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Behrens B, Edler K, Cote K, Valentino K. Child internalizing symptoms during the COVID-19 pandemic among maltreating and non-maltreating families: Examining the effects of family resources and the Reminiscing and Emotion Training intervention. CHILD ABUSE & NEGLECT 2022; 130:105375. [PMID: 34749997 PMCID: PMC8549072 DOI: 10.1016/j.chiabu.2021.105375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The effects of the COVID-19 pandemic on child functioning have been especially pronounced among low-income families. Protective factors, including sensitive reminiscing and sufficient family resources, may reduce the negative effects of the pandemic on child adjustment. OBJECTIVE The current study investigated how family resources during the pandemic, race, maltreatment, and pre-pandemic involvement in an emotion socialization intervention (Myears ago = 4.37, SD = 1.36) were associated with child internalizing symptoms during the pandemic. PARTICIPANTS AND SETTING The study utilized longitudinal data following 137 maltreating and low-income nonmaltreating mother-child dyads (Mage = 9.08, SD = 1.88; 54.7% Male). METHODS Mother-child dyads engaged in a randomized controlled trial of the Reminiscing and Emotion Training (RET; Valentino et al., 2019) intervention prior to the pandemic. Dyads discussed shared, past emotional experiences, and during the pandemic, mothers reported on their family resources and their child's internalizing symptoms. A path analysis examined the effects of family resources, race, maltreatment, and the RET intervention on child internalizing symptoms. RESULTS Family resources during the pandemic were significantly and inversely associated with child internalizing symptoms, b = -0.07, SE = 0.02, p < .01. There was a significant indirect effect of RET on child internalizing symptoms through sensitive reminiscing and a prior assessment of child maladjustment (95% CI [-0.294, -0.001]). CONCLUSIONS These findings suggest adequate family resources and sensitive maternal emotion socialization may be protective against child internalizing symptoms during the pandemic.
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Kappi A, Martel M. Parental Barriers in Seeking Mental Health Services for Attention Deficit Hyperactivity Disorder in Children: Systematic Review. J Atten Disord 2022; 26:408-425. [PMID: 33472504 DOI: 10.1177/1087054720986909] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many children at risk for negative outcomes related to untreated attention deficit hyperactivity disorder (ADHD) do not receive necessary mental healthcare. Parents' mental health-seeking behavior is important in the early identification of ADHD and preventing comorbidities with ADHD. Parents may experience some barriers that may delay or stop parents from seeking mental healthcare for their children. METHOD This systematic review summarized existing evidence of parents' barriers to seeking mental healthcare for their children at risk of ADHD. RESULTS This review included 21 studies that address different parental barriers under the three levels of the social-ecological model, including individual, interpersonal, and community levels. CONCLUSION Raising parents' awareness of the process of seeking mental healthcare has the potential to help identify children at risk for ADHD earlier. Developing psychoeducational intervention that improves parents' seeking behavior and reduces barriers toward seeking mental healthcare is needed.
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Tse JSY, Haslam N. Inclusiveness of the Concept of Mental Disorder and Differences in Help-Seeking Between Asian and White Americans. Front Psychol 2021; 12:699750. [PMID: 34393934 PMCID: PMC8363115 DOI: 10.3389/fpsyg.2021.699750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/07/2021] [Indexed: 01/28/2023] Open
Abstract
Ethnic and racial group differences in help-seeking are a barrier to the effective and equitable delivery of mental health services. Asian American populations demonstrate relatively low levels of help-seeking. Explanations for this effect typically point to elevated levels of stigma in these populations. An alternative explanation is that low help-seeking might also reflect holding a relatively circumscribed concept of mental disorder. Individuals and groups with less inclusive concepts of disorder may be less likely to identify problems as appropriate for mental health treatment. This study aimed to test whether group differences in the breadth of the mental disorder concept account for group differences in help-seeking attitudes. A sample of 212 American participants (102 Asian Americans and 110 White Americans) were assessed on personal stigma, help-seeking attitudes, and mental disorder concept breadth. Mediation analyses examined whether stigma and concept breadth mediated group differences in attitudes. Compared to White Americans, Asian Americans reported higher levels of stigma and narrower concepts of mental disorder, both of which were associated with less positive help-seeking attitudes. Stigma and concept breadth both partially mediated the group difference in attitudes. Theoretical and practical implications for mental health promotion and culturally sensitive clinical practices are explored.
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Affiliation(s)
| | - Nick Haslam
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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Platt R, Weiss-Laxer NS, Creedon TB, Roman MJS, Cardemil EV, Cook B. Association between maternal and child mental health among US Latinos: variation by nativity, ethnic subgroup, and time in the USA. Arch Womens Ment Health 2020; 23:421-428. [PMID: 31222621 DOI: 10.1007/s00737-019-00982-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/05/2019] [Indexed: 12/17/2022]
Abstract
Few studies have examined the association between maternal and youth mental health among US Latinos, or its variation by nativity, country of origin, ethnic subgroup, and time in the mainland US. Using 2007-2014 Medical Expenditure Panel Survey data linking Latino youth (N = 15,686 aged 5-17 years) and their mothers, we estimated multivariate models of the relationship between probable maternal mental illness (a composite of measures) and youth mental health impairment (Columbia Impairment Scale). Children of mothers with probable mental illness were more than three times as likely to have impairment as children of mothers without mental illness (p < 0.01). In adjusted models, there was an 8.5-point (95% CI 5.1, 11.8) increased prevalence of child impairment associated with mother's probable mental illness among mainland US-born youth and mothers and a 6.0-point (95% CI 3.7, 8.3) increased prevalence among US-born youth of foreign/island-born mothers. There was no significant difference in the prevalence of youth impairment associated with maternal mental illness when both youth and mother were born outside of the mainland US. For the Puerto Rican subgroup, the association between maternal and youth mental health was greatest among island-born mothers and mainland US-born youth; for the Mexican subgroup, the link was strongest among US-born mothers and youth. While there were large point differences between those groups, the difference was not statistically significant. This study suggests a protective effect of island/foreign-born nativity on symptom association between Latino mothers and children. Considerations for future research and practice stemming from this finding are discussed.
