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Covino N, Abelard M, Mahr B, Ibrahim Y, Louis GS. The Behavioral Health Service Corps: An Innovative Model for Workforce Development. Community Ment Health J 2025; 61:956-961. [PMID: 39714562 DOI: 10.1007/s10597-024-01434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 12/08/2024] [Indexed: 12/24/2024]
Abstract
The increased prevalence of behavioral health problems in the US is intensified by the critical shortage of providers in the field. The historical failure of behavioral health specialties to attract BIPOC students and workers limits leadership, access to quality care, and the generalizability of research findings. Most workforce development programs serve only those with earned graduate degrees. This report describes a service-learning program that is successfully attracting new graduates with bachelor's degrees and culturally diverse professionals into the behavioral health workforce.
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Affiliation(s)
| | - Marc Abelard
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Bori Mahr
- Babson College, Wellesley Hills, MA, USA
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Ruiz-Yu B, Ni HW, He E. The Role of Interactional Processes in Mental Health Disparities: A Narrative Review of Existing Research and Recommendations for Providers. J Clin Psychol Med Settings 2025; 32:239-252. [PMID: 39187647 DOI: 10.1007/s10880-024-10025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 08/28/2024]
Abstract
Mental health disparities between racial/ethnic minority groups and non-Latinx Whites in the United States persist despite significant efforts aimed at decreasing these disparities. Efforts to address mental health disparities have largely focused on individual (e.g., stigma, help-seeking, health behaviors) and structural (e.g., public policy, interventions, addressing poverty) level factors. In contrast, this paper considers how processes at the interactional level (i.e., interactions between patients and providers) are also an important contributor to racial/ethnic disparities in mental health. Specifically, social psychological research has demonstrated how biases, including stereotypes, prejudice, and discrimination, can affect patient-provider interactions and contribute to mental health disparities. This narrative review of empirical studies that examine interactional processes between patients and mental health providers identified eleven studies to be included. Concepts represented in the studies are summarized and additional frameworks that can help explain how disparities are maintained are proposed. Last of all, practical suggestions for mitigating provider bias during patient-provider interactions are provided based on the findings from the narrative review.
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Affiliation(s)
- Bernalyn Ruiz-Yu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
- Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA.
| | - H Wenwen Ni
- Department of Psychology, Sonoma State University, Rohnert Park, CA, USA
| | - Emily He
- Department of Psychology, Clark University, Worcester, MA, USA
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3
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Loren DM, Reuter T, Bickham N, Booth RT. Racial/Ethnic Trends in Virtual Mental Health Care Utilization Among Undergraduate Students: A Descriptive Study. J Racial Ethn Health Disparities 2025; 12:2023-2032. [PMID: 38780870 PMCID: PMC12069134 DOI: 10.1007/s40615-024-02028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Undergraduate students are particularly in need of mental health support, but demand has far surpassed resources. This gap between mental health diagnoses and support is particularly large among Asian, Hispanic/Latinx, and Black students. Supplementing on-campus care with a virtual-only behavioral health partner may shift these trends. OBJECTIVE This study is aimed at comparing the number of undergraduate students from different racial/ethnic groups (White, Asian, Islander, Hispanic/Latinx, Black, Native, and Multiracial) engaging in virtual mental health visits as part of a partnership with a company providing virtual-only care, with the total enrolled undergraduate students at the same 113 institutions. METHODS We used de-identified visit data and self-reported race/ethnicity to define the "patient" population of undergraduates accessing care. We compared that to the full "student" population of undergraduates among the same schools, available as part of the Integrated Postsecondary Education Data System (IPEDS). RESULTS Patient population race/ethnicity (N = 14,870) differed significantly from student population race/ethnicity (N = 619,459). A significant effect ( χ 26 = 2258, P < .001) indicated that patient demographics differed from student demographics. We found proportionally more Asian, Black, and Multiracial patients than students. At the same time, we found proportionally fewer White and Hispanic/Latinx patients than students. CONCLUSIONS We conclude that, in contrast to prior literature in traditional mental health care, some racial/ethnic minority undergraduates (Asian, Black, and Multiracial) may actually access care at a higher rate under a fully virtual model. On the other hand, White and Hispanic/Latinx students may access care less frequently.
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Affiliation(s)
- D M Loren
- TimelyCare, 1315 S Adams St., Fort Worth, TX, 76104, USA.
| | - T Reuter
- TimelyCare, 1315 S Adams St., Fort Worth, TX, 76104, USA
| | - N Bickham
- TimelyCare, 1315 S Adams St., Fort Worth, TX, 76104, USA
| | - R T Booth
- TimelyCare, 1315 S Adams St., Fort Worth, TX, 76104, USA
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Lê Cook B, McConnell KJ, Parry G, Flores M, Renfro S, Kumar A, Holmes C, Reddy A, Takalkar R, Mullin B, Normand SLT, Horvitz-Lennon M. Disparities in Access to Serious Mental Illness Care Following the Implementation of Value-Based Payment Reform in the Oregon Medicaid Program. Med Care Res Rev 2025:10775587251339969. [PMID: 40433969 DOI: 10.1177/10775587251339969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2025]
Abstract
Racial and ethnic disparities in mental health care access are especially consequential for the health outcomes of Medicaid beneficiaries living with serious mental illness (SMI). This descriptive study of Oregon Medicaid claims data assessed for disparities in access to SMI care for Oregon's adult Medicaid beneficiaries from 2010 to 2019, examining changes following the implementation of value-based payment (VBP) in 2012. Multivariable regression analyses compared changes in access to SMI care, pre- and post-VBP implementation, by race and ethnicity. Relative to White beneficiaries, VBP implementation was associated with net increases of 0.28% (95% confidence interval [CI]: [0.01%, 0.55%]) in the rate of access among Black beneficiaries (a complete reduction of the pre-VBP disparity) and 0.34% (95% CI: [0.17%, 0.51%]) among Latinx beneficiaries (narrowing but not closing the pre-VBP disparity). The Oregon policy's focus on access, equity, and beneficiaries with mental illness might have contributed to the observed reductions in disparities.
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Affiliation(s)
| | | | - Gareth Parry
- Cambridge Health Alliance and Harvard Medical School, MA, USA
| | - Michael Flores
- Cambridge Health Alliance and Harvard Medical School, MA, USA
| | | | | | | | | | | | | | | | - Marcela Horvitz-Lennon
- Cambridge Health Alliance and Harvard Medical School, MA, USA
- RAND Corporation, Boston, MA, USA
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Mahinpey N, Amoako A, Williams DR, Siddiqi A. Race, discrimination, and mental health adversity in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2025:10.17269/s41997-025-01021-9. [PMID: 40399605 DOI: 10.17269/s41997-025-01021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 02/27/2025] [Indexed: 05/23/2025]
Abstract
OBJECTIVE Canada is undergoing a crisis in mental health, and the federal government has established a strategy that is attentive to mental health among Black people. Our objective is to inform this work by understanding the relationships between race, discrimination, and mental health outcomes. METHODS We obtained a sample of 17,526 respondents from the Canadian Community Health Survey Rapid Response Module on Experiences of Discrimination, which asked about respondent race and other sociodemographic and socioeconomic characteristics, the validated Williams Everyday Discrimination Scale, and mental health outcomes (mood and anxiety disorders, substance use, and self-rated mental health). We ran descriptive statistics as well as crude, sociodemographic- and socioeconomic-adjusted logistic regressions to assess relationships in the overall sample between race and the Williams Discrimination Scale and between the Williams Discrimination Scale and mental health outcomes. RESULTS Compared to white people, Black people had two to three times the odds of experiencing frequent discrimination, while Asian people were not statistically different from white people. Frequent experiences of everyday discrimination in the sample were associated with between 40% and two times the odds of experiencing adverse mental health outcomes, though white people had the highest prevalences of adverse mental health outcomes in the sample. CONCLUSION In Canada, experiences of discrimination can produce adverse mental health outcomes, and Black people in particular experience high degrees of discrimination compared to all other racial groups. National health surveys should contain larger and more representative samples of non-white individuals, which allow for more complex analyses.
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Affiliation(s)
- Newsha Mahinpey
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Afia Amoako
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David R Williams
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, ON, Canada.
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada.
- Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
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Kwong K, Ahuvia IL, Schleider JL. Help-seeking at the intersection of race and age: Perceived need and treatment access for depression in the United States. J Affect Disord 2025; 386:119428. [PMID: 40398614 DOI: 10.1016/j.jad.2025.119428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Revised: 05/09/2025] [Accepted: 05/16/2025] [Indexed: 05/23/2025]
Abstract
Race/ethnicity and age are well-documented factors that influence help-seeking variables for adults with depression, yet the intersection of race/ethnicity and age on help-seeking is less known. The present study examined the intersection of race/ethnicity (comparing racial minority groups to White adults) and age on perceived need, treatment access, and unmet need for mental health services among adults with a past-year major depressive episode (N = 35,033) using data from the 2010-2019 waves of the National Survey on Drug Use and Health. After controlling for age, Black (OR = 0.50), Hispanic (OR = 0.50), Pacific Islander (OR = 0.23), and Asian (OR = 0.39) respondents had lower odds of perceiving need (p's < .001); Black (OR = 0.62), Asian (OR = 0.62), Hispanic (OR = 0.77), and multiracial respondents (OR = 0.75) had lower odds of accessing treatment (p's < .05); and Black (OR = 1.38) and Hispanic (OR = 1.19) respondents had higher odds of reporting an unmet need (p's < .05). After controlling for race, younger and older adults had lower odds of perceiving a need (p's < .05) compared to middle-aged adults. Younger adults had lower odds of accessing treatment and higher odds of experiencing an unmet need (p's < .001). An interaction revealed that Black adults were less likely to perceive need than White adults (p < .001), and this gap was especially large among younger members of both groups (p = .020). These results extend previous research by highlighting the intersection of race/ethnicity and age on help-seeking, with implications for culturally competent and age-appropriate interventions, while emphasizing the need for racial/age equity in the mental health care system.
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Affiliation(s)
- Kelly Kwong
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
| | - Isaac L Ahuvia
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Jessica L Schleider
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Vose-O’Neal A, Christmas S, Alfaro KA, Dunigan R, Leon AP, Hickman D, Johnson A, Kim ML, Reif S. Understanding pathways to recovery from alcohol use disorder in a Black community. Front Public Health 2025; 13:1537059. [PMID: 40376060 PMCID: PMC12078236 DOI: 10.3389/fpubh.2025.1537059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 04/07/2025] [Indexed: 05/18/2025] Open
Abstract
Introduction Black Americans suffer a range of health disparities rising from a long history of structural inequities and racism. Black individuals experience alcohol use disorder (AUD) at rates comparable to the general population, yet they suffer more negative consequences due to alcohol use such as illnesses, injuries, criminal-legal involvement, and social problems. The barriers they face challenge their ability to achieve recovery. However, the recovery needs of the Black population and the potential impact of racial disparities on pathways to recovery have not been examined. Methods We conducted semi-structured interviews with 37 participants in the Black-majority city of Detroit, Michigan, who identified as Black or African American and in recovery from AUD. Participants were 50 years old on average, 40% were women, and they reported being in recovery from alcohol for 8.4 years on average. We built upon a priori codes, using a framework analysis approach, to identify and code thematic domains related to recovery pathways. Results We identified four overarching themes. (1) Delayed recovery initiation largely due to systemic challenges and a lack of knowledge about recovery, resulting in the belief that recovery was not possible. (2) Once initiating recovery, many reported getting stuck in chronic early recovery due to relapse cycles that regularly involved system and individual challenges coupled with inadequate support. (3) Use of blended recovery pathways, some common in the recovery literature (e.g., Alcoholics Anonymous), and some more prevalent in Black communities (e.g., religion/spirituality). (4) The facilitators of recovery vary by recovery stage; for example, receiving support was crucial in early recovery while providing support was important for sustained recovery. Discussion Participants' stories emphasized the burdens experienced by this low-income Black community at personal, interpersonal, environmental and societal levels. They directly connected these burdens with the difficult mission of achieving and sustaining recovery from alcohol problems. Some challenges and recovery pathways were common in the broader population, and some, such as the impact of racism, were unique to this Black population. The results have meaningful implications for clinical treatment and recovery support improvements, to advance the recovery journeys of Black individuals with AUD.
