1
|
Enslow MR, Galfalvy HC, Sajid S, Pember RS, Mann JJ, Grunebaum MF. Racial and ethnic disparities in time to first antidepressant medication or psychotherapy. Psychiatry Res 2023; 326:115324. [PMID: 37390599 PMCID: PMC10530353 DOI: 10.1016/j.psychres.2023.115324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
Time from first DSM4 major depressive episode (MDE) until treatment in the community was compared across racial/ethnic groups. This secondary analysis used structured baseline data from a depression research clinic (N = 260). Chi-square and survival analyses compared rates and delays to antidepressant medication and psychotherapy. Non-Hispanic Black and Hispanic (any race) participants had lower rates of both antidepressant medication and psychotherapy and longer delays to antidepressant medication compared with non-Hispanic White participants. The results underscore the need to reduce these disparities.
Collapse
Affiliation(s)
- Meghan R Enslow
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Hanga C Galfalvy
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Sumra Sajid
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | | | - J John Mann
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Michael F Grunebaum
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States.
| |
Collapse
|
2
|
Flores MW, Sharp A, Moyer M, Fung V, Rotter MR, Cook BL. Criminal Legal Involvement Among U.S. Adults With Serious Psychological Distress and Differences by Race-Ethnicity. Psychiatr Serv 2023; 74:702-708. [PMID: 36625137 PMCID: PMC10329978 DOI: 10.1176/appi.ps.202200048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The authors examined associations between criminal legal involvement (CLI) and serious psychological distress and how these associations differed by racial-ethnic group. METHODS The authors conducted a retrospective analysis of multiple cross-sections of data from the National Survey on Drug Use and Health (2015-2019) and used multivariable linear probability regression models to assess lifetime CLI and past-year probation, parole, supervised release, or other conditional release in a nationally representative sample of noninstitutionalized U.S. adults, ages ≥18 years (N=214,505), with and without serious psychological distress. RESULTS Adults with serious psychological distress had higher rates of CLI than adults without such distress (difference of 4.1 percentage points, 95% CI=3.3-4.8, p<0.001). The rate of CLI increased as distress severity increased, from mild (3.2 percentage-point difference, 95% CI=2.6-3.8, p<0.001) to high (7.2 percentage-point difference, 95% CI=6.4-8.0, p<0.001). The risk for CLI among those with serious psychological distress was even greater for Black and Latinx adults than for White adults (1.8 percentage-point difference, 95% CI=0.1-3.5, p<0.05, and 3.2 percentage-point difference, 95% CI=1.3-5.2, p<0.01, respectively). CONCLUSIONS Rates of CLI were higher for adults with serious psychological distress. Efforts are needed to equitably triage individuals with acute mental health needs to timely psychiatric care instead of carceral settings. Collaborative models of care that commingle resources from mental health and law enforcement organizations are needed to prevent unnecessary incarceration of individuals experiencing mental health crises and to increase access to community-based treatment.
Collapse
Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Flores, Sharp, Moyer, Cook); Departments of Psychiatry (Flores, Cook) and Medicine (Fung), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Fung); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Rotter)
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Flores, Sharp, Moyer, Cook); Departments of Psychiatry (Flores, Cook) and Medicine (Fung), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Fung); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Rotter)
| | - Margo Moyer
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Flores, Sharp, Moyer, Cook); Departments of Psychiatry (Flores, Cook) and Medicine (Fung), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Fung); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Rotter)
| | - Vicki Fung
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Flores, Sharp, Moyer, Cook); Departments of Psychiatry (Flores, Cook) and Medicine (Fung), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Fung); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Rotter)
| | - Merrill R Rotter
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Flores, Sharp, Moyer, Cook); Departments of Psychiatry (Flores, Cook) and Medicine (Fung), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Fung); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Rotter)
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Flores, Sharp, Moyer, Cook); Departments of Psychiatry (Flores, Cook) and Medicine (Fung), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Fung); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Rotter)
| |
Collapse
|
3
|
Li K, Richards E, Goes FS. Racial differences in the major clinical symptom domains of bipolar disorder. Int J Bipolar Disord 2023; 11:17. [PMID: 37166695 PMCID: PMC10175527 DOI: 10.1186/s40345-023-00299-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Across clinical settings, black individuals are disproportionately less likely to be diagnosed with bipolar disorder compared to schizophrenia, a traditionally more severe and chronic disorder with lower expectations for remission. The causes of this disparity are likely multifactorial, ranging from the effects of implicit bias, to developmental and lifelong effects of structural racism, to differing cultural manifestations of psychiatric symptoms and distress. While prior studies examining differences have found a greater preponderance of specific psychotic symptoms (such as persecutory delusions and hallucinations) and a more dysphoric/mixed mania presentation in Black individuals, these studies have been limited by a lack of systematic phenotypic assessment and small sample sizes. In the current report, we have combined data from two large multi-ethnic studies of bipolar disorder with comparable semi-structured interviews to investigate differences in