Racial and Ethnic Disparities in Mental Health and Mental Health Care During The COVID-19 Pandemic

The Impact of the COVID-19 Pandemic on Depression, Anxiety, and Stress among Black Women with Depressive Symptoms at a Federally Qualified Health Center

While the COVID-19 pandemic disproportionately impacted Black American communities, there is a lack of empirical research examining mental health experiences during the COVID-19 pandemic among this population. This report examines the relationship between the COVID-19 pandemic and stress, depression, and anxiety among Black women. A cohort study with supplementary data was conducted among 45 Black American women with depressive symptoms participating in an ongoing randomized controlled trial of a mindfulness-based intervention (M-Body) at a Federally Qualified Health Center. Depressive symptoms, anxiety, and stress were measured at multiple time points before and during the COVID-19 pandemic. On average, anxiety [Pre-pandemic: 7.4 (0.5); Peri-pandemic: 7.0 (0.6); MD: -0.4 (0.5), p = 0.18] did not change substantially during the pandemic compared to pre-pandemic levels. However, depression [Pre-pandemic: 19.7 (1.4); Peri-pandemic: 24.4 (1.5); MD: 4.7 (1.0), p < 0.01] worsened while stress [Pre-pandemic: 21.7 (0.4); Peri-pandemic: 20.5 (0.5); MD: -1.2 (0.5), p = 0.01] slightly improved. Individuals caring for children exhibited modest but not statistically significant elevations in pre-pandemic stress than those who did not. These disparities more than doubled during the pandemic for stress [MD: 1.9 (0.9), p = 0.04] and depression [MD: 3.8 (2.6), p = 0.16] but increased only slightly for anxiety [MD: 1.8 (1.0), p = 0.08]. These data indicate that the COVID-19 pandemic impacted mental health among Black women with depressive symptoms, and those caring for children reported greater increases in depression, anxiety, and stress than those who did not during the pandemic. Trial Registration: ClinicalTrials.gov NCT03620721. Registered on 8 August 2018.

Mental Health Concerns During COVID-19: An Observational Study Among a Predominantly Black Community in New York City

PURPOSE

This study examined the prevalence of mental health concerns and its association with COVID-19, selected social determinants of health, and psychosocial risk factors in a predominantly racial/ethnic minoritized neighborhood in New York City.

METHODS

Adult Harlem residents (N = 393) completed an online cross-sectional survey from April to September 2021. The Patient Health Questionnaire (PHQ-4) and the Post-Traumatic Stress Disorder (PC-PTSD) were used to evaluate mental health concerns. Poisson regression with robust variance quantified the associations of interests via prevalence ratios (PR) and 95% confidence intervals (CI).

RESULTS

Two-thirds (66.4%) of the residents reported experiencing mental health concerns, including PTSD (25.7%), depression (41.2%), and anxiety (48.1%). Residents with low-income housing status (PR = 1.16; 95% CI 1.01, 1.34), alcohol misuse (PR = 1.68; 95% CI 1.40, 2.01), food insecurity (PR = 1.23; 95% CI 1.07, 1.42), exposure to interpersonal violence (PR = 1.33; 95% CI 1.08, 2.65), and experience of discrimination (PR = 1.53, 95% CI 1.23-1.92) were more likely to report mental health concerns. Better community perception of the police (PR = 0.97, 95% CI 0.95, 0.99) was associated with fewer mental health concerns. No associations were observed for employment insecurity, housing insecurity, or household COVID-19 positivity with mental health concerns.

CONCLUSIONS

This study showed a high prevalence of mental health concerns in a low-income racial/ethnic minoritized community, where COVID-19 and social risk factors compounded these concerns. Harlem residents face mental health risks including increased financial precarity, interpersonal violence, and discrimination exposure. Interventions are needed to address these concurrent mental health and psychosocial risk factors, particularly in racial/ethnic minoritized residents.

Stimulant Medication Use and Risk of Psychotic Experiences

BACKGROUND AND OBJECTIVES

The prescription of stimulant medications for young people with attention-deficit/hyperactivity disorder is common and increasing. Concerns have been raised about potentially psychotogenic effects of stimulants, and previous observational research has documented an increased risk of psychotic experiences in young people prescribed stimulants. Our aim was to estimate the causal effect of stimulants on psychotic experiences.

METHODS

The trial was emulated using Adolescent Brain Cognitive Development Study data. Eligible participants were aged between 9 and 14 years. Treatment (stimulant prescription) propensities were derived using covariates indexing demographic factors and mental illness severity. The average causal effect of first stimulant prescription on psychotic experiences by 1-year follow-up was derived using inverse probability of treatment weighting followed by standardization (doubly robust estimation).

RESULTS

Of 8391 participants included in the analytical sample, 460 (5.5%) reported 1 or more stimulant prescriptions. In unweighted analyses, stimulant prescription was associated with subsequent psychotic experiences (odds ratio [OR]: 1.46; 95% CI: 1.15-1.84). The reverse, however, was also true, in that baseline psychotic experiences predicted subsequent stimulant treatment (OR: 1.93; 95% CI: 1.57-2.37). When applying doubly robust estimation, there was no evidence of a causal effect of stimulant prescription on the subsequent occurrence of psychotic experiences (OR: 1.09; 95% CI: 0.71-1.56).

CONCLUSIONS

Our findings do not support a causal relationship between stimulant prescription and psychotic experiences. Rather, the association appears to be confounded by factors that both increase probability of stimulant prescription and lead to psychotic experiences.

BD2: A roadmap for learning health networks driving care improvement in bipolar disorder

BACKGROUND

The bipolar disorder field suffers from underinvestment of clinical and research resources, missing links between validated measures and individual biology, poorly understood practice variation, and gaps in clinical practice. These challenges underscore the need for systems-level approaches to improve care delivery. Learning Health Networks (LHNs) are a growing approach driving advances in care delivery by leveraging data and experiences to identify best practices. Key features of LHNs include diverse stakeholder engagement, standardized data collection, measurement-based care, shared governance, information technology infrastructure, and evidence generation. LHNs enable rapid dissemination of shared learnings to drive improvement in bipolar disorder care.

METHODS

A case study of the Breakthrough Discoveries for thriving with Bipolar Disorder (BD2) Integrated Network.

RESULTS

The BD2 Integrated Network is composed of a longitudinal cohort study embedded within an LHN. A novel data platform to integrate new vectors of association in bipolar disorder that include electronic health record, smartphone, and wearable device data will produce actionable evidence to guide care delivery improvements. Feedback from individuals with lived experience of bipolar disorder prompted changes in the measurement strategy including: 1) reframing goals to increase positive outcomes instead of decreasing disease measures; and, 2) considering wellness factors that extend beyond the medical system.

LIMITATIONS

The BD2 Integrated Network is currently enrolling, and actionable insights are forthcoming.

CONCLUSIONS

Lessons learned include the value of lived experience stakeholder input to shape the LHN and the need to navigate challenges in identifying common measures. This work provides a roadmap for advancing bipolar disorder treatment.

Restrictive and permissive alcohol policies during the COVID-19 pandemic and their association with alcohol consumption in the United States

BACKGROUND

Early in the COVID-19 pandemic, alcohol researchers anticipated that psychological distress and changes in alcohol availability would impact alcohol consumption patterns. While psychological distress was expected to increase alcohol use, particularly among vulnerable groups, restrictive alcohol policies might have led to reduced consumption. This study examined the complex relationship between psychological distress, alcohol policies, alcohol consumption, and their interactions with sociodemographic factors during the COVID-19 pandemic in the US.

METHODS

We used 2020-21 US Behavioral Risk Factor Surveillance System Survey (BRFSS, N = 726,962 adults) data to analyze associations between psychological distress, alcohol policy scores, and alcohol consumption, considering age, sex, education, race and ethnicity, and COVID-19 government response as covariates in a zero-inflated multi-level regression. State-level monthly alcohol policy scores derived from Alcohol Policy Information System data reflect the restrictiveness and permissiveness of alcohol policies implemented during the COVID-19 pandemic.

RESULTS

Psychological distress and exposure to restrictive policies increased the likelihood of abstaining from alcohol in the past month, although the observed effects were small. Among past-month drinkers, distress and restrictive policies were associated with slightly higher average daily consumption in pure alcohol grams/day. Younger respondents were more likely to abstain from alcohol when exposed to restrictive policies, while permissive policies correlated with higher drinking prevalence and heavy episodic drinking occurrence among those with higher education.

