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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Price MA, Hollinsaid NL, McKetta S, Mellen EJ, Rakhilin M. Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults. Soc Psychiatry Psychiatr Epidemiol 2024; 59:285-294. [PMID: 37165214 PMCID: PMC10171731 DOI: 10.1007/s00127-023-02482-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/28/2022] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. METHODS We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC). RESULTS Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. CONCLUSION Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.
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Affiliation(s)
- Maggi A Price
- School of Social Work, Boston College, McGuinn Hall 126, 275 Beacon St., Chestnut Hill, MA, 02467, USA.
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | | | - Sarah McKetta
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Emily J Mellen
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Marina Rakhilin
- School of Social Work, Boston College, McGuinn Hall 126, 275 Beacon St., Chestnut Hill, MA, 02467, USA
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Mulawa MI, Docherty SL, Bailey DE, Gonzalez-Guarda RM, Lipkus IM, Randolph SD, Yang Q, Pan W. A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools. Prev Sci 2024:10.1007/s11121-023-01626-x. [PMID: 38175459 DOI: 10.1007/s11121-023-01626-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/05/2024]
Abstract
Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence.
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Affiliation(s)
- Marta I Mulawa
- Duke University School of Nursing, Duke University, Durham, NC, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Sharron L Docherty
- Duke University School of Nursing, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Donald E Bailey
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | | | - Isaac M Lipkus
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | | | - Qing Yang
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Waller BY, Giusto A, Tepper M, Legros NC, Sweetland AC, Taffy A, Wainberg ML. Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic. Community Ment Health J 2024; 60:82-86. [PMID: 37133709 PMCID: PMC10155669 DOI: 10.1007/s10597-023-01124-y] [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: 01/21/2023] [Accepted: 03/25/2023] [Indexed: 05/04/2023]
Abstract
Black, Indigenous, and People of Color (BIPOC) communities have weathered centuries of racism, causing transgenerational mental health consequences and hindering access to quality treatment. In this commentary, we describe the systemic challenges of engaging BIPOC to promote mental health equity during the COVID-19 pandemic. We then describe an initiative that illustrates these strategies, provide recommendations and further readings for academic institutions seeking to partner with community organizations to provide equitable mental health services to populations that have been traditionally overlooked.
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Affiliation(s)
- Bernadine Y. Waller
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Miriam Tepper
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Naomi C. Legros
- Division of Environmental Pediatrics, NYU Langone Health, 403 E. 34Th Street, New York, NY 10016 USA
| | - Annika C. Sweetland
- Department of Psychiatry and Public Health, Columbia University Vagelos College of Physicians & Surgeons/New York State Psychiatric Institute, Columbia Mailman School of Public Health, New York, NY 10032 USA
| | - Amanda Taffy
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
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Lin SY, Schleider JL, Nelson BD, Richmond LL, Eaton NR. Gender and Racial/Ethnic Disparities in Undergraduate and Graduate Students' Mental Health and Treatment Use Amid the COVID-19 Pandemic. Adm Policy Ment Health 2023; 50:552-562. [PMID: 36802042 PMCID: PMC9937864 DOI: 10.1007/s10488-023-01256-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/20/2023]
Abstract
The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.
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Affiliation(s)
- Sin-Ying Lin
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA.
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Lauren L Richmond
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
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Siantz E, Hiller S, Ojeda VD, Gilmer TP. Barriers to Accessing Mental Health Care Under the Mental Health Services Act: A Qualitative Case Study in Orange County, California. Community Ment Health J 2023; 59:381-390. [PMID: 36121527 DOI: 10.1007/s10597-022-01016-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
Despite progress made under California's Mental Health Services Act, limited access to care for cultural and linguistic minority groups remains a serious issue in community mental health. In this qualitative study we report findings from a large-scale community-level assessment that explored barriers to accessing care from the perspectives of multiple stakeholders including county advisors, advocates, community members, and consumers representing a range of cultural and linguistic communities in Orange County, California. We conducted 14 focus groups with N = 112 participants. Qualitative analysis revealed that system fragmentation, limited availability of linguistically appropriate care, and stigma continue to undermine access to mental health care. Peer health navigation and culturally responsive peer support are potential ways to promote service engagement with persons from cultural and linguistic minority groups that encounter barriers when accessing mental health services.