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Affiliation(s)
- Adam Vose-O’Neal
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Shanesha Christmas
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Karen A. Alfaro
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Robert Dunigan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Alex P. Leon
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Drew Hickman
- Detroit Recovery Project, Detroit, MI, United States
| | - Andre Johnson
- Detroit Recovery Project, Detroit, MI, United States
| | - Meelee L. Kim
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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Rosenthal A, Meyer MS, Bolden-Thompson K, Gobrial S, Shim R, Lesh TA, Ragland JD, Loewy R, Savill M, Carter CS, Niendam TA. Qualitative Analysis of Telephone Logs: Client Engagement and Barriers to Completing an Initial Early Psychosis Assessment. Psychiatr Serv 2025; 76:461-468. [PMID: 40103366 DOI: 10.1176/appi.ps.20230465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
OBJECTIVE Time between the onset of psychosis and the start of treatment significantly influences outcomes. Rapid access to care is essential, yet barriers such as stigma, difficulties with navigating the mental health system, and financial constraints prolong this process. This mixed-methods study aimed to assess how these barriers affect participation in early psychosis services. METHODS A directed content analysis of telephone log data was conducted from intake assessments at an early psychosis clinic. Stepwise logistic regression and analyses of variance were used to evaluate the impact of barriers on assessment completion and time from referral to assessment. RESULTS Of 1,048 individuals screened for early psychosis services, 201 completed a telephone assessment. Individuals who dropped out had a higher proportion of barriers overall than did those who completed the assessment (p<0.01). Greater than 50% of interactions included at least one barrier, with logistical issues being the most common. Increased barriers were correlated with longer assessments and lower completion rates. Adults and Hispanic participants reported more barriers, compared with adolescents and non-Hispanic individuals, respectively. Significant contributors to nonengagement included unknown gender, public insurance, and various barriers. CONCLUSIONS Identifiable barriers to intake assessment were frequently reported by clients and were associated with higher intake noncompletion and a longer assessment process. Efforts to address logistical barriers may represent an essential step in improving the linkage process and reducing the duration of untreated psychosis.
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Affiliation(s)
- Adi Rosenthal
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Monet S Meyer
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Khalima Bolden-Thompson
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Sarah Gobrial
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Ruth Shim
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Tyler A Lesh
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - J Daniel Ragland
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Rachel Loewy
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Mark Savill
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Cameron S Carter
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
| | - Tara A Niendam
- Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy)
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Zhen-Duan J, Tsai AC. Invited commentary: mental health services utilization disparities at the intersection of Asian ethnoracial identity and limited English proficiency. Am J Epidemiol 2025; 194:941-945. [PMID: 38872337 DOI: 10.1093/aje/kwae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024] Open
Abstract
Nguyễn et al. (Am J Epidemiol. 2024;193(10):1343-1351) analyzed data from the US National Survey of Drug Use and Health (NSDUH) to show that Asian American Native Hawaiian/Pacific Islander (AANHPI) adults with limited English proficiency have substantially lower levels of mental health services utilization compared with White adults without limited English proficiency. The findings add to the growing literature using an intersectionality framework to understand health and health care disparities. We comment on the authors' notable examination of intersecting minoritized identities in mental health services utilization and the welcome emphasis on AANHPI health. We discuss the limitations of the NSDUH data, which are administered in English and Spanish only, and their limited ability to support analyses disaggregated by ethnoracial subgroups. We conclude by identifying gaps related to funding, training, and data disaggregation, and we highlight the role of mixed-methods approaches to advance our understanding of intersectionality and health disparities research. This article is part of a Special Collection on Mental Health.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, United States
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Mbarara University of Science and Technology, Mbarara, Uganda
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Burns A, Kampman H, Menachemi N. County characteristics associated with behavioral health emergency medical services calls. HEALTH AFFAIRS SCHOLAR 2025; 3:qxaf054. [PMID: 40190697 PMCID: PMC11970235 DOI: 10.1093/haschl/qxaf054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 02/28/2025] [Accepted: 03/13/2025] [Indexed: 04/09/2025]
Abstract
A substantial portion of the 20 million calls that emergency medical services (EMS) personnel respond to each year are considered preventable, including more than 1.5 million behavioral health calls. Despite goals of preventing behavioral health crises and reducing the burden on patients and EMS personnel, little is known about how demographic and community characteristics influence behavioral health calls. Using nationwide 2021 EMS call data, we identified counties with high behavioral health calls and examined their demographic and community characteristics. Low-income and racially diverse counties had a higher incidence of behavioral health EMS calls, while politically conservative counties had a lower incidence of behavioral health EMS calls. To better meet the emergency behavioral health needs of communities, policy and decision-makers should consider strategies that increase access to and awareness of alternative behavioral health crisis services (eg, 988 Suicide and Crisis Lifeline).
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Affiliation(s)
- Ashlyn Burns
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Haleigh Kampman
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, United States
| | - Nir Menachemi
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, United States
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11
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Pederson AB, McLaughlin C, Hawkins D, Jain F, Anglin D, Yeung A, Tsai AC. Medical Mistrust and Willingness to Use Mental Health Services Among a Cohort of Black Adults. Psychiatr Serv 2025; 76:318-325. [PMID: 39818993 PMCID: PMC11961331 DOI: 10.1176/appi.ps.20240016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2025]
Abstract
OBJECTIVE Black adults experience depression that is more severe than that of their White counterparts, yet they are less likely to receive treatment from a mental health professional. This study aimed to examine the relationships between medical mistrust or trust and the willingness to seek mental health care. METHODS The authors conducted an online cross-sectional survey of 1,043 Black adults in the United States. The primary variables of interest were medical mistrust (measured via the 12-item Group-Based Medical Mistrust Scale; GBMMS) and a single item, derived from the General Help-Seeking Questionnaire, that assessed willingness to seek mental health care. The authors hypothesized that mistrust would have a negative correlation with willingness to seek help from a mental health professional. To estimate the association between level of mistrust and willingness to seek care, gamma regression models were fitted with a log link, and the analyses were adjusted for age, ethnic identity or origin, education, insurance status, personal income, citizenship status, and length of time in the United States. RESULTS At low levels of medical mistrust (GBMMS scores ≤3), an increase in mistrust was significantly associated with an increase in the probability of seeking mental health care (rate ratio [RR]=1.55, p<0.001). At high levels of medical mistrust (GBMMS scores >3), an increase in mistrust was associated with a decrease in care seeking (RR=0.74, p<0.001). Similar patterns were observed for medical trust. CONCLUSIONS At low levels of medical mistrust among Black adults, each unit increase in mistrust was counterintuitively associated with an increase in willingness to seek care from a mental health professional.
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Affiliation(s)
- Aderonke Bamgbose Pederson
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Devan Hawkins
- Public Health Program, School of Arts and Sciences, MCPHS University, Boston, Massachusetts
| | - Felipe Jain
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Albert Yeung
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alexander C. Tsai
- Harvard School of Public Health, Boston, Massachusetts
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Starvaggi I, Lorenzo-Luaces L. Psychotherapy Access Barriers and Interest in Digital Mental Health Interventions Among Adults With Treatment Needs: Survey Study. JMIR Ment Health 2025; 12:e65356. [PMID: 40168039 PMCID: PMC12000781 DOI: 10.2196/65356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/18/2024] [Accepted: 12/20/2024] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND Digital mental health interventions (DMHIs) are a promising approach to reducing the public health burden of mental illness. DMHIs are efficacious, can provide evidence-based treatment with few resources, and are highly scalable relative to one-on-one face-to-face psychotherapy. There is potential for DMHIs to substantially reduce unmet treatment needs by circumventing structural barriers to treatment access (eg, cost, geography, and time). However, epidemiological research on perceived barriers to mental health care use demonstrates that attitudinal barriers, such as the lack of perceived need for treatment, are the most common self-reported reasons for not accessing care. Thus, the most important barriers to accessing traditional psychotherapy may also be barriers to accessing DMHIs. OBJECTIVE This study aimed to explore whether attitudinal barriers to traditional psychotherapy access might also serve as barriers to DMHI uptake. We explored the relationships between individuals' structural versus attitudinal barriers to accessing psychotherapy and their indicators of potential use of internet-delivered guided self-help (GSH). METHODS We collected survey data from 971 US adults who were recruited online via Prolific and screened for the presence of psychological distress. Participants provided information about demographic characteristics, current symptoms, and the use of psychotherapy in the past year. Those without past-year psychotherapy use (640/971, 65.9%) answered questions about perceived barriers to psychotherapy access, selecting all contributing barriers to not using psychotherapy and a primary barrier. Participants also read detailed information about a GSH intervention. Primary outcomes were participants' self-reported interest in the GSH intervention and self-reported likelihood of using the intervention if offered to them. RESULTS Individuals who had used psychotherapy in the past year reported greater interest in GSH than those who had not (odds ratio [OR] 2.38, 95% CI 1.86-3.06; P<.001) and greater self-reported likelihood of using GSH (OR 2.25, 95% CI 1.71-2.96; P<.001). Attitudinal primary barriers (eg, lack of perceived need; 336/640, 52.5%) were more common than structural primary barriers (eg, money or insurance; 244/640, 38.1%). Relative to endorsing a structural primary barrier, endorsing an attitudinal primary barrier was associated with lower interest in GSH (OR 0.44, 95% CI 0.32-0.6; across all 3 barrier types, P<.001) and lower self-reported likelihood of using GSH (OR 0.61, 95% CI 0.43-0.87; P=.045). We found no statistically significant differences in primary study outcomes by race or ethnicity or by income, but income had a statistically significant relationship with primary barrier type (ORs 0.27-3.71; P=.045). CONCLUSIONS Our findings suggest that attitudinal barriers to traditional psychotherapy use may also serve as barriers to DMHI use, suggesting that disregarding the role of attitudinal barriers may limit the reach of DMHIs. Future research should seek to further understand the relationship between general treatment-seeking attitudes and attitudes about DMHIs to inform the design and marketing of DMHIs.
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Song W, Tao S, Grest CV, McLean KJ, Mookerjee V, Shea LL. Health disparities between autistic non-citizen adults and US citizens enrolled in Medicaid: An analysis of Medicaid claims data from 2017-2019. Disabil Health J 2025:101825. [PMID: 40133090 DOI: 10.1016/j.dhjo.2025.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 03/12/2025] [Accepted: 03/18/2025] [Indexed: 03/27/2025]
Abstract
BACKGROUND This study addresses critical gaps in our understanding of how immigration status intersects with autism related to health outcomes. OBJECTIVE We aim to quantify physical and mental health disparities between autistic non-citizen adults and US citizens, among those who were enrolled in the Medicaid program. METHODS We analyzed 2017-2019 Transformed Medicaid Statistical Information System Analytic Files to identify autistic adults and categorize them into US citizens and non-citizens. Using propensity score matching (PSM) based on demographic and eligibility variables, we created comparable groups for comparative analysis of health conditions. We used modified Poisson regression models with robust standard errors to quantify the differences in mental and physical health outcomes between the groups, adjusted for co-occurring intellectual disabilities. RESULTS Autistic non-citizens had a 45 % higher prevalence of schizophrenia or other psychotic disorders than autistic citizens, while there were no significant differences in the prevalence of other mental health conditions (e.g., anxiety, depression). Autistic non-citizens also had a higher prevalence of numerous physical conditions (e.g., cancer, diabetes, and kidney disease) than autistic citizens. These patterns were unaffected by adjusting for co-occurring intellectual disabilities. CONCLUSION Our study highlights the heightened vulnerability of Medicaid-enrolled autistic non-citizens compared to their US citizen counterparts. Our findings indicate the critical need for Medicaid policy enhancements to better serve the unique challenges of autistic non-citizen adults, emphasizing the development of practice guidelines that incorporate cross-cultural and immigrant experiences and a culturally and linguistically competent provider base.
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Affiliation(s)
- Wei Song
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St #560, Philadelphia, PA, 19104, United States of America.
| | - Sha Tao
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St #560, Philadelphia, PA, 19104, United States of America.
| | - Carolina Villamil Grest
- School of Social Work, College of Public Health, Temple University, Ritter Annex, 5th floor, 1301 Cecil B. Moore Ave., Philadelphia, PA, 19122, United States of America.
| | - Kiley J McLean
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St #560, Philadelphia, PA, 19104, United States of America.
| | - Veera Mookerjee
- 1322 Raleigh Road, Mamaroneck, NY, 10543, United States of America.
| | - Lindsay L Shea
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St #560, Philadelphia, PA, 19104, United States of America.