CONCLUSION

Alcohol policies and psychological distress during the COVID-19 pandemic were linked to both lower and higher alcohol consumption in different population subgroups. Restrictive and permissive policies had diverging associations with consumption patterns across subgroups. While effect sizes were modest, they could translate into meaningful changes in alcohol consumption at the population level, especially during prolonged times of crisis.

Disparities in group-based medical mistrust and associations with mental health symptoms during the COVID-19 pandemic

BACKGROUND

Racial/ethnic disparities in health-related outcomes may have been exacerbated during the COVID-19 pandemic. Individuals from racial/ethnic minority groups or with a history of alcohol use disorder (AUD) may have greater medical mistrust. We examined racial/ethnic and AUD-related differences in group-based medical mistrust during the pandemic and tested whether medical mistrust dimensions were associated with mental health symptoms.

METHODS

Two hundred and fifty participants from the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study completed an online survey between April and July of 2022. Exploratory factor analysis and path analysis were conducted.

RESULTS

Group-based medical mistrust scores were elevated among participants who identified as Non-Hispanic Black and those with a history of AUD. Two medical mistrust dimensions were found: (1) Suspicion and Lack of Provider Support, and (2) Group Disparities in Health Care. Compared to Non-Hispanic White participants, Non-Hispanic Black participants reported higher scores on the Suspicion and Lack of Provider Support dimension of medical mistrust, which was associated with higher mental health symptoms. This medical mistrust dimension was also a significant mediator of the observed group differences in mental health symptoms.

LIMITATIONS

Cross-sectional data, aggregation of racial/ethnic groups with small sample sizes, and nonrepresentative sample.

CONCLUSIONS

Non-Hispanic Black individuals and individuals with AUD may be more vulnerable to mental health symptoms due to higher suspicion toward medical professionals and healthcare systems and perceived lack of support from healthcare providers. Increased awareness among healthcare providers may help address medical mistrust, encourage help-seeking behaviors, and alleviate mental health symptoms.

"Each one of us did the best we could for the community, while also supporting each other": community residents' perspectives on community health worker (CHW) response during the COVID-19 pandemic - a community science worker-led qualitative study

BACKGROUND

The COVID-19 pandemic significantly disrupted the health and social wellbeing of the United States population, disproportionately affecting low-income, immigrant communities of color. In Orange County, California, community health workers (CHWs) were essential to addressing multilevel community needs among impacted communities. However, little is known about how communities and CHWs responded to meet their needs amid pressing challenges.

METHODS

CHWs completed a popular education qualitative methods program under a Community Science Worker (CSW) model to design and facilitate four semi-structured focus groups and three interviews with 32 residents in Orange County, California, to understand their pandemic experiences and interactions with CHWs. Sessions were recorded, transcribed, and analyzed using an adapted flexible coding approach to derive data-driven themes.

RESULTS

Residents described how they supported one another, advocated for their communities, and fostered livelihood and resilience. Four main themes detail the community's response: (1) facing a chain of interconnected challenges; (2) connecting with CHWs and accessing the services they facilitated; (3) fostering a community of care, a mutuality often inspired by interactions with CHWs; and (4) reinforcing foundations through a whole-of-community approach, including strengthening social policies.

CONCLUSIONS

Engaging community members is crucial for comprehensively understanding the CHW model. Given the enormous ongoing community challenges post-pandemic, these findings call for increased CHW presence, additional support and resources for health and socioeconomic needs, and improved information dissemination to bolster community resilience. Findings center mutual aid, emphasizing the importance of supporting communities in this crucial work. Additionally, engaging with residents who CHWs supported is vital for understanding the full impact of CHW models.

Rural Native Veterans' Perceptions of Care in the Context of Navigator Program Development

INTRODUCTION

American Indian and Alaska Natives serve in the military at one of the highest rates of all racial and ethnic groups. For Veterans, the already significant healthcare disparities Natives experience are aggravated by barriers to accessing care, care navigation, and coordination of health care within the Veterans Health Administration (VHA) between the VHA and tribal health systems. To mitigate these barriers, the VHA is developing a patient navigation program designed specifically for rural Native Veterans. We describe formative work aimed at understanding and addressing barriers to VHA care from the perspective of rural Native Veterans and those who facilitate their care.

METHODS

Thirty-four individuals participated in semi-structured interviews (22 Veterans, 6 family members, and 6 Veteran advocates) drawn from 9 tribal communities across the US.

RESULTS

Participants described many barriers to using the VHA, including perceptions of care scarcity, long travel distances to the VHA, high travel costs, and bureaucratic barriers including poor customer service, scheduling issues, and long waits for appointments. Many Veterans preferred IHS/tribal health care over the VHA due to its proximity, simplicity, ease of use, and quality.

CONCLUSION

Rural Native Veterans must see a clear benefit to using the VHA given the many obstacles to its use. Veteran recommendations for addressing barriers to VHA care within a navigation program include assistance enrolling in, scheduling, and navigating VHA systems; paperwork assistance; cost reimbursement; and care coordination with the IHS/tribal health care.

Emotional and Financial Stressors in New York City During the COVID-19 Pandemic: A Consecutive Cross-Sectional Analysis

Mental and financial hardship during the COVID-19 pandemic in New York City was severe, but how vulnerable groups have been disproportionately impacted is incompletely understood. In partnership with community stakeholders, we administered a web-based survey to a convenience sample of New York City residents (18 + years) from May 2020 to April 2021 to evaluate their financial and emotional stressors. We analyzed outcomes by race, ethnicity, and education level. A total of 1854 adults completed the survey across three consecutive non-overlapping samples. Fifty-five percent identified other than non-Latinx White. Sixty-four percent reported emotional stress; 38%, 32%, and 32% reported symptoms of anxiety, depression, and post-traumatic stress disorder respectively; and 21% reported a large adverse financial impact. The leading unmet needs were mental health and food services (both 19%), and health services (18%). Need for both resources grew over time. Adverse financial impact directly correlated with presence of all four adverse mental health outcomes above. In multivariate analysis, non-White race and lack of college degree were associated with adverse financial impact, whereas LGBT identity and lack of college degree were associated with mental health impact. Throughout the COVID-19 pandemic, participants in this research demonstrated a large and growing mental and financial strain, disproportionately associated with lower education level, non-White race, and LGBT status. Our findings suggest an urgent need to differentially target COVID-19 mental health and resource support in New York City to persons in these vulnerable communities.

Mental Health Status by Race, Ethnicity and Socioeconomic Status among Young Adults in Texas during COVID-19

BACKGROUND

Differences in symptoms of depression and anxiety by race/ethnicity and socioeconomic status (SES) among a diverse cohort of young adults during the COVID-19 pandemic (Spring 2020-Fall 2021) have not been examined.

METHOD

We analyzed four waves of biannual, panel data from n = 2629 emerging adults (16-25 years old) from the Texas Adolescent Tobacco and Marketing Surveillance study (TATAMS). We conducted a series of mixed effects ordinal logistic regression models to compare the independent and joint effects of race/ethnicity and SES on symptoms of (a) depression and (b) anxiety, adjusting for sex, cohort, and time.

RESULTS

Symptoms of depression (aOR range: 1.54 - 2.19; 95% CI: 1.02 - 3.08) and anxiety (aOR range: 1.64 - 2.19; 95% CI: 1.22 - 2.79) were elevated among low SES young adults, across all racial/ethnic groups. Across SES groups, symptoms of depression were lower among non-Hispanic Blacks compared to non-Hispanic Whites (aOR range: 0.33 - 0.41; 95% CI: 0.18 - 0.62) and Hispanics /Latinos (aOR range: 0.33 - 0.38; 95% CI: 0.20 - 0.57); similarly, symptoms of anxiety were lower among non-Hispanic Blacks compared to non-Hispanic Whites (aOR range: 0.44; 95% CI: 25 - 0.77) and Hispanics/Latinos (aOR range: 0.47 - 0.56; 95% CI: 0.29 - 0.83). No significant interaction (joint effect) was observed between SES and race/ethnicity during this period.

CONCLUSION

Low SES was persistently related to poor mental health. Lower odds of symptoms of anxiety and depression among non-Hispanic Black young adults may reflect the 'mental health paradox'. Overall, mental health policies should prioritize lower SES young adults regardless of race and ethnicity.