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Affiliation(s)
- Elizabeth Siantz
- College of Social Work, University of Utah, Salt Lake City, UT, USA.
| | - Sarah Hiller
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
| | - Victoria D Ojeda
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
| | - Todd P Gilmer
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
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Pro G, Brown C, Rojo M, Patel J, Flax C, Haynes T. Downward National Trends in Mental Health Treatment Offered in Spanish: State Differences by Proportion of Hispanic Residents. Psychiatr Serv 2022; 73:1232-1238. [PMID: 35502519 DOI: 10.1176/appi.ps.202100614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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 aimed to determine how the prevalence of mental health treatment facilities that offer services in Spanish has changed over time in the United States. METHODS Data from the National Mental Health Services Survey conducted in 2014 (N=13,015 facilities) and 2019 (N=12,345 facilities) were used to measure changes in the proportions of facilities that offered treatment in Spanish overall and by year, state, and proportion of Hispanic residents. Descriptive statistics were used to illustrate state-level changes in services offered in Spanish. RESULTS Between 2014 and 2019, the national Hispanic population increased by 4.5%, or 5.2 million people. During the same period, the proportion of facilities that offered treatment in Spanish declined by 17.8%, or a loss of 1,163 Spanish-speaking mental health facilities. Overall, 44 states saw a decline in the availability of services in Spanish, despite growth in Hispanic populations across all states. Among states with the fastest Hispanic population growth, several also experienced the greatest reduction in Spanish-language services. CONCLUSIONS The findings indicate that availability of Spanish-language mental health services decreased in most U.S. states during 2014–2019. Promoting mental health service delivery in Spanish is critical for reducing barriers to treatment and ensuring health equity across populations.
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Affiliation(s)
- George Pro
- Department of Health Behavior and Health Education (Pro, Flax, Haynes), Southern Public Health and Criminal Justice Research Center (Pro), and Department of Health Policy and Management (Brown), Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock; College of Nursing, University of Arkansas for Medical Sciences, Little Rock (Rojo); Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Dallas (Patel)
| | - Clare Brown
- Department of Health Behavior and Health Education (Pro, Flax, Haynes), Southern Public Health and Criminal Justice Research Center (Pro), and Department of Health Policy and Management (Brown), Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock; College of Nursing, University of Arkansas for Medical Sciences, Little Rock (Rojo); Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Dallas (Patel)
| | - Martha Rojo
- Department of Health Behavior and Health Education (Pro, Flax, Haynes), Southern Public Health and Criminal Justice Research Center (Pro), and Department of Health Policy and Management (Brown), Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock; College of Nursing, University of Arkansas for Medical Sciences, Little Rock (Rojo); Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Dallas (Patel)
| | - Jenil Patel
- Department of Health Behavior and Health Education (Pro, Flax, Haynes), Southern Public Health and Criminal Justice Research Center (Pro), and Department of Health Policy and Management (Brown), Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock; College of Nursing, University of Arkansas for Medical Sciences, Little Rock (Rojo); Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Dallas (Patel)
| | - Chasmine Flax
- Department of Health Behavior and Health Education (Pro, Flax, Haynes), Southern Public Health and Criminal Justice Research Center (Pro), and Department of Health Policy and Management (Brown), Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock; College of Nursing, University of Arkansas for Medical Sciences, Little Rock (Rojo); Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Dallas (Patel)
| | - Tiffany Haynes
- Department of Health Behavior and Health Education (Pro, Flax, Haynes), Southern Public Health and Criminal Justice Research Center (Pro), and Department of Health Policy and Management (Brown), Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock; College of Nursing, University of Arkansas for Medical Sciences, Little Rock (Rojo); Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Dallas (Patel)
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Robles-Ramamurthy B, Sandoval JF, Tobón AL, Fortuna LR. Beyond Children's Mental Health: Cultural Considerations to Foster Latino Child and Family Mental Health. Child Adolesc Psychiatr Clin N Am 2022; 31:765-778. [PMID: 36182223 PMCID: PMC9529069 DOI: 10.1016/j.chc.2022.05.005] [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] [Indexed: 11/16/2022]
Abstract
Clinicians trained to assess and treat child psychopathology are facing an increasing need to expand their clinical expertise outside of traditional frameworks, which have historically focused largely on the child or the child-mother dyad. Clinicians treating children also need to be prepared to assess and address the systems of care that affect a child's mental health, starting with their family. There is a scarcity of Latino mental health providers and limited clinical opportunities or settings that serve this population by incorporating a developmental, cultural, and sociopolitical framework into high quality care of the whole family.
