meaningful sense of place. Scholarship on the social determinants of health widely recognises the importance of such place-based factors. However, little research has examined how they shape disparities in depression and treatment specifically, limiting the development of practical approaches addressing these factors and their effects on mental well-being for rural minority populations. METHODS AND ANALYSIS This community-driven mixed-method study uses quantitative surveys, qualitative interviews and ecological network research with 125 rural American Indian and Latinx older adults in New Mexico and 28 professional and non-professional social supporters to elucidate how place-based vulnerabilities and protective factors shape experiences of depression among older adults. Data will serve as the foundation of a community-driven plan for a multisystem intervention focused on the place-based causes of disparities in depression. Intervention Mapping will guide the intervention development process. ETHICS AND DISSEMINATION This study has been reviewed and approved by the University of New Mexico Health Sciences Center Institutional Review Board. All participants will provide informed consent. Study results will be disseminated within the community of study through community meetings and presentations, as well as broadly via peer-reviewed journals, conference presentations and social media.
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Affiliation(s)
- Elise Trott Jaramillo
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
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Arnold TD, Polenick CA, Maust DT, Blow FC. Interpersonal discrimination and depressive symptoms among older Black and African American adults. PLoS One 2024; 19:e0304168. [PMID: 38843241 PMCID: PMC11156267 DOI: 10.1371/journal.pone.0304168] [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: 09/04/2023] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
To examine the association between recent experiences of discrimination and depressive symptom presentation and severity among a U.S. sample of older Black and African American adults. A cross-sectional survey of 124 Black and African American adults aged 50 and older in the United States was conducted assessing interpersonal discrimination and depressive symptoms. The Perceived Ethnic Discrimination Questionnaire assessed four forms of interpersonal discrimination. A measure of heightened vigilance to bias assessed anticipatory coping with discrimination experiences. Past-month affective and somatic symptoms of depression were assessed using the Depressive and Somatic Symptoms Scale. All forms of interpersonal racial discrimination were positively associated with greater affective symptom severity. Being avoided, devalued, and threatened or actively physically harmed were associated with greater somatic symptom severity. Vigilant coping was positively associated with affective symptom severity but not somatic symptom severity. Racial discrimination is linked to depression severity among older Black and African American and varies by symptom. This study helps inform work on processes linking discrimination with poorer psychological outcomes and will allow for more effective interventions and prevention efforts that are tailored to older minority populations.
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Affiliation(s)
- Tomorrow D. Arnold
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Courtney A. Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States of America
| | - Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America
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Lin S(L. Healthy Immigrant Effect or Under-Detection? Examining Undiagnosed and Unrecognized Late-Life Depression for Racialized Immigrants and Nonimmigrants in Canada. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad104. [PMID: 37498769 PMCID: PMC11036341 DOI: 10.1093/geronb/gbad104] [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: 08/10/2022] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES Immigrants to Canada tend to have a lower incidence of diagnosed depression than nonimmigrants. One theory suggests that this "healthy immigrant effect (HIE)" is due to positive selection. Another school of thought argues that the medical underuse of immigrants may be the underlying reason. This unclear "immigrant paradox" is further confounded by the intersecting race-migration nexus. METHODS This population-based study analyzed data of participants (n = 28,951, age ≥45) from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was employed to examine associations between race-migration nexus and mental health outcomes, including depressive symptoms (Patient Health Questionnaire [PHQ-9] score ≥10). RESULTS Compared to Canadian-born (CB) Whites, immigrants, regardless of race, were less likely to receive a mood/anxiety disorder diagnosis (M/A-Dx) by health providers in their lifetime. Racialized immigrants were mentally disadvantaged with increased odds of undiagnosed depression (Adjusted odds ratio [AOR] = 1.76, 99% Confidence interval [CI]:1.30-2.37), whereas White immigrants were mentally healthier with decreased odds of PHQ depression (AOR=0.75, 99%CI: 0.58, 0.96) and poor self-rated mental health (AOR=0.56, 99% CI=0.33, 0.95). Among the subpopulation without a previous M/A-Dx (N = 25,203), racialized immigrants had increased odds of PHQ depression (AOR = 1.45, 99% CI: 1.15-1.82) and unrecognized depression (AOR = 1.47, 99% CI: 1.08-2.00) than CB Whites. Other risk factors for undiagnosed depression include the lack of regular care providers, emergency room as the usual source of care, and being home renters. DISCUSSION Despite Canadian universal health coverage, the burden of undiagnosed depression disproportionately affects racialized (but not White) immigrants in mid to late life. Contingent on race-migration nexus, the HIE in mental health may be mainly driven by the healthier profile of White immigrants and partly attributable to the under-detection (by health professionals) and under-recognition of mental health conditions among racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.
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Affiliation(s)
- Shen (Lamson) Lin
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Ho JY. Life Course Patterns of Prescription Drug Use in the United States. Demography 2023; 60:1549-1579. [PMID: 37728437 PMCID: PMC10656114 DOI: 10.1215/00703370-10965990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Prescription drug use has reached historic highs in the United States-a trend linked to increases in medicalization, institutional factors relating to the health care and pharmaceutical industries, and population aging and growing burdens of chronic disease. Despite the high and rising prevalence of use, no estimates exist of the total number of years Americans can expect to spend taking prescription drugs over their lifetimes. This study provides the first estimates of life course patterns of prescription drug use using data from the 1996-2019 Medical Expenditure Panel Surveys, the Human Mortality Database, and the National Center for Health Statistics. Newborns in 2019 could be expected to take prescription drugs for roughly half their lives: 47.54 years for women and 36.84 years for men. The number of years individuals can expect to take five or more drugs increased substantially. Americans also experienced particularly dramatic increases in years spent taking statins, antihypertensives, and antidepressants. There are also important differences in prescription drug use by race and ethnicity: non-Hispanic Whites take the most, Hispanics take the least, and non-Hispanic Blacks fall in between these extremes. Americans are taking drugs over a wide and expanding swathe of the life course, a testament to the centrality of prescription drugs in Americans' lives today.
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Affiliation(s)
- Jessica Y Ho
- Department of Sociology and Criminology, and Population Research Institute, The Pennsylvania State University, University Park, PA, USA
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Lin S(L. Inequities in Mental Health Care Facing Racialized Immigrant Older Adults With Mental Disorders Despite Universal Coverage: A Population-Based Study in Canada. J Gerontol B Psychol Sci Soc Sci 2023; 78:1555-1571. [PMID: 36842070 PMCID: PMC10461535 DOI: 10.1093/geronb/gbad036] [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: 08/21/2022] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVES Contemporary immigration scholarship has typically treated immigrants with diverse racial backgrounds as a monolithic population. Knowledge gaps remain in understanding how racial and nativity inequities in mental health care intersect and unfold in midlife and old age. This study aims to examine the joint impact of race, migration, and old age in shaping mental health treatment. METHODS Pooled data were obtained from the Canadian Community Health Survey (2015-2018) and restricted to respondents (aged ≥45 years) with mood or anxiety disorders (n = 9,099). Multivariable logistic regression was performed to estimate associations between race-migration nexus and past-year mental health consultations (MHC). Classification and regression tree (CART) analysis was applied to identify intersecting determinants of MHC. RESULTS Compared to Canadian-born Whites, racialized immigrants had greater mental health needs: poor/fair self-rated mental health (odds ratio [OR] = 2.23, 99% confidence interval [CI]: 1.67-2.99), perceived life stressful (OR = 1.49, 99% CI: 1.14-1.95), psychiatric comorbidity (OR = 1.42, 99% CI: 1.06-1.89), and unmet needs for care (OR = 2.02, 99% CI: 1.36-3.02); in sharp contrast, they were less likely to access mental health services across most indicators: overall past-year MHC (OR = 0.54, 99% CI: 0.41-0.71) and consultations with family doctors (OR = 0.67, 99% CI: 0.50-0.89), psychologists (OR = 0.54, 99% CI: 0.33-0.87), and social workers (OR = 0.37, 99% CI: 0.21-0.65), with the exception of psychiatrist visits (p = .324). The CART algorithm identifies three groups at risk of MHC service underuse: racialized immigrants aged ≥55 years, immigrants without high school diplomas, and linguistic minorities who were home renters. DISCUSSION To safeguard health care equity for medically underserved communities in Canada, multisectoral efforts need to guarantee culturally responsive mental health care, multilingual services, and affordable housing for racialized immigrant older adults with mental disorders.
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Affiliation(s)
- Shen (Lamson) Lin
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Emerson MR, Dinkel D, Watanabe-Galloway S, Torous J, Johnson DJ. Adaptation of digital navigation training for integrated behavioral health providers: Interview and survey study. Transl Behav Med 2023; 13:612-623. [PMID: 37086443 DOI: 10.1093/tbm/ibad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
Despite effective treatment options, people who experience mental health conditions often do not receive needed care. E-mental health, for instance the use of mobile apps, is emerging as a way to increase access to and extend care. However, little formal training is available to increase the digital literacy level among behavioral healthcare providers (BHPs), seeking to employ such technology. The purpose of this study was to explore the acceptability and usability of an adapted in-person Digital Navigation Training (DNT) curriculum into e-Learning modules focused on the integrated environment for BHPs. BHP confidence to serve as digital navigators was also explored. E-Learning modules were adapted from an existing in-person DNT. A purposeful sampling strategy was used to recruit BHPs (n = 8) to complete the modules. Acceptability, usability, and confidence were assessed via survey and semi-structured interviews. Descriptive statistics were calculated for survey data and qualitative data were analyzed using a directed content analysis approach. BHPs who completed the training (n = 8) felt the modules were usable, enjoyed the structure, and felt the amount of time to complete the modules was acceptable. All participants thought the structure of the training worked well and enjoyed learning new information. While participants' confidence in their digital navigation skills increased, they desired more information and/or experience with screening apps prior to increasing their use of apps within their care. E-Learning modules were an acceptable method of educating BHPs with digital navigation skills. Future research is needed to explore incentives needed for training along with if participating in these modules can increase use of quality mobile apps to augment care within BHP treatment plans.