Multidimensional social support and associations between COVID-19 stress and depressive/anxiety outcomes among Hispanic/Latinx and White first-year college students

Objective: The COVID-19 pandemic has led to greater depression and anxiety among college students. Social support may alleviate this risk. We examined how social support from family, friends, and romantic partners may influence internalizing psychopathology outcomes associated with COVID-19-related stressful events. Participants: Participants were first-years (N = 425, 34.8% Hispanic/Latinx, 74.9% female) enrolled in a United States public university. Methods: Participants completed an online survey in Fall of 2020. Linear regression models examined associations between COVID-19 stressors, social support, depressive and anxiety symptoms, and differences between White and Hispanic/Latinx students. Results: Reported COVID-19 stressors were associated with elevated depressive and anxiety symptoms and higher among Hispanic/Latinx students. Family and friend support were negatively associated with both internalizing outcomes. Partner support was negatively associated with depression and more predictive among White students whereas friend support was for Hispanic/Latinx students' anxiety. Conclusions: These findings demonstrate the importance of social connectedness during the COVID-19 pandemic.

Exploring Coronavirus Disease 2019 Risk Factors: A Text Network Analysis Approach

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected global health, economies, and societies, necessitating a deeper understanding of the factors influencing its spread and severity. Methods: This study employed text network analysis to examine relationships among various risk factors associated with severe COVID-19. Analyzing a dataset of published studies from January 2020 to December 2021, this study identifies key determinants, including age, hypertension, and pre-existing health conditions, while uncovering their interconnections. Results: The analysis reveals five thematic clusters: biomedical, occupational, demographic, behavioral, and complication-related factors. Temporal trend analysis reveals distinct shifts in research focus over time. In early 2020, studies primarily addressed immediate clinical characteristics and acute complications of COVID-19. By mid-2021, research increasingly emphasized long COVID, highlighting its prolonged symptoms and impact on quality of life. Concurrently, vaccine efficacy became a dominant topic, with studies assessing protection rates against emerging viral variants, such as Alpha, Delta, and Omicron. This evolving landscape underscores the dynamic nature of COVID-19 research and the adaptation of public health strategies accordingly. Conclusions: These findings offer valuable insights for targeted public health interventions, emphasizing the need for tailored strategies to mitigate severe outcomes in high-risk groups. This study demonstrates the potential of text network analysis as a robust tool for synthesizing complex datasets and informing evidence-based decision-making in pandemic preparedness and response.

Factors Associated with Leaving Ambulatory Psychiatric Treatment in a Large, Academic Health System During the COVID-19 Pandemic

Detailed evaluation of changes in patient retention in psychiatric care as a result of the onset of the COVID-19 pandemic have not been studied. Here, we present a retrospective analysis of aggregate data from a large academic health system (n = 16,701 patients) to examine if there were differences in patients leaving psychiatric care from the pre-COVID-19 period to the first 12 months of the COVID-19 pandemic. Demographic, clinical, and behavioral factors were studied using logistic regressions to determine significant associations in leaving psychiatric care during COVID-19 and in the 12 months immediately prior to the pandemic. Factors identified with a higher odds of leaving psychiatric care during COVID-19 that were not associated with leaving care prior to COVID-19 included demographic (male sex, uninsured (self-pay) status), behavioral (inactive patient health portal), and diagnostic (anxiety and trauma stressor disorders, pervasive and specific developmental disorders, and disorders of childhood) factors. These results highlight that the reasons patients left care during the period immediately after the COVID-19 pandemic may have been multifactorial in nature, although certain patterns seem to have appeared. Further study is needed to elucidate why these specific factors may have driven patients to leave psychiatric treatment during the COVID-19 pandemic.

Prevalence and Changes in Usage of Mental Health Services for Rhode Island Children and Youth Before, During, and After Onset of the COVID-19 Pandemic

This study reports the prevalence of inpatient, emergency department (ED), and outpatient mental health service usage of children/youth before, during, and after onset of the COVID-19 pandemic in Rhode Island. Additionally, we identify significant changes in usage across these time periods and the prevalence of each service type contingent upon various demographic profiles. This retrospective observational analysis used Rhode Island Medicaid claims to identify the unique children and youth who used inpatient, ED, and outpatient mental health services across three key time periods: pre-onset (March 2019-February 2020); onset (March 2020-February 2021); and post-onset (March 2021-February 2022). We used z-tests to analyze changes in the proportion of children/youth who accessed these services in each period. We examined relationships between demographic characteristics and time period with chi-square tests. Significant decreases in inpatient and ED usage were identified from pre-onset to onset (p < .05). While inpatient nearly returned to pre-pandemic usage in post-onset, ED usage remained lower. Outpatient usage increased significantly leading up to the pandemic but remained at similar levels between pre-onset and post-onset. From pre-onset to post-onset, females grew as a percentage of all inpatient, ED, and outpatient users. Over this same period, the proportion of inpatient users aged 12-18 increased and the proportion of ED and outpatient users aged 19-24 increased. Female usage of mental health services increased significantly, and older children/youth seemed to drive any significant increases. Future public health and disaster preparedness policies should focus on the unique mental health needs of these socially vulnerable groups.

Place-based access to integrated mental health services within substance use disorder treatment facilities in the US

The co-occurrence of substance use (SUD) and mental disorders is increasing in the US. Integrating mental health services into SUD treatment facilities improves treatment retention and success, but access to integrated services is lagging behind growing demand. The purpose of this study was to map the locations of SUD treatment facilities that offer integrated mental health services and identify community characteristics associated with whether a treatment facility offers more comprehensive integrated services. We used the Mental health and Addiction Treatment Tracking Repository to identify the location and characteristics of licensed outpatient SUD treatment facilities in the US (2022; N = 8,858). Our focal predictors included the percentage of a census block group that was White, Black, and Hispanic. We used multilevel multiple logistic regression to model whether a facility offered integrated mental health (y/n), adjusted for relevant facility-, county-, and state-level covariates, and defined state as a random effect. The majority of integrated facilities were located in the eastern US, with notable concentrations around large metropolitan areas of Minneapolis, MN, Chicago, IL, Atlanta, GA, and New York, NY. For every 10-percentage point increase in a census block group's Black and Hispanic population, there was a 5% and 7% decrease in the odds of offering integrated services, respectively (aORBlack = 0.95, 95% CI = 0.91-0.99, p = 0.04; aORHispanic = 0.93, 95% CI = 0.90-0.96, p < 0.0001). We frame our findings around social conditions as fundamental drivers of disease and healthcare access and acknowledge the country's historical disinvestment in nonwhite and rural communities. Racially targeted programs are needed to effectively address growing racial and ethnic inequities in SUD and mental healthcare.

The Role of Social Determinants in Racial and Ethnic Mental Health Disparities: Getting It Right

ABSTRACT

Despite increased research on and attention to mental health, significant racial and ethnic disparities in this area persist. We propose that racial and ethnic disparities in mental health should be examined through the lens of social determinants of mental health (SDoMH). In this perspective article, we review current definitions and frameworks of SDoMH, discuss their strengths and shortcomings, and provide recommendations for a framework to better capture the causal pathways of mental health for racially and ethnically minoritized populations. We also discuss efforts to address SDoMH, focusing on policy-level SDoMH interventions, and review progress and challenges in integrating SDoMH approaches into mental health care.

Exploring gendered racism and the mental health of rural Black women

Background

Gendered racial microaggressions adversely impact Black college women's mental health, but less is known about rural Black women's mental health.

Objective

Examine the association between gendered racism, depression, and psychological distress.

Methods

This cross-sectional study included 200 rural Black women from the Southeastern United States. Gendered racism was assessed using the Gendered Racial Microaggressions scale (GRMS). Linear regression was used to assess GRM subscales, depression (PHQ-9) and psychological distress (K6) as outcomes.

Results

Of the 200, 21.5% reported depression and 31% reported moderate psychological distress. Depression increased with increasing stress appraisal of gendered racism, p = 0.002.

Conclusion

Gendered racial microaggressions impact the mental health of rural Black women.

Child and Adolescent Anxiety and Depression Prior to and During the COVID-19 Pandemic in the United States

Childhood anxiety and depression have been increasing for years, and evidence suggests the COVID-19 pandemic has exacerbated this trend. However, research has examined anxiety and depression primarily as exclusive conditions, overlooking comorbidity. This study examined relationships between the COVID-19 pandemic and anxiety and depression to clarify risk factors for singular and comorbid anxiety and depression in children. Using 2018-2019 and 2020-2021 samples from the National Survey of Children's Health, a nationally representative survey of children aged 0-17 in the United States, associations between the COVID-19 pandemic and child anxiety and depression were examined via survey-weights' adjusted bivariate and multiple regression analyses, controlling for demographic characteristics. The COVID-19 pandemic was associated with higher odds of having comorbid anxiety and depression but not singular anxiety or depression. Female sex, older age, having special healthcare needs, more frequent inability to cover basic needs on family income, and poorer caregiver mental health were associated with having been diagnosed with singular and comorbid anxiety and depression. Children that witnessed or were victims of violence in the neighborhood were also more likely to have comorbid anxiety and depression. Implications for prevention, intervention, and policy are discussed.