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Affiliation(s)
- Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University/Johns Hopkins Bayview Medical Center, 5500 East Lombard St, Room 1214, Baltimore, MD, 21224, USA.
| | - Nomi S Weiss-Laxer
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Timothy B Creedon
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.,IBM Watson Health, Cambridge, MA, USA
| | - Maria Jose Sanchez Roman
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.,Milken School of Public Health, George Washington University, Washington DC, USA
| | | | - Benjamin Cook
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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Slobodin O, Masalha R. Challenges in ADHD care for ethnic minority children: A review of the current literature. Transcult Psychiatry 2020; 57:468-483. [PMID: 32233772 DOI: 10.1177/1363461520902885] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
While attention deficit hyperactivity disorder (ADHD) has been extensively studied in the past decades, the role of social and cultural practices in its assessment, diagnosis, and treatment has been often overlooked. This selective review provides an overview of research that explores social and cultural influences on help-seeking behavior in ethnic minority children with ADHD. Studies were selected that address cultural diversity in three areas of ADHD help-seeking: problem recognition, access to mental health services, and treatment. Special attention was given to studies of treatment selection and adherence in minority groups. Findings suggested that cultural disparities in ADHD care among ethnic minority children occur in the early stages of problem recognition, through service selection, and in the quality of treatment. Ethnic minority children were less likely than their nonminority counterparts to be diagnosed with ADHD and its comorbid conditions and less likely to be prescribed and adhere to stimulant drug treatment. These differences reflect cultural diversity in norms and attitudes towards mental health issues (e.g., fear of social stigma) as well as limited access to qualified health care. Paradoxically, cultural, racial, and language bias may also lead to the overidentification of ethnic minority children as disabled and to higher ratings of ADHD symptoms. This review highlights the importance of sociocultural factors in understanding developmental psychopathology and help-seeking behavior. In addition, it further supports calls for increasing cultural competence in communications during clinical assessment, diagnosis, and treatment in minority communities. Clinical, theoretical, and methodological considerations for future research are discussed.
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Affiliation(s)
- Ortal Slobodin
- Education Department, Ben-Gurion University, Be'er Sheva, Israel
| | - Rafik Masalha
- Faculty of Health Sciences, Ben-Gurion University, Be'er Sheva, Israel
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Adjei Boakye E, Osazuwa-Peters N, Mohammed KA, Challapalli S, Buchanan P, Burroughs TE, Varvares MA. Prevalence and factors associated with diagnosed depression among hospitalized cancer patients with metastatic disease. Soc Psychiatry Psychiatr Epidemiol 2020; 55:15-23. [PMID: 31444517 DOI: 10.1007/s00127-019-01763-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/20/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to examine the factors associated with diagnosed depression among patients with a metastatic cancer. METHODS We conducted a cross-sectional analysis of 39,223 hospital records from 2008 to 2013 National Inpatient Sample for patients with metastatic cancer. Diagnosed depression was defined using ICD-9-CM for major depression. Weighted, multivariable hierarchical regression model was used to examine the association between sociodemographic and clinical factors and depression among patients with a metastatic cancer. RESULTS The prevalence of clinically diagnosed depression in patients with a metastatic cancer in our study sample was 7.3% (5.9% for males and 8.6% for females). The prevalence rate of diagnosed depression increased from 5.3 to 9.4% between 2008 and 2013. In multivariable analysis, patients were more likely to be diagnosed with depression if they were females (aOR = 1.44; 95% CI 1.25-1.66) compared to males; and had higher number of comorbidities (aOR = 1.11 per 1-unit increase in Elixhauser comorbidity score, 95% CI 1.07-1.15). In contrast, patients were less likely to be diagnosed with depression if they were blacks (aOR = 0.59; 95% CI 0.47-0.74) or other race (aOR = 0.58; 95% CI 0.47-0.72) compared with white patients. CONCLUSIONS Women and individuals with more comorbidities were diagnosed with depression more frequently, whereas black patients were diagnosed less. Our findings could help providers to identify hospitalized patients with the higher risk of depression and screened patients with signs and symptoms of clinical depression.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison Street, P. O. Box 19664, Springfield, IL, 62794-9664, USA.
| | - Nosayaba Osazuwa-Peters
- Saint Louis University Cancer Center, 3655 Vista Ave, Third Floor, West Pavilion, St. Louis, MO, 63110, USA.,Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave, 6th Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Kahee A Mohammed
- Department of Internal Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, 12th Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Sai Challapalli
- Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO, 63104, USA
| | - Paula Buchanan
- Saint Louis University Center for Health Outcomes Research (SLUCOR), 3545 Lafayette Ave., 4th Floor, St. Louis, MO, 63104, USA
| | - Thomas E Burroughs
- Saint Louis University Center for Health Outcomes Research (SLUCOR), 3545 Lafayette Ave., 4th Floor, St. Louis, MO, 63104, USA
| | - Mark A Varvares
- Harvard Medical School, Department of Otolaryngology, The Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA, 02114, USA
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Haack LM, Meza J, Jiang Y, Araujo EJ, Pfiffner L. Influences to ADHD Problem Recognition: Mixed-Method Investigation and Recommendations to Reduce Disparities for Latino Youth. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:958-977. [PMID: 29770911 PMCID: PMC6239986 DOI: 10.1007/s10488-018-0877-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
ADHD problem recognition serves as the first step of help seeking for ethnic minority families, such as Latinos, who underutilize ADHD services. The current mixed-method study explores underlying factors influencing recognition of ADHD problems in a sample of 159 school-aged youth. Parent-teacher informant discrepancy results suggest that parent ethnicity, problem domain, and child age influence ADHD problem recognition. Emerging themes from semi-structured qualitative interviews/focus groups conducted with eighteen Spanish-speaking Latino parents receiving school-based services for attention and behavior concerns support a range of recognized ADHD problems, beliefs about causes, and reactions to ADHD identification. Findings provide recommendations for reducing disparities in ADHD problem recognition and subsequent help seeking.
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Affiliation(s)
- Lauren M Haack
- University of California, San Francisco (UCSF), 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Jocelyn Meza
- University of California Berkeley and UCSF, Berkeley, CA, USA
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Abstract
BACKGROUND There have been few prospective studies on the association between anxiety disorders and adolescent obesity; none examine potential reciprocal effects. PURPOSE The purpose of this paper is to examine the prospective association between anxiety disorders and obesity among adolescents. METHODS Using data from a two-wave, prospective study of 3134 adolescents, we examined reciprocal effects between body weight and DSM-IV anxiety disorders. RESULTS Weight status did not increase future risk of anxiety disorders nor did anxiety disorders at baseline increase risk of future obesity in the overall sample. Stratifying by gender revealed an increased risk of overweight and obesity in males with anxiety disorders, but not for females. Major depression did not mediate these associations. CONCLUSION Similar to prospective studies of depression, it appears anxiety disorders may increase risk of obesity. However, more research is needed on the role of psychopathology in adolescent obesity, in particular anxiety disorders and possible moderators (such as gender) and mediators.