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Rodwin AH, Layman D, Finnerty M, Patel SY, Jeong J, Chen Q, Munson MR. Prevalence and Geographic Variation of Serious Mental Illness Among Young Adults Enrolled in Medicaid in New York State. J Adolesc Health 2025:S1054-139X(25)00040-0. [PMID: 40100185 DOI: 10.1016/j.jadohealth.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 11/29/2024] [Accepted: 01/03/2025] [Indexed: 03/20/2025]
Abstract
PURPOSE To estimate the prevalence and geographic variation of serious mental illness (SMI) among young adults enrolled in Medicaid and to identify individual and community-level factors associated with SMI. METHODS We used New York Medicaid data for over 1.6 million young adults aged 18-34 years with continuous Medicaid enrollment from April 2021 through March 2022. We merged 3 additional county and zip code-level datasets, including the Distressed Communities Index, Area Health Resource File, and New York homelessness data. We used descriptive analyses, data visualization methods, and multivariable logistic regression to estimate the prevalence of SMI and identify individual- (sex, race and ethnicity, age, disability aid, and homelessness) and community-level (geography, community distress, number of hospital beds, and community mental health centers per capita) factors associated with SMI. RESULTS The 12-month prevalence of SMI was 8.3% in New York State, with wide geographic variation by zip codes, ranging from 0% to 39%. Young adults identifying as Asian, Black, and Latinx (compared to White), and those living in zip codes with the most community distress were associated with lower odds of SMI, odds ratios (OR) ranged from 0.47 (Asian) (95% confidence interval [CI] [0.46-0.49]) to 0.95 (Latinx) (CI [0.93-0.97]). Young adults identifying as female (compared to male), receiving disability, experiencing homelessness, and rural residence were associated with higher odds of SMI, ORs ranged from 1.64 (female) (95% CI [1.62-1.66]) to 5.49 (homelessness) (95% CI [5.33-5.66]). DISCUSSION SMI prevalence varies by individual- and community-level factors, including homelessness and rural residence, signaling the need for specific interventions and policies.
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Affiliation(s)
- Aaron H Rodwin
- Silver School of Social Work, New York University, New York, New York
| | - Deborah Layman
- Office of Population Health and Evaluation, New York State Office of Mental Health, New York, New York
| | - Molly Finnerty
- Office of Population Health and Evaluation, New York State Office of Mental Health, New York, New York; Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York, New York
| | - Sadiq Y Patel
- Clinical Product Development, Waymark, San Francisco, California; School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junghye Jeong
- Office of Population Health and Evaluation, New York State Office of Mental Health, New York, New York
| | - Qingxian Chen
- Office of Population Health and Evaluation, New York State Office of Mental Health, New York, New York
| | - Michelle R Munson
- Silver School of Social Work, New York University, New York, New York.
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15
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Bongiorno DM, Peters GA, Samuels-Kalow ME, Goldberg SA, Crowe RP, Misra A, Cash RE. Racial and Ethnic Disparities in EMS Use of Restraints and Sedation for Patients With Behavioral Health Emergencies. JAMA Netw Open 2025; 8:e251281. [PMID: 40111364 PMCID: PMC11926657 DOI: 10.1001/jamanetworkopen.2025.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 01/15/2025] [Indexed: 03/22/2025] Open
Abstract
Importance Emergency medical services (EMS) clinicians commonly care for patients with behavioral health emergencies (BHEs), including acute agitation. There are known racial and ethnic disparities in the use of physical restraint and chemical sedation for BHEs in emergency department settings, but less is known about disparities in prehospital use of restraint or sedation. Objective To investigate the association of patient race and ethnicity with the use of prehospital physical restraint and chemical sedation during EMS encounters for BHEs. Design, Setting, and Participants This nationwide retrospective cohort study used data from EMS agencies across the US that participated in the 2021 ESO Data Collaborative research dataset. Emergency medical services encounters among patients aged 16 to 90 years with a primary or secondary impression, sign or symptom, or protocol use associated with a BHE from January 1 to December 31, 2021, were included. Statistical analysis was conducted from July 2023 to March 2024. Exposures Patient race and ethnicity, which was categorized as Hispanic, non-Hispanic Black, non-Hispanic White, non-Hispanic other (American Indian or Alaska Native, Asian, Hawaiian Native or Other Pacific Islander, other, or multiracial), and unknown. Main Outcomes and Measures The primary outcome was administration of any physical restraint and/or chemical sedation (defined as any antipsychotic medication, benzodiazepine, or ketamine). Results A total of 661 307 encounters (median age, 41 years [IQR, 30-56 years]; 56.9% male) were included. Race and ethnicity were documented as 9.9% Hispanic, 20.2% non-Hispanic Black, 59.5% non-Hispanic White, 1.9% non-Hispanic other, and 8.6% unknown race and ethnicity. Restraint and/or sedation was used in 46 042 (7.0%) of encounters, and use differed across racial and ethnic groups (Hispanic, 10.6%; non-Hispanic Black, 7.9%; non-Hispanic White, 6.1%; non-Hispanic other, 10.9%; unknown race and ethnicity, 5.9%; P < .001). In mixed-effects logistic regression models accounting for clustering by EMS agency and adjusted for age, gender, urbanicity, and community diversity, patients who were non-Hispanic Black had significantly greater odds of being restrained or sedated across all categories compared with non-Hispanic White patients (eg, any restraint and/or sedation: adjusted odds ratio [AOR], 1.17 [95% CI, 1.14-1.21]; physical restraint: AOR, 1.22 [95% CI, 1.18-1.26]). There was no significant difference in adjusted odds of any restraint and/or sedation use for the remaining racial and ethnic groups compared to non-Hispanic White patients. Clustering was associated with agency-level variation in restraint or sedation use (intraclass correlation coefficient, 0.16 [95% CI, 0.14-0.17]). Conclusions and Relevance This nationwide retrospective cohort study of EMS encounters for patients with BHEs found differences in the use of prehospital restraint and/or sedation by patient race and ethnicity and an agency-level association with variation in restraint and/or sedation use. These data may inform improvements to protocols and training aimed at equitable care for BHEs.
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Affiliation(s)
- Diana M. Bongiorno
- Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Gregory A. Peters
- Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Margaret E. Samuels-Kalow
- Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Scott A. Goldberg
- Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Anjali Misra
- Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rebecca E. Cash
- Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
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Ng I, Hilario C, Salma J. "If I Stay Quiet, the Only Person That Gets Hurt Is Me": Anti-Asian Racism and the Mental Health of Chinese-Canadian Youth During the COVID-19 Pandemic. Can J Nurs Res 2025; 57:33-46. [PMID: 39410786 PMCID: PMC11967097 DOI: 10.1177/08445621241289515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2025] Open
Abstract
Background and PurposeDespite documented accounts of racial discrimination against Chinese communities during the COVID-19 pandemic, few studies have examined experiences of racism among Canadian youth. This qualitative study explored the experiences of Chinese-Canadian youth during the COVID-19 pandemic and their mental health.MethodsA qualitative descriptive research design, informed by Critical Race Theory (CRT), was used for this study. Data was collected using focus groups and image-based elicitation methods. Youth who self-identified as Chinese-Canadian, aged 18-24, and who experienced some account of self-defined racism were included. We analyzed the data using a coding system developed for this study and formulated key themes.ResultsOur analysis identified three themes: (I) Becoming racialized; (II) Learning the rules of racism; and (III) Effects of racism on mental health. We discuss findings in relation to the model minority stereotype, intersectionality of race and gender, and factors leading to a lack of support.ConclusionsThis study provides evidence that racism had immediate and prolonged effects on the mental health of Chinese-Canadian youth and their relationships with peers, family, and even strangers. Our research suggests the need for enhanced services for Chinese-Canadian youth and other groups experiencing racism.
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Affiliation(s)
- Isabella Ng
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Carla Hilario
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Jordana Salma
- Faculty of Nursing, University of Alberta, Edmonton, Canada
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Buck B, Kadakia A, Larsen A, Tauscher J, Guler J, Ben-Zeev D. Digital Interventions for People Waitlisted for Mental Health Services: A Needs Assessment and Preference Survey. PRACTICE INNOVATIONS (WASHINGTON, D.C.) 2025; 10:32-42. [PMID: 40256356 PMCID: PMC12007810 DOI: 10.1037/pri0000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2025]
Abstract
This study aimed to characterize the needs and preferences for digital health of individuals waitlisted for services. 135 people who sought mental health services in the past year and who were not receiving the service they sought completed questionnaires assessing their experiences during this period as well as their preferences related to digital interventions. Participants had sought services on average nearly eight months prior to completing the survey (M = 7.74 months, SD = 8.51). most commonly for anxiety (N = 118, 87.4%) and depression (N = 101, 74.8%). Relative to the date they first sought services, participants reported reduced interest (d = -0.45) and motivation to engage (d = -0.43) in treatment, as well as reduced conviction in the belief that they would get better (d = -0.23) or that treatment would help (d = -0.30), although they also reported reduced symptom distress (d = -0.39). Very few (8%) reported satisfaction with the materials they were given by providers when seeking services. Participants reported high interest in a digital tool providing information about therapies (94.7% reporting moderate or greater interest), mental illnesses (87.4%), and places to find treatment (91.1%), as well as one that would provide interactive cognitive practices (85.2%) and strategies to improve sleep (85.8%). Over half of all participants reported that a mobile app would be their first choice for mode of delivery. This study highlights the need for and potential of digital tools optimized for waitlisted individuals, particularly interactive and informational resources provided through mobile devices.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Arya Kadakia
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Anna Larsen
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Justin Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Jessy Guler
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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HASELSWERDT JAKE. Mental Health Treatment Access: Experience, Hypotheticals, and Public Opinion. Milbank Q 2025; 103:100-129. [PMID: 39717934 PMCID: PMC11923704 DOI: 10.1111/1468-0009.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 10/04/2024] [Accepted: 11/22/2024] [Indexed: 12/25/2024] Open
Abstract
Policy Points Policymakers should consider both material (e.g., cost) and attitudinal (e.g., skepticism) barriers to mental health treatment access. Public support for government action on mental health is high but varies based on experience-based and hypothetical beliefs about barriers to treatment. Appeals to personal experience and perspective-taking may be successful in building support for government action on mental health. CONTEXT Mental health problems represent a major public health issue for the United States, and access to mental health treatment is both inadequate and unevenly distributed. There is a strong justification for government action on mental health treatment, but it is unclear whether there is a political constituency for such action. Existing work suggests that stigma and othering of people with mental illnesses contributes to reduced support for intervention. I expand on the existing literature by focusing on mental health as an issue that may apply to Americans' own lives rather than only to a stigmatized outgroup. METHODS Using original questions on a nationally representative 2023 survey of 1,000 American adults, I measured agreement with statements about barriers to mental health treatment access that respondents have experienced or, if they have not sought treatment, their hypothetical assessment of these barriers. I also measured their support for statements in favor of change to address mental health. I analyzed the demographic and political correlates of agreement with the barrier statements and used regressions to examine their possible causal effect on support for change. FINDINGS Agreement with statements about access barriers follows expected patterns in some cases (e.g., socioeconomic status) but not in others (e.g., race/ethnicity). I also documented a notable partisan and ideological divide in these experiences and beliefs. I found that Americans who agreed that material factors are a barrier to access were more supportive of action on mental health, whereas those who agreed with statements suggesting discomfort or skepticism were less supportive. CONCLUSIONS These findings suggest that personal experience and perspective-taking should be integrated into the study of public opinion on mental health, complementing existing work on stigma and othering. Appeals to experience and perspective-taking may be a successful strategy for building public support for action on mental health.
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Affiliation(s)
- JAKE HASELSWERDT
- Truman School of Government and Public AffairsUniversity of Missouri
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19
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Moudden IE, Bittner MC, Karpov MV, Osunmakinde IO, Acheamponmaa A, Nevels BJ, Mbaye MT, Fields TL, Jordan K, Bahoura M. Predicting mental health disparities using machine learning for African Americans in Southeastern Virginia. Sci Rep 2025; 15:5900. [PMID: 39966490 PMCID: PMC11836383 DOI: 10.1038/s41598-025-89579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 02/06/2025] [Indexed: 02/20/2025] Open
Abstract
This study examined mental health disparities among African Americans using AI and machine learning for outcome prediction. Analyzing data from African American adults (18-85) in Southeastern Virginia (2016-2020), we found Mood Affective Disorders were most prevalent (41.66%), followed by Schizophrenia Spectrum and Other Psychotic Disorders. Females predominantly experienced mood disorders, with patient ages typically ranging from late thirties to mid-forties. Medicare coverage was notably high among schizophrenia patients, while emergency admissions and comorbidities significantly impacted total healthcare charges. Machine learning models, including gradient boosting, random forest, neural networks, logistic regression, and Naive Bayes, were validated through 100 repeated 5-fold cross-validations. Gradient boosting demonstrated superior predictive performance among all models. Nomograms were developed to visualize risk factors, with gender, age, comorbidities, and insurance type emerging as key predictors. The study revealed higher mental health disorder prevalence compared to national averages, suggesting a potentially greater mental health burden in this population. Despite the limitations of its retrospective design and regional focus, this research provides valuable insights into mental health disparities among African Americans in Southeastern Virginia, particularly regarding demographic and clinical risk factors.
