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Hyatt AS, Mulvaney-Day N, Chow CM, Cook BL, DeLisi LE. Association between electronic nicotine product use and subsequent first episode psychosis. Psychiatry Res 2024; 334:115785. [PMID: 38377800 PMCID: PMC10984181 DOI: 10.1016/j.psychres.2024.115785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
Tobacco use has been established as a possible risk factor for psychosis, but the effect of electronic nicotine delivery systems (ex. nicotine vapes) has not been independently established. Using the Population Assessment of Tobacco and Health study, we found that use of electronic nicotine products was significantly associated with later first episode psychosis after controlling for substance use and other confounders, and that this relationship was only significant among the heaviest users (>20 puffs/day). Given the rapid rise in electronic nicotine products use, clinicians and public health professionals should consider potential impacts and closely monitor trends in the coming years.
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Affiliation(s)
- Andrew S Hyatt
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Norah Mulvaney-Day
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Clifton M Chow
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Benjamin Lê Cook
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
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Livingston NA, Davenport M, Head M, Henke R, LeBeau LS, Gibson TB, Banducci AN, Sarpong A, Jayanthi S, Roth C, Camacho-Cook J, Meng F, Hyde J, Mulvaney-Day N, White M, Chen DC, Stein MD, Weisberg R. The impact of COVID-19 and rapid policy exemptions expanding on access to medication for opioid use disorder (MOUD): A nationwide Veterans Health Administration cohort study. Drug Alcohol Depend 2022; 241:109678. [PMID: 36368167 PMCID: PMC9624112 DOI: 10.1016/j.drugalcdep.2022.109678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In March 2020, Veterans Health Administration (VHA) enacted policies to expand treatment for Veterans with opioid use disorder (OUD) during COVID-19. In this study, we evaluate whether COVID-19 and subsequent OUD treatment policies impacted receipt of therapy/counseling and medication for OUD (MOUD). METHODS Using VHA's nationwide electronic health record data, we compared outcomes between a comparison cohort derived using data from prior to COVID-19 (October 2017-December 2019) and a pandemic-exposed cohort (January 2019-March 2021). Primary outcomes included receipt of therapy/counseling or any MOUD (any/none); secondary outcomes included the number of therapy/counseling sessions attended, and the average percentage of days covered (PDC) by, and months prescribed, each MOUD in a year. RESULTS Veterans were less likely to receive therapy/counseling over time, especially post-pandemic onset, and despite substantial increases in teletherapy. The likelihood of receiving buprenorphine, methadone, and naltrexone was reduced post-pandemic onset. PDC on MOUD generally decreased over time, especially methadone PDC post-pandemic onset, whereas buprenorphine PDC was less impacted during COVID-19. The number of months prescribed methadone and buprenorphine represented relative improvements compared to prior years. We observed important disparities across Veteran demographics. CONCLUSION Receipt of treatment was negatively impacted during the pandemic. However, there was some evidence that coverage on methadone and buprenorphine may have improved among some veterans who received them. These medication effects are consistent with expected COVID-19 treatment disruptions, while improvements regarding access to therapy/counseling via telehealth, as well as coverage on MOUD during the pandemic, are consistent with the aims of MOUD policy exemptions.
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Affiliation(s)
- Nicholas A. Livingston
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA,US Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,Correspondence to: National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA 02130, USA
| | - Michael Davenport
- Data Science Core, Boston CSPCC, VA Boston Healthcare System, Boston, MA, USA
| | | | | | | | | | - Anne N. Banducci
- US Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,National Center for PTSD, Women’s Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA
| | | | | | - Clara Roth
- Boston VA Research Institute, Boston, MA, USA
| | | | - Frank Meng
- Data Science Core, Boston CSPCC, VA Boston Healthcare System, Boston, MA, USA,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA,General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Norah Mulvaney-Day
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | | | - Daniel C. Chen
- Data Science Core, Boston CSPCC, VA Boston Healthcare System, Boston, MA, USA,General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Michael D. Stein
- Health Law, Policy & Management, Boston University School of Public Health, MA, USA
| | - Risa Weisberg
- US Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA,BehaVR, Inc, Elizabethtown, KY, USA
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O'Brien PL, Stewart MT, Shields MC, White M, Dubenitz J, Dey J, Mulvaney-Day N. Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field. Drug Alcohol Depend Rep 2022; 4:100087. [PMID: 36157615 PMCID: PMC9495301 DOI: 10.1016/j.dadr.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. METHODS Using a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. RESULTS We identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. CONCLUSIONS State regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.