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Affiliation(s)
- Margaret R Emerson
- College of Nursing, University of Nebraska Medical Center, Omaha, NE 68154, USA
| | - Danae Dinkel
- College of Education, Health, and Human Sciences, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | | | - John Torous
- Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, 02115 MA, USA
| | - David J Johnson
- Department of Psychiatry & Behavioral Science, Mercer University School of Medicine, Atlanta, GA 30341, USA
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Steinman LE, Gasca A, Hoeft TJ, Raue PJ, Henderson S, Perez R, Huerta A, Fajardo A, Vredevoogd MA, James K, Hinton L, Rath L, Unutzer J. "We are the sun for our community:" Partnering with community health workers/promotores to adapt, deliver and evaluate a home-based collaborative care model to improve equity in access to quality depression care for older U.S. Latino adults who are underserved. Front Public Health 2023; 11:1079319. [PMID: 36817932 PMCID: PMC9932325 DOI: 10.3389/fpubh.2023.1079319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Background While depression is a leading cause of poor health, less than half of older adults receive adequate care. Inequities in both access and outcomes are even more pronounced for socially disadvantaged older adults. The collaborative care model (CCM) has potential to reduce this burden through community-based organizations (CBOs) who serve these populations. However, CCM has been understudied in diverse cultural and resource-constrained contexts. We evaluated the implementation and effectiveness of PEARLS, a home-based CCM adapted with and for community health workers/promotores (CHWs/Ps). Methods We used an instrumental case study design. Our case definition is a community-academic partnership to build CHW/P capacity for evidence-based depression care for older U.S. Latino adults in the Inland Empire region of California (2017-2020). We aimed to understand adaptations to fit local context; acceptability, feasibility, and fidelity; clinical effectiveness; and contextual determinants of implementation success or failure. Data sources included quantitative and qualitative administrative and evaluation data from participants and providers. We used descriptive statistics and paired t-tests to characterize care delivery and evaluate effectiveness post-intervention, and deductive thematic analysis to answer other aims. Findings This case study included 152 PEARLS participants and nine data sources (N = 67 documents). The CBO including their CHWs/Ps partnered with the external implementation team made adaptations to PEARLS content, context, and implementation strategies to support CHWs/Ps and older adults. PEARLS was acceptable, feasible and delivered with fidelity. Participants showed significant reductions in depression severity at 5 months (98% clinical response rate [mean (SD), 13.7 (3.9) drop in pre/post PHQ-9; p < 0.001] and received support for 2.6 social needs on average. PEARLS delivery was facilitated by its relative advantage, adaptability, and trialability; the team's collective efficacy, buy-in, alignment with organization mission, and ongoing reflection and evaluation during implementation. Delivery was challenged by weak partnerships with clinics for participant referral, engagement, reimbursement, and sustainability post-grant funding. Discussion This case study used existing data to learn how home-based CCM was adapted by and for CHWs/Ps to reduce health inequities in late-life depression and depression care among older Latino immigrants. The CBOs and CHWs/Ps strong trust and rapport, addressing social and health needs alongside depression care, and regular internal and external coaching and consultation, appeared to drive successful implementation and effectiveness.
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Affiliation(s)
- Lesley E. Steinman
- Department of Health Systems and Population Health, Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, United States
| | - Amelia Gasca
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Theresa J. Hoeft
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Patrick J. Raue
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Stuart Henderson
- School of Medicine Office of Research, University of California Davis, Sacramento, Sacramento, CA, United States
| | - Rosa Perez
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Alfredo Huerta
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Alex Fajardo
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Melinda A. Vredevoogd
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Katherine James
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, Sacramento, CA, United States
| | - Laura Rath
- Archstone Foundation, Long Beach, CA, United States
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
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Botoseneanu A, Elman MR, Allore HG, Dorr DA, Newsom JT, Nagel CL, Quiñones AR. Depressive Multimorbidity and Trajectories of Functional Status among Older Americans: Differences by Racial/Ethnic Group. J Am Med Dir Assoc 2023; 24:250-257.e3. [PMID: 36535384 PMCID: PMC10280885 DOI: 10.1016/j.jamda.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/08/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the impact of depressive multimorbidity (ie, including depressive symptoms) on the long-term development of activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations according to racial/ethnic group in a representative sample of US older adults. DESIGN Prospective, observational, population-based 16-year follow-up study of nationally representative sample. SETTING AND PARTICIPANTS Sample of older non-Hispanic Black, Hispanic, and nonHispanic White Americans from the Health and Retirement Study (2000‒2016, N = 16,364, community-dwelling adults ≥65 years of age). METHODS Data from 9 biennial assessments were used to evaluate the accumulation of ADL-IADL limitations (range 0‒11) among participants with depressive (8-item Center for Epidemiologic Studies Depression score≥4) vs somatic (ie, physical conditions only) multimorbidity vs those without multimorbidity (no or 1 condition). Generalized estimating equations included race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White), baseline age, sex, body mass index, education, partnered, and net worth. RESULTS Depressive and somatic multimorbidity were associated with 5.18 and 2.95 times greater accumulation of functional limitations, respectively, relative to no disease [incidence rate ratio (IRR) = 5.18, 95% confidence interval, CI (4.38,6.13), IRR = 2.95, 95% CI (2.51,3.48)]. Hispanic and Black respondents experienced greater accumulation of ADL-IADL limitations than White respondents [IRR = 1.27, 95% CI (1.14, 1.41), IRR = 1.31, 95% CI (1.20, 1.43), respectively]. CONCLUSIONS AND IMPLICATIONS Combinations of somatic diseases and high depressive symptoms are associated with greatest accumulation of functional limitations over time in adults ages 65 and older. There is a more rapid growth in functional limitations among individuals from racial/ethnic minority groups. Given the high prevalence of multimorbidity and depressive symptomatology among older adults and the availability of treatment options for depression, these results highlight the importance of screening/treatment for depression, particularly among older adults with socioeconomic vulnerabilities, to slow the progression of functional decline in later life.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health and Human Services, University of Michigan, Dearborn, MI, USA; Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA.
| | - Miriam R Elman
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA; Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ana R Quiñones
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Steinman LE, Parrish AT, Kohn MJ, Wu S, Hara-Hubbard KK, Brown L, Imam S, Baquero B, Hannon PA, Snowden MB. Partnering with community-based organizations to improve equitable access to depression care for underserved older adults in the U.S.: Qualitative formative research. Front Public Health 2023; 10:1079082. [PMID: 36793362 PMCID: PMC9922751 DOI: 10.3389/fpubh.2022.1079082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/29/2022] [Indexed: 02/03/2023] Open
Abstract
Background Embedding evidenced-based programs (EBPs) like PEARLS outside clinical settings can help reduce inequities in access to depression care. Trusted community-based organizations (CBOs) reach older adults who are underserved; however, PEARLS adoption has been limited. Implementation science has tried to close this know-do gap, however a more intentional focus on equity is needed to engage CBOs. We partnered with CBOs to better understand their resources and needs in order to design more equitable dissemination and implementation (D&I) strategies to support PEARLS adoption. Methods We conducted 39 interviews with 24 current and potential adopter organizations and other partners (February-September 2020). CBOs were purposively sampled for region, type, and priority older populations experiencing poverty (communities of color, linguistically diverse, rural). Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; CBO capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. During COVID-19, interviews also addressed remote PEARLS delivery and changes in priorities. We conducted thematic analysis of transcripts using the rapid framework method to describe the needs and priorities of older adults who are underserved and the CBOs that engage them, and strategies, collaborations, and adaptations to integrate depression care in these contexts. Results During COVID-19, older adults relied on CBO support for basic needs such as food and housing. Isolation and depression were also urgent issues within communities, yet stigma remained for both late-life depression and depression care. CBOs wanted EBPs with cultural flexibility, stable funding, accessible training, staff investment, and fit with staff and community needs and priorities. Findings guided new dissemination strategies to better communicate how PEARLS is appropriate for organizations that engage older adults who are underserved, and what program components are core and what are adaptable to better align with organizations and communities. New implementation strategies will support organizational capacity-building through training and technical assistance, and matchmaking for funding and clinical support. Discussion Findings support CBOs as appropriate depression care providers for older adults who are underserved, and suggest changes to communications and resources to better fit EBPs with the resources and needs of organizations and older adults. We are currently partnering with organizations in California and Washington to evaluate whether and how these D&I strategies increase equitable access to PEARLS for older adults who are underserved.
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Affiliation(s)
- Lesley E. Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Amanda T. Parrish
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Marlana J. Kohn
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Sherry Wu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - KeliAnne K. Hara-Hubbard
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Lori Brown
- Southeast Washington Aging and Long-Term Care, Yakima, WA, United States
| | - Syed Imam
- Union for Pan Asian Communities (UPAC) Positive Solutions Program, San Diego, CA, United States
| | - Barbara Baquero
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Peggy A. Hannon
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Mark B. Snowden
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Naicker R. Critically appraising for antiracism. EDUCATION FOR INFORMATION 2022. [DOI: 10.3233/efi-220052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Racial bias in research impacts a study’s relevancy, validity and reliability, though presently this aspect is not addressed in critical appraisal tools, and consequently appraisers may not take racial bias into account when assessing a paper’s quality. Drawing on Critical Race Theory (CRT) tenets that racism is ubiquitous and race a social construct, this paper discusses concerns regarding racism in research which have been broadly divided into two categories for critical appraisers to consider: the underrepresentation of minoritised ethnic groups in health studies, especially where minoritised populations see higher rates of disease occurrence and; the utilisation of racial/ethnicity data to interpret disparities in outcomes, including speculation of biological race, the misinterpretation of genetic ancestry as race, and the lack of investigation into social determinants of health, including systemic, institutional and interpersonal forms of racism. The injustices exposed in this paper impact the health of minoritised ethnic groups and are therefore a Black Lives Matter issue. They risk resurrecting dangerous theories regarding biological inferiority among minoritised ethnic populations, as well as hindering study findings. The application of CRT frameworks in health science research quality appraisal are discussed in relation to the above themes – using largely UK-based contexts with supporting examples from the US – followed by recommendations for critically appraising for antiracism. Further information to support critically appraising for antiracism can be found via https://www.criticallyappraisingantiracism.org/.
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Remmert JE, Guzman G, Mavandadi S, Oslin D. Racial Disparities in Prescription of Antidepressants Among U.S. Veterans Referred to Behavioral Health Care. Psychiatr Serv 2022; 73:984-990. [PMID: 35414191 DOI: 10.1176/appi.ps.202100237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Antidepressants are often prescribed in primary care to treat veterans who have depression. An evaluation of current racial disparities in integrated primary care is warranted. This study examined the association between race and prescription of antidepressants among veterans in primary care. METHODS Veterans in primary care (Black, N=4,120; White, N=4,372) who were referred from primary care to a collaborative care program completed an assessment of demographic characteristics and clinical symptoms, including of current antidepressant prescription before the referral, verified by chart review. Patient data were collected from January 1, 2015, to December 22, 2020. Logistic regression analyses were conducted to examine the relationships between patient race and both depression symptoms and antidepressant prescription. Analyses were also stratified by severity of depression symptoms to understand the results in the context of clinical guidelines. RESULTS White patients were almost two times (odds ratio=1.96, 95% confidence interval [CI]=1.75–2.19, p<0.001) more likely than Black patients to receive an antidepressant prescription, after the analysis was controlled for depression symptoms, demographic characteristics, and other clinical symptoms. Among patients with severe depression, for whom prescription of antidepressants is clinically indicated, White patients were 1.87 times more likely than Black patients to receive an antidepressant prescription (95% CI=1.40–2.50, p<0.001). CONCLUSIONS The findings reveal racial disparities in antidepressant prescription for veterans in primary care. Regular clinical review of antidepressant prescription is recommended to identify disparities in individual clinics. Future research should aim to identify drivers of racial disparities and provide recommendations for health care systems, providers, and patients.
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Affiliation(s)
- Jocelyn E Remmert
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Gabriella Guzman
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Shahrzad Mavandadi
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Dave Oslin
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
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Hankerson SH, Moise N, Wilson D, Waller BY, Arnold KT, Duarte C, Lugo-Candelas C, Weissman MM, Wainberg M, Yehuda R, Shim R. The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression. Am J Psychiatry 2022; 179:434-440. [PMID: 35599541 PMCID: PMC9373857 DOI: 10.1176/appi.ajp.21101000] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.