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Affiliation(s)
- Robert E Roberts
- UTHealth School of Public Health, San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA. .,Michael & Susan Dell Center for Healthy Living, San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA. .,University of Texas Health Science Center at Houston, San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA.
| | - Hao T Duong
- Centers for Disease Control, 5/F 2 Ngo Quyen St., Hoan Kiem, Hanoi, Vietnam
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Social–ecological predictors of externalizing behavior trajectories in at-risk youth. Dev Psychopathol 2017; 30:255-266. [DOI: 10.1017/s0954579417000608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractExtant research consistently links youth externalizing problems and later maladaptive outcomes, and these behaviors are particularly detrimental given their relative stability across development. Although an array of risk and protective factors for externalizing problems have been identified, few studies have examined factors reflecting the multiple social–ecological levels that influence child development and used them to predict longitudinal trajectories of externalizing problems. The current study examined externalizing behavior trajectories in a sample of 1,094 at-risk youth (539 boys, 555 girls) from the Longitudinal Studies in Child Abuse and Neglect multisite longitudinal study of child maltreatment. Normed Child Behavior Checklist externalizing scores were used to estimate group trajectories via growth-based trajectory modeling at ages 10, 12, 14, and 16 using the SAS PROC TRAJ procedure. Model fit was assessed using the Bayes information criterion and the Akaike information criterion statistics. Analyses revealed optimal fit for five distinct behavioral trajectories: low stable, mid-increasing, mid-decreasing, medium high, and high stable. Multinomial logistic regressions revealed that a combination of risk and protective factors at individual, family, school, and neighborhood levels contribute to distinct trajectories of externalizing problems over time. Predictors of low and decreasing trajectories can inform interventions aimed at addressing externalizing problems among high-risk adolescents.
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Roberts RE, Duong HT. Is there an association between short sleep duration and adolescent anxiety disorders? Sleep Med 2016; 30:82-87. [PMID: 28215269 DOI: 10.1016/j.sleep.2016.02.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study is to provide the first data on the prospective, reciprocal association between short sleep duration and DSM-IV anxiety disorders among adolescents. METHODS A community-based two-wave cohort study included 4175 youths aged 11-17 years at baseline, with 3134 of these followed up a year later, drawn from a metropolitan area with a population of over 4 million. Anxiety is defined as any DSM-IV anxiety disorder in the past year generalized anxiety: panic disorder, agoraphobia without panic, social phobia, and post-traumatic stress disorder. Short sleep duration is defined as ≤6 h of sleep per night. RESULTS/CONCLUSIONS In multivariate analyses, short sleep duration every night at baseline predicted anxiety disorders at follow-up, controlling for anxiety at baseline. Examining the reciprocal association, anxiety disorders at baseline did not predict short sleep duration at follow-up. We are the first to examine the reciprocal effects for anxiety disorders and sleep duration among adolescents using prospective data. The data suggest that reduced quantity of sleep may increase risk for anxiety, but anxiety does not increase risk for decreased sleep duration.
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Affiliation(s)
- Robert E Roberts
- UTHealth School of Public Health, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, San Antonio Regional Campus, John Smith Drive, Suite 1100, San Antonio, Texas 78229, USA.
| | - Hao T Duong
- HAIVN: Partnership for Health Advancement in Vietnam, 1st floor, 15-Floor building, 217 Hong Bang, District 5, Ho Chi Minh, Viet Nam
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Roberts RE, Duong HT. Does major depression affect risk for adolescent obesity? J Affect Disord 2015; 186:162-7. [PMID: 26247909 PMCID: PMC4565758 DOI: 10.1016/j.jad.2015.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/04/2015] [Accepted: 06/20/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this paper is to reexamine the association between major depression and obesity in adolescents, testing the hypothesis that body image mediates this association. This is the first paper to examine this question using DSM-IV diagnosis of depression and data from a two-wave cohort of adolescents. METHODS Participants were 4175 youths 11-17 years of age sampled from the community who were followed up a year later (n=3134). Major depression was assessed using DSM-IV diagnostic criteria. Body image was measured with perceived weight. Obesity was defined as BMI ≥95th percentile using measured height and weight. RESULTS When we examined a model which included obesity, perceived weight, major depression and covariates, there was no association between major depression at baseline and obesity at follow-up. We found no independent association between major depression and body weight. LIMITATIONS The study was limited in that it is not a national sample, BMI was the only measure of adiposity, perceived weight was the only measure of body image, and there were no data on lifetime trajectories of depression, obesity, or body image. CONCLUSIONS If there is an etiologic link between major depression and body weight among adolescents, it most likely operates through processes involving components of body image, since controlling for body image eliminated the association between depression and obesity. Clinically, addressing body image in depressed patients who are obese may improve outcomes.
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Affiliation(s)
- Robert E. Roberts
- UTHealth, School of Public Health, University of Texas Health Science Center at Houston San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX 78229 Phone: (210) 276-9023, Fax: (210) 276-9032,
| | - Hao T. Duong
- HAIVN: Partnership for Health Advancement in Vietnam, Ho Chi Minh, Viet Nam
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Aratani Y, Liu CH. English Proficiency, Threshold Language Policy and Mental Health Service Utilization among Asian-American Children. Arch Psychiatr Nurs 2015; 29:326-32. [PMID: 26397437 DOI: 10.1016/j.apnu.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/26/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
This paper explores the role of English proficiency, ethnicity, and California's threshold language policy in the rates of discontinuing mental health services among Asian-American children. We used data from the 2001-2006 Client and Services Information (CSI) System, which contains county-level information about service users in public mental health systems. Our data included 59,218 service users under the age of 18. We used logistic regression to determine the likelihood of discontinuing services, while controlling for sociodemographic and clinical characteristics. English-speaking Asians were 11% more likely than English-speaking Whites to discontinue mental health services. Non-English-speaking Asians were 50% significantly more likely to stay in services. The results also revealed some inter-ethnic variations in the discontinuation patterns; however, the patterns of mental health service utilization appear to be driven by the availability of mental health services in Asian-ethnic languages in county of residence. Further research is needed to understand the intake and referral processes that Asian children go through within the mental health service system.
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Affiliation(s)
- Yumiko Aratani
- Columbia University Mailman School of Public Health, National Center for Children in Poverty, New York, NY.
| | - Cindy H Liu
- Commonwealth Research Center, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.
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Abstract
BACKGROUND Increasing mental health treatment of young people and broadening conceptualizations of psychopathology have triggered concerns about a disproportionate increase in the treatment of youths with low levels of mental health impairment. METHODS We analyzed the 1996-1998, 2003-2005, and 2010-2012 Medical Expenditure Panel Surveys, which were nationally representative surveys of U.S. households, for trends in outpatient use of mental health services by persons 6 to 17 years of age; 53,622 persons were included in the analysis. Mental health impairment was measured with the use of the Columbia Impairment Scale (range, 0 to 52, with higher scores indicating more severe impairment); we classified youths with scores of 16 or higher as having more severe impairment and those with scores of less than 16 as having less severe impairment. RESULTS The percentage of youths receiving any outpatient mental health service increased from 9.2% in 1996-1998 to 13.3% in 2010-2012 (odds ratio, 1.52; 95% confidence interval, 1.35 to 1.72). The proportionate increase in the use of mental health services among youths with more severe impairment (from 26.2% to 43.9%) was larger than that among youths with less severe or no impairment (from 6.7% to 9.6%). However, the absolute increase in annual service use was larger among youths with less severe or no impairment (from 2.74 million to 4.19 million) than among those with more severe impairment (from 1.56 million to 2.28 million). Significant overall increases occurred in the use of psychotherapy (from 4.2% to 6.0%) and psychotropic medications (from 5.5% to 8.9%), including stimulants and related medications (from 4.0% to 6.6%), antidepressants (from 1.5% to 2.6%), and antipsychotic drugs (from 0.2% to 1.2%). CONCLUSIONS Outpatient mental health treatment and psychotropic-medication use in children and adolescents increased in the United States between 1996-1998 and 2010-2012. Although youths with less severe or no impairment accounted for most of the absolute increase in service use, youths with more severe impairment had the greatest relative increase in use, yet fewer than half accessed services in 2010-2012. (Funded by the Agency for Healthcare Research and Quality and the New York State Psychiatric Institute.).