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Affiliation(s)
- Ismail El Moudden
- Eastern Virginia Medical School (EVMS), Norfolk State University, Norfolk, VA, USA
| | - Michael C Bittner
- Eastern Virginia Medical School (EVMS), Norfolk State University, Norfolk, VA, USA
| | - Matvey V Karpov
- Eastern Virginia Medical School (EVMS), Norfolk State University, Norfolk, VA, USA
| | | | | | - Breshell J Nevels
- Department Ethelyn R. Strong School of Social Work, Norfolk State University, Norfolk, VA, USA
| | - Mamadou T Mbaye
- Engineering Department and the Center for Materials Research, Norfolk State University, Norfolk, VA, 23504, USA
| | - Tonya L Fields
- Computer Science Department, Norfolk State University, Norfolk, VA, USA
| | - Karthiga Jordan
- Engineering Department and the Center for Materials Research, Norfolk State University, Norfolk, VA, 23504, USA
| | - Messaoud Bahoura
- Engineering Department and the Center for Materials Research, Norfolk State University, Norfolk, VA, 23504, USA.
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Park S, Alegria M, Bustamante AV, Chen J, Fung V, Ortega AN. Differences in Mental Health Symptoms and Inequities in Mental Health Service Use Among Black and White Populations and Asian and Latine Subpopulations. J Gen Intern Med 2025; 40:569-578. [PMID: 39672982 PMCID: PMC11861445 DOI: 10.1007/s11606-024-09273-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 12/03/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND While studies have observed mental health inequities across aggregated Asian and Latine populations, a critical gap exists in our understanding of inequities within and across Asian and Latine subpopulations. OBJECTIVE We examined the prevalence of mental health symptoms and variations in mental health service use across Black and White populations and Asian and Latine subpopulations at a more granular level. METHODS We conducted a cross-sectional study using data from the 2016-2021 Medical Expenditure Panel Survey. Outcomes included mental health symptoms (mild and serious) and mental health service use (outpatient mental health visits and psychotropic medication fills). The primary independent variable was the category of 13 racial/ethnic groups: Black and non-Latine White individuals and Asian (Asian Indian, Chinese, Filipino, and Other Asian) and Latine (Central/South American, Cuban, Dominican, Mexican, Other Latine, and Puerto Rican) subpopulation individuals. RESULTS We found modest differences in mental health symptoms by race/ethnicity. However, significant differences were observed in mental health service use among individuals with mental health symptoms. These differences were pronounced across Asian subpopulations with serious mental health symptoms. The likelihood of having any outpatient mental health visit was lower among Asian Indian (- 12.2 percentage points [95% CI - 18.2, - 6.2], Chinese (- 11.7 [- 21.6, - 1.7]), and Filipino individuals (- 16.1 [- 22.5, - 9.8]) than White individuals. The likelihood of having psychotropic medication fill was lower among Asian Indian (- 23.3 [- 34, - 12.7]), Chinese (- 19.8 [- 30.7, - 8.9]), Filipino (- 27.6 [- 40.2, - 14.9]), and other Asian individuals (- 22.5 [- 29.4, - 15.6]) than White individuals. On the other hand, some of these differences were observed in certain Latine subpopulations but not in others. CONCLUSIONS There is a heterogeneity in inequities in mental health service use among Asian and Latine subpopulation groups. These findings underscore the importance of studying granular categories of race/ethnicity for targeting mental health inequities.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea.
- L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, 145 Anam-Ro, Seongbuk-Gu, Seoul, 02841, South Korea.
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Arturo Vargas Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, USA
- UCLA Latino Policy and Politics Institute, Los Angeles, USA
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, USA
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Boston, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, USA
| | - Alexander N Ortega
- Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, USA
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Ettman CK, Brantner CL, Goicoechea EB, Dohlman P, Ringlein GV, Straub J, Sthapit S, Mojtabai R, Spivak S, Albert M, Goes FS, Stuart EA, Zandi PP. Gaps in psychiatric care before and after the COVID-19 pandemic among patients with depression using electronic health records. Psychiatry Res 2025; 344:116354. [PMID: 39799819 PMCID: PMC11785417 DOI: 10.1016/j.psychres.2025.116354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 01/01/2025] [Accepted: 01/04/2025] [Indexed: 01/15/2025]
Abstract
The COVID-19 pandemic caused disruption to health services. It is unclear if there were inequalities in the continuity of mental health care in the years around the COVID-19 pandemic. We used electronic health records (EHR) to detect mental health care gaps of more than six months in psychiatric appointments across demographic and socioeconomic characteristics among patients with depression. The analysis included patients with depression who were seen at one of two mental health clinics every year of 2018, 2019, 2021, and 2022 (n = 783 patients). First, we found that the odds of mental health care gaps significantly decreased in the post-pandemic period (2021-2022) relative to the pre-pandemic period (2018-2019). Second, in the pre-pandemic period, patients who lived in areas in the highest tertile of deprivation had greater odds of gaps in mental health care relative to those in the lowest tertile (aOR: 2.18 [95 % CI: 1.02, 4.68]). Males had higher odds of gaps in care than females in the post-pandemic period (aOR: 2.22 [1.13, 4.37]) and the pooled pre- and post-pandemic study period (aOR: 1.58 [1.04, 2.40]). Third, interactions between patient characteristics and time were not significant, suggesting that the change in the odds of gaps of mental health care before relative to after the COVID-19 pandemic did not differ significantly based on patient characteristics. Overall, gaps in care decreased in the post-pandemic period relative to the pre-pandemic period among almost all patient groups.
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Affiliation(s)
- Catherine K Ettman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, MD, United States.
| | - Carly Lupton Brantner
- Department of Biostatistics and Bioinformatics, Duke University, North Carolina, United States
| | - Elena Badillo Goicoechea
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
| | - Priya Dohlman
- University of Maryland School of Medicine, Maryland, United States
| | - Grace V Ringlein
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
| | - Jason Straub
- Department of Psychiatry, Johns Hopkins School of Medicine, Maryland, United States
| | - Sazal Sthapit
- Department of Psychiatry, Johns Hopkins School of Medicine, Maryland, United States
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Tulane Medical School, Louisiana, United States
| | - Stanislav Spivak
- Department of Psychiatry, Johns Hopkins School of Medicine, Maryland, United States
| | - Michael Albert
- Department of Medicine, Johns Hopkins School of Medicine, Maryland, United States
| | - Fernando S Goes
- Department of Psychiatry, Johns Hopkins School of Medicine, Maryland, United States
| | - Elizabeth A Stuart
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
| | - Peter P Zandi
- Department of Psychiatry, Johns Hopkins School of Medicine, Maryland, United States
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22
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Kuo PB, Rudecindo B, Drinane JM, Tao K, Van Epps J, Imel ZE. Cultural Conversations in Therapy: How Often Clients Talk About Their Identities. Psychiatr Serv 2025; 76:133-138. [PMID: 39468846 DOI: 10.1176/appi.ps.20230266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2024]
Abstract
OBJECTIVE The purpose of this study was to examine how often clients report discussing cultural identities during counseling sessions; the extent to which discussion of cultural identities during treatment varies across therapists; whether identifying as BIPOC (Black, Indigenous, and people of color) predicts clients' discussion of cultural identities in sessions; and whether differences in the frequency of cultural conversations (i.e., dialogue that focuses on client cultural identities) across client groups depend on the therapist. METHODS This study examined variation in reports of engagement in cultural conversations during sessions (N=10,731) with 1,997 clients and 72 therapists from a university counseling center. Data were analyzed by using Bayesian multilevel models. RESULTS Overall, clients reported having cultural conversations in 48.4% of sessions. Cultural conversations were much more likely to occur in sessions with BIPOC clients than with White clients: 66.2% of sessions with BIPOC clients involved conversations about cultural identities, compared with only 39.8% of sessions with White clients. Of note, the magnitude of this difference varied by therapist. CONCLUSION Cultural conversations were more likely to occur in treatment with BIPOC clients than with White clients, and the presence of cultural conversations in treatment varied by therapist.
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Affiliation(s)
- Patty B Kuo
- Department of Psychiatry, University of Pennsylvania, Philadelphia (Kuo); Department of Educational Psychology, University of Utah, Salt Lake City (Rudecindo, Drinane, Tao, Van Epps, Imel)
| | - Brendalisse Rudecindo
- Department of Psychiatry, University of Pennsylvania, Philadelphia (Kuo); Department of Educational Psychology, University of Utah, Salt Lake City (Rudecindo, Drinane, Tao, Van Epps, Imel)
| | - Joanna M Drinane
- Department of Psychiatry, University of Pennsylvania, Philadelphia (Kuo); Department of Educational Psychology, University of Utah, Salt Lake City (Rudecindo, Drinane, Tao, Van Epps, Imel)
| | - Karen Tao
- Department of Psychiatry, University of Pennsylvania, Philadelphia (Kuo); Department of Educational Psychology, University of Utah, Salt Lake City (Rudecindo, Drinane, Tao, Van Epps, Imel)
| | - Jake Van Epps
- Department of Psychiatry, University of Pennsylvania, Philadelphia (Kuo); Department of Educational Psychology, University of Utah, Salt Lake City (Rudecindo, Drinane, Tao, Van Epps, Imel)
| | - Zac E Imel
- Department of Psychiatry, University of Pennsylvania, Philadelphia (Kuo); Department of Educational Psychology, University of Utah, Salt Lake City (Rudecindo, Drinane, Tao, Van Epps, Imel)
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23
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Albrecht Soto SL, Santos‐Lozada AR. Neighborhood Cohesion and Symptoms of Anxiety Across Racial/Ethnic Groups in the United States. JOURNAL OF COMMUNITY PSYCHOLOGY 2025; 53:e70000. [PMID: 39949199 PMCID: PMC11826112 DOI: 10.1002/jcop.70000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 01/07/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025]
Abstract
This study evaluates whether the association between neighborhood cohesion and frequency of anxiety symptoms varies by racial/ethnic group in the United States (US). Our study includes 89,617 respondents ages 18 and older from the National Health Interview Survey (2013-2018). We fit multivariate generalized linear regression models with interactions between neighborhood cohesion and race/ethnicity to test our hypotheses. We find that greater neighborhood social cohesion is associated with a lower frequency of anxiety symptoms for all racial/ethnic groups. However, this relationship was strongest for NL-Whites and Asians compared to NL-Black and Latine adults. No significant differences in this relationship were found between NL-Black, Latine, and Asian adults. Our study suggests that examining markers of mental health, such as anxiety symptoms, among the US population should consider variations in associations by race/ethnicity to expand our understanding of contextual factors that are associated with these outcomes. Population-based assessments of mental health markers should consider how sociocultural mechanisms operate differently by race/ethnicity.
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Affiliation(s)
| | - Alexis R. Santos‐Lozada
- Population Research InstitutePennsylvania State UniversityUniversity ParkPAUSA
- Department of Human Development and Family StudiesPennsylvania State UniversityUniversity ParkPAUSA
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24
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Arteaga K, Schepis TS, Cole AB, De Nadai AS. National treatment utilization among racially and ethnically diverse patients with PTSD. Bull Menninger Clin 2025; 89:1-26. [PMID: 40063359 DOI: 10.1521/bumc.2025.89.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
Research suggests that racial/ethnic minoritized individuals have elevated risk for experiencing trauma and developing posttraumatic stress disorder (PTSD) but are less likely to utilize mental health treatment compared to their non-Hispanic White counterparts. However, possessing health insurance may mitigate these disparities. We investigated this issue using a subsample of data obtained from the National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 2,339), to estimate the likelihood of utilizing PTSD-specific and general mental health treatment among a racially/ethnically diverse sample of individuals diagnosed with PTSD. Insurance status was included as a moderating factor. Across racial/ethnic groups, insured individuals had more than twice the odds of utilizing PTSD-specific and general treatment than those without insurance. Black, Hispanic, and Asian/Native Hawaiian/Pacific Islander participants were significantly less likely to utilize PTSD-specific and general mental health treatment regardless of insurance status. These findings can inform targeted public health interventions to address mental health care disparities.