Economic hardships during COVID-19 and maternal mental health: Combining samples with low incomes across three cities

The COVID-19 pandemic increased maternal depression and anxiety, imperiling both mothers' own wellbeing and that of their children. To date, however, little is known about the extent to which these increases are attributable to economic hardships commonly experienced during the pandemic: income loss, job loss, and loss of health insurance. Few studies have examined the individual impacts of these hardships, and none have lasted beyond the first year of the pandemic. This study harmonizes data from six evaluations of pediatric-based parenting programs for women with young children and low incomes across three U.S. cities (N = 1,254). Low-income mothers are of special interest because their families have been disproportionately affected by economic shocks due to COVID-19, and mothers of young children have been more distressed than other mothers by COVID-19. The studies' combined window of observation lasted from the onset of the pandemic to over three years later. Results indicate that income loss, job loss, and health insurance loss were all significantly associated with depression and anxiety. When each hardship was assessed net of the others, lost income was associated with more than a two-fold increase in the odds of anxiety, and a lost job and lost health insurance were associated with 50% and 90% greater odds of depression, respectively. Associations between hardships and maternal mental health did not diminish over time during the window of observation. These associations are likely to have been even greater in the absence of generous social policies enacted during the pandemic.

Experience of Racial Discrimination was Associated with Psychological Distress and Worsening Sex Life Among Adult Americans During COVID-19

The recent escalation of racism in the U.S. during the COVID-19 pandemic points to the importance of examining the association between experienced racism and sexual health. Based on data from a nationally representative survey conducted in the U.S. in October 2020 (n = 1,915), Chi-square tests and multivariable logistic regressions were estimated to examine the association between experience of racism and changes in sex life during the pandemic. We further performed a causal mediation analysis using the bootstrap technique to assess the mediating role of psychological distress in the observed association between the experience of racism and changes in sex life. Among the respondents, the proportions reporting better, worse, or no change in sex life were, respectively, 15%, 21%, and 64%. Experiencing racial discrimination during COVID-19 was significantly associated with worsening sex life (adjusted odd ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.04, 2.25). Respondents with experienced racism were also more likely to report psychological distress (AOR = 1.68; 95% CI = 1.09, 2.59). About one-third (32.66%) of the observed association between experienced racism and worsening sex life was mediated through psychological distress. Addressing racism and its association with psychological distress has the potential to improve sexual health and reduce related racial and ethnic disparities.

Experiences with discrimination during pregnancy in Canada and associations with depression and anxiety symptoms

OBJECTIVES

Experiences of discrimination reported during pregnancy are common and are associated with poor mental health and adverse birth outcomes. No Canadian studies have investigated interpersonal discrimination during pregnancy. This study aimed to quantify and identify lived-experiences of discrimination in a Canadian cohort of pregnant individuals, and examine associations with concurrent prenatal anxiety and depression symptoms.

METHODS

Pregnant individuals from the pan-Canadian Pregnancy During the Pandemic (PdP) study (n = 1943) completed the Everyday Discrimination Scale (EDS), demographic measures and self-report measures of depression and anxiety symptoms. Descriptive statistics and ANCOVA were used to assess prevalence of discrimination and associated mental health outcomes. Open-text responses (n = 189) to a question investigating reasons for discrimination were analyzed using conventional content analysis.

RESULTS

Approximately three quarters (72%) of pregnant individuals experienced at least one instance of discrimination during their pregnancy or within the year prior. Pregnant individuals experiencing more frequent and/or more types of discrimination were more likely to identify as non-white, not be partnered, have lower socioeconomic status, and have a pre-pregnancy history of anxiety and depression. The most common attributions for interpersonal discrimination were gender, age, and education/income level. Pregnant individuals who experienced more frequent discrimination and/or more types of discrimination were more likely to report clinically significant symptoms of depression and anxiety (n = 623; 35.2% and 49.1%, respectively) compared to those who reported no discrimination (n = 539; 11.5% and 19.1%, respectively). Conventional content analysis of open-text responses generated the following main themes: (1) personal attributes and sociodemographic characteristics, (2) occupation, (3) the COVID-19 pandemic, (4) pregnancy and parenting, and (5) causes outside the self.

CONCLUSION

Frequent discrimination was associated with more adverse concurrent mental health symptoms. Understanding experiences of discrimination can inform interventions that better address the needs of pregnant individuals and their infants.

A Systematic Review of the Influence of Social Determinants of Health on Mental Health Service Utilization and Outcomes Among Asian American Cancer Survivors

OBJECTIVE

The purpose of this review was to identify relationships between social determinants of mental health service utilization and outcomes among Asian American cancer survivors in the United States (U.S.).

METHODS

We performed a systematic literature search in PubMed, PsycINFO, CINAHL, and Embase for peer-reviewed studies between January 2000 and May 2024. Based on the Healthy People 2023 framework, social determinants of health (SDOH) were categorized into five SDOH domains. We extracted data using a table of evidence, and we assessed study quality using the Johns Hopkins Evidence-Based Practice.

RESULTS

Ten non-experimental studies, with either "High" or "Good" quality, met eligibility criteria. Two examined mental health service utilization, and nine reported mental health outcomes. Seventy percent of the studies recruited samples from the health systems. The rest were from community settings. Seventy percent included the Asian American subgroup, mainly Chinese Americans. Higher education, English proficiency, more years residing in the U.S., and having social support correlated with better psychological quality of life. Higher-income and education levels were associated with more psychotropic medication use. However, zip code levels were used to estimate actual income and education.

CONCLUSION

We identified significant SDOH factors that influenced mental health outcomes among Asian American cancer survivors. More research is needed to understand the social determinants of mental health service utilization barriers in this population. Allocating more funding to health research tailored to Asian American cancer survivors, along with data disaggregation, standardizing socioeconomic status measures, and diversifying sampling sources, is essential to enhancing their mental health outcomes.

Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study

ABSTRACT

Introduction

A lack of coordinated federal guidance led to substantial heterogeneity in local COVID-19 policies across US states and counties. Local government policies may have contributed to increases in anxiety and mental health disparities during the COVID-19 pandemic.

Methods

We analysed associations between composite policy scores for containment and closure, public health or economic support from the US COVID-19 County Policy Database and self-reported anxiety scores (Generalised Anxiety Disorder-7) from COVID-19 Citizen Science participants between 22 April 2020 and 31 December 2021.

Results

In 188 976 surveys from 36 711 participants in 100 counties across 28 states, associations between anxiety and containment and closure policy differed by employment (p<0.0001), with elevated anxiety under maximal policy for people working in hospitality and food services (+1.05 vs no policy; 95% CI: 0.45, 1.64) or arts and entertainment (+0.56; 95% CI 0.15, 0.97) and lower anxiety for people working in healthcare (-0.43; 95% CI -0.66 to -0.20) after adjusting for calendar time, county-specific effects and COVID-19 case rates and death rates. For public health policy, associations differed by race and ethnicity (p=0.0016), with elevated anxiety under maximal policy among participants identifying as non-Hispanic Black (+1.71; 95% CI 0.26, 3.16) or non-Hispanic Asian (+0.74; 95% CI 0.05, 1.43) and lower anxiety among Hispanic participants (-0.63, 95% CI -1.26 to -0.006). Associations with public health policy also differed by gender (p<0.0001), with higher anxiety scores under maximal policy for male participants (+0.42, 95% CI 0.09, 0.75) and lower anxiety for female participants (-0.40, 95% CI -0.67 to -0.13). There were no significant differential associations between economic support policy and sociodemographic subgroups.

Conclusions

Associations between local COVID-19 policies and anxiety varied substantially by sociodemographic characteristics. More comprehensive containment policies were associated with elevated anxiety among people working in strongly affected sectors, and more comprehensive public health policies were associated with elevated anxiety among people vulnerable to racial discrimination.