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Affiliation(s)
- Sidney H Hankerson
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Nathalie Moise
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Diane Wilson
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Bernadine Y Waller
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Kimberly T Arnold
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Cristiane Duarte
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Claudia Lugo-Candelas
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Myrna M Weissman
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Milton Wainberg
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Rachel Yehuda
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
| | - Ruth Shim
- Department of Psychiatry (Hankerson, Yehuda) and Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York; Department of Medicine (Moise, Wilson) and Department of Psychiatry (Waller, Duarte, Lugo-Candelas, Wainberg), Columbia University Irving Medical Center, New York; City University of New York (Wilson); New York State Psychiatric Institute, New York (Waller, Duarte, Lugo-Candelas, Wainberg, Weissman); Department of Family Medicine and Community Health, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Arnold); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Weissman); James J. Peters VA Medical Center, Bronx, N.Y. (Yehuda); Department of Psychiatry, University of California, Davis (Shim)
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Geographic Region, Racial/Ethnic Disparities, and Late-Life Depression: Results From a Large US Cohort of Older Adults. Am J Geriatr Psychiatry 2022; 30:703-716. [PMID: 34969584 PMCID: PMC9106835 DOI: 10.1016/j.jagp.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine associations between geographic region and late-life depression (LLD) severity, item-level symptom burden, and treatment; to evaluate whether racial/ethnic disparities in LLD, previously observed in the overall sample, vary by region. METHODS We included 25,502 VITAL (Vitamin D and Omega-3 Trial) participants and administered the Patient Health Questionnaire-8 for depressive symptoms; participants also reported medication and/or counseling care for depression. Multivariable regression analyses were performed. RESULTS Despite overall lower LLD severity and item-level symptom burden in the Midwest versus Northeast, higher LLD severity and item-level burden were observed among minorities, especially Black and Hispanic adults, compared to non-Hispanic whites in this region. Racial/ethnic disparities in item-level symptoms (e.g., anhedonia, sadness, psychomotor changes) varied by region. There were no significant differences in depression care by region; furthermore, regional variation was not observed in racial disparities in care: e.g., among those with clinician/physician-diagnosed depression, Blacks versus non-Hispanic whites had greater than 50% lower odds of treatment in all regions. CONCLUSION LLD varied by geographic region. Furthermore, magnitudes of racial/ethnic disparities in LLD severity and item-level symptom burden, but not depression care, differed by region.
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Depression, Is It Treatable in Adults Utilising Dietary Interventions? A Systematic Review of Randomised Controlled Trials. Nutrients 2022; 14:nu14071398. [PMID: 35406011 PMCID: PMC9003461 DOI: 10.3390/nu14071398] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
This systematic literature review examined whole food or whole diet interventions to treat depression. The inclusion criteria encompassed adults, depression, a recognized depression scale and a whole food or diet intervention. APA PsychINFO, CINAHL, the Cochrance Central Register of Controlled Trails, MEDLINE and Scopus were searched for original research addressing diet as a treatment for depression in adult populations. The quality of the study was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Seven studies; with 49,156 participants; met the eligibility criteria. All these studies found positive outcomes with depression levels decreasing after dietary intervention. The calculated effect size varied from small (Cohen’s d = 0.32) to very large (Cohen’s d = 1.82). The inconsistent nature of the studies limited the synthesis of the data. Recommendations are provided to enhance future study design and measurement outcomes. Overall, the findings show a positive result for diets that promote an increased intake of fresh produce, wholegrains, low-fat dairy and lean protein sources, while also decreasing the intake of processed and high-fat foods. No funding was provided for this review. The protocol for this review is registered with PROSPERO (CRD42020210426).
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15
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Cohen S, Stellefson M, Bopp T. Changes in Mental Health Should Be Measured When Evaluating Outdoor Education Programs for Urban Youth. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2021.2019628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Study protocol for comparing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to referral as usual for depression in African American churches. Trials 2022; 23:93. [PMID: 35101100 PMCID: PMC8801931 DOI: 10.1186/s13063-021-05767-8] [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: 04/01/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Depression is a leading cause of disability worldwide. African American adults, compared to White adults, are half as likely to be screened for depression in primary care settings. Disparities in depression screening contribute to poor clinical outcomes, as African Americans with depression are more disabled and sicker longer compared to Whites. African American churches are trusted settings that provide access to supports for depression. Indeed, in the first study of its kind, the investigators found that 20% of adults in African American churches screened positive for depression using the Patient Health Questionnaire-9 (PHQ-9). However, no subjects with a positive screen (PHQ-9 ≥ 10) accepted a treatment referral when offered by research personnel. Community Health Workers, who are trusted paraprofessionals from the target community, may bridge the gap between depression screening and treatment. The investigators have trained and certified 112 Community Health Workers from 45 African American churches in New York City to deliver an evidence-based intervention called Screening, Brief Intervention, and Referral to Treatment (SBIRT). Thus, the aim of the current study is to test the impact of Community Health Worker-delivered depression screening in Black churches on engagement with clinical services. Methods Using a hybrid type 1 effectiveness-implementation design, we propose a 2-arm, mixed-methods cluster randomized controlled trial. Church study sites will be randomized to either SBIRT (intervention arm) or referral as usual (usual care arm). This trial will be conducted with 600 church members across 30 churches (300 intervention; 300 usual care). Our primary outcome is treatment engagement, defined as attending a depression-related clinical visit. Secondary outcomes will be changes in Mental Health-Related Quality of Life and depressive symptoms at 3 and 6 months post-screening. Lastly, we will conduct a concurrent, mixed-methods (qualitative-quantitative) process evaluation to assess contextual facilitators and barriers of screening and referral. Discussion This is the first randomized trial of a church-placed, community health worker-delivered intervention for depression in African American populations. This study may provide a novel and effective approach to increasing depression identification and treatment linkage in economically disadvantaged populations with high depression rates. Trial registration ClinicalTrials.govNCT04524767. Registered on 21 August 2020.
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Chen WC, Boreta L, Braunstein SE, Rabow MW, Kaplan LE, Tenenbaum JD, Morin O, Park CC, Hong JC. Association of mental health diagnosis with race and all-cause mortality after a cancer diagnosis: Large-scale analysis of electronic health record data. Cancer 2022; 128:344-352. [PMID: 34550601 PMCID: PMC8738115 DOI: 10.1002/cncr.33903] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Disparity in mental health care among cancer patients remains understudied. METHODS A large, retrospective, single tertiary-care institution cohort study was conducted based on deidentified electronic health record data of 54,852 adult cancer patients without prior mental health diagnosis (MHD) diagnosed at the University of California, San Francisco between January 2012 and September 2019. The exposure of interest was early-onset MHD with or without psychotropic medication (PM) within 12 months of cancer diagnosis and primary outcome was all-cause mortality. RESULTS There were 8.2% of patients who received a new MHD at a median of 197 days (interquartile range, 61-553) after incident cancer diagnosis; 31.0% received a PM prescription; and 3.7% a mental health-related visit (MHRV). There were 62.6% of patients who were non-Hispanic White (NHW), 10.8% were Asian, 9.8% were Hispanic, and 3.8% were Black. Compared with NHWs, minority cancer patients had reduced adjusted odds of MHDs, PM prescriptions, and MHRVs, particularly for generalized anxiety (Asian odds ratio [OR], 0.66, 95% CI, 0.55-0.78; Black OR, 0.60, 95% CI, 0.45-0.79; Hispanic OR, 0.72, 95% CI, 0.61-0.85) and selective serotonin-reuptake inhibitors (Asian OR, 0.43, 95% CI, 0.37-0.50; Black OR, 0.51, 95% CI, 0.40-0.61; Hispanic OR, 0.79, 95% CI, 0.70-0.89). New early MHD with PM was associated with elevated all-cause mortality (12-24 months: hazard ratio [HR], 1.43, 95% CI, 1.25-1.64) that waned by 24 to 36 months (HR, 1.18, 95% CI, 0.95-1.45). CONCLUSIONS New mental health diagnosis with PM was a marker of early mortality among cancer patients. Minority cancer patients were less likely to receive documentation of MHDs or treatment, which may represent missed opportunities to identify and treat cancer-related mental health conditions.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | - Lauren Boreta
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | - Michael W Rabow
- Department of Internal Medicine, Division of Palliative Medicine, and Department of Urology, University of California San Francisco, California
| | - Lawrence E Kaplan
- Department of Psychiatry, University of California San Francisco, California
| | | | - Olivier Morin
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | - Catherine C Park
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | - Julian C Hong
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA
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Chao AM, Wadden TA, Clark JM, Hayden KM, Howard MJ, Johnson KC, Laferrère B, McCaffery JM, Wing RR, Yanovski SZ, Wagenknecht LE. Changes in the Prevalence of Symptoms of Depression, Loneliness, and Insomnia in U.S. Older Adults With Type 2 Diabetes During the COVID-19 Pandemic: The Look AHEAD Study. Diabetes Care 2022; 45:74-82. [PMID: 34753805 PMCID: PMC8753763 DOI: 10.2337/dc21-1179] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/13/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate changes in the prevalence of depressive symptoms, loneliness, and insomnia among older adults with type 2 diabetes from 2016 to 2020 and to assess risk factors for these conditions including demographics, multimorbidity, BMI, treatment group, and pre-coronavirus 2019 (COVID-19) measure scores. RESEARCH DESIGN AND METHODS This was a prospective, observational study of participants from the Look AHEAD (Action for Health in Diabetes) cohort study. Data were from two assessments before COVID-19 (visit 1: April 2016-June 2018 and visit 2: February 2018-February 2020) and one assessment during COVID-19 (visit 3: July-December 2020). Surveys were administered to assess depressive symptoms, loneliness, and insomnia. RESULTS The study included 2829 adults (63.2% female, 60.6% White, mean [SD] age 75.6 [6.0] years). The prevalence of mild or greater depressive symptoms did not change significantly between the two pre-pandemic visits (P = 0.88) but increased significantly from pre- to during COVID-19 (19.3% at V2 to 30.4% at V3; P < 0.001). Higher odds of mild or greater depressive symptoms at V3 were associated with being female (adjusted odds ratio [OR] 1.4 [95% CI 1.1-1.7]), identifying as non-Hispanic White (OR 1.4 [95% CI 1.1-1.7]), having obesity (OR 1.3 [95% CI 1.0-1.5]), and reporting mild or greater depressive symptoms at V1 (OR 4.0 [95% CI 2.9-5.4]), V2 (OR 4.4 [95% CI 3.2-5.9]), or both visits (OR 13.4 [95% CI 9.7-18.4]). The prevalence of loneliness increased from 12.3% at V1 to 22.1% at V3 (P < 0.001), while the prevalence of insomnia remained stable across visits at 31.5-33.3%. CONCLUSIONS The prevalence of mild or greater depressive symptoms in older adults with diabetes was more than 1.6 times higher during COVID-19 than before the pandemic.
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Affiliation(s)
- Ariana M. Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jeanne M. Clark
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Rena R. Wing
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Bensken WP, Fernandez-Baca Vaca G, Jobst BC, Williams SM, Stange KC, Sajatovic M, Koroukian SM. Burden of Chronic and Acute Conditions and Symptoms in People With Epilepsy. Neurology 2021; 97:e2368-e2380. [PMID: 34706975 PMCID: PMC8673720 DOI: 10.1212/wnl.0000000000012975] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES People with epilepsy, one-third of whom in the United States are on Medicaid, experience a wide range of chronic and physical comorbidities that influence their care and outcomes. In this study, we examine the burden and racial/ethnic disparities of chronic and acute conditions, injuries, and symptoms in a large and diverse group of people with epilepsy on Medicaid. METHODS Using 5 years of Medicaid claims data, we identified adults with epilepsy and used all available claims and diagnoses to identify each person's Clinical Classification Codes groups diagnosed during the study period. Using association rule mining, we identified the top combinations of conditions and stratified these by race/ethnicity to identify potential prevalence disparities. We examined the top combinations of conditions in high utilizers; that is, individuals in the top quartile of hospitalizations and emergency department visits. RESULTS Among 81,963 patients, the most common conditions were anxiety and mood disorders (46.5%), hypertension (36.9%), back problems (35.2%), developmental disorders (31.6%), and headache (29.5%). When examining combinations of conditions, anxiety and mood disorders continued to have an outsized prevalence, appearing in nearly every combination. There were notable disparities in disease burden, with American Indians and Alaskan Natives having a substantially higher prevalence of developmental disorders, while Black individuals had a higher prevalence of hypertension. These disparities persisted to the higher-order combinations that included these conditions. High utilizers had a much higher disease burden, with 75.8% having an anxiety or mood disorder, as well as a higher burden of injuries. DISCUSSION This study shows a high prevalence of psychiatric and physical conditions and identifies racial and ethnic disparities affecting people with epilepsy. Targeting interventions to consider the comorbidities, race, and ethnicity has potential to improve clinical care and reduce disparities.