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Affiliation(s)
| | - Maureen T. Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, United States
| | - Morgan C. Shields
- Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA; Washington University in St. Louis, Brown School, 1 Brookings Dr, St. Louis, MO, United States (Present address)
| | - Mackenzie White
- IBM Watson Health, 75 Binney St, Cambridge, MA, United States
| | - Joel Dubenitz
- Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC, United States
| | - Judith Dey
- Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC, United States
| | - Norah Mulvaney-Day
- IBM Watson Health, 75 Binney St, Cambridge, MA, United States; Dept. of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA (Present address)
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Mulvaney-Day N, Dean D, Miller K, Camacho-Cook J. Trends in Use of Telehealth for Behavioral Health Care During the COVID-19 Pandemic: Considerations for Payers and Employers. Am J Health Promot 2022; 36:1237-1241. [PMID: 36003014 PMCID: PMC9412131 DOI: 10.1177/08901171221112488e] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - David Dean
- National Cancer Institute, Rockville, MD, USA
| | - Kay Miller
- IBM Watson Health, IBM, Santa Barbara, CA, USA
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Creedon TB, Schrader KE, O'Brien PL, Lin JR, Carroll CD, Mulvaney-Day N. Rural-Nonrural Differences in Telemedicine Use for Mental and Substance Use Disorders Among Medicaid Beneficiaries. Psychiatr Serv 2020; 71:756-764. [PMID: 32290806 DOI: 10.1176/appi.ps.201900444] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study investigated recent rural-nonrural trends in the prevalence and amount of mental and substance use disorder telemedicine received by adult Medicaid beneficiaries. METHODS An analysis of 2012-2017 claims data from the IBM MarketScan Multi-State Medicaid Database for adult beneficiaries ages 18-64 years with mental and substance use disorder diagnoses (N= 1,603,066) identified telemedicine services by using procedure modifier codes and ICD-9 and ICD-10 diagnosis codes. Unadjusted trends in telemedicine use were examined, and multivariate regression models compared the prevalence and amount of telemedicine and in-person outpatient treatment received by rural (N=428,697) and nonrural (N= 1,174,369) beneficiaries and by diagnosis. RESULTS Rates of telemedicine treatment for mental and substance use disorders among Medicaid beneficiaries increased during the study period but remained low. Among rural beneficiaries, there was a 5.9 percentage point increase in telemedicine for mental disorders and a 1.9 percentage point increase in telemedicine for substance use disorders. After control for other individual characteristics, rural beneficiaries were more likely than nonrural beneficiaries to receive any telemedicine for mental disorder (2.2 percentage points more likely) or substance use disorder (0.6 percentage points) treatment. Receipt of telemedicine was associated with receipt of more in-person outpatient services by rural beneficiaries (11.2 more visits for mental disorders and 8.2 more for substance use disorders). CONCLUSIONS Although provision of telemedicine for mental and substance use disorders increased during the study period and was somewhat more common among rural Medicaid beneficiaries, it remains an underused resource for addressing care shortages in rural areas.