symptoms presentation across the major clinical symptom domains of bipolar disorder. RESULTS In the combined meta-analysis, there were 4423 patients diagnosed with bipolar disorder type I, including 775 of self-reported as Black race. When symptom presentations were compared in Black versus White individuals, differences were found across all the major clinical symptom domains of bipolar disorder. Psychotic symptoms, particularly persecutory hallucinations and both persecutory and mood-incongruent delusions, were more prevalent in Black individuals with bipolar disorder type I (ORs = 1.26 to 2.45). In contrast, Black individuals endorsed fewer prototypical manic symptoms, with a notably decreased likelihood of endorsing abnormally elevated mood (OR = 0.44). Within depression associated symptoms, we found similar rates of mood or cognitive related mood symptoms but higher rates of decreased appetite (OR = 1.32) and weight loss (OR = 1.40), as well as increased endorsement of initial, middle, and early-morning insomnia (ORs = 1.73 to 1.82). Concurrently, we found that black individuals with BP-1 were much less likely to be treated with mood stabilizers, such as lithium (OR = 0.45), carbamazepine (OR = 0.37) and lamotrigine (OR = 0.34), and moderately more likely to be on antipsychotic medications (OR = 1.25). CONCLUSIONS In two large studies spanning over a decade, we found highly consistent and enduring differences in symptoms across the major clinical symptom domains of bipolar disorder. These differences were marked by a greater burden of mood-incongruent psychotic symptoms, insomnia and irritability, and fewer prototypical symptoms of mania. While such symptoms warrant better recognition to reduce diagnostic disparities, they may also represent potential targets of treatment that can be addressed to mitigate persistent disparities in outcome.
Collapse
Affiliation(s)
- Kevin Li
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA
| | - Erica Richards
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
4
|
Alden AM. Operationalizing antiracism in health systems: Strategies state government administrative organizations use towards racial and ethnic mental health equity. Soc Sci Med 2023; 322:115809. [PMID: 36893503 DOI: 10.1016/j.socscimed.2023.115809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/10/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023]
Abstract
Although a growing body of literature recommends strategies for improving racial equity in organizations and populations, little is known about how racial equity goals are operationalized in actuality, particularly in the context of state health and mental health authorities (SH/MHAs) attempting to promote population wellness while navigating bureaucratic and political constraints. This article seeks to examine the number of states engaging in racial equity work in mental health care, what strategies SH/MHAs use to improve their state's racial equity in mental health care, and how the workforce understands these strategies. A brief survey of 47 states found that all but one state (98%) is enacting racial equity interventions in mental health care. Through qualitative interviews with 58 SH/MHA employees in 31 states, I created a taxonomy of activities within six overarching strategies: 1) running a racial equity group; 2) gathering information and data about racial equity; 3) facilitating training and learning for staff and providers; 4) collaborating with partners and engaging with communities; 5) offering information or services to communities and organizations of color; and 6) promoting workforce diversity. I describe specific tactics within each of the strategies as well as the perceived benefits and challenges of the strategies. I argue that strategies bifurcate into development activities, which are activities creating higher-quality racial equity plans, and equity-advancing activities, which are actions directly impacting racial equity. The results have implications for how government reform efforts can impact mental health equity.
Collapse
Affiliation(s)
- Alexandra M Alden
- Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA.
| |
Collapse
|
5
|
Nicholson HL, Wheeler PB, Smith NC, Alawode OA. Examining the Relationship between Discrimination and Prescription Drug Misuse: Findings from a National Survey of Black Americans. Subst Use Misuse 2022; 57:1014-1021. [PMID: 35395923 DOI: 10.1080/10826084.2022.2052096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Research shows that substance use may be a way individuals cope with psychosocial stressors. Less is known about whether discrimination contributes to prescription drug misuse. Methods: Using a national sample of Black Americans, we examined whether two psychosocial stressors (i.e., everyday and lifetime major discrimination) were associated with lifetime prescription drug misuse (i.e., opioids, tranquilizers, sedatives, or stimulants). Results: Our logistic regression models separately examining the influence of everyday and major discrimination controlling for relevant demographic, health, and other drug use variables showed that only everyday discrimination was associated with higher odds of prescription drug misuse. In the model simultaneously considering both types of discrimination, only unit increases in everyday discrimination were associated with higher odds of prescription drug misuse. Conclusions: Encounters with everyday discrimination may be an important psychosocial stressor linked to prescription drug misuse in Black adults and possibly other racial-ethnic minorities. Intervention strategies aiming to reduce prescription drug misuse should consider developing ways to curb the negative health-related consequences of discriminatory experiences. Strategies to combat discrimination-related prescription drug misuse and limitations of this study are discussed.
Collapse
Affiliation(s)
- Harvey L Nicholson
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, Florida, USA
| | - Paris B Wheeler
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Nicholas C Smith
- Department of Sociology, Indiana University, Bloomington, Indiana, USA
| | - Oluwatobi A Alawode
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, Florida, USA
| |
Collapse
|