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Affiliation(s)
- Mark Olfson
- From the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute - both in New York (M.O.); the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (B.G.D.); and the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and the School of Social Practice and Policy, University of Pennsylvania - both in Philadelphia (S.C.M.)
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Common Versus Specific Correlates of Fifth-Grade Conduct Disorder and Oppositional Defiant Disorder Symptoms: Comparison of Three Racial/Ethnic Groups. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 43:985-98. [PMID: 25411125 DOI: 10.1007/s10802-014-9955-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The extent to which risk profiles or correlates of conduct disorder (CD) and oppositional defiant disorder (ODD) symptoms overlap among youth continues to be debated. Cross-sectional data from a large, representative community sample (N = 4,705) of African-American, Latino, and White fifth graders were used to examine overlap in correlates of CD and ODD symptoms. About 49 % of the children were boys. Analyses were conducted using negative binomial regression models, accounting for several confounding factors (e.g., attention deficit/hyperactivity disorder symptoms), sampling weights, stratification, and clustering. Results indicated that CD and ODD symptoms had very similar correlates. In addition to previously established correlates, several social skills dimensions were significantly related to ODD and CD symptoms, even after controlling for other correlates. In contrast, temperamental dimensions were not significantly related to CD and ODD symptoms, possibly because more proximal correlates (e.g., social skills) were also taken into account. Only two factors (gender and household income) were found to be specific correlates of CD, but not ODD, symptoms. The pattern of common and specific correlates of CD and ODD symptoms was replicated fairly consistently across the three racial/ethnic subgroups. Implications of these findings for further research and intervention efforts are discussed.
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Thurston IB, Phares V, Coates EE, Bogart LM. Child problem recognition and help-seeking intentions among black and white parents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 44:604-15. [PMID: 24635659 DOI: 10.1080/15374416.2014.883929] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Parents play a central role in utilization of mental health services by their children. This study explored the relationship between parents' recognition of child mental health problems and their decisions to seek help. Participants included 251 parents (49% Black, 51% White; 49% fathers, 51% mothers) recruited from community settings. Parents ranged in age from 20 to 66 years old with at least one child between ages 2 and 21. Parents read three vignettes that described a child with an anxiety disorder, ADHD, and no clinically significant diagnosis. Parents completed measures of problem recognition, perception of need, willingness to seek help, and beliefs about causes of mental illness. Findings from Generalized Estimating Equations revealed that parents were more likely to report intentions to seek help when they recognized a problem (odds ratio [OR] = 41.35, p < .001), 95% confidence interval (CI) [14.81, 115.49]; when it was an externalizing problem (OR = 1.85, p < .05), 95% CI [1.14, 3.02]; and when parents were older (OR = 1.04, p < .05), 95% CI [1.01, 1.08]. Predictors of parental problem recognition included perceived need, prior experience with mental illness, and belief in trauma as a cause of mental illness. Predictors of help-seeking intentions included problem recognition, perceived need, externalizing problem type, and being female. Given the relationship between parental problem recognition and willingness to seek help, findings suggest that efforts to address disparities in mental health utilization could focus on problem-specific, gender-sensitive, mutable factors such as helping parents value help-seeking for internalizing as well as externalizing problems.
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Roberts RE, Duong HT. The prospective association between sleep deprivation and depression among adolescents. Sleep 2014; 37:239-44. [PMID: 24497652 DOI: 10.5665/sleep.3388] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To examine the prospective, reciprocal association between sleep deprivation and depression among adolescents. DESIGN A community-based two-wave cohort study. SETTING A metropolitan area with a population of over 4 million. PARTICIPANTS 4,175 youths 11-17 at baseline, and 3,134 of these followed up a year later. MEASUREMENTS Depression is measured using both symptoms of depression and DSM-IV major depression. Sleep deprivation is defined as ≤ 6 h of sleep per night. RESULTS Sleep deprivation at baseline predicted both measures of depression at follow-up, controlling for depression at baseline. Examining the reciprocal association, major depression at baseline, but not symptoms predicted sleep deprivation at follow-up. CONCLUSION These results are the first to document reciprocal effects for major depression and sleep deprivation among adolescents using prospective data. The data suggest reduced quantity of sleep increases risk for major depression, which in turn increases risk for decreased sleep.
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Affiliation(s)
- Robert E Roberts
- Division of Health Promotion and Behavioral Sciences, UTHealth, School of Public Health, University of Texas Health Science Center, Houston, TX
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Roberts RE, Duong HT. Obese youths are not more likely to become depressed, but depressed youths are more likely to become obese. Psychol Med 2013; 43:2143-2151. [PMID: 23298458 DOI: 10.1017/s0033291712002991] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Overweight/obesity and depression are both major public health problems among adolescents. However, the question of a link between overweight/obesity and depression remains unresolved in this age group. We examined whether obesity increases risk of depression, or depression increases risk of obesity, or whether there is a reciprocal effect. METHOD A two-wave prospective cohort study of adolescents aged 11–17 years at baseline (n=4175) followed up a year later (n=3134) sampled from the Houston metropolitan area. Overweight was defined as 95th percentile >body mass index (BMI) < or = 85th percentile and obese as BMI >95th percentile. Three indicators of depression were examined: any DSM-IV mood disorder, major depression, and symptoms of depression. RESULTS Data for the two-wave cohort indicated no evidence of reciprocal effects between weight and depression. Weight status predicted neither major depression nor depressive symptoms. However, mood disorders generally and major depression in particular increased risk of future obesity more than twofold. Depressed males had a sixfold increased risk of obesity. Females with depressive symptoms had a marginally increased risk of being overweight but not obese. CONCLUSIONS Our findings, combined with those of recent meta-analyses, suggest that obese youths are not more likely to become depressed but that depressed youths are more likely to become obese.
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Affiliation(s)
- R E Roberts
- Division of Health Promotion and Behavioral Sciences, UTHealth, School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA.