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Affiliation(s)
- Katherina Arteaga
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, Texas
| | - Ashley B Cole
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Alessandro S De Nadai
- Nancy and Richard Simches Division of Child and Adolescent Psychiatry, McLean Hospital, Belmont, Massachusetts, and the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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25
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Clemens K, Zhdanava M, Teeple A, Voegel A, Joshi K, Shah A, Chen C, Pilon D. Impact of social determinants of health on esketamine nasal spray initiation among patients with treatment-resistant depression in the United States. J Manag Care Spec Pharm 2025; 31:101-111. [PMID: 39704732 PMCID: PMC11695841 DOI: 10.18553/jmcp.2025.24240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
BACKGROUND Disparities in mental health care access and health outcomes based on sociodemographic factors in the United States have been extensively documented. However, there is limited knowledge regarding these socioeconomic factors with respect to initiation of esketamine nasal spray, a novel therapy for treatment-resistant depression (TRD). OBJECTIVE To evaluate the association of socioeconomic factors with the initiation of esketamine nasal spray. METHODS Adults with TRD and commercial or Medicare Advantage (MA) insurance (Commercial-MA cohort) were included from Optum's deidentified Clinformatics Data Mart Database (January 2016-June 2022) and adults with Medicaid insurance (Medicaid cohort) were included from Merative MarketScan Multi-State Medicaid Database (January 2016-June 2022). The baseline period spanned 12 months before the index date (latter of evidence of TRD or US esketamine approval date); follow-up period spanned the index date until the end of health plan eligibility/data availability. Multivariate Cox proportional hazard models were used, separately for each cohort, to evaluate the association of characteristics with time to esketamine initiation; patients who did not initiate esketamine were censored at the end of follow-up. RESULTS In the Commercial-MA cohort, 201,937 patients were included (75.0% female, mean age 62.3 years, 80.9% White, 82.8% having less than a bachelor's degree, 60.3% with a household income less than $75,000). Having both an education of less than a bachelor's degree and a household income less than $75,000 reduced the chance of esketamine initiation by 37% (hazard ratio [HR] = 0.63, P < 0.001). In the Medicaid cohort, 51,206 patients were included (77.8% female, mean age 43.2 years, 78.6% White). In both cohorts, chances of initiation trended to be lower in females (Commercial-MA: HR = 0.63, P < 0.001; Medicaid: HR = 0.68, P = 0.088), whereas racial or ethnic minorities had similar chances of initiation to White patients (Commercial-MA: HR = 1.23, P = 0.104; Medicaid: HR = 0.79, P = 0.376). CONCLUSIONS Disparities in esketamine nasal spray initiation were observed based on education, income, and gender highlighting a potential health equity gap.
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Affiliation(s)
| | | | - Amanda Teeple
- Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Titusville, NJ
| | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Titusville, NJ
| | - Aditi Shah
- Analysis Group, Inc., Montréal, Quebec, Canada
| | - Cindy Chen
- Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Titusville, NJ
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26
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Stanton AM, Chiu C, Dolotina B, Kirakosian N, King DS, Grasso C, Potter J, Mayer KH, O'Cleirigh C, Batchelder AW. Disparities in depression and anxiety at the intersection of race and gender identity in a large community health sample. Soc Sci Med 2025; 365:117582. [PMID: 39631299 DOI: 10.1016/j.socscimed.2024.117582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 11/04/2024] [Accepted: 11/28/2024] [Indexed: 12/07/2024]
Abstract
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.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Christopher Chiu
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Brett Dolotina
- Grossman School of Medicine, New York University, New York, NY, USA
| | - Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Dana S King
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, USA.
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27
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Kirk KF, Budd S, Splain A, Parsons CL, Kini A, Daniel G, Kim L, Alexander K, Rubio D, Warren J, Akoto M, Laccay CD, Tanjutco P. Associations Between Mental Health and Social Needs Among Black Patients in Primary Care Settings. J Prim Care Community Health 2025; 16:21501319251338912. [PMID: 40380974 PMCID: PMC12085757 DOI: 10.1177/21501319251338912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/21/2025] [Accepted: 03/25/2025] [Indexed: 05/19/2025] Open
Abstract
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.
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Affiliation(s)
- Keri F. Kirk
- Medstar Georgetown University Hospital/ Georgetown University Medical Center, Washington, DC, USA
| | - Serenity Budd
- Medstar Health Research Institute, Hyattsville, MD, USA
| | - Ashley Splain
- Medstar Georgetown University Hospital/ Georgetown University Medical Center, Washington, DC, USA
- University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Clara L. Parsons
- Medstar Georgetown University Hospital/ Georgetown University Medical Center, Washington, DC, USA
- Medstar Health Research Institute, Hyattsville, MD, USA
| | - Aniket Kini
- Medstar Health Research Institute, Hyattsville, MD, USA
| | - George Daniel
- Medstar Georgetown University Hospital/ Georgetown University Medical Center, Washington, DC, USA
- Howard University, Washington, DC, USA
| | - Lana Kim
- Georgetown University, Washington, DC, USA
| | | | - Diana Rubio
- Medstar Georgetown University Hospital/ Georgetown University Medical Center, Washington, DC, USA
| | - Jenna Warren
- Medstar Georgetown University Hospital/ Georgetown University Medical Center, Washington, DC, USA
- Howard University, Washington, DC, USA
| | - Marsha Akoto
- Medstar Georgetown University Hospital/ Georgetown University Medical Center, Washington, DC, USA
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28
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Ondusko DS, Klawetter S, Carter EH, Osborne M, Peterson JW, Underwood Carrasco VI, Platteau A, Hunte RS. The Needs and Experiences of Black Families in the Neonatal Intensive Care Unit. Pediatrics 2025; 155:e2024067473. [PMID: 39694052 PMCID: PMC11867027 DOI: 10.1542/peds.2024-067473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 10/14/2024] [Indexed: 12/20/2024] Open
Abstract
OBJECTIVES To identify opportunities for improvement in quality of care, we explore Black families' experiences of family support in the neonatal intensive care unit (NICU) during their infant's hospital stay. METHODS Semistructured qualitative interviews or focus groups (FGs) were conducted to explore Black families' experiences of NICU hospitalization. Inclusion criteria were self-identification as a Black family member and infant admission to our NICU between January 2020 and February 2022. We conducted reflexive thematic analysis of recorded transcripts using Dedoose software. RESULTS Three interviews and 2 FGs were conducted with 9 unique families (n = 13 individuals). We organized 10 key themes into "Experiences" and "Recommendations." Experience themes included distrust and fear of the medical setting, hypervigilance and trauma trajectory formation, the myth of "Black hardiness," policing and surveillance, and undermining of Black parenting. Recommendation themes implored NICU staff to earn rather than assume trust, respect family concerns, improve mental health support, provide compassionate care, and support the parenting role. CONCLUSIONS In this single-center qualitative study of Black families' NICU encounters, families continue to experience differential treatment, which reinforces an untrustworthy medical system perpetuating structural racism. Family recommendations for improving care through transparent communication, advocacy and mental health support, increased engagement in their parental role, and decreasing biased treatment and provision of resources may improve their experience and mitigate hypervigilance and trajectory formation in our NICU.
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Affiliation(s)
- Devlynne S. Ondusko
- Department of Pediatrics, Division of Neonatology, Oregon Health & Science University, Portland, Oregon
| | - Susanne Klawetter
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Emily Hawkins Carter
- Department of Pediatrics, Division of Neonatology, Oregon Health & Science University, Portland, Oregon
| | - Morinne Osborne
- Department of Obstetrics & Gynecology, Women’s Health Research Unit, Oregon Health & Science University, Portland, Oregon
| | - Jaime W. Peterson
- Department of Pediatrics, Division of General Pediatrics, Oregon Health & Science University, Portland, Oregon
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Veronica I. Underwood Carrasco
- Department of Pediatrics, Division of General Pediatrics, Oregon Health & Science University, Portland, Oregon
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Astrid Platteau
- Department of Pediatrics, Division of Neonatology, Salem Health, Salem, Oregon
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29
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Duong LA, Zoupou E, Boga CI, Kashden J, Fisher J, Connolly Gibbons MB, Crits-Christoph P. Gender, Race/Ethnicity, and Patient-Therapist Matching on Gender and Race/Ethnicity: Predictors/Moderators of the Effectiveness of Trust/Respect Feedback. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2025; 52:59-73. [PMID: 38175334 PMCID: PMC11750298 DOI: 10.1007/s10488-023-01335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
A plethora of studies has exhibited the effectiveness of using measurement-based care feedback systems within mental health services to improve treatment outcomes; however, patient gender/race and patient-therapist matching on gender and race remain relatively unexplored as predictors/moderators in feedback studies. We conducted predictor/moderator analyses focusing on the relation of gender, race/ethnicity, and patient-therapist gender and race/ethnicity matching on two outcomes: patient self-reported levels of (1) functioning and (2) trust/respect within the therapeutic relationship. We used data from a randomized controlled trial studying the effectiveness of a feedback system comparing patient-reported levels of trust and respect towards their provider (together with symptom feedback) in comparison to symptom only feedback. We found that men improved in functioning more than women when their therapists received trust/respect feedback compared to symptom only feedback (F[1, 902] = 9.79, p = .002, d = 0.21). We also found that dyads matched on race/ethnicity but not gender, and those matched on gender but not race/ethnicity, improved in functioning over time more than dyads mismatched on both gender and race/ethnicity and those matched on both gender and race/ethnicity (F[1, 897] = 8.63, p = .0034, d = 0.20). On trust/respect outcomes, we found a gender difference over time (F[1, 759] = 6.61, p = .01, d = 0.19), a gender matching difference by feedback condition interaction (F[1, 757] = 5.25, p = .02, d = 0.17), and a racial/ethnic matching difference on trust/respect scores over time (F[1, 785] = 3.89, p = .049, d = 0.14). Male patients showed an initial decrease followed by a steady increase in trust/respect over time while female patients showed an initial increase followed by a steady decrease. Gender-matched therapeutic dyads showed higher levels of trust/respect compared to mismatched dyads when therapists received symptom only feedback, but this difference was not apparent when trust/respect feedback was provided. Dyads mismatched on race/ethnicity improved steadily in trust/respect over time, but matched dyads decreased in trust/respect after an initial increase. Future research should focus on the use of feedback systems to enhance outcomes for patients with specific gender and racial/ethnic identities.
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Affiliation(s)
- Lang A Duong
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
| | - Eirini Zoupou
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
| | - Cathryn I Boga
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
| | - Jody Kashden
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
- Princeton Behavioral Health, Moorestown and Princeton, Moorestown, NJ, USA
| | - Jena Fisher
- Merakey, Sharon Hill and Philadelphia, PA, USA
| | | | - Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
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30
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Sagui Henson SJ, Welcome Chamberlain CE, Smith BJ, Jackson JL, Adusei SL, Castro Sweet CM. Utilization, Satisfaction, and Clinical Outcomes of People of Color and White Adults Using an Employer-Sponsored Digital Mental Health Platform. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1660. [PMID: 39767499 PMCID: PMC11675968 DOI: 10.3390/ijerph21121660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 11/18/2024] [Accepted: 11/29/2024] [Indexed: 01/11/2025]
Abstract
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.
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Gamoran J, Xu Y, Buinewicz SAP, Liu J, Mowrey W, Goldentyer G, Gabbay V, Pimentel SS. An examination of depression severity and treatment adherence among racially and ethnically minoritized, low-income individuals during the COVID-19 transition to telehealth. Psychiatry Res 2024; 342:116221. [PMID: 39378538 DOI: 10.1016/j.psychres.2024.116221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 09/29/2024] [Accepted: 09/30/2024] [Indexed: 10/10/2024]
Abstract
Mental healthcare was fundamentally altered during the COVID-19 pandemic, perhaps most prominently through the massive shift towards telehealth. Herein, we evaluated effects of the transition to teletherapy on treatment adherence and depressive symptoms for 3,476 patients at three outpatient psychiatric clinics, the majority of whom were low-income and experienced ethnoracial minoritization. Number of missed appointments decreased (mean: 6.27 vs. 3.77, p < .0001), and PHQ-9 scores decreased (mean: 8.17 vs. 6.82, p < .0001) between six months prior to and following the March 18, 2020 switch to telehealth. These conclusions held when adjusting for covariates including age, sex, race/ethnicity, and insurance status (i.e., socioeconomic status). Stratified analyses (i.e., adults, emerging adults, and youth) yielded the same conclusions, with the exception of emerging adults, for whom the PHQ-9 change was not significant. Results indicated the transition from in-person to teletherapy was associated with significantly reduced mean numbers of missed visits and depressive symptoms. Such results during this especially tumultuous period may underscore telehealth's effectiveness. Future research should explore whether there is a causal relationship between telehealth or mixed hybrid options, positive treatment outcomes, and prescriptive care delivery models, as well as applications of e-mental health tools for diverse, underserved patient populations.
