Predictors of Mental Health Services Use Across the Life Course among Racially-Ethnically Diverse Adults

A Brief Review of Mental Health Issues among Asian and Pacific Islander Communities in the U.S

The purpose of this paper is to provide a brief summary of mental health issues among Asian and Pacific Islander (API) communities in the U.S. APIs include individuals from Far East Asia (e.g., Korea, China), Central Asia (e.g., Afghanistan, Uzbekistan), South Asia (e.g., India, Pakistan), South East Asia (e.g., Thailand, Philippines), Western Asia (e.g., Iran, Saudi Arabia), and Pacific islands (e.g., Hawaii, Samoa, Mariana island, Fiji, Palau, French Polynesia, Marshall Islands, Micronesia, New Zealand, Tokelau islands, Niue, and Cook Islands). Collectively they speak more than one hundred languages and dialects. Such a diversity across the API community presents unique challenges and opportunities for research, education, and practice. The existing body of literature on mental health issues in API communities is marred by the lack of high-quality data and insufficient degrees of disaggregation. Such a knowledge gap hindered our ability to develop culturally and linguistically tailored interventions, and in turn, API communities have experienced mental health disparities and mental health services’ disparities. To move the field forward, future research effort with APIs should focus on articulating variations across different API subgroups, identifying what explains such variations, and examining the implications of such variations to research, practice, education, and policy.

Selection Into Mental Health Services Among Persons With Depression

OBJECTIVE

This study aimed to identify sociodemographic and health characteristics associated with use of different mental health services (medication only, counseling only, or both) among persons with depression.

METHODS

The analytic sample consisted of adults who had a major depressive episode in the past year and received outpatient professional mental health services (N=4,169). Multinomial logistic regressions were computed with data from the 2015 and 2016 National Survey on Drug Use and Health to identify factors associated with the relative odds of receiving each modality of mental health service.

RESULTS

Sixty-nine percent of the sample received both prescription medication and counseling (talking to a professional health care provider about depression), 22% received counseling only, and 9% received medication only. Being ordered into care and higher probability of having a severe mental illness were associated with higher odds of receiving both medication and counseling.

CONCLUSIONS

How people with depression enter care and select into different mental health service modalities might be an indicator of access. Factors that affect selection into these modalities might also be associated with outcomes of care. Findings could inform efforts to remove modality-specific barriers to treatment, improve timely access to care, and reduce unmet need for mental health care among persons with depression.

Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center

PURPOSE

Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults.

METHODS

We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement.

RESULTS

Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20-0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01-1.08) and suicide attempt (OR 5.79, 95% CI: 2.08-16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73-173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62-125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72-25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26-16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32-87.53), anxiety disorders (OR 15.84, 95% CI: 2.00-125.72), and MDD (OR 10.45, 95% CI: 2.28-47.98).

CONCLUSION

Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement.

High Occurrence of Psychiatric Disorders and Suicidal Behavior Across Dementia Subtypes

OBJECTIVE

To compare occurrence of clinically diagnosed psychiatric disorders and suicidal behavior (mental health disorders) across dementia subtypes in the largest healthcare system in the United States.

METHODS

We aggregated two national databases (Department of Veterans Affairs [VA] National Patient Care Database, National Suicide Prevention Applications Network [SPAN]) and estimated 2-year prevalence of mental health disorders across five dementia subtypes during fiscal years 2012-2013. Using VA healthcare systems throughout the United States, the sample included 56,296 older patients (≥50 years) with Alzheimer's disease (AD; n = 30,578), vascular dementia (VD; n = 17,924), frontotemporal dementia (FTD; n = 1,181), Lewy body dementia (LBD; n = 3,194), and mixed dementia (MD; n = 3,419). Mental health disorders were determined by International Classification of Diseases, Ninth Revision, Clinical Modification codes and the National SPAN.

RESULTS

Roughly 25% of patients had at least one mental health disorder, with 2-year prevalence reaching 30%-45% in FTD, VD, LBD, and MD. Compared with other subtypes, patients with FTD had the highest prevalence of mood (19%), anxiety (20%), and substance use (19%) disorders, as well as suicidal behavior (4%), with nearly 0.5% with a suicidal plan/attempt. Those with VD also showed a high prevalence of these disorders (14%-17%). Although patients with LBD and MD had a slightly lower prevalence of mood and anxiety disorders (12%-15%), they had a much lower prevalence of substance use disorders (9%) and suicidal behavior (2%). Patients with AD had the lowest 2-year prevalence of all mental health disorders (<7%).

CONCLUSION

Occurrence of mental health disorders is high and differs across dementia subtypes, highlighting the importance of reducing the burden of mental health disorders in dementia subtypes.

Prevalence of mental disorders in Uganda: a systematic review protocol

REVIEW QUESTION

The questions to be addressed by this systematic review are.

Coping with mental health issues among older Hispanic adults

Access to mental health services for older Hispanic adults is limited and often older Hispanic adults must rely on their own resources in dealing with mental health issues. The aim of this study was to understand how older Hispanic immigrants cope mental health issues (e.g. stress, anxiety, and/or depression). A qualitative, descriptive approach was used to interview 17 older Hispanic immigrants from Guatemala, Dominican Republic and Colombia. Interviews were audio recorded, transcribed and translated verbatim by bilingual research assistants. Data were analyzed using content analysis with a combination of immersion/crystallization, editing and template organizing styles. Ways of coping included spiritual beliefs and religious practices, social support, distraction, medications and professional help. Primary care providers may be more effective if they build upon the cultural constructs that undergird older Hispanic immigrants' ways of coping in addressing emotional distress and mental health issues in this population.

Burden of Depressive Symptoms Over 2 Decades and Risk of Nursing Home Placement in Older Women

OBJECTIVES

To determine the association between cumulative burden of depressive symptoms and risk of nursing home (NH) placement over 2 decades.

DESIGN

Prospective cohort study with data linked to Medicare claims files.

SETTING

Clinic sites in Baltimore, Maryland; Minneapolis, Minnesota; and the Monongahela Valley near Pittsburgh, Pennsylvania.

PARTICIPANTS

Initially community-dwelling women aged 65 and older (N=3,646).

MEASUREMENTS

Depressive symptom burden was determined using the Geriatric Depression Scale measured over 18 years to calculate accumulation of burden. NH placement was determined using Medicare claims data.

RESULTS

In Fine-Gray proportional hazards analyses including demographic characteristics, medical comorbidities, functional impairment, and recent depression exposure and accounting for competing risk of death, women with low depressive symptom burden were twice as likely to experience NH placement as those with minimal burden (hazard ratio (HR) = 1.92, 95% confidence interval (CI) = 1.16-3.20), women with moderate burden were more than twice as likely (HR = 2.62, 95% CI = 1.59-4.31), and women with high burden (HR = 3.08, 95% CI = 1.87-5.08) were three times as likely. The addition of antidepressant use to this model attenuated the risk only slightly.

CONCLUSION

In older women, cumulative burden of depressive symptoms over nearly 2 decades is associated with greater risk of transitioning from community-living to a NH irrespective of recent depression exposure, medical comorbidities, functional impairment, and the competing risk of death. This work supports the need for improving recognition, monitoring, and treatment of depressive symptoms early, which may reduce or delay NH placement.