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What Latina Mothers Think of Evidence-Based Parenting Practices: A Qualitative Study of Treatment Acceptability. COGNITIVE AND BEHAVIORAL PRACTICE 2013. [DOI: 10.1016/j.cbpra.2012.08.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roberts RE, Duong HT. Perceived weight, not obesity, increases risk for major depression among adolescents. J Psychiatr Res 2013; 47:1110-7. [PMID: 23643102 PMCID: PMC3686272 DOI: 10.1016/j.jpsychires.2013.03.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 01/15/2023]
Abstract
UNLABELLED This study examined the association between major depression, obesity and body image among adolescents. METHODS Participants were 4175 youths 11-17 years of age sampled from the community who were interviewed using the Diagnostic Interview Schedule for Children and Adolescents, Version IV, completed a self-report questionnaire, and had their weight and height measured. There were 2 measures of body image: perceived weight and body satisfaction. Obesity was associated with increased risk of depression, with no controls for covariates. However, when the association was examined in models which included weight, major depression, and body image measures and covariates, there was no association between major depression and body weight, nor between body satisfaction and major depression. Perceived overweight was strongly and independently associated with body weight (O.R. = 2.62). We found no independent association between major depression and body weight. If there is an etiologic link between major depression and body weight among adolescents, it most likely operates through processes involving components of body image. Future research should focus on the role of depression and body image in the etiology of obesity.
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Affiliation(s)
- Robert E. Roberts
- Corresponding Author: Robert E. Roberts, PH.D., UTHealth, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler Dr., Suite E1017, Houston, Texas 77030, Phone: (713) 500-9291, Fax: (713) 500-9406,
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Roberts RE, Duong HT. Depression and insomnia among adolescents: a prospective perspective. J Affect Disord 2013; 148:66-71. [PMID: 23261135 PMCID: PMC3644326 DOI: 10.1016/j.jad.2012.11.049] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/20/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND No studies of adolescents have examined the prospective, reciprocal association between insomnia and major depression. METHODS A two-wave, community-based cohort of 3134 youths aged 11-17 at baseline. Major depression was assessed using DSM-IV criteria. Three measures of insomnia were used also following DSM-IV: P1, any symptom of insomnia; P2, any symptom plus impairment; P3, P2 with no comorbid mood, anxiety or substance use disorders. RESULTS In general, the association between insomnia and depression was stronger and more consistent for major depression than for symptoms of depression. Baseline insomnia (P1 and P2) increased subsequent risk of major depression 2-3-fold and P1 2-fold in multivariate analyses. Major depression increased risk for subsequent insomnia 2-3-fold for P1 and P2 2-fold for P2 in multivariate analyses. Results varied by measure of insomnia used. LIMITATIONS Only symptoms of insomnia were assessed, so we could not examine the effects of comorbid sleep disorders nor did we have objective or biological measures of disturbed sleep. We also did not collect data on parental reports of youth depression nor insomnia or sleep problems. CONCLUSION Our results provide the first prospective data on insomnia and major depression among adolescents indicating the two are reciprocally related. More studies are needed examining trajectories of insomnia and major depression in childhood and adolescence.
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Affiliation(s)
- Robert E. Roberts
- Correspondence to: Dr. Robert E. Roberts, UTHealth, School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Dr., E1017, Houston, TX 77030, USA Tel: (713) 500-9296; Fax: (713) 500-9406;
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Burgos G, Rivera F. The (In)Significance of Race and Discrimination among Latino Youth: The Case of Depressive Symptoms. ACTA ACUST UNITED AC 2012; 42:152-171. [PMID: 23559683 DOI: 10.1080/00380237.2009.10571348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the growing population of Latinos in the United States, there is little research that explores how discrimination affects the mental health of Latino youth along racial lines. In this paper we ask two closely related questions. First, do black Latino youth have higher or lower symptoms of depression than nonblack Latinos? Second, is the relationship between race and depression among Latino youth buffered by discrimination stress? Results from the Transitions Study show that black Latino youth have significantly higher symptoms of depression than nonblack Latinos. The relationship between race and depression depends on daily-but not on lifetime-experiences of discrimination. The combined effect of race and discrimination holds in the face of a wide range of measures of stress, including major lifetime events, recent life events, and chronic stressors. These findings encourage future research that considers the mental health effects of racial variation among Latinos.
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Bevaart F, Mieloo CL, Jansen W, Raat H, Donker MCH, Verhulst FC, van Oort FVA. Ethnic differences in problem perception and perceived need for care for young children with problem behaviour. J Child Psychol Psychiatry 2012; 53:1063-71. [PMID: 22681505 DOI: 10.1111/j.1469-7610.2012.02570.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Problem perception and perceived need for professional care are important determinants that can contribute to ethnic differences in the use of mental health care. Therefore, we studied ethnic differences in problem perception and perceived need for professional care in the parents and teachers of 5- to 6-year-old children from the general population who were selected for having emotional and behavioural problems. METHODS A cross-sectional study with data of 10,951 children from grade two of the elementary schools in the Rotterdam-Rijnmond area, The Netherlands. Parents and teachers completed the strengths and difficulties questionnaire (SDQ) as well as questions on problem perception and perceived need for care. The SDQ was used to identify children with emotional and behavioural problems. We included Dutch, Surinamese, Antillean, Moroccan and Turkish children in our sample with high (>P90) SDQ scores (N = 1,215), who were not currently receiving professional care for their problems. RESULTS Amongst children with high SDQ scores, problem perception was lower in non-Dutch parents than in Dutch parents (49% vs. 81%, p < 0.01). These lower rates of problem perception could not be explained by differences in socioeconomic position or severity of the problems. No ethnic differences were found in parental perceived need and in problem perception and perceived need reported by teachers. Higher levels of problem perception and perceived need were reported by teachers than by parents in all ethnic groups (PP: 87% vs. 63% and PN: 48% vs. 23%). CONCLUSIONS Child health professionals should be aware of ethnic variations in problem perception as low problem perception in parents of non-Dutch children may lead to miscommunication and unmet need for professional care for the child.
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Affiliation(s)
- Floor Bevaart
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Brannan AM, Athay MM, de Andrade ARV. Measurement Quality of the Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7). ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 39:51-9. [PMID: 22407562 DOI: 10.1007/s10488-012-0412-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the measurement quality of an abbreviated version of the Caregiver Strain Questionnaire. The CGSQ-Short Form 7 (CGSQ-SF7) is practical for routine assessment of objective and subjective internalized caregiver strain. The subjective externalized subscale is not included in the CGSQ-SF7. Findings indicate that the reliability and validity of the shortened objective and subjective internalized subscales are comparable to the original. Examination of construct validity suggested that caregiver, youth, and clinician ratings of child clinical severity were related to objective caregiver strain. However, youth and clinician ratings of child clinical severity were not related to subjective internalized caregiver strain.