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Affiliation(s)
- Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA.
| | - Jessica F Sandoval
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA
| | - Amalia Londoño Tobón
- National Institutes on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892-5465, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California in San Francisco, 1001 Potrero Avenue, 7M16, San Francisco, CA 94110, USA
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Kodish T, Lau AS, Belin TR, Berk MS, Asarnow JR. Improving Care Linkage for Racial-Ethnic Minority Youths Receiving Emergency Department Treatment for Suicidality: SAFETY-A. Psychiatr Serv 2022; 74:419-422. [PMID: 36128694 DOI: 10.1176/appi.ps.20220129] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study evaluated the effects of Safe Alternatives for Teens and Youths-Acute (SAFETY-A), a brief strengths-based, cognitive-behavioral family intervention, on racial-ethnic minority youths receiving emergency department (ED) treatment for suicidal episodes. METHODS Participants were 105 racial-ethnic minority youths enrolled in a randomized controlled trial evaluating SAFETY-A versus enhanced usual care for youths receiving ED treatment for suicidal episodes. Analyses examined group effects on care linkage after discharge and adequate treatment dose. A sample of 55 White youths was included for comparison. RESULTS Racial-ethnic minority youths who received SAFETY-A had higher treatment linkage rates than those receiving usual care. Adequate treatment dose rates did not differ by group. CONCLUSIONS Racial-ethnic minority youths receiving SAFETY-A had higher treatment linkage rates after discharge than those receiving usual care. SAFETY-A is a promising approach to enhance care continuity and mental health equity for racial-ethnic minority youths at risk for suicide.
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Affiliation(s)
- Tamar Kodish
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Anna S Lau
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Thomas R Belin
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Michele S Berk
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Joan R Asarnow
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
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Waite R, Hassouneh D. Structural competency in mental health nursing: Understanding and applying key concepts. Arch Psychiatr Nurs 2021; 35:73-79. [PMID: 33593518 DOI: 10.1016/j.apnu.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/08/2019] [Revised: 01/02/2020] [Accepted: 09/07/2020] [Indexed: 10/22/2022]
Abstract
Achieving mental health equity requires that nursing address structures that impede the ability of individuals and populations to achieve optimal mental health. Consistent with calls for structural change, this paper intends to promote structural competency in mental health nursing by applying this concept to the field. The first half of the paper discusses structural competency and key concepts vital for its development, namely, structure, social influencers of mental health, equity, structural justice, and historical understanding. In the second half we apply structural competency to mental health nursing at the educational, practice and system levels and conclude with recommendations for change.
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Abstract
This article briefly reviews the influences of protective and risk factors of child and adolescent mental health, and explores promising practices and outcomes of evidence-based programs designed to improve the mental health of youth, and the barriers for accessing quality and evidence-based child and adolescent mental health service delivery systems. The authors provide recommendations for individual practice improvements and policy, funding, and organizational practice improvements that will support mental health equity in child and adolescent populations.
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Affiliation(s)
- Toi Blakley Harris
- Psychiatry, Institutional Diversity, Inclusion and Equity & Student and Trainee Services, Center of Excellence in Health Equity, Training and Research, PI/PD, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Pediatrics, Institutional Diversity, Inclusion and Equity & Student and Trainee Services, Center of Excellence in Health Equity, Training and Research, PI/PD, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Family and Community Medicine, Institutional Diversity, Inclusion and Equity & Student and Trainee Services, Center of Excellence in Health Equity, Training and Research, PI/PD, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Sade C Udoetuk
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS Stop 350, Houston, TX 77030, USA
| | - Sala Webb
- Behavioral Health, Comprehensive Medical & Dental Plan, Arizona Department of Child Safety, 3003 North Central Avenue, Phoenix, AZ 85012, USA
| | - Andria Tatem
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 6701 Fannin Street, Suite 1540, Houston, TX 77030, USA. https://twitter.com/doc2be2014
| | - Lauren M Nutile
- Department of Psychiatry, Virginia Treatment Center for Children, PO Box 980489, Richmond, VA 23298-0489, USA
| | - Cheryl S Al-Mateen
- Department of Psychiatry, Virginia Treatment Center for Children, Virginia Commonwealth University, PO Box 980489, Richmond, VA 23298-0489, USA; Department of Pediatrics, Virginia Treatment Center for Children, Virginia Commonwealth University, Richmond, VA, USA.