The Goldilocks Zone: Finding the right balance of user and institutional risk for suicide-related generative AI queries

Generative artificial intelligence (genAI) has potential to improve healthcare by reducing clinician burden and expanding services, among other uses. There is a significant gap between the need for mental health care and available clinicians in the United States-this makes it an attractive target for improved efficiency through genAI. Among the most sensitive mental health topics is suicide, and demand for crisis intervention has grown in recent years. We aimed to evaluate the quality of genAI tool responses to suicide-related queries. We entered 10 suicide-related queries into five genAI tools-ChatGPT 3.5, GPT-4, a version of GPT-4 safe for protected health information, Gemini, and Bing Copilot. The response to each query was coded on seven metrics including presence of a suicide hotline number, content related to evidence-based suicide interventions, supportive content, harmful content. Pooling across tools, most of the responses (79%) were supportive. Only 24% of responses included a crisis hotline number and only 4% included content consistent with evidence-based suicide prevention interventions. Harmful content was rare (5%); all such instances were delivered by Bing Copilot. Our results suggest that genAI developers have taken a very conservative approach to suicide-related content and constrained their models' responses to suggest support-seeking, but little else. Finding balance between providing much needed evidence-based mental health information without introducing excessive risk is within the capabilities of genAI developers. At this nascent stage of integrating genAI tools into healthcare systems, ensuring mental health parity should be the goal of genAI developers and healthcare organizations.

Disparities in depression and anxiety at the intersection of race and gender identity in a large community health sample

BACKGROUND

Persons of color experience are disproportionately impacted by poor mental health compared to White individuals, as are gender diverse populations relative to cisgender individuals. Yet, few studies have assessed differences in common mental health disorders at the intersection of race and gender identity.

METHODS

Using health record data from an urban US community health center in Massachusetts that primarily serves LGBTQIA + communities, we organized patients (N = 29,988) into 24 race and gender identity categories, pairing four race groups (White, Black, Asian, and another race, which was inclusive of Native American/Alaskan, Native Hawaiian, Multiracial, and other) with six gender identity groups (cisgender men and women, transgender men and women, nonbinary individuals assigned male and female at birth [AMAB/AFAB]). We compared the severity of self-reported symptoms of depression and anxiety and the likelihood of meeting diagnostic thresholds across the four race categories within three gender groups (cisgender and transgender men, cisgender and transgender women, nonbinary individuals).

RESULTS

Depression and anxiety symptom severity differed within men and women; transgender men and women across races had higher severity than cisgender men and women. In nonbinary individuals, symptom severity was high and consistent across the race groups. Differences were observed in the likelihood of meeting clinical thresholds for depression and anxiety across races in men and women, reflecting the pattern described above. Nonbinary participants across races had high likelihood of meeting the thresholds for both diagnoses (29.2%-47.1%). The likelihood of meeting the depression and anxiety thresholds were highest among Black nonbinary AFAB adults (44.4%) and transgender women in the another race category (48.7%), respectively.

CONCLUSION

In this unique sample, differences in depression and anxiety symptom severity and likely diagnoses suggest disparities among nonbinary individuals across races, as well as among transgender men and women grouped into the another race category and women who identify as Black. Focused mental health strategies tailored to address race and gender identity may be critical to proactively address these disparities.

Associations Between Mental Health and Social Needs Among Black Patients in Primary Care Settings

INTRODUCTION

Integrated Behavioral Health (IBH) clinics in primary care offer cost-effective options for receiving mental health (MH) support for Black patients. By tracking specific aspects of social determinants of health (SDOH), more commonly assessed in primary care, IBH programs can provide helpful insights to both MH and primary care providers.

METHODS

This retrospective study examined the impact of IBH care delivery on MH and social needs variables in a Black adult patient population. MH outcomes were assessed using the PHQ9 and GAD7, with a positive score being greater than 5.

RESULTS

There were N = 119 Black patients included in analysis. The sample was 83% female and the average age at first visit was 41. There was a significant reduction in both GAD7 (change = -1.8, P < .001) and PHQ9 (change = -2.3, P < .001) scores for patients receiving IBH services. There were no significant differences between those who had a SDOH screen and having an initial elevated GAD7/PHQ9 score.

CONCLUSION

More culturally inclusive research on the impact of IBH implementation where Black patients receive their primary care is needed to maximize treatment possibilities among this group.

Utilization, Satisfaction, and Clinical Outcomes of People of Color and White Adults Using an Employer-Sponsored Digital Mental Health Platform

Evaluating digital mental health services across racial and ethnic identities is crucial to ensuring health equity. We examined how People of Color (POC) and White adults were using and benefiting from an employer-sponsored digital mental health platform. A sample of 947 adults (42% POC) consented to an observational study and completed surveys on their identities and mental health outcomes at baseline and three-month follow-up. We examined care preferences, utilization, therapeutic alliance with mental health providers, and changes in outcomes among POC and White adults. At baseline, there were no race or ethnicity differences in preferred topics of focus (p = 0.36), rates of depression, anxiety, or loneliness (ps > 0.35), or self-reported well-being or stress (ps > 0.07). POC adults were more likely to prefer one-on-one care than White adults (p = 0.02). After 3 months of care utilization, there were no differences in therapeutic alliance (p = 0.52), use of therapy, coaching, or self-guided digital resources (ps > 0.47), or in the likelihood of improving, recovering, or maintaining clinical symptoms or psychosocial factors (ps > 0.07). Utilization, satisfaction, and clinical effectiveness were similar between POC and White adults, indicating the platform may offer comparable experiences. Evaluating utilization and outcomes among POC communities is necessary to inform consumers and help developers assess if innovations are fostering health equity.

Identifying the Black Country's Top Mental Health Research Priorities Using a Collaborative Workshop Approach: Community Connexions

Background: The Black Country (BC) is an area of the United Kingdom covering Dudley, Sandwell, Walsall, and Wolverhampton. The area is ethnically, culturally and religiously diverse. One-fifth of the total population is in the lowest socioeconomic quintile, with an uneven distribution of wealth. The area manifests unmet needs and as perceived underserved community groups. Objectives and Methods: To better understand the situation and inform future provision, listening events were organised across the BC to engage with local underserved communities. A mixed-methods design was employed, using collaborative workshops. The workshops enabled stakeholders to explore priorities, perceived barriers and solutions to mental health services' access within the BC. Results: Sixty participants verbally consented and signed in to attend the three workshops. There were nine groups that provided 247 statements on the topic, yielding a total of 12 codes and six themes (priorities). The top identified priorities were inappropriate periodisation of accessible funded healthcare needs (n = 42, 18.03%), barriers to appropriate healthcare (n = 49, 21.03%) and limited resources for training, health promotion, preventative care and support networks (n = 62, 26.61%). Conclusions: Addressing the identified priorities will require location and community-specific solutions to establish those communities' trust and engagement. Cultural stigma should not be viewed as the only barrier to access healthcare but should be considered in combination with the population's reluctance to reach out to healthcare services due to loss of trust between community groups and lack of co-design of culturally and religiously appropriate services for the community.

Spatiotemporal patterns of youth isolation and loneliness in the US: a geospatial analysis of Crisis Text Line data (2016-2022)

In 2021, the US Surgeon General issued a national advisory citing an epidemic of isolation and loneliness. Even before the onset of the COVID-19 pandemic, approximately half of people in the US reported experiencing measurable levels of loneliness. Despite localized and select cross-sectional studies highlighting even higher increases in isolation/loneliness during the COVID-19 pandemic, additional research is needed, particularly for youth and young adults. This work examines patterns of isolation/loneliness across the US from 2016 to 2022 among individuals aged 24 and younger. Our study leverages a unique dataset, Crisis Text Line, which provides complete spatiotemporal coverage of crisis conversations in the US. We conducted a geospatial analysis using Kuldroff's Space-Time SatScan to identify statistically significant clustering of elevated isolation/loneliness-related conversations. The statistical significance of spatiotemporal clusters was determined using Monte Carlo simulations (n = 9999). Results demonstrated local relative risk as high as 1.47 in high-risk populations in Southern, Midwest, and Atlantic states, indicating areas where the actual case count is 147% of the expected cases (p value < 0.01) from May to July 2020. Results also identified co-occurrence of isolation/loneliness and other crises concerns, including depression/sadness, anxiety, and multiple suicidality indicators, with higher rates among racial/ethnic minority, transgender and gender diverse, and younger individuals. This work makes a unique contribution to the literature by elucidating spatiotemporal disparities in isolation/loneliness among young people, providing much-needed knowledge as to where future public health interventions are immediately needed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10708-024-11253-w.

Communities conquering COVID-19: Black and Latinx community perspectives on the impact of COVID-19 in regions of Michigan hardest hit by the pandemic

Introduction

In Michigan, the COVID-19 pandemic severely impacted Black and Latinx communities. These communities experienced higher rates of exposure, hospitalizations, and deaths compared to Whites. We examine the impact of the pandemic and reasons for the higher burden on communities of color from the perspectives of Black and Latinx community members across four Michigan counties and discuss recommendations to better prepare for future public health emergencies.