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Affiliation(s)
- Wyatt P Bensken
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Guadalupe Fernandez-Baca Vaca
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Barbara C Jobst
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Scott M Williams
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kurt C Stange
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Martha Sajatovic
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Siran M Koroukian
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Mladen SN, Williams AB, Griffin SC, Perrin PB, Rybarczyk BD. Models of Trauma Exposure, Depression, and Suicidality in Safety-Net Primary Care. J Trauma Stress 2021; 34:1139-1148. [PMID: 33561310 DOI: 10.1002/jts.22658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 11/09/2022]
Abstract
Suicidality is a major public health concern, particularly for low-income, trauma-exposed patients with limited access to mental health providers. However, limited research has modeled pathways of suicidality in safety-net primary care samples. Patients (N = 207) in a safety-net primary care clinic completed measures of childhood and adult trauma exposure, depression, and suicidality. Participants (M age = 44.8 years, SD = 11.6), were 60.4% male, 63.8% Black/African American, and predominantly low-income (i.e., 69.1% reported an annual income less than $5,000 USD). Half of the sample reported at least four childhood traumatic events (M = 3.9 events, SD = 3.0) and approximately three adult traumatic events (M = 3.0 events, SD = 2.1). Most participants (82.1%) reported significant depressive symptoms, and 43.5% endorsed recent suicidality. Models showing the mediational effect of depression on the association between trauma exposure and suicidality, β = .20, B = 0.23, SE = 0.05, 95% CI [0.16, 0.32], and the moderational effect of trauma exposure on the association between depression and suicidality, β = .16, B = 0.20, SE = 0.08, p = .007, were both supported. These results underscore the high prevalence of trauma exposure, depression, and suicidality in a safety-net primary care sample. They also highlight the pervasiveness and complexity of suicidality in low-income primary care patients, emphasize the importance of trauma-informed suicide assessment, and identify trauma sequelae and depression as potential treatment targets to reduce suicidality.
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Affiliation(s)
- Samantha N Mladen
- Department of Clinical Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Allison B Williams
- Department of Clinical Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah C Griffin
- Department of Clinical Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul B Perrin
- Department of Counseling Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bruce D Rybarczyk
- Department of Clinical Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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21
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Parikh RB, Gallo JJ, Wong YN, Robinson KW, Cashy JP, Narayan V, Jayadevappa R, Chhatre S. Long-term depression incidence and associated mortality among African American and White prostate cancer survivors. Cancer 2021; 127:3476-3485. [PMID: 34061986 DOI: 10.1002/cncr.33656] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression is common after a diagnosis of prostate cancer and may contribute to poor outcomes, particularly among African Americans. The authors assessed the incidence and management of depression and its impact on overall mortality among African American and White veterans with localized prostate cancer. METHODS The authors used the Veterans Health Administration Corporate Data Warehouse to identify 40,412 African American and non-Hispanic White men diagnosed with localized prostate cancer from 2001 to 2013. Patients were followed through 2019. Multivariable logistic regression was used to measure associations between race and incident depression, which were ascertained from administrative and depression screening data. Cox proportional hazards models were used to measure associations between incident depression and all-cause mortality, with race-by-depression interactions used to assess disparities. RESULTS Overall, 10,013 veterans (24.5%) were diagnosed with depression after a diagnosis of prostate cancer. Incident depression was associated with higher all-cause mortality (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.23-1.32). African American veterans were more likely than White veterans to be diagnosed with depression (29.3% vs 23.2%; adjusted odds ratio [aOR], 1.15; 95% CI, 1.09-1.21). Among those with depression, African Americans were less likely to be prescribed an antidepressant (30.4% vs 31.7%; aOR, 0.85; 95% CI, 0.77-0.93). The hazard of all-cause mortality associated with depression was greater for African American veterans than White veterans (aHR, 1.32 [95% CI, 1.26-1.38] vs 1.15 [95% CI, 1.07-1.24]; race-by-depression interaction P < .001). CONCLUSIONS Incident depression is common among prostate cancer survivors and is associated with higher mortality, particularly among African American men. Patient-centered strategies to manage incident depression may be critical to reducing disparities in prostate cancer outcomes.
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Affiliation(s)
- Ravi B Parikh
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph J Gallo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yu-Ning Wong
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle W Robinson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Cashy
- VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - Vivek Narayan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ravishankar Jayadevappa
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sumedha Chhatre
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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22
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Cherrington AL, Krause-Steinrauf H, Bebu I, Naik AD, Walker E, Golden SH, Gonzalez JS. Study of emotional distress in a comparative effectiveness trial of diabetes treatments: Rationale and design. Contemp Clin Trials 2021; 107:106366. [PMID: 33766761 DOI: 10.1016/j.cct.2021.106366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
Emotional distress, including depression and diabetes-specific distress (e.g., feeling overwhelmed by living with diabetes, feelings of failure related to diabetes self-care), is a significant and prevalent problem for patients with type 2 diabetes. Both depression and diabetes distress have been associated with metabolic/glycemic control, diabetes complications, mortality, and quality of life. Recent findings further suggest that risk for emotional distress is influenced by diabetes treatment. The GRADE Study (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study) is generating prospective data that will provide a unique opportunity to examine the relationships between emotional distress, diabetes treatment, and outcomes in an experimental design. The GRADE study is a randomized clinical trial that will compare the metabolic effects of four common anti-hyperglycemic drugs when combined with metformin. This sub-study recruited a subset (n = 1739) of GRADE participants and will examine patient-level variation in baseline emotional distress as a predictor of glycemic control and other health outcomes, independent of treatment effects. The study will also provide an experimental examination of treatment regimen effects on emotional distress over time as part of the overall evaluation of comparative effectiveness. Evaluation of emotional distress using validated measures will allow us to disentangle the roles of depressive symptoms and diabetes distress, factors that share significant overlap but require distinct approaches to screening and treatment. Study findings may directly influence practice decisions regarding screening and treatment for emotional distress as part of diabetes care. ClinicalTrials.gov Identifier: NCT01794143.
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Affiliation(s)
- Andrea L Cherrington
- Department of Medicine (General Internal and Preventive Medicine), University of Alabama, Birmingham, Birmingham, AL, United States of America.
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States of America
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States of America
| | - Aanand D Naik
- Department of Medicine (Geriatrics and Palliative Medicine Section), Baylor College of Medicine, Houston, Texas, United States of America; Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - Elizabeth Walker
- Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Sherita H Golden
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Jeffrey S Gonzalez
- Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America; Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, United States of America
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23
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Association between preexisting mental illnesses and mortality among medicaid-insured women diagnosed with breast cancer. Soc Sci Med 2021; 270:113643. [PMID: 33387965 PMCID: PMC9989878 DOI: 10.1016/j.socscimed.2020.113643] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND We investigated the impact of preexisting mental illnesses on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. METHODS Data from the New York State Cancer Registry for 10,444 women diagnosed with breast cancer from 2004 to 2016 and aged <65 years at diagnosis were linked with Medicaid claims. Women were categorized as having depression or a severe mental illness (SMI) if they had at least three relevant diagnosis claims with at least one claim within three years prior to breast cancer diagnosis. SMI included schizophrenia, bipolar disorder, and other psychotic disorders. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated with Cox proportional hazards regression, adjusting for potential confounders. RESULTS Preexisting SMI was associated with greater all-cause (HR = 1.36; 95%CI 1.18, 1.57) and cancer-specific (HR = 1.21; 95%CI 1.03, 1.44) mortality compared to those with no mental illnesses. No association was observed between preexisting depression and mortality. Among racial/ethnic subgroups, the association between SMI and all-cause mortality was observed among non-Hispanic white (HR = 1.47; 95%CI 1.19, 1.83) and non-Hispanic Asian/Pacific Islander (HR = 2.59; 95% 1.15, 5.87) women. Additionally, mortality hazards were greatest among women with preexisting SMI that were postmenopausal (HR = 1.49; 95%CI 1.25, 1.78), obese (HR = 1.58; 95%CI 1.26, 1.98), and had documented tobacco use (HR = 1.42; 95%CI 1.13, 1.78). CONCLUSION Women with preexisting SMI prior to breast cancer diagnosis have an elevated mortality hazard and should be monitored and treated by a coordinated cross-functional clinical team.
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24
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Buch AM, Liston C. Dissecting diagnostic heterogeneity in depression by integrating neuroimaging and genetics. Neuropsychopharmacology 2021; 46:156-175. [PMID: 32781460 PMCID: PMC7688954 DOI: 10.1038/s41386-020-00789-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
Depression is a heterogeneous and etiologically complex psychiatric syndrome, not a unitary disease entity, encompassing a broad spectrum of psychopathology arising from distinct pathophysiological mechanisms. Motivated by a need to advance our understanding of these mechanisms and develop new treatment strategies, there is a renewed interest in investigating the neurobiological basis of heterogeneity in depression and rethinking our approach to diagnosis for research purposes. Large-scale genome-wide association studies have now identified multiple genetic risk variants implicating excitatory neurotransmission and synapse function and underscoring a highly polygenic inheritance pattern that may be another important contributor to heterogeneity in depression. Here, we review various sources of phenotypic heterogeneity and approaches to defining and studying depression subtypes, including symptom-based subtypes and biology-based approaches to decomposing the depression syndrome. We review "dimensional," "categorical," and "hybrid" approaches to parsing phenotypic heterogeneity in depression and defining subtypes using functional neuroimaging. Next, we review recent progress in neuroimaging genetics (correlating neuroimaging patterns of brain function with genetic data) and its potential utility for generating testable hypotheses concerning molecular and circuit-level mechanisms. We discuss how genetic variants and transcriptomic profiles may confer risk for depression by modulating brain structure and function. We conclude by highlighting several promising areas for future research into the neurobiological underpinnings of heterogeneity, including efforts to understand sexually dimorphic mechanisms, the longitudinal dynamics of depressive episodes, and strategies for developing personalized treatments and facilitating clinical decision-making.
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Affiliation(s)
- Amanda M Buch
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, 413 East 69th Street, Box 240, New York, NY, 10021, USA
| | - Conor Liston
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, 413 East 69th Street, Box 240, New York, NY, 10021, USA.
