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Hankerson SH, Moise N, Wilson D, Waller BY, Arnold KT, Duarte C, Lugo-Candelas C, Weissman MM, Wainberg M, Yehuda R, Shim R. The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression. Am J Psychiatry 2022; 179:434-440. [PMID: 35599541 PMCID: PMC9373857 DOI: 10.1176/appi.ajp.21101000] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 11/30/2022]
Abstract
Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.
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Affiliation(s)
- Sidney H. Hankerson
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, Department of Population Health Sciences & Policy, 1425 Madison Avenue, New York, NY 10029
| | - Nathalie Moise
- Columbia University Irving Medical Center, Department of Medicine, 622 West 168 Street, PH 9, New York, NY 10032
| | - Diane Wilson
- Icahn School of Medicine at Mount Sinai, New York; Department of Medicine Columbia University Irving Medical Center, New York; City University of New York
| | - Bernadine Y. Waller
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Kimberly T. Arnold
- University of Pennsylvania Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania Center for Public Health Initiatives, University of Pennsylvania Leonard Davis Institute of Health Economics, Penn Presbyterian Medical Center, Andrew Mutch Building, Floor 6, 51 N. 39th Street, Philadelphia, PA 19104
| | - Cristiane Duarte
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Claudia Lugo-Candelas
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Myrna M Weissman
- Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 24, New York, New York 10032
| | - Milton Wainberg
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, The Bronx James J. Peters VA Medical Center, 1 Gustave L. Levy Pl, New York, NY 10029
| | - Ruth Shim
- University of California at Davis, Department of Psychiatry
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Affiliation(s)
- Ruth Shim
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California
| | - Moira Szilagyi
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - James M Perrin
- Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, Boston, Massachusetts
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Meyer MS, Rosenthal A, Bolden KA, Loewy RL, Savill M, Shim R, Rodriguez J, Flores V, Pavao E, Niendam TA. Psychosis screening in schools: Considerations and implementation strategies. Early Interv Psychiatry 2020; 14:130-136. [PMID: 31287611 DOI: 10.1111/eip.12858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 10/11/2018] [Revised: 03/07/2019] [Accepted: 06/09/2019] [Indexed: 11/26/2022]
Abstract
AIM Duration of untreated psychosis, or the time between onset of psychosis symptoms and accurate diagnosis and treatment, is a significant predictor of both initial treatment response and long-term outcomes. As such, efforts to improve rapid identification are key. Because early signs of psychosis commonly emerge in adolescence, schools have the potential to play an important role in the identification of psychosis-spectrum disorders. METHODS To illustrate the potential role of schools in this effort, the current paper describes implementation of a psychosis screening tool as part of a larger study focused on reducing the duration of untreated psychosis in Sacramento, CA. RESULTS Clinical considerations related to screening for psychosis in schools, including ethical concerns, logistics, screening population and stigma are addressed. Implementation strategies to address these concerns are suggested. CONCLUSIONS Early psychosis screening in the school system could improve early identification, reduce stigma and may represent an important further step towards an integrative system of mental health.