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Affiliation(s)
- Timothy B Creedon
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Kristin E Schrader
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Peggy L O'Brien
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Janice R Lin
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Christopher D Carroll
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Norah Mulvaney-Day
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
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Mulvaney-Day N, Gibbons BJ, Alikhan S, Karakus M. Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. Am J Public Health 2019; 109:S190-S196. [PMID: 31242013 DOI: 10.2105/ajph.2019.305023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess the impact of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) on mental and substance use disorder services in the private, large group employer-sponsored insurance market in the United States. Methods. We analyzed data from the IBM MarketScan Commercial Database from January 2005 through September 2015 by using population-level interrupted time series regressions to determine whether parity implementation was associated with utilization and spending outcomes. Results. MHPAEA had significant positive associations with utilization of mental and substance use disorder outpatient services. A spending decomposition analysis indicated that increases in utilization were the primary drivers of increases in spending associated with MHPAEA. Analyses of opioid use disorder and nonopioid substance use disorder services found that associations with utilization and spending were not attributable only to increases in treatment of opioid use disorder. Conclusions. MHPAEA is positively associated with utilization of outpatient mental and substance use disorder services for Americans covered by large group employer-sponsored insurance. Public Health Implications. These trends continued over the 5-year post-MHPAEA period, underscoring the long-term relationship between this policy change and utilization of behavioral health services.
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Affiliation(s)
- Norah Mulvaney-Day
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Brent J Gibbons
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Shums Alikhan
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Mustafa Karakus
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
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Mulvaney-Day N, Marshall T, Downey Piscopo K, Korsen N, Lynch S, Karnell LH, Moran GE, Daniels AS, Ghose SS. Screening for Behavioral Health Conditions in Primary Care Settings: A Systematic Review of the Literature. J Gen Intern Med 2018; 33:335-346. [PMID: 28948432 PMCID: PMC5834951 DOI: 10.1007/s11606-017-4181-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/14/2017] [Accepted: 08/30/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Mounting evidence indicates that early recognition and treatment of behavioral health disorders can prevent complications, improve quality of life, and help reduce health care costs. The aim of this systematic literature review was to identify and evaluate publicly available, psychometrically tested tools that primary care physicians (PCPs) can use to screen adult patients for common mental and substance use disorders such as depression, anxiety, and alcohol use disorders. METHODS We followed the Institute of Medicine (IOM) systematic review guidelines and searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Health and Psychosocial Instruments databases to identify literature addressing tools for screening of behavioral health conditions. We gathered information on each tool's psychometrics, applicability in primary care, and characteristics such as number of items and mode of administration. We included tools focused on adults and the most common behavioral health conditions; we excluded tools designed for children, youth, or older adults; holistic health scales; and tools screening for serious but less frequently encountered disorders, such as bipolar disorder. RESULTS We identified 24 screening tools that met the inclusion criteria. Fifteen tools were subscales stemming from multiple-disorder assessments or tools that assessed more than one mental disorder or more than one substance use disorder in a single instrument. Nine were ultra-short, single-disorder tools. The tools varied in psychometrics and the extent to which they had been administered and studied in primary care settings. DISCUSSION Tools stemming from the Patient Health Questionnaire had the most testing and application in primary care settings. However, numerous other tools could meet the needs of primary care practices. This review provides information that PCPs can use to select appropriate tools to incorporate into a screening protocol.