Methods

Using a community-based participatory research approach, we conducted semi-structured interviews (n = 40) with Black and Latinx individuals across the four counties. Interviews focused on knowledge related to the pandemic, the impact of the pandemic on their lives, sources of information, attitudes toward vaccination and participation in vaccine trials, and perspectives on the pandemic's higher impact on communities of color.

Results

Participants reported overwhelming effects of the pandemic in terms of worsened physical and mental health, financial difficulties, and lifestyle changes. They also reported some unexpected positive effects. They expressed awareness of the disproportionate burden among Black and Latinx populations and attributed this to a wide range of disparities in Social Determinants of Health. These included racism and systemic inequities, lack of access to information and language support, cultural practices, medical mistrust, and varied individual responses to the pandemic.

Conclusion

Examining perspectives and experiences of those most impacted by the pandemic is essential for preparing for and effectively responding to public health emergencies in the future. Public health messaging and crisis response strategies must acknowledge the concerns and cultural needs of underrepresented populations.

Racial and ethnic composition of peer recovery community members and barriers to acquiring funding for organizations in the ecosystem of recovery

INTRODUCTION

Organizations in the "ecosystem of recovery"-most often non-profits led and staffed by individuals with lived substance use disorder (SUD) experience-offer peer services, group counseling, and a wide variety of programs to help those struggling with SUD. The efforts of such organizations are effective in transitioning those suffering from SUD into long-term recovery. Despite well-established evidence depicting inequitable access to SUD treatment between BIPOC and non-Hispanic White Americans, there has been no empirical undertaking of whether organizations in the ecosystem of recovery face barriers to fund their operations based on the racial and ethnic composition of their community members.

METHODS

In this 2022 needs assessment, "Optimizing Recovery Funding," we combined the results of quantitative and qualitative data for a mixed methods analytic approach. The study employs bivariate descriptive statistics and inferences along with thematic analyses. From an initial list of 537 organizations across U.S. states and territories, 145 leaders of these organizations comprise our survey analytic sample. A total of 85 leaders participated in one of 16 focus groups, with 10 based on geography and 6 based on population identity. This needs assessment produced comprehensive data on the operations of organizations in the ecosystem of recovery.

RESULTS

A lack of training and existing organizational funding, as well as non-inclusive language in funding requests for proposals contributed to some organizations' decisions not to pursue certain grants and funding mechanisms. There were no statistical differences in applying for, nor success in receiving, federal and state funding between organizations serving predominantly BIPOC community members and those serving mostly non-Hispanic White community members. However, there were key instances of-at times inexplicable-inequity in funding outcomes.

CONCLUSIONS

All leaders of organizations in the ecosystem of recovery who participated in the needs assessment made it clear that there are fundamental issues to accessing peer recovery operational and programmatic funding. Innovative strategies for developing inclusive and culturally responsive funding approaches that prioritize organizations predominantly serving historically marginalized communities are needed.

Examining Factors Associated With Intention to Seek Professional Mental Health Support Among First-Generation Iranian Americans

PURPOSE

Research suggests immigrants are at a greater risk of mental health disorders compared to native-born populations. Thus, the current study investigated factors associated with professional mental help-seeking intention among American immigrants.

METHOD

A cross-sectional study was conducted with 207 first-generation Iranian Americans, and data were collected using survey questionnaires.

RESULTS

Younger Iranians living in western states in the United States and those with positive attitudes toward professional mental health services had greater intention to seek these services. Unexpectedly, those with better mental health literacy (MHL) held more mental health stigma (MHS).

CONCLUSION

Findings elucidated valuable insights into the complex dynamics among sociodemographic factors, acculturation, MHL, MHS, attitudes, and intentions toward professional mental health help-seeking. We also highlighted the intricate relationship between MHL and MHS, suggesting that strategies to improve MHL may not necessarily mitigate MHS within this community. Therefore, integrating anti-stigma, contact-based approaches to MHL programs could effectively reduce stigma while facilitating mental health help-seeking. [Journal of Psychosocial Nursing and Mental Health Services, 62(12), 37-48.].

A Critical Scoping Review of Mental Health and Wellbeing Research with Multiracial Subsamples 2012-2022

This critical scoping review examined a decade of mental health and wellbeing outcome research inclusive of subsamples of multiracial participants (or persons identifying with two or more different racial groups) in order to draw initial conclusions about the contemporary state of multiracial mental health. Mental health disparities research inclusive of multiracial subsamples appears to be trending upward. Studies that used subsample analyses offer initial evidence that multiracial persons are at greater risk to experience worsened mental health in comparison to white monoracial peers, and that this disparity is compounded for multiracial persons from gender and/or sexual minoritized groups. This review uncovered numerous theoretical and methodological inconsistencies that constrained existing research from advancing more meaningful understandings of how white supremacy and systemic mono/racism differently impact the mental health and wellbeing of multiracial persons in the USA. Implications for future mental health disparities research inclusive of multiracial subsamples are presented.

Cumulative Disadvantage or Strained Advantage? Remote Schooling, Paid Work Status, and Parental Mental Health during the COVID-19 Pandemic

During the COVID-19 pandemic, parents experienced difficulties around employment and children's schooling, likely with detrimental mental health implications. We analyze National Longitudinal Survey of Youth 1997 data (N = 2,829) to estimate depressive symptom changes from 2019 to 2021 by paid work status and children's schooling modality, considering partnership status, gender, and race-ethnicity differences. We draw on cumulative disadvantage theory alongside strained advantage theory to test whether mental health declines were steeper for parents with more disadvantaged statuses or for parents with more advantaged statuses. Parents with work disruptions, without paid work, or with children in remote school experienced the greatest increases in depressive symptoms, with steepest increases among single parents without paid work and single parents with children in remote school (cumulative disadvantage), fathers without paid work (strained advantage), and White parents with remote school (strained advantage). We discuss the uneven impacts of the pandemic on mental health and implications for long-term health disparities.

Social Vulnerability, COVID-19, Racial Violence, and Depressive Symptoms: a Cross-sectional Study in the Southern United States

BACKGROUND

In March 2020, the novel 2019 coronavirus disease (COVID-19) was declared a pandemic. In May 2020, George Floyd was murdered, catalyzing a national racial reckoning. In the Southern United States, these events occurred in the context of a history of racism and high rates of poverty and discrimination, especially among racially and ethnically minoritized populations.

OBJECTIVES

In this study, we examine social vulnerabilities, the perceived impacts of COVID-19 and the national racial reckoning, and how these are associated with depression symptoms in the South.

METHODS

Data were collected from 961 adults between June and November 2020 as part of an online survey study on family well-being during COVID-19. The sample was majority female (87.2%) and consisted of 661 White participants, 143 Black participants, and 157 other racial and ethnic minoritized participants. Existing social vulnerability, perceived impact of COVID-19 and racial violence and protests on families, and depressive symptoms were assessed. Hierarchical regression analysis was used to predict variance in depressive symptoms.

RESULTS

Half of the sample (52%) reported a negative impact of COVID-19, and 66% reported a negative impact of national racial violence/protests. Depressive symptoms were common with 49.8% meeting the cutoff for significant depressive symptoms; Black participants had lower levels of depressive symptoms. Results from the hierarchical regression analysis indicate social vulnerabilities and the perceived negative impact of COVID-19 and racial violence/protests each contribute to variance in depressive symptoms. Race-specific sensitivity analysis clarified distinct patterns in predictors of depressive symptoms.

CONCLUSION

People in the South report being negatively impacted by the confluence of the COVID-19 pandemic and the emergence of racial violence/protests in 2020, though patterns differ by racial group. These events, on top of pre-existing social vulnerabilities, help explain depressive symptoms in the South during 2020.

The unmet mental health needs of U.S. adults living with chronic pain

ABSTRACT

Previous research suggests that individuals with mental health needs and chronic pain may be less likely to use mental health treatment compared with those with mental health needs only. Yet, few studies have investigated the existence of population-level differences in mental health treatment use. We analyzed data from the National Health Interview Survey (n = 31,997) to address this question. We found that chronic pain was associated with end-to-end disparities in the mental health journeys of U.S. adults: (1) Those living with chronic pain are overrepresented among U.S. adults with mental health needs; (2) among U.S. adults with mental health needs, those living with chronic pain had a lower prevalence of mental health treatment use; (3) among U.S. adults who used mental health treatment, those living with chronic pain had a higher prevalence of screening positive for unremitted anxiety or depression; (4) among U.S. adults living with both chronic pain and mental health needs, suboptimal mental health experiences were more common than otherwise-just 44.4% of those living with mental health needs and co-occurring chronic pain reported use of mental health treatment and screened negative for unremitted anxiety and depression, compared with 71.5% among those with mental health needs only. Overall, our results suggest that U.S. adults with chronic pain constitute an underrecognized majority of those living with unremitted anxiety/depression symptoms and that the U.S. healthcare system is not yet adequately equipped to educate, screen, navigate to care, and successfully address their unmet mental health needs.