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Affiliation(s)
- Monet S Meyer
- Department of Psychiatry, University of California, Davis, Sacramento, California
| | - Adi Rosenthal
- Department of Psychiatry, University of California, Davis, Sacramento, California
| | - Khalima A Bolden
- Department of Psychiatry, University of California, Davis, Sacramento, California
| | - Rachel L Loewy
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Mark Savill
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Ruth Shim
- Department of Psychiatry, University of California, Davis, Sacramento, California
| | | | - Victoria Flores
- Sacramento City Unified School District, Sacramento, California
| | - Earl Pavao
- Natomas Unified School District, Sacramento, California
| | - Tara A Niendam
- Department of Psychiatry, University of California, Davis, Sacramento, California
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Compton MT, Bakeman R, Capulong L, Pauselli L, Alolayan Y, Crisafio A, King K, Reed T, Broussard B, Shim R. Associations Between Two Domains of Social Adversity and Recovery Among Persons with Serious Mental Illnesses Being Treated in Community Mental Health Centers. Community Ment Health J 2020; 56:22-31. [PMID: 31552538 DOI: 10.1007/s10597-019-00462-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 02/13/2018] [Accepted: 09/07/2019] [Indexed: 11/24/2022]
Abstract
As mental health services are increasingly embracing the recovery model, we conducted a study to better understand how social adversity impacts recovery. We also examined how associations between social adversity and recovery are influenced (moderated or mediated) by symptom severity. Data on seven social adversity measures, eight recovery measures, and symptom severity were collected from 300 English-speaking participants, ages 18-65 years, with a diagnosis of a psychotic or mood disorder, from five community mental health agencies in diverse neighborhoods in Washington, D.C. We employed standard correlation, exploratory factor analyses, analysis of variance, and hierarchic regression procedures. Diagnostic category and gender impacted Home Environment Adversities (e.g., food insecurity, perceived neighborhood disorder), the diagnostic category-by-gender interaction influenced Social and Economic Adversities (e.g., years of education and income), and gender affected Recovery. Controlling for diagnostic category and gender, Social and Economic Adversities accounted for 1.7% of variance in Recovery, while Home Environment Adversities accounted for 8.6% (their joint influence was 3.4%). Although symptom severity did not moderate these associations, it partially mediated the effect of Social and Economic Adversities on Recovery, and substantially mediated the effect of Home Environment Adversities on Recovery. The extent to which patients with serious mental illnesses experience recovery may be meaningfully influenced not only by symptoms, but by their social and environmental circumstances.
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Affiliation(s)
- Michael T Compton
- Division of Behavioral Health Services and Policy Research, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Roger Bakeman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Luca Pauselli
- Division of Behavioral Health Services and Policy Research, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yazeed Alolayan
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anthony Crisafio
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kelly King
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Thomas Reed
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Beth Broussard
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ruth Shim
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA, USA
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Pauselli L, Galletti C, Verdolini N, Paolini E, Gallucci D, Balducci PM, Bernardini F, Kogan JH, Shim R, Moretti P, Compton MT. Predictors of Client Satisfaction with Outpatient Mental Health Clinic Services in Italy and New York. Community Ment Health J 2018; 54:562-570. [PMID: 29147978 DOI: 10.1007/s10597-017-0196-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Received: 01/31/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
The aim of this cross-sectional study was to assess factors associated with client satisfaction in two mental health outpatient settings in Italy and the US. Sociodemographic and clinical variables, hope, and personality characteristics were evaluated in 18-65-year-old patients who had been receiving services for at least 2 months in one of two outpatient clinics, in Italy and the US. Patients were administered: the Healthy Days Core Module, the Kessler Screening Scale for Psychological Distress, the Verona Service Satisfaction Survey, the Client Satisfaction Inventory, the Health Service OutPatient Experience questionnaire, the Herth Hope Index, and the NEO Five-Factor Inventory-3. Bivariate tests for differences between the two samples were conducted, a Satisfaction Composite z-score was computed, and a stepwise, backward elimination, multiple linear regression model-including the variables that were significantly associated with Satisfaction Composite Score in bivariate tests-was built. From July 1, 2015 to April 30, 2016, 184 patients (121 in Foligno, 63 in New York City) were enrolled in the study. Predictors of client satisfaction included: receiving services in New York City, being older, having lower educational attainment, having inner positive readiness and expectancy as well as interconnectedness with self and others, and high scores on the agreeableness personality domain. Interestingly, diagnosis and treatment characteristics did not influence satisfaction. Client satisfaction with outpatient mental health services is mainly influenced by sociodemographic characteristics and personality factors more than clinical variables or patterns of care. These findings could have implications regarding trends toward value-based payment models.
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Affiliation(s)
- Luca Pauselli
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy. .,Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY, USA. .,New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Box 100, New York, NY, 10032, USA.