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Affiliation(s)
- Jesse Gamoran
- Department of Psychology, College of Science and Health, DePaul University, Chicago, IL, United States
| | - Yingchen Xu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Sophie A Palitz Buinewicz
- Center for the Treatment and Study of Anxiety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jianyou Liu
- Cardiovascular Research Foundation, New York, NY, United States
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Vilma Gabbay
- University of Miami, Miller School of Medicine, Miami, FL, United States; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Sandra S Pimentel
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
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32
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Park JH, Bui K. Mental health of undergraduates one year after the start of the COVID-19 pandemic: Findings from the national college health assessment III. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:3143-3146. [PMID: 36596231 DOI: 10.1080/07448481.2022.2161822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/04/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To compare the mental health of undergraduates before the COVID-19 pandemic lockdown to their mental health one year later. PARTICIPANTS Data from the American College Health Association (ACHA)'s National College Health Assessment III (ACHA-NCHAIII) were used, averaging a sample size of 54,844 undergraduate students and 106 schools nationwide per time point of assessment in the study. METHODS Secondary analyses of the ACHA-NCHAIII compared undergraduates' scores on five measures of mental health measures (loneliness, psychological distress, suicidality, flourishing, and resilience) from Spring 2020 to Spring 2021. RESULTS Undergraduates' responses showed an increase in loneliness, psychological distress, and suicidality as well as a decrease in flourishing and resilience. CONCLUSIONS The worsening of undergraduates' mental health calls for greater action by schools to alleviate students' distress and improve their wellbeing.
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Yeh PG, Tsai J. Differential prevalence of psychiatric disorders and mental health characteristics associated with lifetime suicide attempts in the Asian American and Pacific Islander adult population. J Psychiatr Res 2024; 180:86-95. [PMID: 39383714 DOI: 10.1016/j.jpsychires.2024.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/27/2024] [Accepted: 09/29/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND Asian American and Pacific Islander (AAPI) adults are an understudied group in terms of their mental health and mental healthcare needs. This has been complicated by the difficulty of recruiting adequate national samples of AAPI adults for research. OBJECTIVE This study aimed to analyze national data to examine the lifetime prevalence of major psychiatric disorders among AAPI adults relative to non-AAPI adults, as well as to identify and compare sociodemographic and clinical characteristics associated with lifetime suicide attempts among AAPI and non-AAPI adults. METHODS Cross-sectional data on 36,109 adults, including 1801 AAPI adults, from the National Epidemiological Survey of Alcohol and Related Conditions-III (NESARC-III), were analyzed with a series of chi-square and logistic regression analyses. RESULTS We found a significantly lower lifetime prevalence of mental health disorders in the AAPI versus the non-AAPI population nationally, including 2% of AAPI adults reporting lifetime suicide attempts as compared to about 5% of non-AAPI adults. Female sex and a history of major depressive disorder diagnosis were associated with lifetime suicide attempts in the AAPI and non-AAPI populations. Several unique factors were associated with having a history of suicide attempts in only the AAPI population, including a military service history and a diagnosis of panic disorder. DISCUSSION Our analysis demonstrated the significant sectors of the AAPI population that merit research, support, and intervention, including the AAPI veteran population. This study identifies several characteristics among AAPI adults that may make them particularly vulnerable to psychiatric problems and suicide risk, which may inform targeted prevention and efforts to provide culturally competent care to this population.
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Affiliation(s)
- Paul Gerardo Yeh
- Department of Kinesiology, Rice University, Houston, TX, USA; Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.
| | - Jack Tsai
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Rai P, Sahadevan P, Issac TG, Sundarakumar JS. Decomposing rural-urban differences in depression prevalence: a cross-sectional analysis of two community-based southern Indian cohorts. BMJ PUBLIC HEALTH 2024; 2:e000760. [PMID: 40018548 PMCID: PMC11816397 DOI: 10.1136/bmjph-2023-000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 10/17/2024] [Indexed: 03/01/2025]
Abstract
Introduction Depression is a growing public health concern in India but its prevalence is uneven across the country, possibly influenced by several sociodemographic factors. We aimed to assess the rural-urban disparity in the prevalence of depression and their associated sociodemographic and lifestyle-related factors. Methods Participants were middle-aged and older adults (≥45 years) from two parallel, prospective cohorts from rural (CBR-SANSCOG, n=4493) and urban (CBR-TLSA, n=972) southern India. We used cross-sectional data from the baseline clinical and biochemical assessments of the above two cohorts. The Geriatric Depression Scale (GDS-30) was used to screen for depression (cut-off ≥10). Logistic regression was used to assess the relationship between place of residence (rural vs urban) and prevalence of depression, adjusting for age, sex, education, income, marital status, Body Mass Index (BMI), alcohol use, tobacco use and number of comorbidities. The Fairlie decomposition analysis was used to decompose the rural-urban disparity. Results We found that the prevalence of depression was significantly higher in rural than in urban participants (14.49% vs 8.23%, p<0.001). The fully adjusted binary logistic regression model showed that rural-dwelling individuals were 1.57 times more likely to have depression than urban residents (AOR: 1.57, 95% CI: 1.03, 2.39). In the decomposition analysis, the variables included in this model (age, sex, education, income, marital status, BMI, alcohol use, tobacco use and number of comorbidities) explained 35.21% of the rural-urban disparity in the prevalence of depression, with sex and marital status being the significant contributors. Conclusion Participants in our rural cohort had significantly higher odds for depression as compared to their urban counterparts, with sociodemographic factors playing a key role in this disparity. This underscores the need for scaling up mental health services in the rural communities of India including training primary healthcare providers to promptly identify and manage depression.
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Affiliation(s)
- Pooja Rai
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka, India
| | - Pravin Sahadevan
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka, India
| | - Thomas G Issac
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka, India
| | - Jonas S Sundarakumar
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka, India
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Perrino T, Lozano A, Estrada Y, Tapia MI, Brown CH, Horigian VE, Beardslee WR, Prado G. Adaptation of an evidence-based, preventive intervention to promote mental health in Hispanic adolescents: eHealth Familias Unidas Mental Health. Transl Behav Med 2024; 14:713-721. [PMID: 39460747 PMCID: PMC11587815 DOI: 10.1093/tbm/ibae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2024] Open
Abstract
Youth internalizing symptoms (i.e., depression and anxiety), suicide ideation and attempts have been rising in recent years, including among Hispanics. Disparities in mental healthcare are concerning and require intervention, ideally prevention or early intervention. Familias Unidas is a culturally-syntonic, family-centered intervention effective in reducing youth drug use and sexual risk, with evidence of unanticipated effects on internalizing symptoms. This paper describes the systematic process used to adapt the eHealth version of the Familias Unidas intervention to more directly address internalizing symptoms and suicide risk in preparation for an effectiveness-implementation hybrid trial for youth with elevated internalizing symptoms, a history of suicide ideation/attempts, or poor parent-youth communication. The resulting eHealth Familias Unidas Mental Health intervention is described. Guided by a 4-phase framework, the steps in the adaptation process involved: assessment of the community and intervention delivery setting (pediatric primary care clinics); integration of previous intervention research, including intervention mechanisms of action; and expert and community consultation via focus groups. Focus group analyses showed that youth and parents perceived that the intervention was helpful. Their feedback was categorized into themes that were used to directly target mental health by addressing technology use, parent mental health, and social support. Effective and scalable preventive interventions are needed to address mental health disparities. The systematic adaptation process described in this paper is an efficient approach to expanding interventions while maintaining known, empirical and theoretical mechanisms of action. Findings from the ongoing effectiveness-implementation trial will be critical.
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Affiliation(s)
- Tatiana Perrino
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL 33146, USA
| | - Alyssa Lozano
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL 33146, USA
| | - Yannine Estrada
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL 33146, USA
| | - Maria I Tapia
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL 33146, USA
| | - C Hendricks Brown
- Department of Psychiatry & Behavioral Sciences, Preventive Medicine & Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 6061
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | - Guillermo Prado
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL 33146, USA
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Patrick ME, Peterson SJ, Pang YC, Terry-McElrath YM. Links between adolescent binge drinking and midlife alcohol use behaviors by age, sex, and race/ethnicity. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:2060-2069. [PMID: 39462274 DOI: 10.1111/acer.15435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/13/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND Alcohol use is increasing among adults in midlife (i.e., ages 35-60), but few studies examine specific alcohol use behaviors in this age group. We examined measures of typical drinks, maximum drinks, binge drinking, and high-intensity drinking by age, sex, and race/ethnicity among midlife adults, as well as the prospective association between age 18 binge drinking and midlife behaviors. METHODS Data from 5180 respondents participating in the national Monitoring the Future Panel study who were aged 35-60 in 2022 (followed since they were in 12th grade in 1980-2005) were used to estimate past 30-day midlife drinking behaviors (i.e., typical drinks, maximum drinks, binge, and high-intensity drinking) by age group, sex, and race/ethnicity. Associations between age 18 binge drinking status and midlife drinking outcomes were examined, as well as moderation by sociodemographic characteristics. RESULTS Across ages 35-60, the mean typical number of drinks on drinking days within the past month ranged from 1.4 to 1.8; the mean maximum drinks ranged from 2.3 to 3.2. Past-month binge and high-intensity drinking prevalence ranged from 19.1% to 31.2% and 3.6% to 8.1%, respectively. Estimates of drinking behaviors were generally higher among respondents aged 35-40 (vs. older age groups), males (vs. females), those identifying as White (vs. other racial/ethnic groups), and those who reported age 18 binge drinking (vs. not). Adolescent binge drinking was a stronger predictor of high-intensity drinking among females than males and of typical and maximum drinks among older (age 60) than younger (age 35) respondents. CONCLUSION Binge and high-intensity drinking were reported by a meaningful percentage of the US midlife adults. Binge drinking in adolescence was a predictor of subsequent alcohol-related risks. These long-term connections were especially strong among females. Age 18 binge drinking was a stronger predictor of high-intensity drinking at age 60 than earlier in midlife, underscoring that adolescent binge drinking is a key indicator of risk across the lifespan.
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Affiliation(s)
- Megan E Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah J Peterson
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Yuk C Pang
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Kaurin A, Asbrand J, Mann H, Calvano C. Clinical psychology, social identities and societal challenges: Implications for diversity-sensitive practice and training. J Clin Psychol 2024; 80:2268-2282. [PMID: 39241235 DOI: 10.1002/jclp.23736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/02/2024] [Accepted: 07/27/2024] [Indexed: 09/08/2024]
Abstract
Clinical psychologists are increasingly urged to recognize and understand the significance of societal factors such as marginalization experiences, within themselves and among the individuals and communities they serve. At the same time, there is a dearth of research in the field to guide this pursuit, and especially so in European contexts. We conducted an online survey (N = 646) to assess the social identities of clinical psychologists (graduate and trainees) in Germany and their incorporation of societal challenges in therapy and training. Overall, our sample was demographically rather homogenous and privileged: Clinical psychologists tended to be white (91%), nonmigrant (77.6%), female (74.5%), cis-gender (93.8%), heterosexual (75.4%), able-bodied (56.0%), and grew up in families with an academic background (68%). Although the majority of participants expressed a tendency to contemplate their identity when it came to their psychotherapeutic practices and believed that discussing societal challenges in therapy was pertinent, only a small proportion (~5%) reported actively introducing related subjects during therapy sessions or taking them into account during initial case conceptualization (~8%). The majority of participants indicated a lack of coverage of related topics in standard clinical psychological curricula. Greater perceived competence in addressing these topics was linked to clinicians initiating discussions about marginalization or discrimination in therapy. We explore the implications for future training aimed at fostering equitable, effective, and diversity-sensitive therapeutic practices.