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25
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Differential Experiences of Mental Health among Trans/Gender Diverse Adults in Michigan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186805. [PMID: 32961959 PMCID: PMC7557385 DOI: 10.3390/ijerph17186805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Abstract
Transgender and gender diverse individuals experience high rates of health disparities, as compared with their cisgender (non-transgender) counterparts. One area in which these disparities is most grave is that of mental health, with some studies indicating transgender and gender diverse individuals as having a 40% rate of lifetime suicide attempts and similarly high rates of depression, anxiety, and suicidal ideation. These rates vary further within this population, with differential rates seen across sociodemographic factors, including race/ethnicity, gender, sexual orientation, disability status, education level, and income. This study explores mental health experiences across different social identities, using data from the 2018 Michigan Trans Health Survey (N = 659), a community-based participatory action research project collected in Michigan, United States, analyzed using chi-square tests of independence and logistic regressions. Findings indicate incredibly high rates of mental health concerns; 72.2% had been diagnosed with depression in their lifetime and 73.0% had been diagnosed with anxiety in their lifetime. In the past year, 49.9% had had non-suicidal self-injury (NSSI) thoughts, 45.4% had suicidal thoughts, 26.3% engaged in NSSI, and 7.7% had attempted suicide. Bivariate regressions showed some nuanced experiences of rates of mental health diagnoses and experiences, such as greater odds of experiencing all mental health disparities among those with disabilities, and differential odds across gender in regard to ever having a depression diagnosis, non-suicidal self-injury thoughts and engaging in non-suicidal self-injury behavior. This indicates a need for social workers, counselors, therapists, and other human services professionals to act more intentionally and with an intersectional lens when it comes to exploring the mental health of transgender and gender diverse persons.
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26
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Calidad de Vida: a systematic review of quality of life in Latino cancer survivors in the USA. Qual Life Res 2020; 29:2615-2630. [PMID: 32430782 DOI: 10.1007/s11136-020-02527-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer is the leading cause of death among Hispanics/Latinos. Thus, understanding health-related quality of life (HRQOL) needs among this diverse racial/ethnic group is critical. Using Ferrell's multidimensional framework for measuring QOL, we synthesized evidence on HRQOL needs among Hispanic/Latino cancer survivors. METHODS We searched MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO, for English language articles published between 1995 and January 2020, reporting HRQOL among Hispanic/Latino cancer survivors in the USA. RESULTS Of the 648 articles reviewed, 176 met inclusion criteria, with 100 of these studies focusing exclusively on breast cancer patients and no studies examining end-of-life HRQOL issues. Compared with other racial/ethnic groups, Hispanics/Latinos reported lower HRQOL and a higher symptom burden across multiple HRQOL domains. Over 80% of studies examining racial/ethnic differences in psychological well-being (n = 45) reported worse outcomes among Hispanics/Latinos compared with other racial/ethnic groups. Hispanic/Latino cancer survivors were also more likely to report suboptimal physical well-being in 60% of studies assessing racial/ethnic differences (n = 27), and Hispanics/Latinos also reported lower social well-being relative to non-Hispanics/Latinos in 78% of studies reporting these outcomes (n = 32). In contrast, reports of spiritual well-being and spirituality-based coping were higher among Hispanics/Latinos cancer survivors in 50% of studies examining racial/ethnic differences (n = 15). DISCUSSION Findings from this review point to the need for more systematic and tailored interventions to address HRQOL needs among this growing cancer survivor population. Future HRQOL research on Hispanics/Latinos should evaluate variations in HRQOL needs across cancer types and Hispanic/Latino subgroups and assess HRQOL needs during metastatic and end-of-life disease phases.
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Lara-Cinisomo S, Akinbode TD, Wood J. A Systematic Review of Somatic Symptoms in Women with Depression or Depressive Symptoms: Do Race or Ethnicity Matter? J Womens Health (Larchmt) 2020; 29:1273-1282. [PMID: 32397866 DOI: 10.1089/jwh.2019.7975] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Racial and ethnic minority women in the United States have an elevated risk of depression or depressive symptoms compared with White women. There is evidence to suggest that these women are more likely to report somatic symptoms. The objective of this systematic review was to determine whether there are racial and ethnic differences in somatization in women with depression or depressive symptoms. Materials and Methods: The study focused on peer-reviewed, English-written publications of adult women that compared two or more racial or ethnic women and used reliable measures. Quantitative studies conducted in the United States were considered. Articles were reviewed from March 2017 to April 2019, with no publication start date. Results: Seven studies met the inclusion criteria. Results suggest that African American women were more likely to endorse somatic symptoms compared with White women and, in one instance Hispanic/Latinas. Three of four studies found that Hispanic/Latinas were significantly more likely to endorse somatic symptoms compared with White women; one study found that White women were significantly more likely to report somatic symptoms than Hispanic women. Another study found that White women endorsed significantly higher somatic symptoms than Chinese American women. One study did not find significant differences. Conclusions: A pattern emerged with African American and Hispanic/Latina women with depression or depressive symptoms more likely to report somatic symptoms compared with White women. However, it is not clear whether differences were a function of culturally acceptable presentation of symptoms or if the stress of being depressed increased somatization in minority women. Future studies should assess how depression/depressive symptoms affect racial and ethnic minority women to identify mechanisms involved in increased somatization.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Tanitoluwa Demilade Akinbode
- Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Jayme Wood
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
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Kim K, Lehning AJ, Sacco P. The Role of County Characteristics in Mental Health Service Use by Older African Americans. Psychiatr Serv 2020; 71:465-471. [PMID: 31960776 DOI: 10.1176/appi.ps.201900351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Older African Americans may underutilize mental health services, although they experience mental health problems at rates comparable with those of whites. Untreated mental disorders contribute to increased risk of morbidity and mortality and decreased quality of life, and therefore, understanding the factors that influence racial disparities in service use is critical. This study examined whether county characteristics were associated with mental health service use by older African Americans after the analyses adjusted for individual characteristics. METHODS This study combined individual-level data from the 2008-2012 Medical Expenditure Panel Survey with county-level data for 2008-2012 from the 2013-2014 Area Health Resources Files and county-level data from the 2008-2012 Chronic Conditions Report of the Chronic Conditions Data Warehouse for 1,567 community-dwelling African Americans ages 60 and older. Multilevel logistic regressions were used to examine the role of county characteristics on mental health services use with adjustment for individual-level risk factors. RESULTS At the county level, individuals living in a county with a higher proportion of African Americans were less likely to use mental health services. At the individual level, higher income and mental health status were associated with mental health service utilization. CONCLUSIONS Among older African Americans, the racial composition of one's county of residence played a role in mental health service use, indicating the need for future research focusing on the relationship between an area's racial composition and mental health service use. Programs may be able to ameliorate racial disparities in mental health care by targeting areas with a higher percentage of African Americans.
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Affiliation(s)
- Kyeongmo Kim
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
| | - Amanda J Lehning
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
| | - Paul Sacco
- Virginia Commonwealth University School of Social Work, Richmond (Kim); University of Maryland School of Social Work, Baltimore (Lehning, Sacco)
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29
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Porteny T, Alegría M, del Cueto P, Fuentes L, Markle SL, NeMoyer A, Perez GK. Barriers and strategies for implementing community-based interventions with minority elders: positive minds-strong bodies. Implement Sci Commun 2020; 1:41. [PMID: 32885198 PMCID: PMC7427860 DOI: 10.1186/s43058-020-00034-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group. This population has an increased risk of mental and physical disability with significant barriers to access care. Community-based organizations (CBOs) often provide programming to serve minority and immigrant elders. Limited resources and other barriers such as lack of trained staff make it difficult to implement evidence-based interventions (EBIs) in CBOs for long-term adoption. Yet little is known about what factors can facilitate adoption of EBIs in CBOs serving minority elders. METHODS Positive-Minds-Strong Bodies (PM-SB), an evidence-based intervention offered in four languages, aims to reduce mental and physical disability for minority and immigrant elders through the efforts of community health workers and exercise trainers. The intervention consists of cognitive behavior therapy and exercise training sessions delivered over 6 months. During a recent clinical trial of this intervention, we elicited feedback from CBO staff to determine how best to facilitate the implementation and long-term sustainability of PM-SB within their agencies. We surveyed 30 CBO staff members, held four focus groups, and conducted 20 in-depth interviews to examine staff perspectives and to reveal factors or changes needed to facilitate long-term adoption in prospective CBOs. RESULTS Participants reported that staff motivation and implementation could be improved through the following changes: increasing patient compensation for treatment sessions, decreasing levels of organizational accountability, and reducing staff demands embedded in the intervention. Although most staff perceived that PM-SB improved their agency's ability to address the health and well-being of elders, capacity-building strategies such as a "train-the-trainer" initiative were identified as priorities to address staff turnover for sustainability. Adapting the intervention to get financial reimbursement also emerged as vital. CONCLUSIONS Augmenting financial incentives, streamlining procedures, and simplifying staff accountability were suggested strategies for facilitating the transition from a disability prevention clinical trial in minority and immigrant elders to a scalable implementation in routine services at CBOs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02317432.
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Affiliation(s)
- Thalia Porteny
- Interfaculty Initiative in Health Policy, Graduate School of Arts and Science, Harvard University, 1350 Massachusetts Avenue, Suite 350, Cambridge, MA 02138-3654 USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215 USA
| | - Paola del Cueto
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Larimar Fuentes
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
| | - Giselle K. Perez
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215 USA
- Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA 02114 USA
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Vyas CM, Donneyong M, Mischoulon D, Chang G, Gibson H, Cook NR, Manson JE, Reynolds CF, Okereke OI. Association of Race and Ethnicity With Late-Life Depression Severity, Symptom Burden, and Care. JAMA Netw Open 2020; 3:e201606. [PMID: 32215634 PMCID: PMC7325738 DOI: 10.1001/jamanetworkopen.2020.1606] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Importance Knowledge gaps persist regarding racial and ethnic variation in late-life depression, including differences in specific depressive symptoms and disparities in care. Objective To examine racial/ethnic differences in depression severity, symptom burden, and care. Design, Setting, and Participants This cross-sectional study included 25 503 of 25 871 community-dwelling older adults who participated in the Vitamin D and Omega-3 Trial (VITAL), a randomized trial of cancer and cardiovascular disease prevention conducted from November 2011 to December 2017. Data analysis was conducted from June to September 2018. Exposure Racial/ethnic group (ie, non-Hispanic white; black; Hispanic; Asian; and other, multiple, or unspecified race). Main Outcomes and Measures Depressive symptoms, assessed using the Patient Health Questionnaire-8 (PHQ-8); participant-reported diagnosis, medication, and/or counseling for depression. Differences across racial/ethnic groups were evaluated using multivariable zero-inflated negative binomial regression to compare PHQ-8 scores and multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. Results There were 25 503 VITAL participants with adequate depression data (mean [SD] age, 67.1 [7.1] years) including 12 888 [50.5%] women, 17 828 [69.9%] non-Hispanic white participants, 5004 [19.6%] black participants, 1001 [3.9%] Hispanic participants, 377 [1.5%] Asian participants, and 1293 participants [5.1%] who were categorized in the other, multiple, or unspecified race group. After adjustment for sociodemographic, lifestyle, and health confounders, black participants had a 10% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (rate ratio [RR], 1.10; 95% CI, 1.04-1.17; P < .001); Hispanic participants had a 23% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.23; 95% CI, 1.10-1.38; P < .001); and participants in the other, multiple, or unspecified group had a 14% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.14; 95% CI, 1.04-1.25; P = .007). Compared with non-Hispanic white participants, participants belonging to minority groups had 1.5-fold to 2-fold significantly higher fully adjusted odds of anhedonia (among black participants: odds ratio [OR], 1.76; 95% CI, 1.47-2.11; among Hispanic participants: OR, 1.96; 95% CI, 1.43-2.69), sadness (among black participants: OR, 1.31; 95% CI, 1.07-1.60; among Hispanic participants: OR, 2.09; 95% CI, 1.51-2.88), and psychomotor symptoms (among black participants: OR, 1.77; 95% CI, 1.31-2.39; among Hispanic participants: OR, 2.12; 95% CI, 1.28-3.50); multivariable-adjusted odds of sleep problems and guilt appeared higher among Hispanic vs non-Hispanic white participants (sleep: OR, 1.24; 95% CI, 1.01-1.52; guilt: 1.84; 95% CI, 1.31-2.59). Among those with clinically significant depressive symptoms (ie, PHQ-8 score ≥10) and/or those with diagnosed depression, black participants were 61% less likely to report any treatment (ie, medications and/or counseling) than non-Hispanic white participants after adjusting for confounders (adjusted OR, 0.39; 95% CI, 0.27-0.56). Conclusions and Relevance In this cross-sectional study, significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care were observed after adjustment for numerous confounders. These findings suggest a need for further examination of novel patient-level and clinician-level factors underlying these associations.