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Racial and Ethnic Disparities in the Continuation of Community-Based Children’s Mental Health Services. J Behav Health Serv Res 2011; 39:116-29. [DOI: 10.1007/s11414-011-9261-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Ivert AK, Svensson R, Adler H, Levander S, Rydelius PA, Torstensson Levander M. Pathways to child and adolescent psychiatric clinics: a multilevel study of the significance of ethnicity and neighbourhood social characteristics on source of referral. Child Adolesc Psychiatry Ment Health 2011; 5:6. [PMID: 21385366 PMCID: PMC3060829 DOI: 10.1186/1753-2000-5-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 03/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. As the Swedish society becomes increasingly multicultural, and as ethnic and economic residential segregation become more pronounced, this study utilises ethnicity and neighbourhood context to examine referral pathways to child and adolescent psychiatric (CAP) clinics. METHODS The analysis examines four different sources of referrals: family referrals, social/legal agency referrals, school referrals and health/mental health referrals. The referrals of 2054 children aged 11-19 from the Stockholm Child-Psychiatric Database were studied using multilevel logistic regression analyses. RESULTS Results indicate that ethnicity played an important role in how children and adolescents were referred to CAP-clinics. Family referrals were more common among children and adolescents with a Swedish background than among those with an immigrant background. Referrals by social/legal agencies were more common among children and adolescents with African and Asian backgrounds. Children with Asian or South American backgrounds were more likely to have been referred by schools or by the health/mental health care sector. A significant neighbourhood effect was found in relation to family referrals. Children and adolescents from neighbourhoods with low levels of socioeconomic deprivation were more likely to be referred to CAP-clinics by their families in comparison to children from other neighbourhoods. Such differences were not found in relation in relation to the other sources of referral. CONCLUSIONS This article reports findings that can be an important first step toward increasing knowledge on reasons behind differential referral rates and uptake of psychiatric care in an ethnically diverse Swedish sample. These findings have implications for the design and evaluation of community mental health outreach programs and should be considered when developing measures and strategies intended to reach and help children with mental health problems. This might involve providing information about the availability and accessibility of health care for children and adolescents with mental health problems to families in certain neighbourhoods and with different ethnic backgrounds.
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Affiliation(s)
- Anna-Karin Ivert
- Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Robert Svensson
- Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Hans Adler
- Department of Medical sciences, Malmö, Lund University, SE-221 84 Lund, Sweden
| | - Sten Levander
- Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Per-Anders Rydelius
- Department of Woman and Child Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-171 76 Stockholm Sweden
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Chavez LM, Shrout PE, Alegría M, Lapatin S, Canino G. Ethnic differences in perceived impairment and need for care. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2010; 38:1165-77. [PMID: 20521095 PMCID: PMC3120015 DOI: 10.1007/s10802-010-9428-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos.
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Affiliation(s)
- Ligia M Chavez
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067, USA.
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Roberts RE, Roberts CR, Xing Y. One-year incidence of suicide attempts and associated risk and protective factors among adolescents. Arch Suicide Res 2010; 14:66-78. [PMID: 20112145 DOI: 10.1080/13811110903479078] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of this study was to estimate incidence of adolescent suicide attempts and predictors of attempts. Data were collected using diagnostic interviews and questionnaires with a sample of 4,175 youths 11-17 and 3,134 followed-up a year later. Total incidence was 0.95% and first incidence 0.84% for attempts. We found few significant independent predictors of attempts. Multivariate analyses identified only 2 independent predictors of first incidence (marijuana use and caregiver attempts). We did find evidence for cumulative effects of risk factors, with increased odds of attempts with increasing number of risk factors. The difficulty in identifying a common set of modifiable risk factors continues to make development of effective interventions difficult. However, based on our results and those of other researchers, the impact of the cumulative risk conferred by multiple factors would seem to offer a viable strategy for reducing risk of suicide attempts as well as other mental health outcomes among adolescents.
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Abstract
BACKGROUND Guidelines for assessment, diagnosis, and treatment of ADHD have been drawn from research focused primarily on Caucasian males generating, in part, the need to redress health disparities. Diagnostic criteria may therefore be limited, especially regarding gender differences and other associated cultural, familial, socio-environmental, and individual influences. OBJECTIVE To examine how one woman with ADHD managed social, academic, interpersonal, and familial roles and to discuss the need for culturally proficient practice and treatment frameworks that are gender-sensitive to diagnosis and treatment. METHOD A case example of a 29-year-old Hispanic woman. FINDINGS There is a gap in early diagnosis and treatment for some woman and individuals from ethnic minority and diverse groups. CONCLUSION Cultural competence in practice and research are critical to mitigate the disparities in accurate and timely diagnosis and treatment of adult ADHD among the American population.
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Affiliation(s)
- Roberta Waite
- Drexel University, College of Nursing and Health Professions, Philadelphia, USA.
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Abstract
OBJECTIVES This study investigated predictors of mental health service utilization from age 5 through age 16. METHODS Data were collected on a community sample of 399 children, including 338 European Americans and 61 African Americans. Internalizing and externalizing behaviors were assessed by maternal and teacher reports in kindergarten. History of mental health service utilization was assessed by maternal reports when participants were 16 years old. RESULTS On average, the probability of first-time mental health service utilization increased in early to middle childhood, stabilized, and then increased in early adolescence. Mother reports of internalizing behaviors (independent of teacher reports of externalizing behaviors) predicted an increased likelihood of service use among European American children but a decreased likelihood of service use among African American children. Externalizing behaviors (independent of internalizing behaviors) predicted a higher likelihood of first-time service use in middle childhood. The combination of elevated internalizing and externalizing behaviors predicted a higher likelihood of first-time service use in adolescence, mainly among European American children. CONCLUSIONS This study provides evidence that elevated mother-reported internalizing behaviors are less likely to forecast mental health service utilization among African American children compared with European American children. To meet the mental health service needs of all children, it is critical to further examine reasons for service utilization and underutilization among children with internalizing problems.
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Snowden LR, Masland MC, Fawley K, Wallace N. Ethnic Differences in Children's Entry into Public Mental Health Care via Emergency Mental Health Services. JOURNAL OF CHILD AND FAMILY STUDIES 2009; 18:512-519. [PMID: 19730741 PMCID: PMC2734252 DOI: 10.1007/s10826-008-9253-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 12/17/2008] [Indexed: 05/22/2023]
Abstract
For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care.
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Affiliation(s)
- Lonnie R. Snowden
- School of Social Welfare, University of California Berkeley, 120 Haviland Hall, Berkeley, CA 94720 USA
| | - Mary C. Masland
- Center for Mental Health Services Research, University of California Berkeley, Berkeley, CA USA
| | - Kya Fawley
- School of Social Welfare, University of California Berkeley, 120 Haviland Hall, Berkeley, CA 94720 USA
| | - Neal Wallace
- Mark O. Hatfield School of Government, Portland State University, Portland, OR USA
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Wasserman GA, McReynolds LS, Musabegovic H, Whited AL, Keating JM, Huo Y. Evaluating Project Connect: improving juvenile probationers' mental health and substance use service access. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 36:393-405. [PMID: 19582568 DOI: 10.1007/s10488-009-0229-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
Project Connect is a multilayered county-specific program aimed at linking juvenile probationers to needed mental health and substance use services. In four NY counties, the intervention included cooperative agreements between probation and mental health authorities, program materials to facilitate referral, in-service training for probation officers, and systematic screening for mental health needs. Charts for 583 Baseline youths were reviewed and compared with 594 youths undergoing intake under Project Connect. Compared to Baseline, under Project Connect, referred youths were 2.7 times as likely to access services, regardless of youth or county characteristics, service availability, or when the intervention took place.