| | - Chiara Galletti
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | - Norma Verdolini
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy.,Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Enrico Paolini
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | - Daniela Gallucci
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | | | - Francesco Bernardini
- Department of Psychiatry, Erasme Hospital, Université Libre de Bruxelles, Anderlecht, Belgium
| | - Jerome H Kogan
- Department of Psychiatry, Lenox Hill Hospital, New York, NY, USA
| | - Ruth Shim
- Department of Psychiatry and Behavioral Sciences, UC Davis Health System, Sacramento, CA, USA
| | - Patrizia Moretti
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | - Michael T Compton
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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Malhotra K, Shim R, Baltrus P, Heiman HJ, Adekeye O, Rust G. Racial/Ethnic Disparities in Mental Health Service Utilization among Youth Participating in Negative Externalizing Behaviors. Ethn Dis 2015; 25:123-129. [PMID: 26118137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
PURPOSES Racial/ethnic differences in mental health service utilization were examined among youth who reported participating in negative externalizing behaviors. METHODS The study utilized merged data from the 2007-2010 National Survey on Drug Use and Health (NSDUH) to examine differences in utilization of inpatient or outpatient mental health services not related to substance or alcohol use by White, Black and Hispanic youth who reported engaging in negative externalizing behaviors ("acting out"). Differences in service utilization in these groups were assessed using logistic regression models. RESULTS Race/ethnicity was a significant predictor of outpatient mental health service use. Black and Hispanic children were less likely to use outpatient services. Inpatient service use decreased with increasing income. Parental presence in the household increased the likelihood of outpatient service use for minorities. CONCLUSION Racial/ethnic minority youth in the United States continue to use outpatient mental health services at lower rates. This may lead to high prevalence of untreated negative externalizing behaviors among minority adolescent groups and, in turn, lead to use of inpatient services from systems such as juvenile justice and foster care. Such severe treatment alternatives can be prevented if timely and culturally tailored outpatient intervention is provided.
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Kim G, Shim R, Ford KL, Baker TA. The relation between diabetes self-efficacy and psychological distress among older adults: do racial and ethnic differences exist? J Aging Health 2014; 27:320-33. [PMID: 25231883 DOI: 10.1177/0898264314549662] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examined racial/ethnic differences in the relationship between diabetes self-efficacy and psychological distress among older adults with diabetes mellitus. METHOD Adults aged 60 or older with a diagnosis of diabetes mellitus (N = 3,067) were drawn from the 2009 California Health Interview Survey (CHIS). Hierarchical multiple regression analyses were conducted. RESULTS After controlling for covariates, African Americans and those with higher levels of diabetes self-efficacy tended to have lower levels of psychological distress. Significant interactions were found in the Hispanic/Latino and Asian groups: The effect of diabetes self-efficacy on psychological distress was greater for Hispanics/Latinos and Asians than non-Hispanic Whites. DISCUSSION Findings suggest that diabetes self-efficacy is associated with psychological distress among older diabetic patients and that race/ethnicity moderates the relationship between diabetes self-efficacy and psychological distress. Increasing diabetes self-efficacy will help racial/ethnic minority older patients with diabetes to improve psychological well-being at a greater level.
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Affiliation(s)
- Giyeon Kim
- The University of Alabama, Tuscaloosa, USA
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Ye J, Shim R, Rust G. Health care avoidance among people with serious psychological distress: analyses of 2007 Health Information National Trends Survey. J Health Care Poor Underserved 2014; 23:1620-9. [PMID: 23698676 DOI: 10.1353/hpu.2012.0189] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Using data of 2007 Health Information National Trends Survey, we investigated the association between individuals' psychological distress and their reported avoidance of medical care and assessed whether people with serious psychological distress (SPD) were more likely to report psychosocial barriers to care. After controlling for demographic and health characteristics, individuals with SPD were more likely than those without SPD to report having avoided visiting a doctor even when they suspected they should (OR=1.64, 95% CI=1.08-2.48). The distressed individuals were also more likely to agree that they avoided a doctor because of fear of having a serious illness (OR=1.99, 95% CI=1.15-3.44) or thinking about dying (OR=2.15, 95% CI=1.12-4.11). Further understanding of the mechanism under which an individuals' mental health status may influence their perceived need for health and their use of medical services would improve the interface between mental health and primary care services.
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Affiliation(s)
- Jiali Ye
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr., Atlanta, GA 30310, USA.