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Affiliation(s)
- Aleksandra Kaurin
- Institute of Psychology, University of Wuppertal, Wuppertal, Germany
| | - Julia Asbrand
- Department of Psychology, University of Jena, Jena, Germany
| | - Hendrik Mann
- Institute of Psychology, University of Wuppertal, Wuppertal, Germany
| | - Claudia Calvano
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Desmarais SL, Morrissey B, Lowder EM, Zottola SA. Patterns of Self-Reported Mental Health Symptoms and Treatment among People Booked into a Large Metropolitan County Jail. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:916-934. [PMID: 39014285 DOI: 10.1007/s10488-024-01398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
The Brief Jail Mental Health Screen (BJMHS) is one of the most well-known and frequently used tools to conduct routine mental health screening at jail intake. In prior research, the BJMHS results typically have been evaluated overall (i.e., yes/no positive screen). However, there is heterogeneity in symptom presentation and treatment histories among people with serious mental illness, and there are potential consequences of this heterogeneity for mental health administration and policy in jails. We conducted a latent class analysis of BJMHS item-level results using administrative data for 37,998 people booked into a southeastern, metropolitan, U.S. county jail over a 3.5-year period. A 4-class solution provided the best fitting and most interpretable model. The largest class (89.5%) comprised people unlikely to report symptoms or treatment histories (limited symptoms). The next class comprised people who were unlikely to report ongoing symptoms but reported medication and hospitalization (managed symptoms). The third class (2.5%) included people likely to report feeling useless/sinful, prior hospitalization, and current psychiatric medication (depressive symptoms). The fourth class (1.0%) comprised people likely to report thought control, paranoia, feeling useless/sinful, medication, and hospitalization (psychotic symptoms). Controlling for sociodemographic and booking characteristics, people in the managed, depressive, and psychotic symptoms classes had significantly longer jail stays compared to those in the limited symptoms class. People in the managed and depressive symptoms classes were at heightened risk of re-arrest compared to the limited symptoms class. Findings can inform case prioritization and the allocation of resources to support efficient and effective jail-based mental health services.
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Affiliation(s)
| | - Brandon Morrissey
- Policy Research Associates, Inc, Troy, 12180, NY, US
- North Carolina State University, Raleigh, NC, 27695, US
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Sellinger JJ, Gilstad-Hayden K, Lazar C, Seal K, Purcell N, Burgess DJ, Martino S, Heapy A, Higgins D, Rosen MI. Impact of the COVID-19 pandemic on participants in pragmatic clinical trials for chronic pain: implications for trial outcomes and beyond. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:S17-S27. [PMID: 39514885 PMCID: PMC11548862 DOI: 10.1093/pm/pnae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 11/16/2024]
Abstract
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.
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Affiliation(s)
- John J Sellinger
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Kathryn Gilstad-Hayden
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Christina Lazar
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Karen Seal
- San Francisco VA Healthcare System, Integrative Health Service San Francisco, San Francisco, CA 94121, United States
- University of California, San Francisco, San Francisco, CA 94158, United States
| | - Natalie Purcell
- San Francisco VA Healthcare System, Integrative Health Service San Francisco, San Francisco, CA 94121, United States
- University of California, San Francisco, San Francisco, CA 94158, United States
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States
- University of Minnesota Medical School, Minneapolis, MN 55455, United States
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Alicia Heapy
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Diana Higgins
- Durham VA Healthcare System, Durham, NC 27705, United States
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, United States
| | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
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Bitomsky L, Pfitzer EC, Nißen M, Kowatsch T. Advancing health equity and the role of digital health technologies: a scoping review protocol. BMJ Open 2024; 14:e082336. [PMID: 39414274 PMCID: PMC11481109 DOI: 10.1136/bmjopen-2023-082336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 09/30/2024] [Indexed: 10/18/2024] Open
Abstract
INTRODUCTION Healthcare systems around the world exhibit inherent systemic inequities that disproportionately impact marginalised populations. Digital health technologies (DHTs) hold promising potential to address these inequities and to play a pivotal role in advancing health equity. However, there is a notable gap regarding a comprehensive and structured overview of existing frameworks and guidelines on advancing health equity and a clear understanding of the potential of DHTs in their implementation. To this end, our primary objectives are first to identify prevalent frameworks and guidelines that promote health equity and second to pinpoint the contemporary role of DHTs as an avenue for implementing these frameworks and guidelines. This synthesis will guide future DHTs, ensuring equitable accessibility and effectiveness and ultimately contributing to enhancing health equity among marginalised populations. METHODS AND ANALYSIS This work adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Reviews. To identify pertinent evidence, we will employ seven electronic databases (PubMed, EMBASE, Cochrane, PsycINFO, Scopus, Web of Science and WISO) encompassing the fields of medicine, healthcare and social sciences. Moreover, selected grey literature will be considered. We will include primary and secondary studies published in English between 2010 and 2023 that focus on (technology and non-technology-based) frameworks and guidelines for health equity improvement. Each article will undergo an independent assessment for eligibility, followed by the extraction of pertinent data from eligible sources. Subsequently, the extracted data will be subjected to qualitative and quantitative analyses, and findings will be presented using narrative and descriptive formats. ETHICS AND DISSEMINATION Ethical approval is deemed unnecessary for this scoping review, as it involves synthesising existing knowledge. The findings from this study will be disseminated through peer-reviewed publications. PROTOCOL REGISTRATION https://osf.io/94pht.
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Affiliation(s)
- Laura Bitomsky
- School of Medicine, University of St Gallen, St Gallen, Switzerland
| | | | - Marcia Nißen
- School of Medicine, University of St Gallen, St Gallen, Switzerland
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- School of Medicine, University of St Gallen, St Gallen, Switzerland
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
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Shi W, Donovan EE, Quaack KR, Mackert M, Shaffer AL, De Luca DM, Nolan-Cody H, Yang J. A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions. HEALTH COMMUNICATION 2024; 39:2197-2210. [PMID: 37733424 DOI: 10.1080/10410236.2023.2259690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
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.
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Affiliation(s)
- Weijia Shi
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin
| | - Erin E Donovan
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin
| | - Karly R Quaack
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin
| | - Michael Mackert
- Center for Health Communication, Moody College of Communication & Dell Medical School, The University of Texas at Austin
- Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Audrey L Shaffer
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin
| | - Daniela M De Luca
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Haley Nolan-Cody
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin
| | - Jiahua Yang
- Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin
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Song S, Martin MJ, Wang Z. School belonging mediates the longitudinal effects of racial/ethnic identity on academic achievement and emotional well-being among Black and Latinx adolescents. J Sch Psychol 2024; 106:101330. [PMID: 39251307 DOI: 10.1016/j.jsp.2024.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 09/11/2024]
Abstract
Social Identity Theory proposes that a positive in-group social identification fosters students' academic motivation and psychological well-being. The present study, grounded in Social Identity Theory, investigated the roles of racial/ethnicity identity (REI) in the development of school adjustment among Black and Latinx youth as well as the psychological mechanisms underlying these longitudinal associations. We hypothesized that REI would positively predict the development of academic achievement and emotional symptoms. In addition, we hypothesized that the development of school belonging would mediate the predictive effects of REI on the growth of academic achievement and emotional symptoms. Participants were 475 (n = 182 Black, 48.9% female; 293 Latinx, 47.8% female) students in Grades 7-9. Students self-reported their REI, school belonging, and emotional symptoms. Academic achievement was assessed using standardized achievement test scores. The longitudinal mediation models indicated that REI indirectly predicted the development of academic achievement and emotional symptoms through students' sense of school belonging. Specifically, higher REI embedded achievement and lower REI awareness of racism predicted higher school belonging in Grade 7. Higher Grade 7 school belonging in turn predicted faster academic growth in Grade 7 to Grade 9 as well as lower emotional symptoms in Grade 7. In addition, the three dimensions of REI also directly predicted the growth of academic achievement and emotional symptoms in Grades 7-9. The mediated effects were smaller in size than the direct effects. These findings highlight the importance of fostering positive REI and a strong sense of school belonging in promoting school adjustment among racial/ethnic minoritized, academically at-risk youth.
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Affiliation(s)
- Seowon Song
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock, TX, USA
| | - Monica J Martin
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock, TX, USA
| | - Zhe Wang
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA.
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Matthews TA, Shao H, Forster M, Kim I. Associations of adverse childhood experiences with depression and anxiety among children in the United States: Racial and ethnic disparities in mental health. J Affect Disord 2024; 362:645-651. [PMID: 39029666 DOI: 10.1016/j.jad.2024.07.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/29/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
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.
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Affiliation(s)
- Timothy A Matthews
- Department of Environmental and Occupational Health, California State University, Northridge, United States of America
| | - Hongshan Shao
- Department of Educational Psychology and Counseling, California State University, Northridge, United States of America
| | - Myriam Forster
- Department of Health Sciences, California State University, Northridge, United States of America
| | - Isak Kim
- Department of Counseling, University of Nebraska Omaha, United States of America.
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Marshall IC, Hammer LA, Springfield CR, Bonfils KA. Activism in the Digital Age: The Link Between Social Media Engagement With Black Lives Matter-Relevant Content and Mental Health. Psychol Rep 2024; 127:2220-2244. [PMID: 36574995 PMCID: PMC10293473 DOI: 10.1177/00332941221146706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Research shows that participation in political activism on social media is linked to psychological stress. Additionally, race-based stress disproportionately affects minorities and is linked to greater psychological symptoms. Yet, the impact of the social media presence of Black Lives Matter (BLM) on mental health has yet to be meaningfully assessed.Methods: This study assessed whether engagement with BLM-related social media vignettes was related to mental health symptoms in two non-clinical samples (total N = 389), using a mixed-methods design. Participants completed an online survey with social media vignettes, self-report inventories of mental health symptoms, and open-ended questions about experiences with and the impact of BLM.Results: Correlations revealed that greater engagement with BLM-related social media posts was related to more severe mental health symptoms. Further, moderation analyses revealed that race significantly moderated the relationship between engagement and anxiety and trauma-related symptoms, such that these relationships were stronger for participants who identified as racial minorities. Qualitative analyses revealed that most participants who were engaged in mental health treatment had not discussed BLM-related topics with their providers, despite many participants reporting disrupted relationships and negative emotions due to exposure to BLM-related social media content.Discussion: Taken together, results suggest that engagement with BLM-related content online is linked to increased mental health symptoms, but these issues are infrequently addressed in treatment. Future research should extend these findings with clinical samples, assess the comfort of therapists in addressing these topics in therapy, and develop interventions to improve mental health in digital activists.
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Affiliation(s)
- Iyanna C Marshall
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Lillian A Hammer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Cassi R Springfield
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kelsey A Bonfils
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Abu-Ras W, Aboul-Enein BH, Almoayad F, Benajiba N, Dodge E. Mosques and Public Health Promotion: A Scoping Review of Faith-Driven Health Interventions. HEALTH EDUCATION & BEHAVIOR 2024; 51:677-690. [PMID: 39099318 PMCID: PMC11416736 DOI: 10.1177/10901981241252800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND Religious institutions play a crucial role in health promotion and hold significant influence in the public health field. AIM The aim of this review is to examine outcomes of health-promoting interventions involving the use of mosques as the intervention venue, its role in promoting health behavior change, and the role of theory in each intervention. METHODS A scoping review was conducted across 17 databases for relevant publications published up to and including August 2023 that involved the use of mosques as the intervention venue. Fourteen articles met inclusion criteria and were reviewed. RESULTS The studies featured a wide range of interventions. However, only eight of these studies integrated theoretical frameworks into their approaches, indicating a need for more structured guidance in this field. These theoretical frameworks included Participatory Action Research (PAR), the theory of planned behavior, behavior-change constructs, the patient-centered outcomes research (PCOR) framework, and prolonged exposure techniques within Islamic principles. The review identified three main health-focused intervention categories: mental health, prevention, and communication, each providing valuable insights into initiatives within Muslim communities. CONCLUSIONS This review underscores the significance of inclusive and culturally sensitive health interventions, emphasizing the effectiveness of faith-based approaches in improving health outcomes, promoting positive health behaviors, and addressing communication and cultural barriers. The reviews findings stress the need for further research that incorporates theoretical frameworks and tailored interventions to meet the specific cultural needs of these communities, ultimately contributing to enhanced well-being within them.