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Affiliation(s)
- Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, MA, USA
| | - Heike Gibson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy R. Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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Benson C, Szukis H, Sheehan JJ, Alphs L, Yuce H. An Evaluation of the Clinical and Economic Burden Among Older Adult Medicare-Covered Beneficiaries With Treatment-Resistant Depression. Am J Geriatr Psychiatry 2020; 28:350-362. [PMID: 31735488 DOI: 10.1016/j.jagp.2019.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the clinical and economic burden of treatment-resistant depression (TRD) among older adult patients with major depressive disorder (MDD) to non-TRD MDD and non-MDD patients. METHODS Retrospective cohort study using 5% Medicare data (January 1, 2012-December 31, 2015) for MDD patients aged ≥65 years who were defined as TRD if they received ≥2 antidepressant treatments in the current episode. MDD patients not meeting TRD criteria were deemed non-TRD MDD; those without an MDD diagnosis were categorized as non-MDD. All were required to have continuous health plan enrollment for ≥6 months pre- and ≥12 months postindex date (index: first antidepressant claim/random [non-MDD]). Three cohorts were matched, and generalized linear and Cox proportional hazards models were used to compare medication use, healthcare resource utilization, costs, and risks of initial hospitalization and readmission ≤30 days postdischarge from initial hospitalization. RESULTS After matching, 178 patients from each cohort were analyzed. During 12 months of follow-up, TRD patients had higher use of different antidepressants and antipsychotics, higher inpatient and emergency room visits, longer inpatient stays, and higher total healthcare costs ($24,543 versus $16,059, $8,058) than non-TRD MDD and non-MDD cohorts, respectively (all p <0.05). Risk of initial hospitalization was higher in the TRD (hazard ratio [HR] = 3.60, 95% confidence interval [CI] = 2.08-6.23) and non-TRD MDD cohorts (HR = 1.82, 95% CI = 1.02-3.25) than the non-MDD cohort. CONCLUSIONS The burden of MDD among older adult Medicare beneficiaries is substantial, and even greater among those with TRD compared to non-TRD MDD, demonstrating the need for more effective treatments than those currently available.
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Affiliation(s)
- Carmela Benson
- Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ
| | - Holly Szukis
- Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ
| | - John J Sheehan
- Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ.
| | - Larry Alphs
- Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ
| | - Huseyin Yuce
- New York City College of Technology (HY), Brooklyn, NY
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Mansour R, Tsamakis K, Rizos E, Perera G, Das-Munshi J, Stewart R, Mueller C. Late-life depression in people from ethnic minority backgrounds: Differences in presentation and management. J Affect Disord 2020; 264:340-347. [PMID: 32056770 DOI: 10.1016/j.jad.2019.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND An elevated risk of late-life depression has been suggested in older adults from minority ethnic groups, but little is known about ethnic group differences in symptom and treatment profiles. The current study aimed to compare symptoms and types of treatment between ethnic groups in patients with late-life depression. METHODS Data were extracted from the Clinical Record Interactive Search (CRIS) system , which provides access to the anonymised electronic health records of a large mental health care provider in South London. In total, 5,546 individuals aged 65 years and older, and diagnosed with late-life depression between 2006 and 2017, were included. Patients from ethnic minority backgrounds were compared to White British individuals on the following features recorded at depression diagnosis: mental and physical wellbeing,functional scales, individual depressive symptoms recorded, and treatments administered. RESULTS Black Africans and Black Caribbeans more frequently presented with psychotic problems and were significantly less likely to have antidepressant treatment prescribed post diagnosis compared to White British. White Irish had higher rates of substance use and sleep disturbance. Depressive symptoms of hopelessness, guilt feelings, and suicidal thoughts were less common in Black Caribbeans, Black Africans, and South Asians compared to White British. LIMITATIONS Only patients with depression under a specialist mental health care provider were included in the study. CONCLUSIONS Ethnic minority elders have significantly different presentations and undertake different types of treatment both across groups and relative to their White British counterparts. These differences need to be taken into consideration to optimise pathways into care and to personalise treatment.
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Affiliation(s)
- Rand Mansour
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Konstantinos Tsamakis
- Second Department of Psychiatry, University General Hospital 'ATTIKON', School of Medicine, Athens, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, University General Hospital 'ATTIKON', School of Medicine, Athens, Greece
| | - Gayan Perera
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Jayati Das-Munshi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
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Donneyong M, Reynolds C, Mischoulon D, Chang G, Luttmann-Gibson H, Bubes V, Guilds M, Manson J, Okereke O. Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study. BMJ Open 2020; 10:e033173. [PMID: 31915172 PMCID: PMC6955513 DOI: 10.1136/bmjopen-2019-033173] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/03/2022] Open
Abstract
INTRODUCTION Current evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in depression care. Thus, the primary objectives of this protocol are to: (1) quantify racial/ethnic disparities in depression treatment and (2) identify and quantify the magnitude of these disparities accountable for by a multifactorial combination of patient, provider and healthcare system factors. METHODS AND ANALYSIS Data will be derived from the Vitamin D and Omega-3 Trial-Depression Endpoint Prevention (VITAL-DEP) study, a late-life depression prevention ancillary study to the VITAL trial. A total of 25 871 men and women, aged 50+ and 55+ years, respectively, were randomised in a 2×2 factorial randomised trial of heart disease and cancer prevention to receive vitamin D and/or fish oil for 5 years starting from 2011. Most participants were aged 65+ years old at randomisation. Medicare claims data for over 19 000 VITAL/VITAL-DEP participants were linked to conduct our study.The major study outcomes are depression treatment (antidepressant use and/or receipt of psychotherapy services) and adherence to medication treatment (antidepressant adherence and acceptability). The National Academy of Medicine framework for studying racial disparities was leveraged to select patient-level, provider-level and healthcare system-level variables and to address their potential roles in depression care disparities. Blinder-Oaxaca regression decomposition methods will be implemented to quantify and identify correlates of racial/ethnic disparities in depression treatment and adherence. ETHICS AND DISSEMINATION This study received Institutional Review Board (IRB) approval from the Partners Healthcare (PHS) IRB, protocol# 2010P001881. We plan to disseminate our results through publication of manuscripts patient engagement activities, such as study newsletters regularly sent out to VITAL participants, and presentations at scientific meetings. TRIAL REGISTRATION NUMBER NCT01696435.
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Affiliation(s)
- Macarius Donneyong
- Pharmacy Practice and Science, College of Pharmacy, The Ohio University State University, Columbus, Ohio, USA
| | - Charles Reynolds
- Psychiatry, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Grace Chang
- Psychiatry, Harvard University, Cambridge, Massachusetts, USA
- Psychiatry, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Heike Luttmann-Gibson
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Vadim Bubes
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Joann Manson
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Olivia Okereke
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kim K. County Context and Mental Health Service Utilization by Older Hispanics. THE GERONTOLOGIST 2020; 59:456-464. [PMID: 29672691 DOI: 10.1093/geront/gny033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/25/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although older Hispanics experience high rates of depression, they tend to underuse mental health services. The study examined the association between county characteristics and mental health service use among older Hispanics, controlling for individual characteristics. RESEARCH DESIGN AND METHODS The study used the 2008-2012 Medical Expenditure Panel Study and linked county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse, using the Federal Information Processing Standard county code. The sample includes 1,143 community-dwelling Hispanics ages 60 years or older (Level 1) and 156 counties (Level 2) where the sample resides. The single dichotomous measure of mental health service utilization was based on whether or not the respondent met one or more of three conditions: (1) the respondent received care from a mental health professional, (2) received a service including mental health counseling or psychotherapy, or (3) received a service that was related to the International Classification of Diseases. Multilevel logistic regression analysis was used to examine the role of county context. RESULTS The proportion of older adults and the existence of community mental health centers at the county-level were associated with mental health services use among this population. At the individual-level, education and mental health status were also associated with using mental health services. DISCUSSION AND IMPLICATIONS The county context plays an important role in understanding mental health services use among older Hispanics, indicating the need for intervention strategies at the county level.
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Affiliation(s)
- Kyeongmo Kim
- Virginia Commonwealth University School of Social Work, Richmond
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Bhattacharjee S, Lee JK, Vadiei N, Patanwala AE, Malone DC, Knapp SM, Lo-Ciganic WH, Burke WJ. Extent and Factors Associated with Adherence to Antidepressant Treatment During Acute and Continuation Phase Depression Treatment Among Older Adults with Dementia and Major Depressive Disorder. Neuropsychiatr Dis Treat 2020; 16:1433-1450. [PMID: 32606697 PMCID: PMC7292261 DOI: 10.2147/ndt.s241749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/12/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Little is known about adherence to antidepressant treatment during acute and continuation phase of depression among older adults with dementia and newly diagnosed major depressive disorders (MDD). This study estimated the extent of and factors associated with adherence to acute and continuation phase antidepressant treatment among older adults with dementia and newly diagnosed MDD. METHODS We conducted a retrospective cohort study using the Medicare 5% sample claims data (2012-2013) among older adults (age≥65 years) with dementia who were newly diagnosed with MDD. Intake period of our study was from 01-May-2012 through 30-April-2013. The dependent variables of this study were acute and continuation phase depression treatment adherence. Factors associated with acute and continuation phase antidepressant treatment adherence were identified using multiple logistic regression analyses. RESULTS The final study sample consisted of 6239 [adherent: N=4644 (74.44%)] and 5617 [adherent: N=3584 (63.81%)] older adults with dementia and MDD during the acute and continuation phase treatment, respectively. During the acute phase, only race/ethnicity was significantly associated with adherence to depression treatment, whereas race/ethnicity and baseline antipsychotic use were significantly associated with adherence to depression treatment during the continuation phase. CONCLUSION Approximately, 74% and 64% older adults with dementia and MDD were adherent to acute and continuation phase antidepressant treatment in this nationally representative sample of Medicare beneficiaries, and we identified several modifiable and non-modifiable factors associated with adherence.