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Affiliation(s)
| | | | | | - Neil Korsen
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
| | - Sean Lynch
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | - Lucy H Karnell
- Truven Health Analytics, an IBM Company, Cambridge, MA, USA
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Abstract
OBJECTIVES We used data from the 2015 National Association of State Alcohol and Drug Abuse Directors Web-based questionnaire and other sources to demonstrate the range and scope of state initiatives being used to deal with the opioid crisis in the United States. METHODS State alcohol and drug agency directors and designated senior agency managers responded to the questionnaire, which asked respondents about recent opioid-related state-level public health initiatives at their agencies. RESULTS State alcohol and drug agencies in all 50 states and the District of Columbia responded, all of which reported that prescription drug misuse was a high priority or the highest priority area for their agencies. Of the 51 respondents, states reported initiatives to educate the general public (n = 48), prescribers (n = 31), patients and families (n = 24), and pharmacists (n = 22) about the risks of opioids. In addition, 29 states had increased funding for medication-assisted treatment of opioid addiction, 28 had expanded the availability of naloxone (an opioid antidote), 26 had established guidelines for safe opioid prescribing, 23 had launched requirements for prescriber use of prescription monitoring programs, 23 had passed Good Samaritan laws to protect those helping treat overdoses, and 14 had enacted legislation to regulate pain clinics. CONCLUSIONS US state alcohol and drug agencies demonstrated a robust response to the opioid crisis in the United States. They have pursued and expanded on an array of evidence-based initiatives aimed at the opioid crisis. Future public health efforts should focus on maintenance and further expansion of high-quality, evidence-based practices, policies, and programs.
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Affiliation(s)
| | - Julia Zur
- 2 Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | | | | | - Elizabeth Selmi
- 1 National Association of State Alcohol and Drug Abuse Directors, Washington, DC, USA
| | - Henrick Harwood
- 1 National Association of State Alcohol and Drug Abuse Directors, Washington, DC, USA
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Lee LK, Mulvaney-Day N, Berger AM, Bhaumik U, Nguyen HT, Ward VL. The Patient Passport Program: An Intervention to Improve Patient-Provider Communication for Hospitalized Minority Children and Their Families. Acad Pediatr 2016; 16:460-467. [PMID: 26724179 DOI: 10.1016/j.acap.2015.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/23/2015] [Accepted: 12/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Effective patient-provider communication is essential to improve health care delivery and satisfaction and to minimize disparities in care for minorities. The objective of our study was to evaluate the impact of a patient-provider communication program, the Patient Passport Program, to improve communication and satisfaction for hospitalized minority children. METHODS This was a qualitative evaluation of a communication project for families with hospitalized children. Families were assigned to either the Patient Passport Program or to usual care. The Passport Program consisted of a personalized Passport book and additional medical rounds with medical providers. Semistructured interviews at the time of patient discharge were conducted with all participants to measure communication quality and patient/family satisfaction. Inductive qualitative methods were used to identify common themes. RESULTS Of the 40 children enrolled in the Passport Program, 60% were boys; the mean age was 9.7 years (range, 0.16-19 years). The most common themes in the qualitative analysis of the interviews were: 1) organization of medical care; 2) emotional expressions about the hospitalization experience; and 3) overall understanding of the process of care. Spanish- and English-speaking families had similar patient satisfaction experiences, but the Passport families reported improved quality of communication with the medical care team. CONCLUSIONS The Patient Passport Program enhanced the quality of communication among minority families of hospitalized children with some common themes around the medical care expressed in the Passport book.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass.
| | | | | | - Urmi Bhaumik
- Division of Adolescent Medicine, Boston Children's Hospital, Boston, Mass
| | - Hiep T Nguyen
- Division of Pediatric Urology, Cardon Children's Hospital, Mesa, Ariz
| | - Valerie L Ward
- Department of Radiology, Boston Children's Hospital, Boston, Mass
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Schlenger WE, Mulvaney-Day N, Williams CS, Kulka RA, Corry NH, Mauch D, Nagler CF, Ho CL, Marmar CR. PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War. Psychiatr Serv 2016; 67:543-50. [PMID: 26725289 DOI: 10.1176/appi.ps.201400576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. METHODS Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. RESULTS Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. CONCLUSIONS Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.