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Affiliation(s)
- Gail A Wasserman
- Center for the Promotion of Mental Health in Juvenile Justice, NY State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
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Immigrant Status, Mental Health Need, and Mental Health Service Utilization Among High-Risk Hispanic and Asian Pacific Islander Youth. CHILD & YOUTH CARE FORUM 2008. [DOI: 10.1007/s10566-008-9056-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Snowden LR, Masland MC, Libby AM, Wallace N, Fawley K. Racial/ethnic minority children's use of psychiatric emergency care in California's Public Mental Health System. Am J Public Health 2007; 98:118-24. [PMID: 18048783 DOI: 10.2105/ajph.2006.105361] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined rates and intensity of crisis services use by race/ethnicity for 351,174 children younger than 18 years who received specialty mental health care from California's 57 county public mental health systems between July 1998 and June 2001. METHODS We used fixed-effects regression for a controlled assessment of racial/ethnic disparities in children's use of hospital-based services for the most serious mental health crises (crisis stabilization services) and community-based services for other crises (crisis intervention services). RESULTS African American children were more likely than were White children to use both kinds of crisis care and made more visits to hospital-based crisis stabilization services after initial use. Asian American/Pacific Islander and American Indian/Alaska Native children were more likely than were White children to use hospital-based crisis stabilization services but, along with Latino children, made fewer hospital-based crisis stabilization visits after an initial visit. CONCLUSIONS African American children used both kinds of crisis services more than did White children, and Asian Americans/Pacific Islander and American Indians/Alaska Native children visited only when they experienced the most disruptive and troubling kind of crises, and made nonrecurring visits.
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Affiliation(s)
- Lonnie R Snowden
- Center for Mental Health Services Research, School of Social Welfare, 120 Haviland Hall, University of California, Berkeley, CA 94720-7400, USA.
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Roberts RE, Roberts CR, Xing Y. Comorbidity of substance use disorders and other psychiatric disorders among adolescents: evidence from an epidemiologic survey. Drug Alcohol Depend 2007; 88 Suppl 1:S4-13. [PMID: 17275212 PMCID: PMC1935413 DOI: 10.1016/j.drugalcdep.2006.12.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 12/20/2006] [Indexed: 11/18/2022]
Abstract
This paper extends our knowledge of comorbidity of substance use disorders (SUDs) and other psychiatric disorders by examining comorbidity of specific types of SUDs and risk of comorbidity separately for abuse and dependence. The research question is whether there is specificity of risk for comorbidity for different SUDs and whether greater comorbidity is associated with dependence. Data are presented from a probability sample of 4175 youths aged 11-17 assessed with the NIMH DISC-IV and self-administered questionnaires. SUDs outcomes are alcohol, marijuana and other substances in past year. Mean number of other comorbid disorders ranged from 1.9 for marijuana abuse to 2.2 for other substance abuse and 1.9 for marijuana dependence to 2.8 for other substance dependence. None of the abuse SUDs does not increase risk of anxiety disorders, but dependence does. Both abuse and dependence increased risk of comorbid mood disorders. Similar results were observed for disruptive disorders. Patterns of comorbidity varied by substance, by abuse versus dependence, and by category of other psychiatric disorders. In general, there was greater association of comorbidity with other disorders for dependence versus abuse. Marijuana is somewhat less associated with other disorders than alcohol or other substances. The strongest association is for comorbid disruptive disorders, regardless of SUDs category. Having SUDs and comorbid other psychiatric disorders was associated with substantial functional impairment. Females with SUDs tended to have higher rates of comorbid disorders, as did older youths. There were no differences observed among ethnic groups. When comorbidity of SUDs with other disorders was examined, controlling for other non-SUDs disorders for each specific disorder examined, the greater odds for dependence versus abuse essentially disappeared for all disorders except disruptive disorders, suggesting larger number of comorbid non-SUDs in part account for the observed effects for dependence.
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Affiliation(s)
- Robert E Roberts
- Division of Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, P.O. Box 20186, 1200 Herman Pressler Dr., Houston, TX 77030, USA.
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Roberts RE, Roberts CR, Xing Y. Are Mexican American adolescents at greater risk of suicidal behaviors? Suicide Life Threat Behav 2007; 37:10-21. [PMID: 17397276 DOI: 10.1521/suli.2007.37.1.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A reexamination of ethnicity as a risk factor for adolescent suicidal behavior, focusing on whether Mexican American youths are at increased risk, was undertaken. Data from a sample of 4,175 African, European, and Mexican Americans, aged 11-17, are presented. We examined lifetime attempts and past year attempts, thoughts, and plans. Odds ratios, adjusting for covariates, indicate no differences between European and Mexican Americans on past year thoughts, plans, or attempts or lifetime attempts. Although some studies have reported Mexican American youths are at increased risk, we did not find any differences. Possible explanations for disparate results across studies are discussed, in particular methods effects.
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Affiliation(s)
- Robert E Roberts
- Division of Health Promotion and Behavioral Sciences in the School of Public Health, University of Texas Health Science Center at Houston, USA
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Roberts RE, Roberts CR, Xing Y. Prevalence of youth-reported DSM-IV psychiatric disorders among African, European, and Mexican American adolescents. J Am Acad Child Adolesc Psychiatry 2006; 45:1329-1337. [PMID: 17075355 DOI: 10.1097/01.chi.0000235076.25038.81] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The authors present prevalence data for adolescents in a large metropolitan area and examine the association of DSM-IV diagnoses with functional impairment and selected demographic correlates among European Americans (EA), African Americans (AA), and Mexican (MA) Americans. METHOD The authors sampled 4,175 youths ages 11 to 17 years whose households were enrolled in large health maintenance organizations. Data were collected using questionnaires, the Diagnostic Interview Schedule for Children-IV and the Children's Global Assessment Scale. The data were collected in the Houston Metropolitan area in 1998-2000. Data on psychiatric disorders were derived from interviews with youths only. RESULTS AA had a lower prevalence of mood disorders, substance use disorders, and any disorders adjusted for Diagnostic Interview Schedule for Children-IV impairment or Children's Global Assessment Scale score than did others. EA had greatest prevalence of substance use disorders, whereas AA were lowest. After adjusting for covariates, EA had a higher risk for some disorders than AA. Effects of gender, age, parent education, family income, and marital status were not consistent across groups. Family income was protective only for EA. CONCLUSIONS There appear to be few systematic differences between majority and minority adolescents at risk for psychiatric disorders. MA are not at increased risk contrasted to EA. AA had lower risk for some disorders, but adjusting for impairment and covariates eliminated most differences. Thus, multivariate analyses support the hypothesis that initial ethnic differences appear to be a function of factors associated with disadvantaged minority status rather than to distinctive ethnic culture. A noteworthy finding was that disadvantaged social status did not appear to increase the risk for disorders among minority youths.