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Affiliation(s)
| | | | - Fatmah Almoayad
- Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Lu M, Sharmin S, Tao Y, Xia X, Yang G, Cong Y, Yang G, Razavilar N, Aziz R, Jiang J, Xiao Y, Peng L, Xu B. Economic evaluation of acupuncture in treating patients with pain and mental health concerns: the results of the Alberta Complementary Health Integration Project. Front Public Health 2024; 12:1362751. [PMID: 39386945 PMCID: PMC11461202 DOI: 10.3389/fpubh.2024.1362751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 09/16/2024] [Indexed: 10/12/2024] Open
Abstract
Background The COVID-19 pandemic and its economic impact have heightened the risk of mental health and pain-related issues. The integration of acupuncture with conventional medicine shows promise in improving treatment outcomes for these conditions. The Alberta Complementary Health Integration Project (ABCHIP) aimed to provide acupuncture to youth (aged 24 and under) and seniors (aged 55 and above) experiencing chronic pain, pain management issues, mental health issues, and/or related conditions. The program aimed to promote integrative care, assess the effectiveness and cost-effectiveness of these therapies, and deliver patient-centered care. Design ABCHIP provided acupuncture to address pain, mental health, and addiction issues at no cost to two vulnerable populations in Alberta: youth and the older adult. A total of 606 patients aged 14-65 received 5,424 acupuncture treatments. Outcome measures included pain interference, pain severity, sleep quality, depression, anxiety, fatigue, anger, and quality of life. Short-term outcomes were assessed through questionnaires completed at the beginning and completion of the treatments, while long-term benefits were estimated using these outcome indicators and existing literature on the economic cost of illnesses. Result The cost-effectiveness analysis revealed the following ratios per Quality-Adjusted Life Year (QALY): CND12,171 for the overall sample, CND10,766 for patients with pain, CND9,331 for individuals with depression, and CND9,030 for those with anxiety. The cost-benefit analysis demonstrated annual cost savings ranging from CND1,487 to CND5,255, with an average of CND3,371. Conclusion The study findings indicate that ABCHIP's treatment for pain, depression, anxiety, and sleep issues is cost-effective, leading to substantial cost savings and improved quality of life for patients. The program's cost per Quality-Adjusted Life Year (QALY) is significantly lower than benchmarks used in other countries, demonstrating high cost-effectiveness and value. Patients receiving 12 treatments experienced significant improvements across all measures, with estimated economic benefits surpassing treatment costs. In summary, ABCHIP offers a cost-effective and economically efficient therapy choice for individuals dealing with pain and mental health issues.
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Affiliation(s)
- Mingshan Lu
- Department of Economics, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta College of Acupuncture and Traditional Chinese Medicine, Calgary, AB, Canada
- Huatuo Clinic, Calgary, AB, Canada
| | - Sumaiya Sharmin
- Department of Economics, University of Calgary, Calgary, AB, Canada
| | - Yong Tao
- Healing Point Acupuncture Clinic/Classic Acupuncture & Herbal Clinic, Los Altos, CA, United States
| | - Xin Xia
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta College of Acupuncture and Traditional Chinese Medicine, Calgary, AB, Canada
- Huatuo Clinic, Calgary, AB, Canada
- Healing Point Acupuncture Clinic/Classic Acupuncture & Herbal Clinic, Los Altos, CA, United States
| | - Gongliang Yang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta College of Acupuncture and Traditional Chinese Medicine, Calgary, AB, Canada
| | - Yingying Cong
- Alberta College of Acupuncture and Traditional Chinese Medicine, Calgary, AB, Canada
- Huatuo Clinic, Calgary, AB, Canada
| | - Guanhu Yang
- Department of Specialty Medicine, Ohio University, Athens, OH, United States
| | | | | | - Jing Jiang
- Department of Forest and Conservation Sciences, Faculty of Forestry, University of British Columbia, Vancouver, BC, Canada
| | - Yun Xiao
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Laura Peng
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Bentong Xu
- Alberta College of Acupuncture and Traditional Chinese Medicine, Calgary, AB, Canada
- Huatuo Clinic, Calgary, AB, Canada
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Robinson A, Flom M, Forman-Hoffman VL, Histon T, Levy M, Darcy A, Ajayi T, Mohr DC, Wicks P, Greene C, Montgomery RM. Equity in Digital Mental Health Interventions in the United States: Where to Next? J Med Internet Res 2024; 26:e59939. [PMID: 39316436 PMCID: PMC11462105 DOI: 10.2196/59939] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 09/25/2024] Open
Abstract
Health care technologies have the ability to bridge or hinder equitable care. Advocates of digital mental health interventions (DMHIs) report that such technologies are poised to reduce the documented gross health care inequities that have plagued generations of people seeking care in the United States. This is due to a multitude of factors such as their potential to revolutionize access; mitigate logistical barriers to in-person mental health care; and leverage patient inputs to formulate tailored, responsive, and personalized experiences. Although we agree with the potential of DMHIs to advance health equity, we articulate several steps essential to mobilize and sustain meaningful forward progression in this endeavor, reflecting on decades of research and learnings drawn from multiple fields of expertise and real-world experience. First, DMHI manufacturers must build diversity, equity, inclusion, and belonging (DEIB) processes into the full spectrum of product evolution itself (eg, product design, evidence generation) as well as into the fabric of internal company practices (eg, talent recruitment, communication principles, and advisory boards). Second, awareness of the DEIB efforts-or lack thereof-in DMHI research trials is needed to refine and optimize future study design for inclusivity as well as proactively address potential barriers to doing so. Trials should incorporate thoughtful, inclusive, and creative approaches to recruitment, enrollment, and measurement of social determinants of health and self-identity, as well as a prioritization of planned and exploratory analyses examining outcomes across various groups of people. Third, mental health care advocacy, research funding policies, and local and federal legislation can advance these pursuits, with directives from the US Preventive Services Taskforce, National Institutes of Health, and Food and Drug Administration applied as poignant examples. For products with artificial intelligence/machine learning, maintaining a "human in the loop" as well as prespecified and adaptive analytic frameworks to monitor and remediate potential algorithmic bias can reduce the risk of increasing inequity. Last, but certainly not least, is a call for partnership and transparency within and across ecosystems (academic, industry, payer, provider, regulatory agencies, and value-based care organizations) to reliably build health equity into real-world DMHI product deployments and evidence-generation strategies. All these considerations should also extend into the context of an equity-informed commercial strategy for DMHI manufacturers and health care organizations alike. The potential to advance health equity in innovation with DMHI is apparent. We advocate the field's thoughtful and evergreen advancement in inclusivity, thereby redefining the mental health care experience for this generation and those to come.
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Affiliation(s)
| | - Megan Flom
- Woebot Health, San Francisco, CA, United States
| | | | | | | | | | - Toluwalase Ajayi
- Joan & Irwin Jacobs Center for Health Innovation, University of California, San Diego, San Diego, CA, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Carolyn Greene
- United States Department of Veterans Affairs, Mann-Grandstaff Veterans Affairs Medical Center, Spokane, WA, United States
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Lu FQ, Flores MW, Carson NJ, Le T, Cook BL. Trends and Disparities in Mental Health Use Among Asian American Sub-groups, 2013-2019. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02177-9. [PMID: 39302564 PMCID: PMC11922797 DOI: 10.1007/s40615-024-02177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 09/03/2024] [Accepted: 09/07/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE The objective of this study was to characterize and compare national estimates of mental healthcare use among White and Asian American groups to provide an update using post Affordable Care Act data. METHODS We analyzed yearly cross-sectional data from the 2013-2019 Medical Expenditure Panel Survey, including White (n = 112,590) and Asian American (n = 10,210) individuals, and examined rates of mental healthcare use for Asian (overall), Asian Indian, Chinese, Filipino, and Other Asian individuals relative to White individuals. Using multivariable logistic regression models and predictive margin methods, we estimated overall Asian disparities and Asian subgroup disparities compared to White group rates in mental health care (outpatient, specialty, psychotropic medication) among adults with and without elevated risk for mental illness. Regression models were adjusted for variables related to need for treatment, demographic, and socioeconomic status variables. RESULTS Asian individuals had lower rates of mental healthcare use than White individuals. Unadjusted results and adjusted regression model predictions are consistent in identifying wide disparities in mental health care treatment across risk for mental illness, Asian subgroups, and types of treatment. CONCLUSIONS Asian Americans have significantly lower rates of mental healthcare use than White Americans, even among those with elevated risk for mental illness. There is small variation by Asian subgroups but disparities persist across subgroups and types of treatment. Our results imply interventions are needed to improve linguistically, culturally, and ethnically tailored outreach and engagement in treatment services, as well as examining treatment and its effectiveness for Asian American individuals living with psychological distress.
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Affiliation(s)
- Frederick Q Lu
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.
| | - Michael W Flores
- Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Nicholas J Carson
- Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Thomas Le
- Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychology, Bryn Mawr College, Bryn Mawr, PA, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Canady MT, Barrington-Trimis JL, Harlow AF. Racial/Ethnic Differences in Adverse Childhood Experiences and Mental Health. Am J Prev Med 2024; 67:397-406. [PMID: 38697322 DOI: 10.1016/j.amepre.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Racial/ethnic differences exist in the prevalence of adverse childhood experiences (ACEs). However, few studies have examined racial/ethnic differences in the association between ACEs and poor mental health outcomes in young adulthood. METHODS Data on 10 self-reported, recalled ACEs (prior to age 18) and current symptoms of depression, anxiety, post-traumatic stress disorder, and sleep problems in early adulthood were collected from 2,020 young adults (age 20-23 years) between January and June 2021 enrolled in a Southern California prospective community-based cohort. Logistic regression models run in 2022-2023 evaluated the association of cumulative (0, 1, 2, 3, 4+ ACEs), grouped (abuse, neglect, household dysfunction), and individual ACE exposure with mental health outcomes; interaction models tested for differences by race/ethnicity. RESULTS All ACE exposures (cumulative, grouped, individual ACEs) were associated with increased odds of most mental health symptoms. Significant differences by race/ethnicity emerged for individual and grouped (but not cumulative) ACEs. For example, associations of any abuse-related ACE and emotional and physical abuse with depressive symptoms were greater for Hispanic participants than for those of another race/ethnicity. Further, associations of emotional abuse with sleep problems were greater for Hispanic participants than for Asian American and Pacific Islander participants (interaction ps<0.05). Though not significant, the association of familial incarceration with depression symptoms was higher for AAPI participants than for other racial/ethnic groups (interaction p-value=0.06). CONCLUSIONS Evaluation of individual and grouped ACEs reveals important racial/ethnic heterogeneity in associations with mental health outcomes. Findings have implications for targeted prevention efforts for racial/ethnic groups at higher risk for poor mental health.
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Affiliation(s)
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California; Institute for Addiction Science, University of Southern California, Los Angeles, California.
| | - Alyssa F Harlow
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California; Institute for Addiction Science, University of Southern California, Los Angeles, California
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Huh J, Blevins B, Wong K, Lee R, Herzig SE, Unger JB, Oh H. The underrepresentation of racial/ethnic minorities in research on co-use of nicotine, alcohol, and/or cannabis via ecological momentary assessment methods: A narrative review. Drug Alcohol Depend 2024; 262:111391. [PMID: 39047639 PMCID: PMC11330314 DOI: 10.1016/j.drugalcdep.2024.111391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Co-use of nicotine, alcohol and/or cannabis is common among adults in the United States. Co-use may represent greater addiction severity than single substance use. Recent studies have examined the extent to which the frequency, order, simultaneity, motivations, and contextual factors associated with co-use differ from that of single use. Co-use has become prevalent among racial/ethnic minority individuals who exhibit distinct co-use patterns and related outcomes; however, most of these studies rely on cross-sectional or sparse longitudinal observations. Ecological momentary assessment (EMA) can illuminate such patterns and associations with time-varying contexts. This review summarizes EMA studies on co-use published from 2008 to 2023 involving racial/ethnic minority individuals and point to gaps. Our review addresses: 1) whether use of one substance leads to substitution or complementary use of another, 2) whether antecedents/contexts differ by co-use patterns and minority status, and 3) what consequences of co-use have been documented across co-use patterns or minority status. METHODS Search results yielded 465 articles, with 33 meeting inclusion criteria. We extracted study-level characteristics and synthesized the findings. RESULTS The findings largely focused on co-use patterns, categories of co-use, proximal antecedents and contexts, and consequences. Variations by minority status were rarely examined; few examined acute effects of unique experiences that may contribute to co-use among racial/ethnic minority adults. CONCLUSIONS The EMA literature on co-use is burgeoning in recent years and supports complementary hypothesis. More research to capture time-intensive data on experiences to contextualize the co-use among racial/ethnic minority groups with greater diversity in race/ethnicity is warranted.
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Affiliation(s)
- Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA.
| | - Brittany Blevins
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Kelly Wong
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Shirin E Herzig
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, USC, USA
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