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Abstract
This article highlights the history of the psychiatric training practices that have contributed to inequity in mental health service delivery, particularly to underserved populations. It discusses current training practices that may be effective at reducing such disparities, suggests policy recommendations to increase the number of underrepresented minorities in health services, and makes recommendations for the further development and implementation of training practices that address health inequity. The article reviews issues in both general psychiatry and child/adolescent training in addition to lifelong learning needs.
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Affiliation(s)
- Donna M Sudak
- Drexel-Tower Health Psychiatry, Drexel University, 219 Broad Street, Fifth Floor #506, Philadelphia, PA 19107, USA.
| | - Sandra M DeJong
- Harvard Medical School, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA
| | - Brigitte Bailey
- Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive MC 7792, San Antonio, TX 78229, USA
| | - Robert M Rohrbaugh
- Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06437, USA
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Abstract
There are historical predicates for the inequities noted in present-day community mental health. Stigma has led to discrimination for those living with mental illness. It is more difficult for research to occur, and to access care (prevention, early identification, evidence-based treatment services) because funding is limited and workforce development curtailed. Strategies to decrease stigma are suggested, means to enhance funding are offered, and models for workforce development are noted. Different treatment delivery systems are suggested to recruit and retain sufficient numbers of culturally competent and trauma-informed providers, so as to maximize access to necessary services.
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Affiliation(s)
- Jacqueline Maus Feldman
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Zeng J, Jian W. Changes in income-related inequalities of depression prevalence in China: a longitudinal, population study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1133-42. [PMID: 31004180 DOI: 10.1007/s00127-019-01710-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to measure the income-related inequality of depressive symptoms and its trends among middle-aged and elderly people in China. METHODS Data were extracted from the 2011 baseline and 2015 follow-up of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey for people aged 45 years and more. Depressive symptoms were evaluated with the Chinese version of the ten-item Center for Epidemiologic Studies Depression Scale. Five relative income levels were derived from ratios between the participants' annual per capita household expenditure, excluding medical expenditure, and the median PCE of their cities. The concentration curve and index were used to compare the magnitude of income-related inequality between 2 years. A logistic regression model was used to control the other socio-economic factors. RESULTS The prevalence of depression among middle-aged and elderly people in China decreased from 37.0% (5540 of 14,956 participants) in 2011 to 32.7% (5606 of 17,165) in 2015. However, the absolute value of the standardized concentration index increased from 0.005 to 0.028. Although the second lowest-income group had the greatest improvement in the decline of prevalence (5.7%, from 38.6 to 32.9%), the lowest-income group had only the minimal decline (2.4%, from 40.6 to 38.2%). In 2015, there were significant differences between the lowest-income group and other four groups while the differences among other four groups were not statistically significant. CONCLUSIONS The prevalence of depression among the middle-aged and elderly in China is declining, but the issue of income-related inequality has been exacerbated. The fairness of mental health deserves more attention.
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15
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Rahmanian Koushkaki S, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. Curr Psychiatry Rep 2019; 21:35. [PMID: 30927093 PMCID: PMC6440941 DOI: 10.1007/s11920-019-1017-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. RECENT FINDINGS There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.
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Affiliation(s)
- Enrico G Castillo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA.
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA.
| | - Roya Ijadi-Maghsoodi
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Division of Population Behavioral Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Sonya Shadravan
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Elizabeth Moore
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Michael O Mensah
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Mary Docherty
- Harkness Fellow in Healthcare Policy and Practice, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Maria Gabriela Aguilera Nunez
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nicolás Barcelo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nichole Goodsmith
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Laura E Halpin
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Isabella Morton
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Joseph Mango
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Alanna E Montero
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Sara Rahmanian Koushkaki
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Department of Anthropology, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Bowen Chung
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- Los Angeles Biomedical Research Institute, Los Angeles, CA, USA
- Healthy African American Families II, Los Angeles, CA, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | - Sonya Gabrielian
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Jared M Greenberg
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ippolytos Kalofonos
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA
- UCLA International Institute, Los Angeles, CA, USA
| | - Sheryl H Kataoka
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Jeanne Miranda
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Harold A Pincus
- Rand Corporation, Santa Monica, CA, USA
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, NewYork-Presbyterian Hospital, Irving Institute for Clinical and Translational Research, New York, NY, USA
| | - Bonnie T Zima
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Kenneth B Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
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