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Affiliation(s)
- Robert E Roberts
- Dr. R.E. Roberts is with the Division of Health Promotion and Behavioral Sciences and Ms. Xing is with the Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston; and Dr. C.R. Roberts is with the Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston..
| | - Catherine Ramsay Roberts
- Dr. R.E. Roberts is with the Division of Health Promotion and Behavioral Sciences and Ms. Xing is with the Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston; and Dr. C.R. Roberts is with the Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston
| | - Yun Xing
- Dr. R.E. Roberts is with the Division of Health Promotion and Behavioral Sciences and Ms. Xing is with the Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston; and Dr. C.R. Roberts is with the Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston
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Eiraldi RB, Mazzuca LB, Clarke AT, Power TJ. Service Utilization among ethnic minority children with ADHD: a model of help-seeking behavior. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2006; 33:607-22. [PMID: 16862391 DOI: 10.1007/s10488-006-0063-1] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite a significant increase in the number of children and adolescents who receive clinical services for attention deficit hyperactivity disorder (ADHD), there is still a considerable level of unmet need. Children of ethnic minority status continue to lag well behind their non-minority counterparts in the rate of diagnosis and treatment for the disorder. Racial/ethnic disparities in service use are the result of a combination of access barriers and individual, cultural, and societal factors. The ADHD Help-Seeking Behavior Model is proposed as a framework for understanding factors that may be predictive of service use. Variables specific to ADHD and ethnic-minority populations are integrated within the framework of a four-stage pathway model encompassing problem recognition, decision to seek help, service selection, and service use. The authors argue that by systematically addressing factors related to service use for each ethnic minority group, more effective intervention initiatives can be developed to improve identification and treatment for ADHD among underserved children.
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Affiliation(s)
- Ricardo B Eiraldi
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Rappaport N, Flaherty LT, Hauser ST. Beyond psychopathology: assessing seriously disruptive students in school settings. J Pediatr 2006; 149:252-6. [PMID: 16887445 DOI: 10.1016/j.jpeds.2006.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 02/15/2006] [Accepted: 03/13/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To obtain a demographic profile of aggressive students in an urban setting and discern psychiatric diagnoses, functional impairment, and psychosocial stressors. STUDY DESIGN Participants were 33 students in an urban public school district referred for comprehensive psychiatric evaluation by school staff because they were viewed as a threat to school safety. Evaluations included a review of records, interviews with school and mental health professionals, and student and parent interviews. RESULTS Students were characterized by severe and untreated or undertreated psychopathology together with high levels of psychosocial stressors and learning disorders. Thirty-two students received at least one Axis I diagnosis, and the mean number of diagnoses for each student was 3; 33% had substance abuse problems, and 30% had nonpsychiatric medical conditions. CONCLUSIONS The sample is a chronically impaired group of students confronting serious adversity in their daily lives, whose psychosocial and psychiatric needs are not met by current educational and mental health programming. Necessary interventions include prevention and early identification, substance abuse and family treatment, and appropriate psychopharmacological treatment. A comprehensive psychiatric assessment can help change the outcomes for this group of aggressive students.
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Affiliation(s)
- Nancy Rappaport
- Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA.
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Eiraldi RB, Mazzuca LB, Clarke AT, Power TJ. Service Utilization among Ethnic Minority Children with ADHD: A Model of Help-Seeking Behavior. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2006. [DOI: 10.1007/s10488-006-0076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW To describe recent advances in the development of mental health needs screening tools for use with young offenders and implications for this vulnerable group. RECENT FINDINGS The literature shows that young offenders in North America and Europe have high levels of diverse needs that often go unmet because of lack of methods for recognizing and assessing them. Effective screening could play an important role in improving recognition of these needs. Substantial developments have been occurring in the United States, England and Wales and the Netherlands in developing screening tools for this purpose and for this population. Now, the literature is beginning to provide a broad understanding of the optimal psychometric properties, utility and limitations of the screening tools that are required. SUMMARY Several centres are engaged in work to construct mental health screening and assessment tools for use with young offenders. Psychometric measures are being used to determine their validity and reliability. The work has highlighted deficiencies in the healthcare of young persons involved in criminal justice systems but should assist policymakers, healthcare strategists, planners and commissioners to come to better informed decisions about how to utilize most appropriately the limited mental health expertise that is available and how to enhance awareness of nonhealth professionals of basic mental health risks, problems and disorders.
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Affiliation(s)
- Susan Bailey
- University of Central Lancashire, c/o The Adolescent Forensic Service, Gardener Unit, Manchester, UK
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Ganz ML, Tendulkar SA. Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs. Pediatrics 2006; 117:2138-48. [PMID: 16740858 DOI: 10.1542/peds.2005-1531] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and correlates of unmet needs for mental health care services for children with special health care needs and their families. METHODS We use the National Survey of Children With Special Health Care Needs to estimate the prevalence of unmet mental health care needs among children with special health care needs (1-17 years old) and their families. Using logistic-regression models, we also assess the independent impact of child and family factors on unmet needs. RESULTS Substantial numbers of children with special health care needs and members of their families have unmet needs for mental health care services. Children with special health care needs who were poor, uninsured, and were without a usual source of care were statistically significantly more likely to report that their mental health care needs were unmet. More severely affected children and those with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Families of severely affected children or of children with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. CONCLUSIONS Our results indicate that children with special health care needs and their families are at risk for not receiving needed mental health care services. Furthermore, we find that children in families of lower socioeconomic status are disproportionately reporting higher rates of unmet needs. These data suggest that broader policies to identify and connect families with needed services are warranted but that child- and family-centered approaches alone will not meet the needs of these children and their families. Other interventions such as anti-poverty and insurance expansion efforts may be needed as well.
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Affiliation(s)
- Michael L Ganz
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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Franzini L, Fernandez-Esquer ME. The association of subjective social status and health in low-income Mexican-origin individuals in Texas. Soc Sci Med 2006; 63:788-804. [PMID: 16580107 DOI: 10.1016/j.socscimed.2006.01.009] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Indexed: 10/24/2022]
Abstract
There is only limited research on subjective social status (SSS) and its effect on health in general and in minority US populations in particular. This study first investigates the determinants of SSS and the relationship between SSS and objective social status. It then explores the relationships of SSS to self-reported physical health, self-reported mental health, and self-rated health (SRH). The study population consists of Mexican-origin individuals living in low-income neighborhoods in Texas and grouped into acculturation categories based on nativity and use of the Spanish language. We also investigate the role of reference groups. Results indicate that there is no disjuncture between subjective and objective status in this population but that the less acculturated groups rank their social status based on different criteria than the more acculturated. People compare themselves mainly with those similar to them and average subjective status in the different acculturation groups accurately reflects the objective status of the group. Sociocultural factors, in particular perceived differences in opportunities, explain differences between subjective and objective status. Subjective status was associated with all health outcomes. When controlling for objective status, subjective status was associated with mental health and SRH but not with physical health. Objective status indicators were consistently associated with all health outcomes, indicating the prominence of objective socioeconomic status in affecting health in this low-income minority population. Sociocultural characteristics appear to mediate the effect of SSS on health. In particular, perceived victimization might mediate the effect of SSS on mental health.
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Affiliation(s)
- Luisa Franzini
- University of Texas, School of Public Health, Houston, TX, USA.
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