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Affiliation(s)
- William E Schlenger
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Norah Mulvaney-Day
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Christianna S Williams
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Richard A Kulka
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Nida H Corry
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Danna Mauch
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Caryn F Nagler
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Chia-Lin Ho
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
| | - Charles R Marmar
- Dr. Schlenger, Dr. Williams, and Dr. Corry are with Abt Associates, Durham, North Carolina, where Dr. Ho was affiliated when this work was done. Dr. Ho is now with the Department of Business Administration, Shih Hsin University, Taipei, Taiwan. When this work was done, Dr. Mulvaney-Day and Dr. Mauch were with Abt Associates, Cambridge, Massachusetts. Dr. Mulvaney-Day is now with Truven Health Analytics, Cambridge, Massachusetts. Dr. Mauch is now with the Massachusetts Association for Mental Health, Boston. Dr. Kulka is an independent consultant in Raleigh, North Carolina. Ms. Nagler is with Abt Associates, Bethesda, Maryland. Dr. Marmar is with Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York City. Send correspondence to Dr. Mulvaney-Day (e-mail: )
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Schlenger WE, Corry NH, Williams CS, Kulka RA, Mulvaney-Day N, DeBakey S, Murphy CM, Marmar CR. A Prospective Study of Mortality and Trauma-Related Risk Factors Among a Nationally Representative Sample of Vietnam Veterans. Am J Epidemiol 2015; 182:980-90. [PMID: 26634285 DOI: 10.1093/aje/kwv217] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/12/2015] [Indexed: 11/13/2022] Open
Abstract
Because Vietnam veterans comprise the majority of all living veterans and most are now older adults, the urgency and potential value of studying the long-term health effects of service in the Vietnam War, including effects on mortality, is increasing. The present study is the first prospective mortality assessment of a representative sample of Vietnam veterans. We used one of the longest follow-up periods to date (spanning older adulthood) and conducted one of the most comprehensive assessments of potential risk factors. Vital status and cause of death were ascertained for the 1,632 veterans who fought in the Vietnam theater (hereafter referred to as theater veterans) and for 716 Vietnam War-era veterans (hereafter referred to as era veterans) who participated in the National Vietnam Veterans Readjustment Study (1987-2011). As of April 2011, 16.0% (95% confidence interval: 13.1, 19.0) of all Vietnam veterans who were alive in the 1980s were deceased. Male theater veterans with a high probability of posttraumatic stress disorder (PTSD) were nearly 2 times more likely to have died than were those without PTSD, even after adjustment for sociodemographic and other characteristics. A high level of exposure to war zone stress was independently associated with mortality for both male and female theater veterans after adjustment for sociodemographic characteristics, PTSD, and physical comorbid conditions. Theater veterans with a high level of exposure to war zone stress and a high probability of PTSD had the greatest mortality risk (adjusted hazard ratio = 2.34, 95% confidence interval: 1.24, 4.43).
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Abstract
We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005-2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients.
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Affiliation(s)
- Marta Gonçalves
- Centre for Social Research and Intervention, Instituto Universitário de Lisboa, Lisbon, Portugal.
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Mulvaney-Day N, Alegría M, Nillni A, Gonzalez S. Implementation of Massachusetts health insurance reform with vulnerable populations in a safety-net setting. J Health Care Poor Underserved 2012; 23:884-902. [PMID: 22643631 DOI: 10.1353/hpu.2012.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This qualitative study examines the experience of racial and ethnic minorities receiving behavioral health care in a safety net setting during the early process of health insurance reform in Massachusetts. Three rounds of interviews were conducted between August 2007 and May 2009, collecting information from patients (n=65) on the experience of health reform and delivery of mental health care. Four categories of enrollees transitioning into health reform emerged over the course of the study that grouped into a typology of experiences with reform: early enrollees, middle enrollees, late enrollees, and multiple switchers. With support, a majority of the sample transitioned smoothly to the new health insurance mechanisms. However, some experienced administrative confusion and disruption in mental health care during the transition. Administrative policies providing special accommodations for individuals with mental health disorders and other vulnerable populations may be important to consider during the transition to health insurance reform.
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Affiliation(s)
- Norah Mulvaney-Day
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, MA 02143, USA.