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Abstract
Asian Americans often face cultural and language barriers when obtaining mental health treatment. With the small number of Asian mental health providers, it is difficult to ensure the linguistic and ethnic matching of providers and patients. Telepsychiatry holds great promise to address the unique needs of Asian Americans. We developed a project to establish telepsychiatry services that connect Korean mental health patients in Georgia with a linguistically and culturally competent psychiatrist in California and assessed the level of acceptability of psychiatric treatment via real-time teleconferencing among these patients. Upon the completion of the program, 16 patients (5 men, 11 women) completed a questionnaire that measured their acceptability of the telepsychiatry service. The findings indicate a high level of acceptance of the program among Korean patients. The quantitative and qualitative data show that they especially appreciated the cultural sensitivity of the consultation and the comfortable interaction with the provider. However, challenges such as technical issues of teleconferencing may negatively affect the quality of the clinical interaction. Our study expands the knowledge base regarding the acceptability of such services to a population that experiences disparities in mental health care. Future research should extend telepsychiatry services to other Asian population groups that experience lower access to mental health services.
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Affiliation(s)
- Jiali Ye
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA.
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Abstract
To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.
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Affiliation(s)
- Shun Zhang
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Kathryn Cardarelli
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ruth Shim
- Department of Psychiatry, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jiali Ye
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Karla L. Booker
- Division of Maternal-Child Health, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - George Rust
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
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Affiliation(s)
- Ruth Shim
- Morehouse School of Medicine, National Center for Primary Care, Atlanta, Georgia, USA.
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Affiliation(s)
- Deina Nemiary
- Assistant Professor, Department of Psychiatry and Neurobiology, University of Alabama at Birmingham
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Ye J, Shim R, Garrett SL, Daniels E. Health-related quality of life in elderly black and white patients with cancer: results from Medicare managed care population. Ethn Dis 2012; 22:302-307. [PMID: 22870573 PMCID: PMC4039285] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE To compare differences in various aspects of health-related quality of life (HRQOL) between Black and White individuals diagnosed with cancer. DESIGN The data were extracted from 2005-2007 Medicare Health Outcome Survey, a health outcomes measure for the Medicare population in managed care settings. A total of 14089 Black and White respondents aged > or = 65 with cancer were included in the study. Multivariable linear regressions were used to assess the association between race and the HRQOL after accounting for age, sex, education years, marital status, and non-cancer comorbid conditions. RESULTS When compared with their White counterparts, Black patients had lower scores for the physical component summary (PCS) and mental component summary (MCS), and all health domains with the exception of vitality. After adjusting for demographic features and comorbid conditions, the MCS scores of Black patients were still lower than that of White patients. However, the mean PCS was not different for Black and White patients. Black patients had significantly lower HRQOL in general health, social functioning, and role emotion, whereas they had a higher mean score in vitality. CONCLUSIONS Race had a significant impact on quality of life for older cancer patients. The effect was likely to be moderated by comorbid conditions and socioeconomic indicators. To optimize cancer outcomes at the population level, it is important to identify subgroups of cancer patients with an increased risk of low quality of life and to develop appropriate supportive interventions of cancer care.
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Affiliation(s)
- Jiali Ye
- National Center for Primary Care and the Department of Community Health & Preventive Medicine at Morehouse School of Medicine, Atlanta, GA 30310, USA.
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Abstract
OBJECTIVE We sought to gain a better understanding of the relationship between patients' serious psychological distress (SPD) and their perception of interactions with health care providers and their ratings of the health care quality. METHODS We analyzed data from 6286 adult respondents to the 2007 Health Information National Trends Survey. We conducted cross-tabulations to compare sociodemographic characteristics between those with SPD and those without SPD. Using odds ratios and 95% confidence intervals from logistic regression models, we assessed the association between psychological status and indicators of perceived health care communication and the overall health care quality after controlling for sociodemographic variables. RESULTS Patients with SPD were less likely to report that their provider "always" paid attention to their feelings and emotions, "always" ensured their understanding of the needed care, and "always" assisted them dealing with uncertain feelings. These distressed patients were also less satisfied with the overall health care quality. CONCLUSIONS Patients' psychological distress is negatively associated with their perceived quality of communication with health providers. Further knowledge on the health care need of patients with SPD would be important in improving health service delivery and optimizing the psychological care of medical patients.
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Affiliation(s)
- Jiali Ye
- National Center for Primary Care, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA 30310, USA.
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Shim R. Examining housing policy for persons with severe mental illness. Am J Psychiatry 2009; 166:234-5. [PMID: 19188293 DOI: 10.1176/appi.ajp.2008.08111617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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