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Affiliation(s)
- Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Jeannie K Lee
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Nina Vadiei
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | | | - Daniel C Malone
- Department of Pharmacotherapy, Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Shannon M Knapp
- Statistics Consulting Laboratory, Bio5 Institute, The University of Arizona, Tucson, AZ, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
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Samples H, Stuart EA, Saloner B, Barry CL, Mojtabai R. The Role of Screening in Depression Diagnosis and Treatment in a Representative Sample of US Primary Care Visits. J Gen Intern Med 2020; 35:12-20. [PMID: 31388917 PMCID: PMC6957618 DOI: 10.1007/s11606-019-05192-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/28/2018] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Primary care providers encounter a large proportion of the population with depression. Yet, many primary care patients with depression remain undiagnosed and untreated. OBJECTIVE This study aims to examine depression screening patterns and the role of screening in depression diagnosis and treatment in the outpatient primary care setting. DESIGN This is a cross-sectional analysis of nationally representative survey data of visits to outpatient physician offices from the 2005 to 2015 National Ambulatory Medical Care Surveys. PARTICIPANTS The sample included the first visit in the past year to a primary care provider by patients 12 years and older (N = 16,887). METHODS The associations of visit characteristics with depression screening and of depression screening with depression diagnosis and treatment during the visit were assessed using logistic regression. Logistic regression with propensity score weighting was used to estimate the odds of depression diagnosis and treatment under the counterfactual scenario in which patients who visited providers with lower depression screening rates had visited providers with higher screening rates instead. All models were adjusted for patient and visit characteristics. KEY RESULTS A small proportion of sample visits involved depression screening (3.0%). Visits by patients with depressive symptom complaints were associated with higher odds of depression screening than other visits. When visits were weighted to have similar demographic and clinical characteristics, visits to providers with higher screening rates had higher odds of diagnosis (OR = 1.99, p < 0.001) and treatment (OR = 1.61, p = 0.001) compared to visits to providers with lower screening rates. CONCLUSIONS Physicians appear to use depression screening selectively based on patients' presenting symptoms. Higher screening rates were associated with higher odds of depression diagnosis and treatment, and even modest increases in screening rates could meaningfully increase population-level rates of depression identification and treatment in primary care. Future research is needed to identify barriers to depression care and implement systematic interventions to improve services and patient outcomes.
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Affiliation(s)
- Hillary Samples
- Columbia University Mailman School of Public Health, New York, NY, USA.
| | | | - Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen L Barry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ramin Mojtabai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hawkins JM, Schwenzer C, Hecht HK, Jones L, Velez-Ortiz D, Lee J, Ahmedani B, Piatt G. Mental health care use in men with comorbid diabetes and depression: The role of age and race. ACTA ACUST UNITED AC 2019; 4. [PMID: 33869794 PMCID: PMC8049769 DOI: 10.15761/hec.1000163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Older adults with diabetes have double the normal average risk for depression. While women also report higher rates of depression, men are less likely than women to recognize symptoms and seek assistance for mental health treatment. Racial disparities in mental health care use among men have also been identified. While age and gender differences in mental health care use have been accounted for in adults with comorbid diabetes and depression little is known about within group differences among men. The purpose of this study was to examine the influence of age and race on mental health service use in a sample of men with comorbid diabetes and depression. Methods: This study utilized secondary data from a large health care delivery system serving in a Midwestern urban city and included 335 Black, and non-Latino White men with comorbid type 2 diabetes and depression. Results and Discussion: Findings indicate that men under the age of 55 were less likely to experience a 6-month or more delay in receiving a psychiatric medication prescription after their initial depression diagnosis. Black men over 55 years of age were significantly more likely to experience a delay of over six months to receiving psychiatric medication. More research is needed to explore preferred depression treatment methods for older Black men with type 2 diabetes, in addition to any issues with access to pharmacological medications to treat depression.
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Affiliation(s)
| | | | | | | | | | - Jaewon Lee
- School of Social Work Michigan State University, USA
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Turner N, Hastings J, Neighbors HW. Mental health care treatment seeking among African Americans and Caribbean Blacks: what is the role of religiosity/spirituality? Aging Ment Health 2019; 23:905-911. [PMID: 29608328 PMCID: PMC6168439 DOI: 10.1080/13607863.2018.1453484] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES As adults increase in age, the likelihood for using mental health care services decrease. Underutilization, expecially among racial/ethnic minorities such as African American and Caribbean Blacks, can result in a decrease in quality of life, as well as significant costs to families, employers, and health systems. METHODS The study explored the differences in relationships between mental health care usage and strength of religious/spiritual beliefs between African American and Caribbean Black older adults (54 years or older) and adults (18-53 years) using data from the National Survey of American Life (NSAL). Descriptive statistics and logistic regression analyses were conducted using Stata version 13.1. RESULTS Subjective ratings about the strength of religious/spiritual beliefs (OR = 1.26; 95 CI: 0.99, 1.61), age (OR = 0.62; 95 CI: 0.48, 0.81), and sex (OR = 1.59; 95 CI: 1.25, 2.02) were significantly associated with the odds of seeking mental health care. Additionally, persons living in the South were less likely to seek mental health care services (OR = 0.47; 95 CI: 0.37, 0.60). CONCLUSION Strong religious/spiritual beliefs may promote mental health care usage. Future studies should examine the strength of religious/spiritual beliefs on mental health care usage among different demographic groups.
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Affiliation(s)
- Natalie Turner
- School of Social Welfare, University at Albany, State University of New York, Albany, NY, USA
| | - Julia Hastings
- School of Social Welfare, University at Albany, State University of New York, Albany, NY, USA,School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Harold W. Neighbors
- Division of Public Health, Department of Family Medicine, College of Human Medicine, Michigan State University, Flint, Michigan
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Depression as a moderator and a mediator of marital quality’s effect on older adults’ self-rated physical health. Arch Gerontol Geriatr 2019; 83:50-54. [DOI: 10.1016/j.archger.2019.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/18/2019] [Accepted: 03/26/2019] [Indexed: 01/16/2023]
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Breslau J, Elliott MN, Haviland AM, Klein DJ, Dembosky JW, Adams JL, Gaillot SJ, Horvitz-Lennon M, Schneider EC. Racial And Ethnic Differences In The Attainment Of Behavioral Health Quality Measures In Medicare Advantage Plans. Health Aff (Millwood) 2019; 37:1685-1692. [PMID: 30273044 DOI: 10.1377/hlthaff.2018.0655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
As the Medicare population becomes more diverse and its demand for behavioral health care grows, a better understanding of racial/ethnic disparities in the quality of behavioral health care is crucial. Medicare Advantage (MA) plans are accountable through the public reporting of quality performance on measures, including the Healthcare Effectiveness Data and Information Set (HEDIS). We examined HEDIS data on eight MA behavioral health care quality measures, using mixed-effects logistic regressions to distinguish racial/ethnic differences within and between MA health plans. We found that performance differed across racial/ethnic groups by more than 10 percentage points on most quality measures. Significant within-plan disparities were found in twenty of twenty-four comparisons of racial/ethnic minority groups with whites. Within-plan disparities varied widely across plans, with performance being equivalent across racial/ethnic groups in some plans and widely divergent in others. Unlike other types of medical care, in behavioral health within-plan quality disparities are prominent in MA plans, which suggests a role for stratified reporting by racial/ethnic group.
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Affiliation(s)
- Joshua Breslau
- Joshua Breslau is a senior health/behavioral scientist at the RAND Corporation in Pittsburgh, Pennsylvania
| | - Marc N Elliott
- Marc N. Elliott ( ) is a senior statistician in the Department of Economics, Sociology, and Statistics, RAND Corporation, in Santa Monica, California
| | - Amelia M Haviland
- Amelia M. Haviland is a professor of statistics and health policy at Carnegie Mellon University, in Pittsburgh
| | - David J Klein
- David J. Klein is a statistical analyst in the Department of Economics, Sociology, and Statistics, RAND Corporation, in Santa Monica
| | - Jacob W Dembosky
- Jacob W. Dembosky is a policy analyst at the RAND Corporation in Pittsburgh
| | - John L Adams
- John L. Adams is a principal senior statistician at Kaiser Permanente in Pasadena, California
| | - Sarah J Gaillot
- Sarah J. Gaillot is a social science research analyst at the Centers for Medicare and Medicaid Services, in Baltimore, Maryland
| | | | - Eric C Schneider
- Eric C. Schneider is senior vice president for policy and research at the Commonwealth Fund, in New York City
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Ditah CM, Rahman E, Agbor VN, Foryoung JB, Shahzad M, Amgai B, Kafle P, Jonnadula S, Nfor TK, Dufresne A. Disparities and drivers of early age at diagnosis of congestive heart failure in the USA. Int J Cardiol 2019; 293:143-147. [PMID: 31230932 DOI: 10.1016/j.ijcard.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/13/2019] [Accepted: 06/01/2019] [Indexed: 12/12/2022]
Abstract
AIM Heart failure (HF) constitutes a major public health problem in the USA due to its high morbidity and mortality. Age at diagnosis of HF would refine burden quantification, budgeting, disease surveillance and assessment of interventions. We set out to determine the median age at diagnosis of HF and drivers of young age at diagnosis among patients 20 years or older in the USA. METHODS AND RESULTS We utilized NHANES data collected across five survey cycles (2007-2016). Included were individuals aged 20 to 80 years diagnosed of HF with valid entries for age at diagnosis. Differences in age at diagnosis between groups and major drivers for younger age at diagnosis were assessed using linear regression models with p-values <0.05 considered statistically significant. The prevalence of HF in the USA was 2.44% with a median age at diagnosis of 59 years (IQR 47-70). Non-Hispanic (NH) Blacks -4.94 years (95% CI -7.95 to -1.93), individuals living below the poverty line -5.79 years (95% CI -10.36 to -1.01), obese persons -5.63 years (95% CI -8.35 to -2.92), individuals without health insurance -4.31 years (95% CI -7.87 to -0.75) and those without hypertension -3.99 years (95% CI -7.19 to -0.78) were diagnosed at significantly younger ages than their respective counterparts. CONCLUSION The median age at diagnosis of HF in the USA is 59 years. NH Blacks, living in poverty, lack of health insurance and obesity are the main drivers of early age at diagnosis of HF in the USA.
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Affiliation(s)
| | - Ebad Rahman
- Interfaith Medical Center, Brooklyn, NY, USA
| | - Valirie Ndip Agbor
- Ibal Sub-divisional Hospital, Oku, Northwest Region, Cameroon; Department of Clinical Research, Health Education and Research Organisation (HERO), Cameroon
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Xiang X. Seven-Year Trajectories of Depressive Symptoms and Their Predictors Among Older Americans. J Aging Health 2019; 32:795-806. [PMID: 31169060 DOI: 10.1177/0898264319852835] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: This study examined the trajectories of depressive symptoms and associated factors in older adults using an enhanced group-based trajectory modeling. Method: The study sample consisted of 7,573 adults aged ≥65 years from the National Health and Aging Trends Study (Rounds 1-7). Depressive trajectories were estimated using a group-based trajectory modeling accounting for nonrandom attrition. Results: A four-trajectory model including "persistently low" (77.7%), "increasing" (7.9%), "declining," (5.5%), and "persistently high" (8.9%) was the best fit using methods accounting for nonrandom attrition. In comparison, methods not accounting for attrition estimated that only 3.2% of older adults were on the "persistently high" trajectory. There were significant differences in depressive trajectories by age, race/ethnicity, sex, physical, and cognitive functioning, and social connections. Discussion: Persistently high depressive symptoms affected a larger proportion of older adults than previously estimated. Depression had a more long-term and increasing course in the oldest-old.