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14
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Mulvaney-Day N, DeAngelo D, Chen CN, Cook B, Alegría M. Unmet need for treatment for substance use disorders across race and ethnicity. Drug Alcohol Depend 2012; 125 Suppl 1:S44-50. [PMID: 22658581 PMCID: PMC3435455 DOI: 10.1016/j.drugalcdep.2012.05.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective was to analyze disparities in unmet need for substance use treatment and to observe variation across different definitions of need for treatment. METHODS Data were analyzed from the 2002 to 2005 National Survey of Drug Use and Health and the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regressions estimated the likelihood of specialty substance use treatment across the two data sets. Parallel variables for specialty, informal and any substance abuse treatment were created. Perceived need and normative need for substance use treatment were defined, with normative need stratified across lifetime disorder, past twelve month disorder, and heavy alcohol/any illicit drug use. Treatment rates were analyzed, comparing Blacks, Asians and Latinos to non-Latino whites across need definitions, and adjusting for age, sex, household income, marital status, education and insurance. RESULTS Asians with past year substance use disorder had a higher likelihood of unmet need for specialty treatment than whites. Blacks with past year disorder and with heavy drinking/illicit drug use had significantly lower likelihood of unmet need. Latinos with past year disorder had a higher likelihood of unmet need for specialty substance abuse treatment. Asians with heavy drinking/illicit drug use had lower likelihood of unmet need. CONCLUSIONS The findings suggest that pathways to substance abuse treatment differ across groups. Given high rates of unmet need, a broad approach to defining need for treatment is warranted. Future research to disentangle social and systemic factors from factors based on diagnostic criteria is necessary in the identification of need for treatment.
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Affiliation(s)
| | - Darcie DeAngelo
- Center for Multicultural Mental Health Reserarch, Somerville, MA
| | | | - Benjamin Cook
- Center for Multicultural Mental Health Reserarch, Somerville, MA
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15
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Womack CA, Mulvaney-Day N. Health agency in fried foodways. A qualitative investigation of fast food workers and eating attitudes. Appetite 2011. [DOI: 10.1016/j.appet.2010.11.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Alegría M, Wong Y, Mulvaney-Day N, Nillni A, Proctor E, Nickel M, Jones L, Green B, Koegel P, Wright A, Wells KB. Community-based partnered research: new directions in mental health services research. Ethn Dis 2011; 21:S1-8-16. [PMID: 22352075 PMCID: PMC3653438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Community-based participatory research has the potential to improve implementation of best practices to reduce disparities but has seldom been applied in mental health services research. This article presents the content and lessons learned from a national conference designed to stimulate such an application. DESIGN Mental health program developers collaborated in hosting a two-day conference that included plenary and break-out sessions, sharing approaches to community-academic partnership development, and preliminary findings from partnered research studies. Sessions were audiotaped, transcribed and analyzed by teams of academic and community conference participants to identify themes about best practices, challenges faced in partnered research, and recommendations for development of the field. Themes were illustrated with selections from project descriptions at the conference. SETTING AND PARTICIPANTS Participants, representing 9 academic institutions and 12 community-based agencies from four US census regions, were academic and community partners from five research centers funded by the National Institute of Mental Health, and also included staff from federal and non-profit funding agencies. RESULTS Five themes emerged: 1) Partnership Building; 2) Implementing and Supporting Partnered Research; 3) Developing Creative Dissemination Strategies; 4) Evaluating Impact; and 5) Training. CONCLUSIONS Emerging knowledge of the factors in the partnership process can enhance uptake of new interventions in mental health services. Conference proceedings suggested that further development of this field may hold promise for improved approaches to address the mental health services quality chasm and service disparities.
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Affiliation(s)
- Margarita Alegría
- Center for Multicultural Mental Health Research, Harvard Medical School, 120 Beacon St., Fourth Floor, Somerville, MA 02116, USA.