Change in mental health service utilization from pre- to post-COVID-19 period in the United States

Objectives

This study aimed to explore the change in mental health service utilization before and after the COVID-19 pandemic as well as determine the association of various sociodemographic characteristics and comorbidities on the utilization pattern.

Methods

Data from the National Health Interview Survey (NHIS) 2019 and 2022 were explored in this study. Along with the univariate analysis, bivariate analysis was conducted using the Chi-square and Cochran-Armitage trend tests. Stepwise binary logistic regression was implemented to find the best-fitted model and examine the effects of different factors on mental healthcare utilization. We also conducted a subgroup analysis for the variables that showed heterogeneous changes in utilization from 2019 to 2022.

Results

Analysis of a total of 53,856 complete cases showed that the percentage of mental healthcare utilization changed from 20% in 2019 to 23.31% in 2022. Logistic regression results showed that the odds of mental health service utilization in the post-COVID period is 1.41 times of the pre-COVID [95% CI odds ratio (OR) = (1.26, 1.58)]. Sex, age, race, education, income group, insurance coverage, birth country, marital status, limitations of social functioning, having a place for healthcare, symptoms and history of depression/anxiety, diabetes, and hypertension had significant effects on the odds of receiving mental healthcare. Subgroup analysis revealed that the utilization changed significantly from 2019 to 2022 for age group "18-34" [OR = 1.41, 95% CI = (1.26, 1.58)], "35-49" [OR = 1.35, 95% CI = (1.21, 1.50)], and "50-64" [OR = 1.12, 95% CI = (1.01, 1.24)], while for the age group "above 64" was not significant.

Conclusion

Pre- and post-COVID periods were found to be significantly different in terms of the utilization of mental healthcare utilization. Changes in the utilization was also found to differ in terms of different age groups.

Why Collect and Use Race/Ethnicity Data? A Qualitative Case Study on the Perspectives of Mental Health Providers and Patients During COVID-19

CONTEXT

Calls to collect patients' race/ethnicity (RE) data as a measure to promote equitable health care among vulnerable patient groups are increasing. The COVID-19 pandemic has highlighted how a public health crisis disproportionately affects racialized patient groups. However, less is known about the uptake of RE data collection in the context of mental health care services.

METHODOLOGY

A qualitative case study used surveys with mental health patients (n = 47) and providers (n = 12), a retrospective chart review, and a focus group to explore healthcare providers' and patients' perspectives on collecting RE data in Canada.

RESULTS

The patient survey data and focus groups show that patients avoid providing identifying information due to perceived stigma and discrimination and a lack of trust. Providers did not feel comfortable asking patients about RE, leading to chart review data where RE information was not systematically collected.

CONCLUSIONS

The uptake and implementation of RE data collection in mental health care contexts require increased training and support, systematic implementation, and further evaluation and measurement of how the collection of RE data will be used to mitigate systemic racism and improve mental health outcomes.

Developing a Statewide Strategic Plan for Prevention, Early Identification, and Treatment of Psychosis

Access to evidence-based programs that address early psychosis is a substantial public health concern. The authors describe the community-engaged, data-driven process that informed the development of the Massachusetts Strategic Plan for Early Psychosis, an effort to identify actionable priorities to build a system of prevention and care that responds to the needs of individuals who experience psychosis and their caregivers. A multiphase, mixed-methods approach was used to gather knowledge from young adults experiencing early psychosis and their caregivers, including two symposia with diverse stakeholders. Six overarching goals were identified, each with possible action steps and stigma reduction strategies: connecting and supporting individuals who experience psychosis and their families, promoting early identification of and intervention for psychosis through community education, providing specialized support to key community members, providing specialized support to medical and behavioral health care professionals, supporting specialized treatment teams in the delivery of evidence-based care, and developing a statewide system of psychosis services. Next steps for and operationalization of the statewide strategic plan for psychosis in Massachusetts will require a population health approach that engages the community through intersectoral and multisectoral strategies.

Impact of the COVID-19 pandemic on participants in pragmatic clinical trials for chronic pain: implications for trial outcomes and beyond

OBJECTIVE

The COVID-19 pandemic had profound effects on society, including those living with chronic pain. This study sought to examine pandemic impacts on individuals enrolled in pragmatic clinical trials focused on nonpharmacological treatments for chronic pain.

METHODS

We evaluated responses to a questionnaire on COVID-19 impacts that had been administered to participants (n=2024) during study enrollment in 3 pragmatic clinical trials for chronic pain treatment. All trials were part of the National Institutes of Health (NIH)-Department of Veterans Affairs (VA)-Department of Defense (DOD) Pain Management Collaboratory. COVID-19-related impacts on access to health care, mental health, finances, ability to meet basic needs, and social support were assessed.

RESULTS

Pandemic impacts were found in all domains assessed, including access to health care, mental and emotional health, ability to meet basic needs, finances, and social support. Impacts varied by demographic and clinical characteristics. The participants most negatively impacted by the pandemic were younger, Black or Latino, female, more educated, and unemployed and had screened positive for depression. No impact differences were found with regard to alcohol use disorder screenings or a prior history of COVID-19. Higher levels of pain were associated with worse pandemic impacts, and negative impacts declined over time.

CONCLUSIONS

Negative impacts of the pandemic on individuals living with chronic pain cut across aspects of life that are also central to effective pain management, including access to health care, social support, and mental and emotional health, with differential impacts found across key demographic and clinical factors. These findings should yield consideration of pandemic impacts in clinical practice and as moderating effects of treatment outcomes in clinical trials conducted during the pandemic.

Latent Profile Analysis of Acute Stress Disorder Symptoms and Their Links to Individual Characteristics and Mental Health Among College Students During the Early COVID-19 Pandemic

OBJECTIVES

acute stress disorder (ASD) became prevalent among various populations during the COVID-19 pandemic, yet little research has examined the heterogeneity of ASD symptoms among college students. The purpose of this research was to explore subgroups of ASD symptoms using latent profile analysis (LPA) and to explore the predictors and mental health outcomes associated with these profiles.

METHODS

Using the person-centered method, we recruited 1198 college students (71.7% female) who self-reported their ASD, perceived social support, anxiety, depression, and life satisfaction from two Chinese universities following the COVID-19 outbreak.

RESULTS

The LPA results found three ASD symptom severity profiles: low (56.7%), moderate (31.6%), and high (11.7%), particularly characterized by reexperiencing and arousal symptoms. This study found that students in the moderate and high ASD subgroups were more likely to be female, have lower socioeconomic status, belong to minority groups, report lower self-rated health, and perceive less social support compared to those in the low ASD subgroup. Furthermore, compared to the low and moderate ASD subgroups, the high ASD subgroup was linked to elevated anxiety and depression and lower life satisfaction.

CONCLUSIONS

These findings underscore the significance of identifying specific ASD symptom subgroups to effectively target prevention and intervention efforts.

Prevalence of Depressive Symptoms in a Predominantly Hispanic/Latinx South Texas Community in the Aftermath of the COVID-19 Pandemic

OBJECTIVE

COVID-19 has a lasting impact on mental health, particularly within the Hispanic/Latinx communities. This paper empirically investigates the post-COVID-19 presence and severities of depression, one of the most common mental health disorders, among adults in a predominantly U.S.-born Hispanic/Latinx community in South Texas composed primarily of Mexican Americans.

METHODS

Multiple statistic regression models were applied to data from 515 adults in Nueces County who completed all questions in a survey from convenience sampling between June 2022 and May 2023. Depression was assessed using both standard PHQ-2 and PHQ-9 measurements.

RESULTS

Of the 515 participants, 377 (64.5%) were Hispanic, and 441 (85.6%) had a high school education or higher, reflecting the county's demographics. About half of the participants (47%) reported mild/moderate to severe depression. The regression model estimation results reveal that female participants, those not in full-time employment, and individuals with disabilities were more likely to feel depressed after COVID-19. Middle-aged adults demonstrated greater resilience to depression compared to other age groups. Notably, non-Hispanic participants in the study reported higher levels of depression compared to their Hispanic counterparts. Additionally, COVID-19-related experiences, such as testing positive for the virus, being hospitalized, or having a history of depression before COVID-19, were associated with higher levels of reported depression.