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Downer B, Al Snih S, Chou LN, Kuo YF, Markides KS, Ottenbacher KJ. Differences in hospitalizations, emergency room admissions, and outpatient visits among Mexican-American Medicare beneficiaries. BMC Geriatr 2019; 19:136. [PMID: 31113371 PMCID: PMC6528336 DOI: 10.1186/s12877-019-1160-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/14/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have investigated the healthcare utilization of Mexican-American Medicare beneficiaries. We used survey data that has been linked with Medicare claims records to describe the healthcare utilization of Mexican-American Medicare beneficiaries, determine common reasons for hospitalizations, and identify characteristics associated with healthcare utilization. METHODS Data came from wave five (2004/05) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample included 1187 participants aged ≥75 who were followed for two-years (eight-quarters). Generalized estimating equations were used to estimate the probability of ≥1 hospitalization, emergency room (ER) admissions, and outpatient visits. RESULTS The percentage of beneficiaries who had ≥1 hospitalizations, ER admissions, and outpatient visits for each quarter ranged from 10.12-12.59%, 14.15-19.03%, and 76.61-80.68%, respectively. Twenty-three percent of hospital discharges were for circulatory conditions and 17% were for respiratory conditions. Hospitalizations for heart failure and simple pneumonia were most common. Older age was associated with significantly higher odds for ER admissions (OR = 1.49, 95% CI = 1.21-1.84) but lower odds for outpatient visits (OR = 0.74, 95% CI = 0.57-0.96). Spanish language and female gender were associated with significantly higher odds for hospitalizations (OR = 1.53, 95% CI = 1.14-2.06) and outpatient visits (OR = 1.82, 95% CI = 1.43-2.33), respectively. Having a middle-school or higher level of education was associated with significantly lower odds for ER admissions (OR = 0.71, 95% CI = 0.56-0.91). Participants who were deceased within two-years had significantly higher odds for hospitalizations (OR = 6.15, 95% CI = 4.79-7.89) and ER admissions (OR = 3.63, 95% CI = 2.88-4.57) than participants who survived at least three-years. CONCLUSION We observed high healthcare utilization among Mexican-American Medicare beneficiaries. Forty percent of all hospitalizations were for circulatory and respiratory conditions with hospitalizations for heart failure and pneumonia being the most common. Older age, gender, education, language, and mortality were all associated with healthcare utilization. Continued research is needed to identify patterns and clusters of social determinants and health characteristics associated with healthcare utilization and outcomes in older Mexican-Americans.
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Affiliation(s)
- Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Soham Al Snih
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Lin-Na Chou
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos S Markides
- Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
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Abstract
Introduction: Research has often been viewed as a passive process by which participants enroll in studies developed by researchers. It is becoming clearer that to understand the nuances of mood episodes and how to prevent them, we need to conduct large clinical trials that have the power to investigate moderators and mediators, or catalysts and mechanisms of change. MoodNetwork, the first online, patient-centered research community for individuals with mood disorders, aims to change the way that traditional research has been conducted by involving patients, their caregivers, and advocates in the process of research. The aim of this report is to share lessons learned from developing MoodNetwork. Methods: Participants enroll by completing a demographic survey and consent form. Once enrolled, participants are encouraged to complete optional surveys about their mood disorders and areas of research priority. Stakeholder and advocacy partners developed the website, web-based surveys, and recruitment materials. Results: MoodNetwork has enrolled 4103 participants to date. Of this sample, 96.9% report experiencing depression and 79.7% endorse symptoms of mania or hypomania. Participants rated reducing stigma and alleviating symptoms as their 2 largest research priorities. Recruitment has been slower than expected. Recruiting a diverse sample has been challenging, and this impacts the Network’s ability to conduct comparative effectiveness research studies. Discussion: We discuss lessons learned from recruiting individuals with mood disorders to MoodNetwork, an innovative approach to conducting clinical trials. We identify and review 5 strategies for increasing enrollment as well as future directions.
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Cherrington AL, Khodneva Y, Richman JS, Andreae SJ, Gamboa C, Safford MM. Impact of Peer Support on Acute Care Visits and Hospitalizations for Individuals With Diabetes and Depressive Symptoms: A Cluster-Randomized Controlled Trial. Diabetes Care 2018; 41:2463-2470. [PMID: 30373734 PMCID: PMC6463553 DOI: 10.2337/dc18-0550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/13/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Comorbid depression is associated with increased health care utilization and cost. We examined the effects of peer support on acute care (AC) and hospital utilization in individuals with diabetes with or without depressive symptoms. RESEARCH DESIGN AND METHODS This was a cluster-randomized controlled trial conducted in 2010-2012, with the clusters being practices and their surrounding communities. Adults with type 2 diabetes who wanted help with self-management were eligible to participate. Those without a doctor, with limited life expectancy, with plans to move within the next year, and with an unwillingness to work with a peer advisor were excluded. Intervention participants received 1 year of peer support. Control participants received usual care. The Patient Health Questionnaire (PHQ-8) (range 0-24; 5 indicates mild and 10 indicates moderate depressive symptoms) assessed depressive symptoms. AC and hospital utilization were measured by self-report. Data were collected at baseline, 6 months, and 12 months. Quasi-Poisson regression using generalized estimating equations examined differences in utilization per year attributable to the intervention for those with and without mild depressive symptoms (and separately, moderate depressive symptoms), controlling for imbalance across treatment arms. RESULTS At baseline, half of the sample reported mild depressive symptoms (52% intervention and 48% control, P = 0.37), a quarter reported moderate depressive symptoms (25% intervention and 26% control, P = 1.0), and there were no significant differences in utilization. A total of 168 intervention (six clusters) and 187 control (five clusters) participants had follow-up data. In individuals with mild depressive symptoms, the incident rate ratio (IRR) for hospitalization among intervention compared with control was 0.26 (95% CI 0.08-0.84) per 10 patient-years. The IRR for AC was 0.55 (95% CI 0.28-1.07) per 10 person-years. Findings were similar for individuals with moderate depressive symptoms. CONCLUSIONS Peer support lowered AC visits and hospitalizations for individuals with depressive symptoms but not for those without depressive symptoms; these findings can guide resource allocation for population health management.
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Affiliation(s)
- Andrea L Cherrington
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Yulia Khodneva
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua S Richman
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Susan J Andreae
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Christopher Gamboa
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
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Akinyemi E, Watkins DC, Kavanagh J, Johnson-Lawrence V, Lynn S, Kales HC. A qualitative comparison of DSM depression criteria to language used by older church-going African-Americans. Aging Ment Health 2018; 22:1149-1155. [PMID: 28612654 DOI: 10.1080/13607863.2017.1337717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Depression in late life is associated with substantial suffering, disability, suicide risk, and decreased health-related quality of life. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a depression diagnosis is derived from a constellation of symptoms that may be described differently by different people. For example, the DSM language may be inadequate in capturing these symptoms in certain populations such as African-Americans, whose rates of depression misdiagnosis is high. METHODS This study reports the findings from a church-based, qualitative study with older African-Americans (n = 50) regarding the language they use when discussing depression and depression treatment, and how this compares to the DSM-IV depression criteria. Content analyses of the in-depth discussions with African-American male and female focus group participants resulted in a deeper understanding of the language they used to describe depression. This language was then mapped onto the DSM-IV depression criteria. RESULTS While some words used by the focus group participants mapped well onto the DSM-IV criteria, some of the language did not map well, such as language describing irritability, negative thought processes, hopelessness, loneliness, loss of control, helplessness, and social isolation. CONCLUSIONS The focus group setting provided insight to the language used by older, church-going African-Americans to describe depression. Implications include the advantages of using qualitative data to help inform clinical encounters with older African-Americans.
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Affiliation(s)
- Esther Akinyemi
- a Department of Psychiatry , Henry Ford Health System , Detroit , MI , USA
| | - Daphne C Watkins
- b School of Social Work , University of Michigan , Ann Arbor , MI , USA
| | - Janet Kavanagh
- c Department of Psychiatry , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Vicki Johnson-Lawrence
- d Department of Pubic Health and Health Sciences , University of Michigan Flint , Flint , MI , USA
| | - Shana Lynn
- c Department of Psychiatry , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Helen C Kales
- c Department of Psychiatry , University of Michigan Medical School , Ann Arbor , MI , USA
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Pinheiro LC, Check DK, Rosenstein D, Reeder-Hayes KE, Dusetzina S. Examining potential gaps in supportive medication use for US and foreign-born Hispanic women with breast cancer. Support Care Cancer 2018; 27:1639-1646. [DOI: 10.1007/s00520-018-4406-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/03/2018] [Indexed: 02/02/2023]
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Li Y, Cai X, Harrington C, Hasselberg M, Conwell Y, Cen X, Temkin-Greener H. Racial and Ethnic Differences in the Prevalence of Depressive Symptoms Among U.S. Nursing Home Residents. J Aging Soc Policy 2018; 31:30-48. [PMID: 29883281 DOI: 10.1080/08959420.2018.1485394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study aimed to examine racial and ethnic differences in significant depressive symptoms among long-term nursing home residents. We analyzed the 2014 national Minimum Data Set linked to a nursing home file and estimated multivariable logistic regressions to determine the associations of race and ethnicities with significant depressive symptoms (score ≥ 10 on the 9-item Patient Health Questionnaire [PHQ-9] scale) and whether associations were explained by resident and nursing home covariates. Stratified analyses further determined independent associations in subgroups of residents. We found that the prevalence rate of PHQ-9 scores ≥ 10 was 8.8% among non-Hispanic White residents (n = 653,031) and 7.4%, 6.9%, and 6.6% among Black (n = 97,629), Hispanic (n = 39,752), and Asian (n = 16,636) residents, respectively. The reduced likelihoods of significant depressive symptoms for minority residents compared to non-Hispanic Whites persisted after sequential adjustments for resident and nursing home covariates, as well as in stratified analyses. The persistently lower rate of significant depressive symptoms among racial and ethnic minority residents suggests that training of nursing home caregivers for culturally sensitive depression screening is needed for improved symptom recognition among minority residents.
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Affiliation(s)
- Yue Li
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, New York, USA
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Charlene Harrington
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Michael Hasselberg
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Xi Cen
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, New York, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, New York, USA
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Gibbons RD, Alegría M, Cai L, Herrera L, Markle SL, Collazos F, Baca-García E. Successful validation of the CAT-MH Scales in a sample of Latin American migrants in the United States and Spain. Psychol Assess 2018; 30:1267-1276. [PMID: 29792502 DOI: 10.1037/pas0000569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined cultural differences in the item characteristic functions of self-reported of symptoms of depression, anxiety, and mania-hypomania in a Latino population taking Computerized Adaptive Tests for Mental Health (CAT-MH) in Spanish versus a non-Latino sample taking the tests in English. We studied differential item functioning (DIF) of the most common adaptively administered symptom items out of a bank of 1,008 items between Latino (n = 1276) and non-Latino (n = 798) subjects. For depression, we identified 4 items with DIF that were good discriminators for non-Latinos but poor discriminators for Latinos. These items were related to cheerfulness, life satisfaction, concentration, and fatigue. The correlation between the original calibration and a Latino-only new calibration after eliminating these items was r = .990. For anxiety, no items with DIF were identified. The correlation between the original and new calibrations was r = .993. For mania-hypomania, we identified 4 items with differential item functioning that were good discriminators for non-Latinos but poor discriminators for Latinos. These items were related to risk-taking, self-assurance, and sexual activity. The correlation between the original and new calibration was r = .962. Once the identified items were removed, the correlation between the original calibration and a Latino-only calibration was r = .96 or greater. These findings reveal that the CAT-MH can be reliably used to measure depression, anxiety, and mania in Latinos taking these tests in Spanish. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Robert D Gibbons
- Departments of Medicine and Public Health Sciences, University of Chicago
| | | | - Li Cai
- Graduate School of Education and Information Studies, University of California-Los Angeles
| | - Lizbeth Herrera
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
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Seo JY, Chao YY. Effects of Exercise Interventions on Depressive Symptoms Among Community-Dwelling Older Adults in the United States: A Systematic Review. J Gerontol Nurs 2018; 44:31-38. [DOI: 10.3928/00989134-20171024-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023]
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