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17
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Mulvaney-Day N, Womack CA. Obesity, Identity and Community: Leveraging Social Networks for Behavior Change in Public Health. Public Health Ethics 2009. [DOI: 10.1093/phe/php022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cortes DE, Mulvaney-Day N, Fortuna L, Reinfeld S, Alegría M. Patient--provider communication: understanding the role of patient activation for Latinos in mental health treatment. Health Educ Behav 2009; 36:138-54. [PMID: 18413668 PMCID: PMC3538365 DOI: 10.1177/1090198108314618] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article highlights results from the Right Question Project-Mental Health (RQP-MH), an intervention designed to teach skills in question formulation and to increase patients' participation in decisions about mental health treatment. Of participants in the RQP-MH intervention, 83% were from a Latino background, and 75% of the interviews were conducted in Spanish. The authors present the steps participants undertook in the process of becoming "activated" to formulate effective questions and develop decision-making skills in relation to their care. Findings suggest that patient activation and empowerment are interdependent because many of the skills (i.e., question formulation, direct patient-provider communication) required to become an "activated patient" are essential to achieve empowerment. Also, findings suggest that cultural and contextual factors can influence the experience of Latinos regarding participation in health care interactions. The authors provide recommendations for continued research on the patient activation process and further application of this strategy in the mental health field, especially with Latinos.
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Affiliation(s)
- Dharma E Cortes
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, MA 02143, USA
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Rappaport N, Alegria M, Mulvaney-Day N, Boyle B. STAYING AT THE TABLE: BUILDING SUSTAINABLE COMMUNITY-RESEARCH PARTNERSHIPS. J Community Psychol 2008; 36:693-701. [PMID: 23667274 PMCID: PMC3647474 DOI: 10.1002/jcop.20249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this study, the authors identify three guiding principles or relational strategies for developing successful community partnerships and building an alliance for systemic change. These principles were derived from their work over 4 years with an urban public school system, which was focused on generating a series of interventions for improving the behavioral and academic functioning of immigrant students. In their process, they developed an analysis and monitoring system of students' progress, which allowed for earlier targeted effective support.
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20
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Rivera FI, Guarnaccia PJ, Mulvaney-Day N, Lin JY, Torres M, Alegria M. Family Cohesion and its Relationship to Psychological Distress among Latino Groups. Hisp J Behav Sci 2008; 30:357-378. [PMID: 19444326 DOI: 10.1177/0739986308318713] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents analyses of a representative sample of US Latinos (N=2540) to investigate whether family cohesion moderates the effects of cultural conflict on psychological distress. The results for the aggregated Latino group suggests a significant association between family cohesion and lower psychological distress and the combination of strong family cohesion with presence of family cultural conflict was associated with higher psychological distress. However, this association differed by Latino groups. We found no association for Puerto Ricans, Cuban results were similar to the aggregate group, family cultural conflict in Mexicans was associated with higher psychological distress, while family cohesion in Other Latinos was associated with higher psychological distress. Implications of these findings are discussed to unravel the differences in family dynamics across Latino subethnic groups.
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Alegría M, Mulvaney-Day N, Woo M, Torres M, Gao S, Oddo V. Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study. Am J Public Health 2007. [PMID: 17138911 DOI: 10.2105/ajph,2006,087197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES We examined correlates and rates of past-year mental health service use in a national sample of Latinos residing in the United States. METHODS We used data from the National Latino and Asian American Study, a national epidemiological household survey of Latinos. RESULTS Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status were associated with whether or not Latinos had used mental health services. However, when the analysis was stratified according to past-year psychiatric diagnoses, these associations held only among those who did not fulfill criteria for any of the psychiatric disorders assessed. Rates of mental health service use among those who did not fulfill diagnostic criteria were higher among Puerto Ricans and US-born Latinos than among non-Puerto Ricans and foreign-born Latinos. CONCLUSIONS Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.