CONCLUSIONS

COVID-19 has significantly impacted the mental health of this predominantly U.S.-born Hispanic/Latinx community. These findings can assist healthcare providers and policymakers in developing targeted strategies to tailor interventions aimed at enhancing mental health well-being, reducing disparities, and fostering overall improvement within the Hispanic/Latinx community.

A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions

This study employed a Reasoned Action Approach to investigate two communication behaviors that were being built into a statewide behavioral health campaign: initiating a conversation about one's own mental health struggles, and starting a conversation to discuss someone else's mental health difficulties. We examined whether the extent of attitudes, perceived norms, and perceived behavioral control regarding intent to perform these behaviors varied by racial identity. Using original survey data from Texans (N = 2,033), we conducted regression analyses for the two communication behaviors and found that intention to seek help was primarily explained by instrumental attitude, injunctive norm, descriptive norm, and perceived capacity; and intention to start a conversation to help someone else was primarily explained by instrumental attitude, injunctive norm, and perceived capacity. Additionally, we identified important common and distinct determinants of the two behaviors across different racial groups. Implications for health communication campaign message development and audience segmentation are discussed.

Psychosocial alterations during the COVID-19 pandemic and the global burden of anxiety and major depressive disorders in adolescents, 1990-2021: challenges in mental health amid socioeconomic disparities

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic, a global health crisis, profoundly impacted all aspects of daily life. Adolescence, a pivotal stage of psychological and social development, is heavily influenced by the psychosocial and socio-cultural context. Hence, it is imperative to thoroughly understand the psychosocial changes adolescents experienced during the pandemic and implement effective management initiatives.

DATA SOURCES

We examined the incidence rates of depressive and anxiety disorders among adolescents aged 10-19 years globally and regionally. We utilized data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to compare pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Our investigation covered 204 countries and territories across the six World Health Organization regions. We conducted a comprehensive literature search using databases including PubMed/MEDLINE, Scopus, and Google Scholar, employing search terms such as "psychosocial", "adolescent", "youth", "risk factors", "COVID-19 pandemic", "prevention", and "intervention".

RESULTS

During the pandemic, the mental health outcomes of adolescents deteriorated, particularly in terms of depressive and anxiety disorders. According to GBD 2021, the incidence rate of anxiety disorders increased from 720.26 [95% uncertainty intervals (UI) = 548.90-929.19] before the COVID-19 pandemic (2018-2019) to 880.87 per 100,000 people (95% UI = 670.43-1132.58) during the COVID-19 pandemic (2020-2021). Similarly, the incidence rate of major depressive disorder increased from 2333.91 (95% UI = 1626.92-3138.55) before the COVID-19 pandemic to 3030.49 per 100,000 people (95% UI = 2096.73-4077.73) during the COVID-19 pandemic. This worsening was notably pronounced in high-income countries (HICs). Rapid environmental changes, including heightened social anxiety, school closures, economic crises, and exacerbated racism, have been shown to adversely affect the mental well-being of adolescents.

CONCLUSIONS

The abrupt shift to remote learning and the absence of in-person social interactions heightened feelings of loneliness, anxiety, sadness, and stress among adolescents. This change magnified existing socioeconomic disparities, posing additional challenges. These complexities profoundly impact adolescents' well-being, especially vulnerable groups like those from HICs, females, and minorities. Acknowledging the underreporting bias in low- to middle-income countries highlights the importance of addressing these mental health alterations in assessments and interventions within these regions as well. Urgent interventions are crucial as the pandemic-induced mental stress may have lasting effects on adolescents' mental health.

Food Insufficiency Increased After The Expiration Of COVID-19 Emergency Allotments For SNAP Benefits In 2023

In response to economic distress and food insecurity during the COVID-19 pandemic, Congress expanded the Supplemental Nutrition Assistance Program (SNAP) by introducing emergency allotments to increase monthly benefits, starting in March 2020. In March 2023, emergency allotments expired in the thirty-five states and territories still offering them. We provide some of the first evidence of the impacts of this loss of nutrition support-in some cases, more than $250 a month-for economically disadvantaged households. Our quasi-experimental study examined the effects of the program's expiration on food insufficiency, mental health, and financial well-being, using data from the Census Bureau's Household Pulse Survey. In difference-in-differences analyses, we compared pre-post differences among SNAP participants with pre-post differences among income-eligible nonparticipants. The emergency allotment expiration led to a substantial increase in food insufficiency (8.4 percentage points) and greater food pantry use (2.1 percentage points) and difficulty paying expenses (2.0 percentage points). Non-Hispanic Black SNAP participants experienced a greater increase in anxiety symptoms compared with non-Hispanic White SNAP participants. This study has implications for ongoing policy making with respect to nutrition and safety-net programs to support vulnerable families, especially amid inflated food prices.

How Can the Roma Deal with the Health and Social Crisis Generated by the COVID-19 Pandemic? Inequalities, Challenges, and Successful Actions in Catalonia (Spain)

The Roma is the most excluded non-migrant ethnic minority in Europe, facing prejudice, intolerance, discrimination, and social exclusion in their daily lives. This has led to a huge gap in several social domains between the Roma and non-Roma created for centuries. The COVID-19 pandemic has only increased the social and health inequalities that the Roma faced. In this context, it is important to identify actions that have been successful in mitigating the effects that the COVID-19 has had in increasing such inequalities. This paper presents the findings of a mixed-method study carried out in Catalonia (Spain) with the participation of more than 500 Roma, who reported their experience. The study results confirm the significant vulnerability and the negative impact of the COVID-19 pandemic on the Roma communities. Our research also highlights several successful actions developed by the Integrated Plan for the Roma of the Catalan Government, such as health literacy and adult education, as having a positive impact on the quality of life of many Roma during the health and social crisis generated by the COVID-19 pandemic. This paper suggests that the lessons learned from Catalonia could be transferred to other contexts across Europe and guide decision makers to promote the social inclusion and quality of life of the Roma, protecting Roma communities during current and future pandemics.

Associations of adverse childhood experiences with depression and anxiety among children in the United States: Racial and ethnic disparities in mental health

OBJECTIVE

To assess associations of ACEs with depression and anxiety, with special emphasis on potential racial and ethnic disparities.

METHOD

Data were from the National Survey of Children's Health (NSCH), 2021-2022, a large, cross-sectional, nationally representative, population-based study of United States children aged 0-17. The associations of cumulative ACEs with depression and anxiety among 104,205 children and adolescents were assessed via multivariable logistic regression, including adjustment for age, sex, race, household income, and parental educational attainment.

RESULTS

ACEs were associated with depression and anxiety in a linear, dose-dependent manner. After adjustment for covariates, compared to no ACE exposures, participants with exposures to one, two, and three ACEs exhibited significantly higher odds of depression (fully-adjusted ORs and 95 % CIs = 2.18 [2.03, 2.35], 4.95 [4.55, 5.39], and 11.39 [10.18, 12.75], respectively). For anxiety, compared to no ACEs exposures, participants with exposure to one, two, and three ACEs had significantly higher odds of anxiety (fully-adjusted ORs and 95 % CIs = 1.90 [1.81, 2.00], 3.66 [3.44, 3.90], and 6.91 [6.30, 7.58], respectively). Notably, stratified analyses indicated potential effect modification by race, wherein the associations of ACEs with depression and anxiety were strongest in Black and White participants.

CONCLUSION

ACEs were robustly associated with depression and anxiety in a national sample of U.S. children and adolescents, with differential impacts of ACES on mental health observed across racial and ethnic groups. These findings underscore the need for urgent government and healthcare interventions and policies to ameliorate ACEs' health effects, especially among disproportionately impacted minority groups.

The Worst of Times: Depressive Symptoms Among Racialized Groups Living With Dementia and Cognitive Impairment During the COVID-19 Pandemic

Objective: To explore differences in depressive symptoms for older adults (Black, Latinx, and White) by cognitive status during the 2020 COVID-19 pandemic. Methods: Data from the Health and Retirement Study identified older adults as cognitively normal, cognitively impaired without dementia (CIND), and persons living with dementia (PLWD). Multiple linear regression analyses examined associations between cognitive status and depressive symptoms among these racialized groups. Results: Compared to the cognitively normal older adults racialized as Black, those with CIND reported higher depressive symptoms during the pandemic (overall and somatic) and PLWD had higher somatic symptoms (p < .01). Older adults racialized as White with CIND reported higher somatic (p < .01) symptoms compared to cognitively normal older adults racialized as White. Discussion: The COVID-19 pandemic was a challenging event among older adults racialized as Black with CIND and PLWD. Future studies should examine if these depressive symptoms persist over time.