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Affiliation(s)
- Margarita Alegría
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Harvard Medical School, Somerville, Mass 02143, USA.
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22
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Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G. Prevalence of psychiatric disorders across Latino subgroups in the United States. Am J Public Health 2007. [PMID: 17138910 DOI: 10.2105/ajph.2006.087205)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVES We examined the prevalence of depressive, anxiety, and substance use disorders among Latinos residing in the United States. METHODS We used data from the National Latino and Asian American Study, which included a nationally representative sample of Latinos. We calculated weighted prevalence rates of lifetime and past-year psychiatric disorders across different sociodemographic, ethnic, and immigration groups. RESULTS Lifetime psychiatric disorder prevalence estimates were 28.1% for men and 30.2% for women. Puerto Ricans had the highest overall prevalence rate among the Latino ethnic groups assessed. Increased rates of psychiatric disorders were observed among US-born, English-language-proficient, and third-generation Latinos. CONCLUSIONS Our results provide important information about potential correlates of psychiatric problems among Latinos that can inform clinical practice and guide program development. Stressors associated with cultural transmutation may exert particular pressure on Latino men. Continued attention to environmental influences, especially among third-generation Latinos, is an important area for substance abuse program development.
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Affiliation(s)
- Margarita Alegría
- Center for Multi-cultural Mental Health Research, Cambridge Health Alliance, Harvard Medical School, Somerville, Mass 02143, USA.
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23
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Alegría M, Mulvaney-Day N, Woo M, Torres M, Gao S, Oddo V. Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study. Am J Public Health 2006; 97:76-83. [PMID: 17138911 PMCID: PMC1716237 DOI: 10.2105/ajph.2006.087197] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined correlates and rates of past-year mental health service use in a national sample of Latinos residing in the United States. METHODS We used data from the National Latino and Asian American Study, a national epidemiological household survey of Latinos. RESULTS Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status were associated with whether or not Latinos had used mental health services. However, when the analysis was stratified according to past-year psychiatric diagnoses, these associations held only among those who did not fulfill criteria for any of the psychiatric disorders assessed. Rates of mental health service use among those who did not fulfill diagnostic criteria were higher among Puerto Ricans and US-born Latinos than among non-Puerto Ricans and foreign-born Latinos. CONCLUSIONS Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.
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Affiliation(s)
- Margarita Alegría
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Harvard Medical School, Somerville, Mass 02143, USA.
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Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G. Prevalence of psychiatric disorders across Latino subgroups in the United States. Am J Public Health 2006; 97:68-75. [PMID: 17138910 PMCID: PMC1716243 DOI: 10.2105/ajph.2006.087205] [Citation(s) in RCA: 433] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We examined the prevalence of depressive, anxiety, and substance use disorders among Latinos residing in the United States. METHODS We used data from the National Latino and Asian American Study, which included a nationally representative sample of Latinos. We calculated weighted prevalence rates of lifetime and past-year psychiatric disorders across different sociodemographic, ethnic, and immigration groups. RESULTS Lifetime psychiatric disorder prevalence estimates were 28.1% for men and 30.2% for women. Puerto Ricans had the highest overall prevalence rate among the Latino ethnic groups assessed. Increased rates of psychiatric disorders were observed among US-born, English-language-proficient, and third-generation Latinos. CONCLUSIONS Our results provide important information about potential correlates of psychiatric problems among Latinos that can inform clinical practice and guide program development. Stressors associated with cultural transmutation may exert particular pressure on Latino men. Continued attention to environmental influences, especially among third-generation Latinos, is an important area for substance abuse program development.
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Affiliation(s)
- Margarita Alegría
- Center for Multi-cultural Mental Health Research, Cambridge Health Alliance, Harvard Medical School, Somerville, Mass 02143, USA.
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Mulvaney-Day N. Approaches to Research: A Handbook for Those Writing a Dissertation. Art Therapy 1997. [DOI: 10.1080/07421656.1987.10759273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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